Real Food for a G-tube

There is no such thing as a one-size fits all diet.  No two human bodies are the same and as such not all foods are necessary or beneficial for everyone as a whole.  The same can be said about formula foods.   One formula 24/7 is severely inadequate for a healthy person, much less a medically fragile person whose nutritional needs far surpass that of the healthy one.   Yet, every patient who has a feeding tube ends up being prescribed formula regardless of their unique nutritional needs.   Something is wrong with this picture.

  When our son, Samuel, was diagnosed with leukemia, within the first month of treatment, he suffered many unheard of complications of chemotherapy, one of which resulted in the complete loss of his colon.    We were in the hospital for three months due to further complications from the initial treatment in which time, he became anorexic and was put on formula.    While hospitalized, we had no choice over feeding but once we came home, one thing was obvious.  He wasn't thriving, urinating properly and was constantly vomiting.  The formula wasn't nourishing him and in the very frail condition that he was in, I knew I needed to try something else.

With the help of an ND and an aspiring holistic herbalist, I begin to put foods together to make him a balanced real food formula.   Once we made the switch to real food, he immediately started urinating more frequently, felt better and threw up less often.  We knew we were onto something..  What we did not know, was how it would prolong his life.  When his cancer relapsed, we were able to use diet and herbs alone to get him into remission to the surprise of the entire Oncology Team at Mary Bridge Children's Hospital.

Samuel was tube fed for four years before the consequences of chemotherapy fully came to fruition destroying his gut thus ending his life.   But through those years of dealing with a gut that always wanted to quit, I learned a great many things about not just nutrition but also proper digestion.   I have come to believe that many diseases begin in the gut and many diseases can be healed through the gut.   Being fed through a tube gives a person the opportunity to receive optimum nutrition if they'll do their research.  It takes more work, but it is worthwhile and so rewarding. 

You can feed any food which can be pureed through a tube.    Determining what will be most nourishing should be based on whatever the medical condition was that necessitated the tube in the first place so do your research.  Start small and keep a daily log of what was fed, how much, what time and how the body reacted to it.  If good, keep going.  If not find the ingredient that didn't agree and stop using it.  My goal in creating this page is to give you a place to start and to say that you can do this if you're willing to do the research as well as spend the extra money and time it will take to accomplish.  It's worth it.  I promise.

 That said,  my son's gut was destroyed. and I was saddled with a worst case scenario, one even his doctors had never seen and thus had no clue what to do about.   When he had an ostomy, his rectum and anus actually collapsed and healed closed because there was so much damage.  His small intestine had so many adhesions and scar tissue that it was a battle to keep it operating.  So, I  chose foods that would be not just healing to his body, but also healing and easily digestible for his gut.  

There are two major problems with traditional formulas.  One is constipation - traditional formulas have no fiber.  Fiber is necessary to regulate peristalsis of the gut.  It regulates food transit times though the gut, absorbs toxins and waste, and activates integral enzyme functions of digestion.  Real food formulas allow you to add fiber back into the diet.  Another problem that arises is that traditional formula has no digestive enzymes.   Digestion begins in the mouth.  A person who eats with their mouth secretes Amylase and Lipase through saliva as they chew which begins the digestive process and signals the stomach to get ready.   When you dump foods into the stomach bypassing the mouth, not only is the stomach not ready to work yet, but it's just is much more difficult as the food is missing critical enzymes.    Real food formula allows you to add these enzymes back as well as many others.  You can purchase Digestive Enzymes at health food stores.  Compare products and get one higher in amylase and lipase.  Other enzymes in these formulas are also great too but not as important as the two you miss by bypassing the mouth.  They can be added directly to formula before feeding  it although for best results, a few hours before and shake it up well.  Dosage is usually 1-2 capsules per meal so you will need to estimate if you package more than one meal into each bag.

Enzymes can also be added to formula in the form of food's like kefir, real yogurt, miso, and other fermented foods.  These add much needed calories to any formula as well as probiotics.   Kefir is extremely easy to make and very nourishing so I highly recommend it.  I  used it as a base for much of my son's formulas.  You can purchase kefir grains on ebay.  All you need is kefir grains and whole milk and you are good to go.  Kefir also works in goat milk, breast milk, coconut milk and water.

I made Samuel's real food formula every few days to ensure freshness.  I used organic foods as much as possible.   Items you need are a good quality blender or food processor.  I used Kitchen Aid.  Also a Juicer if you plan to provide fresh fruit and vegetable juices.  I used an Omega Juicer.  Finally, a tightly woven wire strainer because everything in the blender will have to be strained to fit into a tube.  I had great success with a Zevex Entralite pump; the old style, not the Infinity.  Some pumps are very quirky about thicker foods and I found the Entralite to be the best for pushing them through.

Foods cooked on low heat for long periods of time work best for those who are extremely malnourished, nauseous or wasting.   Real bone stocks loaded with chicken or turkey meat, root veggies, several handfuls of grains, some apple cider vinegar, and certain digestive herbs like dill, ginger, cumin, or rosemary work great.  Seaweeds such as nori and kelp are great additions.  Other useful nutritious herbs to add toward the end of the cooking time are nettles and alfalfa.  Also, add some green foods to the finished puree such as parsley, cilantro, arugula, etc for their cooling and digestive effects.   I would start everything in a large pot in the late afternoon, set it on low for the night, and start using it the next day.   Bring contents slowly to a boil, skim off the foam for twenty minutes, reduce heat to low and let it go.  I have had things on the stove for up to three days.  Be careful about utensils that touch your soup.  Do not use plastic.  The strained stock is great as a "clear" food but adding a few cups of the veggies/meat in the stock into the formula is great for protein and fiber.  Basically, anything you cook in a stock pot on low for a long period of time will assimilate well so be creative in food choices.   My top recommended book on diet and nutrition is Nourishing Traditions by Sally Fallon.  and there are some great recipes for bone stocks as well as infant formulas that incorporate real food.  There is also a section on superfoods in this book which can be incorporated into your formulas.

Raw milks are invaluable to a person with GI issues.  I was able to pump breastmilk for Samuel for many years and later had a donor who gave me fresh, not frozen, milk.   Human milk is similar to giving someone a lifesaving blood transfusion.  You get the enzymes, probiotics, white cells, healthy fats, and easily assimilated nutrients.  Breastmilk gave my son his life back and restored his vitality.  A back up to human milk would be raw goat's milk.  Raw goat milk is as close as you can get to human milk.  For a severely debilitated condition, slow cooking raw milk with a dash of ginger and a tsp of Marshmallow Root or Slippery Elm greatly restores nutrients and helps the body cope.  If I had had enough breastmilk or raw goat's milk to sustain my son's caloric intake, I would have fed these solely and nothing else.  They are THAT good. 

Raw fruit or vegetable juices are very cleansing and energizing and will work great for a person with good digestion strength.  Add kefir to either one before using.  Also, freshly juiced foods are only good for 48 hours and must be stored tightly sealed out of the light in the refrigerator.  Use fresh as much as possible.    I used raw juices at 1/4 part of the daily intake and only if the GI tract was behaving perfectly.   Fruit juices are very cleansing and may cause diarrhea.  They are very beneficial in constipation crises though.  Vegetable juices may also initially cause diarrhea until the gut gets used to them.  Don't mix fruit and veggies.  As a rule, digestion is usually strongest at lunchtime and weakest in the evenings.  Therefore, don't use juices as dinner.  Go with the more cooked foods.

If digestion is poor, you can still incorporate fruits and veggies but you will need to lightly cook them first.   While cooking does destroy most of the enzymes present in the fruits and veggies, it makes them more easily digestible for a weak person.  Adding digestive spices and kefir puts much needed enzymes back into the finished food.  You can steam veggies and puree by adding bone stock and 1/4 cup of kefir when you are done.  You can simmer the veggies in broth and add some cumin, fennel or mint to aid digestion.  Then puree, and add a little kefir.  You can also steam or boil fruits.  Use enough water to just cover the fruits and simmer.  Add a dash of cinnamon, nutmeg, ginger, cloves or cardamom to aid digestion.  Puree using kefir as the extra liquid.  All items must be strained before use. 

Breakfast should incorporate a more "watery" meal.  Because the person hasn't eaten all night, their body needs more liquids to restore the fluid balance.  If the person doesn't drink water on their own, you can add a little more stock to the morning meal.  A vegetable/stock food makes a great breakfast and you can add a scoop of a protein powder to this as needed.  If you have miso, it is a great addition to a veggie/stock meal.  A hearty lunch or dinner of stock with all the meat, veggies, grains, etc does a body good.  Foods given after 7pm should be easiest to digest and a fruit/kefir food is the best choice.

Water between meals is important.  If the person doesn't drink on their own, give them water through the tube between meals.  Nourishing teas are nice as well.  A great digestive enhancing tea is Chamomile, Dandelion and also Peppermint.  Peppermint is especially good for most digestive complaints.   Use Dandelion tea if the person is not urinating well or has dark circles under their eyes.

I used grain and seek milks for their fiber and enzyme content.  Soak whole grains overnight in water with a little kefir or apple cider vinegar.  Blend adding more water as necessary and strain.   If you use nuts, soak overnight adding a little salt to the water.  Discard soak water and rinse.  Add more water and blend and strain.  To the milk, you can then add any vitamin/mineral powders.  I pureed banana, avocado or homemade yogurt into seed milks.  Raw eggs are another great addition!

Cooked grains, soothe the gut.  Always soak them the night before use.  Cooking grains in the bone stock makes them more digestible.  I found millet put through a blender has virtually no waste when you strain it.  It is a wonderful grain because it is non-allergenic, does not aggravate celiac, and is alkaline forming in the body.  It is a great grain to add fiber, nutrients and also helps reduce inflammation in the gut. 

Cooked oats were healing to the gut mucosa and I used a 1:1 ratio of raw carrot juice and cooked strained oatmeal in times of GI crises. 

Keep meals simple; don't do a lot of mixing and matching.  Have bone stock for a clear liquid, a milk food, a fruit and/or veggie food, and feed them separately so as not to overwhelm the gut.    The supplements below mix well with any of the foods as does kefir or any other fermented item.  "Green" foods mix with anything well.

Other specific nutrients should be added to any formula.

Spirulina; build to 1 TB per day

Chlorella; build to 1 gram per day

Living Fuel RX  Both Berry and Greens  - Follow directions but strain out the seeds on this excellent whole food product.

Omega 3 oils.  Cod Liver Oil in the winter and all summer too if the person does not get one hour of sun a day.  Olive Oil, Coconut Oil. Red Palm Oil,  Fish Oil, etc.  All oils add calories and much needed nutrients.  You will need a separate syringe to give oils. They float in formula and some even solidify.  Oils aid digestion so a Tsp to a couple TB's with each meal is a benefit.  You can use most oils liberally except Cod Liver Oil.  For this oil, follow dosages recommended.   If digestion is poor, Coconut Oil is the easiest to digest.   Next in line is Red Palm.

Hemp protein powder made from ground hemp seeds is one of the easiest protein powders to digest.  The fiber and omega 3 content are amazing.  Protein powders digest best with fruit juices, kefir, raw milk or grain/seed milks.

A Tsp. of apple cider vinegar will relieve GERD or acid indigestion.  It also curbs diarrhea and aids digestion.

Save yourself time, hassle and problems with medical staff by typing out the ingredients of your formula etc, including your alternative providers name and phone number if you have one.  I cannot tell you how often some well meaning dietitian has showed up at our door because some MD did not know what kefir was and thus determined that Samuel was somehow malnourished.  Nothing is more irritating.  Handing them a well written itemized list including preparation methods and a contact number solves this issue in seconds flat.  And it will save you from explaining everything you do.  I tend to forget the minor details of everything we do because it is just second nature.  Having it on a list has been a very useful tool.

A word about feeding intervals as well.  Hospitals often send a patient home with a nighttime drip feeding schedule for their tube feeds.  It supposedly make life easier for the patient.  Our bodies are not meant to eat all night long.  They are meant to eat meals and snacks throughout the day and FAST at night.  Nighttime is when the liver detoxes the blood and if you feed at night, the liver cannot do it's job properly. Breakfast is so named because you break the fast.   Eating erratically means the GI tract never gets to rest and it needs to, just as the rest of the body does.  Large bolus feeds over 30 minutes if you can make this work during the day are most like a normal "meal"  I have been on the end where Samuel was unable to keep meals down, or take large boluses over short periods of time, however.   Short term use of anti-emetics can be useful.  Also digestive enzymes and herbs like fennel and ginger can help give the tummy the jump start it needs to keep things going the right direction.    Bolus feeds during the day will also help your child eat on their own again as they will be hungry at mealtimes and you can choose to see if they will eat with you.  If they eat enough to be considered a meal, skip the feeding.  If they don't, no loss.   Your child can gain and maintain weight with a feeding tube.

For Severe Constipation

4 oz freshly juiced fruit.

4 oz water

1tsp. Bentonite Powder

1 Tab HCL (Stomach acid)