Improving Hospital Nutrition
Hospitals, Rehabilitation Centers, and Nursing Homes, Please Let Food Be Thy Medicine!
For as long as I can remember, hospital food has been a subject of ridicule and jokes. We might laugh at the ridiculousness of being in desperate need of medical care, and then being delivered an unappetizing, low quality slop that couldn’t possibly support the restoration of health and well-being. And unless our loved one or ourselves are personally being served this slop, we might laugh an uncomfortable laugh, write off the situation as incompetence, and move on. But maybe instead of laughing, we should instead acknowledge what may be the most obvious example of our medical system placing profits before people.
While the US Department of Agriculture (USDA) works with the Department of Health and Human Services (HHS) to create and to continuously update dietary guidelines and policies, these efforts to improve health through nutrition fall incredibly short when it comes to the nutritional practices of hospitals and nursing homes, and this is no mistake as been has been the case for a very long time without correction.
Patients in hospitals throughout the country are frequently given white bread, processed meats, microwaved vegetables, chemically enhanced and colored gelatin, and other meals and desserts containing a large amount of sugar, corn syrup, or artificial sweeteners.
The scarcity of fresh and healthy ingredients, as well as the overabundance of processed industrial foodstuffs (processed substance with some nutrient value) is deficient in nutrients that patients need to recuperate from sickness, not to mention components that have been linked to disease.3,4 In fact, “the prevalence of malnutrition in hospitalized patients has been estimated at 30%–60%, with up to 69% of patients experiencing a decline in their nutrition status during hospitalization.”5
And these statistics are mostly concerning patients who are still able to eat conventionally, as opposed to those who are unable to eat orally for one reason or another. If hospital food in general does not support the restoration of health, imagine what goes into the processed formulas fed to patients who are completely reliant on liquid or pureed food.
What ingredients are found in typical gastric feeds?
Given that one of the primary objectives of healthcare is to “maintain health and promote wellbeing,” it’s strange to find out that most commonly used enteral formulas contain several inflammatory or neurodegenerative ingredients.
A patient who is unable to eat orally is unlikely to receive anything other than the typical brands, such as Neocate, EleCare, Boost, Ensure, or Osmolite. These formulas tend to be largely made up of some combination of the following ingredients: corn or glucose syrup, hydrolyzed corn starch, maltodextrin, sodium and calcium caseinates, soy protein isolate, canola oil (or other refined vegetable oils, such as high oleic sunflower oil, corn oil, or modified coconut and/or palm kernel oil), and synthetic vitamins (which are not as easily absorbed by the body as natural ones, and can build up to toxic levels in some individuals).12-17
Yet quality research shows us time and time again that these ingredients contribute to or exacerbate many chronic diseases.
Corn syrup, for example, has been linked to cardiovascular disease, obesity, diabetes, cancer, and high fructose corn syrup is also linked to inflammatory bowel disease, colorectal neoplasia, nonalcoholic fatty liver disease and other health problems.20, 21, 22, 23 Soy protein isolate has been associated with endocrine dysfunction, cancer of the pancreas, breast, and thyroid gland tumors; kidney and liver toxicity; and allergic reactions.26 Additionally, calcium caseinate has been linked to heart disease, cancer, digestive discomfort and gut inflammation,27 and canola oil to inflammation and, in a mouse model, memory deficits.28
Despite this (and much more) evidence, the Food and Drug Administration (FDA) has not evaluated these statements. Keep in mind that this is the same FDA that has been investigated for receiving large contributions from pharmaceutical companies. 18, 19
And these feeds are consistently fed to patients for breakfast, lunch, and dinner for months, or even years for some patients! If you have a loved one in hospice or a nursing home who is unable to eat conventionally, I am likely talking about them. In effect, some people are essentially fed fortified glucose syrup or corn starch and vegetable oil as their primary source of nutrition on a daily basis for the remainder of their lives.
Are there healthier alternatives?
You can create your own feed and a few companies now create feeds from ingredients that are much better than what you find in conventional feeds. These products created by these companies don’t have corn and glucose syrup, soy protein isolate, or canola oil. Instead, they contain only a few key ingredients like wild-caught salmon, gluten-free oats, organic produce, beans, and nuts. Plus added vitamins that are far more bioavailable.30,31 A few of my favorite companies who are leading the charge of making pre-made real food gastric feeds accessible to patients are Functional Formularies and Real Food Blends.
Hospitals and other institutional settings do not typically offer these real food choices to patients. But…
THIS DOES NOT MEAN THEY ARE BEYOND YOUR REACH.
Families and support teams who effectively advocate for their loved ones have been successful in getting the feeds they prefer or in making their own gastric feeds to be administered.
Enzymes, Gastric Feeds, Soups, and Smoothies
A gastric feed (also known as tube feed) is a liquid diet that is fed through a tube which bypasses the pharynx and allows for liquid nutrition to be fed into the esophagus or directly into the stomach. This is where the next phase of digestion begins.
Among other reasons, saliva is important because it contains special enzymes, namely amylase, an enzyme that breaks down complex carbohydrates into simple sugars to prepare the food for the next phase of digestion in the stomach. Because we are skipping this step in smoothies or gastric feeds, we are going to want to add digestive enzymes to our gastric feeds or smoothies. For products that are designed to include important enzymes especially for when the first stage of digestion is skipped (like in gastric feeds and smoothies), go to feedabrain.com/enzymes.
It’s worth noting that the nutritional demands of the body when we are rebuilding the nervous system are very similar to our nutritional needs during childhood development. For this reason, in How To Feed a Brain, I provide a Baby Food or Gastric Feed Creation Guide that you can use in making real food gastric feeds and/or baby food at home. You can download this guide and other essential nutritional guides by clicking here.
Blenderized Gastric-Feeds
You can make your own blenderized gastric feeds using a high speed blender like a Vitamix, Nutribullet, Ninja, or Blendtec Blender. These kinds of blenders can chop up the food at a cellular level.
Even if you can eat conventionally, drinking a smoothie or eating a soup made of fruits and veggies that have already been made ready to absorb is a great way to get a ton of nutrition in an easy to consume package. Just remember that we want to make sure we are still introducing important enzymes when consuming soups or smoothies.
Functional Formularies:
In our quest to improve hospital nutrition, we found another crusader with the exact same mission as us, and also with a very similar story. Robin Gentry McGee has a background in nutrition, and has studied functional medicine for a number a years.
When her father incurred a traumatic brain injury after slipping on black ice, he was left only able to eat through a gastric tube. After being on this liquid feed for nearly a year, Robin made the startling discovery that this “food” product was mostly corn syrup, and chemicals as listed above.
She talked to her doctor of osteopathy, scoured the internet, and looked for any possible alternative that she could to help her father. To her dismay, no alternatives existed at that time.
Taking Her Family’s Health into Her Own Hands
She began her mission to create a high quality gastric feed that could help her father recover. She succeeded and has been providing “Liquid Hope” to the world for over a decade! She never intended to sell the formula, but so many people came to her wanting this solution that she had created.
She began her company Functional Formularies in order to help families around the world heal their loved ones using real food. Her formula is a complete formula that addresses all macronutrients and micronutrients. I was astonished that even each individual form of each vitamin was the optimal for absorption and efficacy.
Click to zoom in on image above
Get Functional Formularies here and use FEEDABRAIN at checkout for 10% off.
Real Food Blends:
Another great option for non-vegetarian versions of gastric feed come from none other than Real Food Blends. This is another great example of an amazing family taking their personal health into their own hands, and changing how the game in this country is played.
After a very severe seizure, the son of the creators of this company could no longer swallow food conventionally. Their son was drinking all sorts of synthetic formulas, and was having serious digestive issues and a multitude of other negative side effects…
until they started blending real food.
It wasn’t until they had to go on vacation with their son that they began to create their portable, shelf-stable, real food blends. After a wildly successful Kickstarter campaign, they were able to launch their company that now helps tens of thousands of people across the globe.
For their full listing of products check out their website HERE, and for their full story, check out the video below.
The Story of Real Food Blends:
Blenderized Gastric-Feed
You can also make your own blenderized gastric feeds using a high speed blender like a Vitamix, Nutribullet, Ninja, or Blendtec Blender. These kinds of blenders can chop up the food at a cellular level.
Even if you can eat conventionally, drinking a smoothie or eating a soup made of fruits and veggies that have already been made ready to absorb is a great way to get a ton of nutrition in an easy to consume package.
How to Feed a Brain: Nutrition for Optimal Brain Function and Repair has a step-by- step guide for blenderized feeds and baby food (along with a few other essential guides), which you can download here.
Here is One of The Blenders We Really Love
How Do These Feeds Compare?
When finding the best feed, it’s important to know what to look for. This is an excellent video comparison of ingredients done by Veronica Brill from Blenderized RN.
What is Cavin’s Preference?
When it comes to nutrient value, my preference is actually not a gastric feed, but a combination of two very functional foods: Ample and BrothMasters. Ample is a high-quality meal replacement shake that contains all the nutrients you need in a single serving, while BrothMasters provides an easy and convenient way to get all the benefits of fresh homemade bone broth without having to make it yourself. Between these two products, we can easily get all the nutrients we need with minimal effort.
If you are looking for an easy and convenient way to provide your loved one with a high-quality gastric feed, then you can simply add AMPLE powder to BrothMasters Broth and mix. This will provide them with all the nutrients they need in a single serving.
AMPLE:
All of AMPLE’s products are amazing meal replacements for people who are eating conventionally and they can also be fed as a gastric feed. They are a nutrient-dense collection of superfoods including a probiotics, soluble and insoluble fiber to feed them, foods that regulate blood sugar, and so much more.
AMPLE is currently my favorite supplemental and low-carb feed!
AMPLE alone is very convenient to be fed (just add water or broth and shake), and can be used in conjunction with other feeds (recommended with BrothMasters). It encourages ketogenic metabolism, which is neuroprotective and promotes healing, while also providing many important nutrients.
Check out the video below to see Connor’s mission with AMPLE. To learn more about the ingredients, and why they choose these ingredients, See their full formula here and use the coupon code FEEDABRAIN at check out for a 15% discount.
AMPLE Meals Founder Connor Explains His Mission:
BrothMasters:
Another company I absolutely love is BrothMasters. Using their bone broth as a base helps to heal leaky gut syndrome (aka intestinal permeability) which will in turn lowers inflammation levels and supports overall health.
While Hippocrates said “All disease begins in the gut,”
I remind myself that all health begins in the gut.
By supporting digestive health, and using the ingredients that nature provided for us, we are already way on our way to living a healthy and wholesome lifestyle.
We love their products, and while they are not a complete gastric feed yet, their products are amazing for any paleo or keto household or even if you just love to make delicious home-cooked meals.
My favorite gastric formula for TBI
My favorite ketogenic gastric formula is any BrothMasters broth mixed with AMPLE. This mixture is extremely nutrient rich, providing much of the nutrition needed for optimal brain function and repair.
Click here to learn more about BrothMasters. Use the coupon code FEEDABRAIN for a 15% discount!
An Even Better Rx
Our primary goal is to improve the nutritional status of patients and to supply the building blocks needed for recovery . In conjunction with improving the nutrition that is given to patients, there is another step that can be taken to improve brain health immensely. Research shows us numerous cases that establish high-quality Omega-3s as being very therapeutic after a brain injury. As we talk about in the Omega-3’s and Traumatic Brain Injury Treatment article, high-dose fish oils, particularly those high in DHA, have been shown to powerfully support TBI recovery and neuroprotection.
High-DHA Omega-3s may be the most important supplementation we can take after a brain injury, especially if you or your loved one is receiving a conventional gastric feed formula. With coaching, my clients have had great success in getting the feed and supplementation they want for their loved one.
My passion for helping to get your loved one high-quality nutrition while in or out of the hospital is immense, so please don’t hesitate to reach out for support. I offer one-on-one consultations at feedabrain.com/consult.
REFERENCES
- World Health Organization. (n.d.). What we do. World Health Organization. Retrieved September 4, 2022, from https://www.who.int/about/what-we-do/
- Dietary guidelines. Food and Nutrition Service U.S. Department of Agriculture. (2015, December 4). Retrieved September 4, 2022, from https://www.fns.usda.gov/dietary-guidelines
- Sukalingam, K., Ganesan, K., Das, S., & Thent, Z. C. (2015). An insight into the harmful effects of soy protein: A review. Clin Ter, 166(3), 131-139. https://pubmed.ncbi.nlm.nih.gov/26152621/
- Johnson, David A. “Sickeningly Sweet”…. High-Fructose Corn Syrup-Caveat Emptor!. American Journal of Gastroenterology: October 2021 – Volume 116 – Issue 10 – p 1970-1971 https://doi.org/10.14309/ajg.0000000000001335
- Kozeniecki, M., & Fritzshall, R. (2015). Enteral nutrition for adults in the hospital setting. Nutrition in Clinical Practice, 30(5), 634–651. https://doi.org/10.1177/0884533615594012
- Deciphering dysphagia. National Foundation of Swallowing Disorders. Retrieved August 24, 2022, from https://swallowingdisorderfoundation.com/deciphering-dysphagia/
- Cohen DL, Roffe C, Beavan J, et al. Post-stroke dysphagia: A review and design considerations for future trials. International Journal of Stroke. 2016;11(4):399-411. https://doi.org/10.1177%2F1747493016639057
- Nutrition Support Patient Data. ASPEN | Nutrition Support Patient Data. (n.d.). Retrieved September 4, 2022, from https://www.nutritioncare.org/about_clinical_nutrition/nutrition_support_patient_data_fact_sheet/
- Mitchell, S. L. (1997). The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Archives of Internal Medicine, 157(3), 327. https://doi.org/10.1001/archinte.1997.00440240091014
- Kuo, S., Rhodes, R. L., Mitchell, S. L., et al. (2009). Natural history of feeding-tube use in nursing home residents with advanced dementia. Journal of the American Medical Directors Association, 10(4), 264–270. https://doi.org/10.1016/j.jamda.2008.10.010
- Mundi, M. S., Pattinson, A., McMahon, M. T., et al. (2017). Prevalence of home parenteral and Enteral Nutrition in the United States. Nutrition in Clinical Practice, 32(6), 799–805. https://doi.org/10.1177/0884533617718472
- Atta, E. M., Mohamed, N. H., & Silaev, A. A. A. (2017). Antioxidants: An overview on the natural and synthetic types. European Chemical Bulletin, 6(8), 365-375. https://www.researchgate.net/profile/Ahmed_Abdelgawad3/publication/321844679_Antioxidants_An_Overview_on_the_Natural_and_Synthetic_Types/links/5b61fa84aca272a2d67af9f4/Antioxidants-An-Overview-on-the-Natural-and-Synthetic-Types.pdf
- Neocate. (n.d.). Duocal protein-Free Energy Medical Food. Neocate. Retrieved August 11, 2022, from https://www.neocate.com/shop/hypoallergenic-formula-and-products/duocal
- EleCare® (for infants). Abbott. (n.d.). Retrieved August 11, 2022, from https://abbottnutrition.com/elecare-for-infants
- Boost® Original Nutritional Drink. BOOST®. (n.d.). Retrieved August 11, 2022, from https://www.boost.com/products/boost-original.
- Ensure® powder. Abbott Nutrition. (n.d.). Retrieved August 11, 2022, from https://nutrition.abbott/au/product/ensure-powder/ingredients
- Osmolite®. Abbott Nutrition. (n.d.). Retrieved August 11, 2022, from https://nutrition.abbott/au/product/osmolite/ingredients
- Hidden conflicts? | science. (n.d.). Retrieved August 11, 2022, from https://www.science.org/doi/10.1126/science.361.6397.16
- Affairs, O. of R. (n.d.). Food and Drug Administration employee pleads guilty to conflict. U.S. Food and Drug Administration. Retrieved August 11, 2022, from https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/press-releases/food-and-drug-administration-employee-pleads-guilty-conflict-interest
- Wang, Jing; Armour, Tanya; Geiss, Linda S; Engelgau, Michael M. Obesity and diabetes: dual epidemics on the rise. Current Opinion in Endocrinology & Diabetes: April 2005 – Volume 12 – Issue 2 – p 174-180 doi:10.1097/01.med.0000157075.71572.c3
- Christopher E Anderson, Shannon E Whaley, Michael I Goran, Lactose-reduced infant formula with corn syrup solids and obesity risk among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), The American Journal of Clinical Nutrition, 2022;, nqac173, https://doi.org/10.1093/ajcn/nqac173
- Michael I. Goran, Stanley J. Ulijaszek & Emily E. Ventura (2013) High fructose corn syrup and diabetes prevalence: A global perspective, Global Public Health, 8:1, 55-64, https://doi.org/10.1080/17441692.2012.736257
- Sukalingam, K., Ganesan, K., Das, S., & Thent, Z. C. (2015). An insight into the harmful effects of soy protein: A review. Clin Ter, 166(3), 131-139. https://pubmed.ncbi.nlm.nih.gov/26152621/ [the numbering here is only to keep the numbers following to stay as they are. Please renumber accordingly.]
- Sukalingam, K., Ganesan, K., Das, S., & Thent, Z. C. (2015). An insight into the harmful effects of soy protein: A review. Clin Ter, 166(3), 131-139. https://pubmed.ncbi.nlm.nih.gov/26152621/
- Yalavarthi, P., Prabhakar, O., & Arun, K. (2020). ROLE OF DIETARY PROTEINS IN CARDIOVASCULAR DISEASES. Journal of Advanced Scientific Research, 11(02), 39-44.
- Lauretti, E., Praticò, D. Effect of canola oil consumption on memory, synapse and neuropathology in the triple transgenic mouse model of Alzheimer’s disease. Sci Rep 7, 17134 (2017). https://doi.org/10.1038/s41598-017-17373-3
- MarketWatch. (2022, August 29). Enteral feeding formulas market [4.3% CAGR] share 2022 key growth drivers, CAGR value, industry revenue and sales channel, growing opportunity and challenges forecast by 2028. MarketWatch. Retrieved September 6, 2022, from https://www.marketwatch.com/press-release/enteral-feeding-formulas-market-43-cagr-share-2022-key-growth-drivers-cagr-value-industry-revenue-and-sales-channel-growing-opportunity-and-challenges-forecast-by-2028-2022-08-29
- Pellico, L. H., Brewer, C. S., & Kovner, C. T. (2009). What newly licensed registered nurses have to say about their first experiences. Nursing Outlook, 57(4), 194–203. https://doi.org/10.1016/j.outlook.2008.09.008
- Anjelica Cappellino, J. D. (2022, May 5). The standard of care for medical malpractice: What you need to know. Expert Institute. Retrieved August 11, 2022, from https://www.expertinstitute.com/resources/insights/standard-care-medical-malpractice-need-know
- What is the medical standard of care? – times laws. (n.d.). Retrieved August 11, 2022, from https://timeslaws.com/what-is-the-medical-standard-of-care/
- Talukder, M. H. K., Nazneen, R., Hossain, M. Z., & Chowdhury, I. J. (1970). Basic ideas on medical ethics. Bangladesh Journal of Medical Science, 9(3), 131–135. https://doi.org/10.3329/bjms.v9i3.6467
- Ingredients archive. Functional Formularies. (n.d.). Retrieved August 25, 2022, from https://www.functionalformularies.com/ingredients/
- Real food blends nutritional data. Real Food Blends: Meals For People with Feeding Tubes. (2020, April 6). Retrieved August 25, 2022, from https://www.realfoodblends.com/rd-nutritional-information/
Comments
So…is there a way to use any of these feeds with something else to design a complete feeding bag that a care facility might accept? Haven’t gotten self blending approved. Hoped something else that could be purchased might be.
Hi Kathryn,
I work with clients who have a 100% success rate in getting blenderized feeds approved. Let’s hop on a call. I’ll send you an email. 🙂
Hello I am looking for better nutrition for my brother, he has a feeding tube. My brother is currently in the hospital in a stage of coma after his accident resulting in severe TBI on May 9th. The hospital has fought with us on getting him the nutrition he needs to promote healing of his brain.
It was recommended that I reach out to you for your help.
Hi Elizabeth,
I’m sorry to hear about your brother. I also sustained a severe TBI in May: May 8th.
My book has a guide for creating gastric feeds. You can get the book on amazon, and you can download the gastric feed creation guide here: https://feedabrain.com/gastric
In order to get the hospitals to implement the right treatments, I also work with folks who have a loved one in a medical crisis to navigate a profit driven medical model and to get the best treatments, including IV vitamin therapy and real food feeds. My clients learn how to speak with their medical team in order to get the feeds they choose, the supplements they choose, and often to also get IV nutrient injections, and they are always successful in doing so. If you’re interested, let’s have a conversation to see if we’re a good fit. Initial calls are $250 and that amount will be credited to us working together further, should we decide we’re a good fit. You can fill out this form and schedule a call here: https://adventuresinbraininjury.com/consult
Looking forward to hearing from you. 🙏