Using Food As Medicine for individuals with Feeding Tubes

Written by Erin Gattuso, ND

(this post is an adaptation of a handout that I have. The PDF includes the calorie counts and nutritional facts of the recipes. Unfortunately, I would not convert into blog format. If you email me, I am happy to send a copy of the PDF)

Families that decide to use blenderized diets through g or J tubes, can run into a number of challenges.


The first challenge is of course the inconvenience of making, blending and cleaning. Because of this, it can be helpful to have 3-4 different meals pre-made and frozen, so that when you need them you can quickly pull a meal out of the freeze and use as needed. If you have a support network, it can be really nice to ask other people to make the food for you. Anything you can do to take away some of the time and effort towards feeding can help the entire family.


Common medical challenges facing

children using feeding


Small Intestine Bacterial Overgrowth (SIBO)- when the transit time is slower than ideal, it can be very easy for children to develop SIBO which causes bloating, gas and acid reflux. The way to help prevent and manage this, is to include food based antimicrobials and probiotics. A few examples of antimicrobial foods are; onion, garlic, ginger. These often are too strong for little tummies when ingested raw but cooking causes them to lose most of their anti-microbial activity. The gentlest way is to create a tea with raw minced onion or ginger, let it steep for 5 minutes and bullus 1-2 oz through their tube. Ginger is the most gentle and can be used on a semi-regular basis. Raw onion tea is a safe bet for someone with moderate bacterial overgrowth but should not be used in people with severe bacterial overgrowth. It is best to seek professional help in cases of severe bacterial overgrowth. Garlic is very strong and should be used with caution.

Slow transit time- for slow transit time, it is very important to incorporate “bitter” foods. There are over 30 bitter taste receptors compared to 1 sweet and 1 unami taste receptor. These receptors are all the way through the digestive tract so even if you give “bitters” via J or G tube, it will have the same effect. The bitter receptor stimulates peristalsis, gastric secretions, digestive enzyme release increase bile secretions. Examples of bitters are gentian artichoke leaf. It is easy to purchase a bitter tincture and use this before meals. It can be used after meals but 5-10 minutes before a meal is preferred.

Food Allergies- Children with food allergies tend to do better with rotation diets, unfortunately, it is not uncommon for children o develop food allergies to the foods they eat the most, which can be an added frustration to an already restricted diet. This is why it is a good idea to have a couple different types of meals prepared in the freezer to help maintain a varied diet.

Poor digestion/absorption-For very sensitive tummy, considerer using digestive enzymes. Digestive enzymes are VERY safe, even for infants as young at 2 weeks old. They help in the breakdown of food for people who are deficient in digestive enzymes and if there isn’t food to break down, they act like a scrubbing brush for the digestive tract. You must bolus the digestive enzymes before or directing the feed. If you add the digestive enzyme in the blender, the texture of the food will become very sticky and be hard to push through the tube.

Instructions from Transformational Enzyme Corporation ( please work with a medical professional when doing this or call the company directly and ask for assistance)


  • Mix Either 1 scoop OR open one capsule with 20-30 cc’s water (enough water to make a loose slurry.)

  • If feeding is continuous, give above dosage 4-6 times / day with periodic flushes of water (usually every 4 hours.)

  • If bolus feedings, five above dosage at the beginning of each bolus feeding, usually every 4 hours (6 x day.)

  • Each “slurry mixture should be given immediately after mixing, inservice syringe into feeding tube and flush tube with water.


Herbs to have at home

Ginger- intraduodenal doses of ginger extract were shown to increase bile secretion in rats, mild anti-microbial and anti-fungal activity. In can potentially aggravate acid reflux, especially in people who tend to “run hot.” Ginger is safe in infants, children, pregnancy and nursing. There are no known pharmaceutical interactions though theoretically, should be avoided if on blood thinners such as warfarin. 

Meadowsweet- children’s diarrhea. Mild anti-microbial effect. Protects the mucosa of the upper GI tract, decreases acidity. zero pharmaceutical contraindications, safe in infants, children, pregnancy and lactation, no known side effects, no known overdose. 

Peppermint- Digestive spasmolytic. Decreases gas, bloating, and spasms. Mildly sedative to the central nervous system. No known pharmaceutical interactions, safe with infants, children, pregnancy and nursing, no known side effects for ingested peppermint tea. Peppermint essential oil, mixed with a carrier oil, can be very helpful for stomach aches and indigestion.

Recipes


Bone Broth

Why Bone Broth? Bone broth is an easily digestible food that helps heal the lining of the digestive track. 

NOTE: If you do not want to go through the trouble of cooking the bone broth, store bough bone broth is a very good substitute. Bare Bones and Epic are good brands. You can purchase these off thrivemarket.com for a discounted price.

It is very important to make sure you have organic grass-fed, Pasteur raised bones. The best way to ensure quality is to visit WestonAPrice.org and find the contact information for you local chapter leader. They will be able to tell you what farms in your area are able to provide ethically raised meat products. 

Most people tolerate bone broth well BUT some individuals with high histamine sensitivity have trouble tolerating bone broth, therefore meat stock might a better option for them. The difference is that bone broth is cooked for a long period of time and extracts more amino acids than meat both, unfortunately, some people react to those amino acids. 

Easiest way to make bone broth is in an Instant Pot. If done in an insta pot, place pot on HIGH for 120- 160 minutes it should be slightly gelatinous but not enough that it makes it hard to push through the tube. If this becomes an issue, then decrease the time. 

Chicken Stock

1 whole free-range chicken or 2 to 3 pounds of bony chicken parts, such as necks, backs, breastbones and wings*
gizzards from one chicken (optional)
2-4 chicken feet (optional)
4 quarts cold filtered water
2 tablespoons vinegar
1 large onion, coarsely chopped
2 carrots, peeled and coarsely chopped
3 celery stalks, coarsely chopped
1 bunch parsley

*Note: Farm-raised, free-range chickens give the best results. Many battery-raised chickens will not produce stock that gels.

If you are using a whole chicken, cut off the wings and remove the neck, fat glands and the gizzards from the cavity. Cut chicken parts into several pieces. (If you are using a whole chicken, remove the neck and wings and cut them into several pieces.) 

Place chicken or chicken pieces in a large stainless steel pot with water, vinegar and all vegetables except parsley. Let stand 30 minutes to 1 hour. Bring to a boil, and remove scum that rises to the top. 

Reduce heat, cover and simmer for 6 to 8 hours. The longer you cook the stock, the richer and more flavorful it will be. 

About 10 minutes before finishing the stock, add parsley. This will impart additional mineral ions to the broth.

Remove whole chicken or pieces with a slotted spoon. If you are using a whole chicken, let cool and remove chicken meat from the carcass. Reserve for other uses, such as chicken salads, enchiladas, sandwiches or curries. Strain the stock into a large bowl and reserve in your refrigerator until the fat rises to the top and congeals. Skim off this fat and reserve the stock in covered containers in your refrigerator or freezer.


Beef Stock

about 4 pounds beef marrow and knuckle bones
1 calves foot, cut into pieces (optional)
3 pounds meaty rib or neck bones
4 or more quarts cold filtered water
1/2 cup vinegar
3 onions, coarsely chopped
3 carrots, coarsely chopped
3 celery stalks, coarsely chopped
several sprigs of fresh thyme, tied together
1 teaspoon dried green peppercorns, crushed
1 bunch parsley

Place the knuckle and marrow bones and optional calves foot in a very large pot with vinegar and cover with water. Let stand for one hour. Meanwhile, place the meaty bones in a roasting pan and brown at 350 degrees in the oven. When well browned, add to the pot along with the vegetables. 

Pour the fat out of the roasting pan, add cold water to the pan, set over a high flame and bring to a boil, stirring with a wooden spoon to loosen up coagulated juices. Add this liquid to the pot. Add additional water, if necessary, to cover the bones; but the liquid should come no higher than within one inch of the rim of the pot, as the volume expands slightly during cooking. Bring to a boil. A large amount of scum will come to the top, and it is important to remove this with a spoon. After you have skimmed, reduce heat and add the thyme and crushed peppercorns.

Simmer stock for at least 12 and as long as 72 hours. Just before finishing, add the parsley and simmer another 10 minutes. You will now have a pot of rather repulsive-looking brown liquid containing globs of gelatinous and fatty material. It doesn’t even smell particularly good. But don’t despair. After straining you will have a delicious and nourishing clear broth that forms the basis for many other recipes in this book.

Remove bones with tongs or a slotted spoon. Strain the stock into a large bowl. Let cool in the refrigerator and remove the congealed fat that rises to the top. Transfer to smaller containers and to the freezer for long-term storage.

Fish Stock

3 or 4 whole carcasses, including heads, of non-oily fish such as sole, turbot, rockfish or snapper
2 tablespoons butter
2 onions, coarsely chopped
1 carrot, coarsely chopped
several sprigs fresh thyme
several sprigs parsley
1 bay leaf
1/2 cup dry white wine or vermouth
1/4 cup vinegar
about 3 quarts cold filtered water

Ideally, fish stock is made from the bones of sole or turbot. In Europe, you can buy these fish on the bone. The fish monger skins and filets the fish for you, giving you the filets for your evening meal and the bones for making the stock and final sauce. Unfortunately, in America sole arrives at the fish market preboned. But snapper, rock fish and other non-oily fish work equally well; and a good fish merchant will save the carcasses for you if you ask him. As he normally throws these carcasses away, he shouldn’t charge you for them. Be sure to take the heads as well as the body—these are especially rich in iodine and fat-soluble vitamins. Classic cooking texts advise against using oily fish such as salmon for making broth, probably because highly unsaturated fish oils become rancid during the long cooking process.

Melt butter in a large stainless steel pot. Add the vegetables and cook very gently, about 1/2 hour, until they are soft. Add wine and bring to a boil. Add the fish carcasses and cover with cold, filtered water. Add vinegar. Bring to a boil and skim off the scum and impurities as they rise to the top. Tie herbs together and add to the pot. Reduce heat, cover and simmer for at least 4 hours or as long as 24 hours. Remove carcasses with tongs or a slotted spoon and strain the liquid into pint-sized storage containers for refrigerator or freezer. Chill well in the refrigerator and remove any congealed fat before transferring to the freezer for long-term storage.


Liver Pate

16 servings

This is a power-punch, medicinal food. Intended more as medicine than a meal but it can serve as both. More than 1 oz at once is not recommended however because the high fat content can be hard on some stomachs. 

Traditional Cultures would eat organ meats and held the believe that organ meats would help support the strength of the corresponding organ. Many cultures would have brain for breakfast and tell their kids “if you want to be smart, eat the brain!” Since the liver is the key organ that “cleans out the blood,” it is very important to keep it as healthy as possible. Unfortunately, the liver can easily become compromised from polypharmacy and slow bowel movement transit time.  It’s a great source of Vitamin A, Activated (methylated) B12, Activated (Methylated) Folate an Carnitine.

  • 4-5 cups water (play with the water content for consistency)

  • 1 pound chicken liver

  • 1 onion, thinly sliced

  • 3/4 cup butter, softened

  • 1/4 Real salt

Directions

  • In a medium saucepan, combine water, chicken livers, and sliced onion. Bring to a boil, reduce heat to low, and cover. Simmer for about 20 minutes, or until liver is cooked and tender. Remove from heat, drain, remove and discard any hard portions of the liver.

  • Place cooked livers in a blender or food processor, and process until smooth.

  • 1 oz serving size has 90-116 calories.

Lemon egg and chicken and Rice broth

4 servings

This is a traditional Greek medicinal soup, anytime someone came down with a fever or a cold, this was the winning combo used to nurse people back to health. This is probably because it the lemon juice is one of the highest sources of vitamin C and eggs are full of choline, vitamin A and zinc, all things important for the immune system. It is especially easy on the tummy and packed full of nutrition. 

  • 4 cups chicken broth

  • 4 eggs

  • 4 Tablespoon fresh lemon juice

  • 1/4 cup of cooked rice

  • 1/2 teaspoon of Real salt

  1. Bring 4 cups of chicken broth, salt and rice to a boil,

  2. Mix the egg and lemon mixture in a separate bowl.

  3. Slowly whisk 1 cup of the hot broth into the lemon mixture. Once fully incorporated, add the picture to the remaining broth and mix until the text is smooth and silky.

  4. Let cool until room temperature then blend completely.

Creamy Asparagus soup with Avocado and Fennel

4 servings

I especially love this recipe because asparagus is wonderful for the kidneys because it has  asparagine in it which a natural diuretic and the fennel helps aid digestion and decreases bloating a gas. 

Ingredients

2 tablespoons olive oil plus more for serving

1 large leek white and pale green parts finely chopped

1 bulb fennel thinly sliced

Kosher salt

4 cups Kettle & Fire Chicken Bone Broth

2 pounds asparagus trimmed and cut into 1-inch pieces

1 tablespoon lemon thyme leaves minced

1 lemon juiced

1 avocado peeled, pitted, and diced

Freshly ground black pepper

Greek yogurt for serving (optional)

Instructions


In a large saucepan over medium-low heat, warm oil. Add leek and fennel and a large pinch of salt. Cook, stirring frequently, until fully softened but not browned, 3 to 5 minutes. Stir in bone broth and bring to a simmer.

Add asparagus and thyme. Bring to a simmer and cook for 1 minute. Remove a few asparagus tips and use them for garnish. Continue simmering soup until asparagus is soft, 4 to 5 minutes. Remove from heat and add lemon juice and avocado.

Blend soup using an immersion blender or in batches using a blender until it's smooth. Season to taste with salt and pepper and serve. Garnish with reserved asparagus tips, fennel fronds, olive oil and greek yogurt, if using.


The Following Recipes are from http://www.foodfortubies.org/transition-blend-recipes/

Anything in red are the changes I would make.

 

High Protein

1-2 servings

If you are using dried beans, soak them overnight with a tablespoon of applecyider vinegar. This will decrease gas production and aid in digestion.

1/4 Avocado
1/4 cup Unsweetened Applesauce
1/8 cup Beans (garbanzo, black, pinto, etc.)
2 oz Whole milk (coconut Milk)
1 Tbsp Collagen Protein 

Maintain Regularity 

8 Servings

This is a good meal to keep on hand if a child is having trouble with constipation. 


½ medium banana

6 prunes

½ c peas (frozen, steamed)

½ c sweet potato (steamed and mashed)

2 c whole milk (coconut milk)

1 hardboiled egg

1.5 c brown rice, cooked in water

Blend the brown rice, prunes and 1 cup of the milk until smooth. Add the remaining ingredients and blend. If it is too thick, add a bit of water.

(Note: you can use any 1 cup of fruits and any 1 cup of veggies, just rotate them around. I like the prunes because they help with regularity


Easy Blending 

6 servings

This is usually pretty well tolerated, well rounded meal. 

Very well Cooked white Quinoa – 1 cup

Cooked Chicken – 1 cup

Strawberries – 1 cup

Sweet potato – 1 cup

Cooked spinach – 1/2 cup

Almond milk – 2.5 cups

Olive oil – 3 tbs

Ground flax seed – 2 tbs


Add Water as necessary
















Author’s Note


These suggestions are humbly given by someone who has not personally had to prepare a slenderized diet for someone, therefore many of the recipes were from other websites (as listed.) The information provided is derived partly from working as a naturopathic doctor with individuals that have J/G tubes and my own working knowledge of herbs and nutrition.


I practice in Manheim, PA but do telemedicine anywhere in the world.

Please visit dreringattusond.com for more information about my practice. 

Erin GattusoHBCER