Faculty/Staff

TROY faculty on cutting edge of feeding tube research

September 5, 2018

Troy University faculty members from multiple departments are shedding new light on feeding techniques that could improve patient health.

Faculty members from TROY’s Department of Kinesiology and Health Promotion, Department of Biological and Environmental Sciences, and School of Nursing have spent several years studying the effects of blended tube feeding — in other words, using blended natural food instead of processed formulas.

Their research, unique in recent U.S. history, indicates that many patients being tube fed who struggle with commercial formulas might benefit from switching to blended foods, a practice previously considered unsanitary and disallowed by most hospitals and clinics.

As explained by TROY kinesiology professor Dr. Teresa Johnson, tube feeding has existed for more than 3,500 years, and for the bulk of that time, natural food was used in feedings.

In the mid-20th century, concerns about food sanitation led most experts and, subsequently, hospitals to favor sterile formulas that could be used to feed patients unable to eat by conventional means.

“I was one of those dietitians that said, ‘Let’s not give people this brown, green or yellow mystery mush in a bag,’” Johnson said. “I made it my mission to get rid of blended tube feeding at the hospital where I worked.”

But time and experience changed Johnson’s views. One case, in particular, opened her eyes to the value of blended food.

“I worked a lot with children with developmental disabilities, and a dietitian from Auburn called and said, ‘I want you to look at this case,’” Johnson said. “We had a case of a boy who was able to eat when he was born, but as he got older, he couldn’t eat enough to grow. They had to give him supplemental tube feedings. As soon as they put that feeding in, he started gagging and vomiting.”

The child’s body was rejecting the formula.

His doctors changed formulas and even performed surgery in an effort to reduce his vomiting. Nothing worked.

After doing research on the internet, the boy’s mother asked the clinic to transition him to blended tube feeding.

Incredibly, the switch soon alleviated all of his symptoms. He began eating by mouth again, and now he has been completely weaned off the tube feedings.

“He’s doing great,” Johnson said.

Johnson, along with Dr. Amy Spurlock and Pam Galloway, published a study about this case in 2013.

From there, they wanted to find out more about the usage of blended tube feeding throughout the U.S.

“We wanted to know if other dietitians were using blended tube feeding in their practices,” Johnson said. “We contacted the Mayo Clinic for permission to adapt their survey tool used in a patient population. They agreed, and 242 U.S. dietitians working in pediatric populations responded.”

Half those responses indicated support and even recommendation for blended tube feeding in their clinical practices.

The Troy/Mayo team published the study and followed up with a similar survey of parents of tube-fed children and again found similar positive outcomes with whole food blends. That study was also published last year.

The next step was to address the concerns of healthcare facilities about the potential for bacterial infection from using whole food blends, Johnson said.

Johnson and Spurlock, along with Dr. Debra Milton, Dr. Kelly Johnson, Daniel Bass, Holly Carter, and the Mayo Clinic’s Dr. Ryan T. Hurt, Dr. Manpreet S. Mundi and registered dietitian Lisa Epp, wanted to compare microbial growth between blended tube feeding and standard formula.

“Recent investigations on the safety of blended tube feeding have been conducted outside the U.S., where food handling practices are quite different than expected in U.S. facilities,” Johnson said. “Our research was conducted at Troy Regional Medical Center with feeding samples analyzed by Dr. Milton in the biological sciences department. We found no significant differences between the products. All were safe for patient feeding, and we expect to see those results published shortly, the first published study of its kind that we know of in the last 30 years.”

Johnson says commercial formula feeding will remain the go-to product, but many patients with tube-feeding intolerance can benefit from a whole food blend.

“The pharmaceutical industry is already responding with the introduction of new whole food blend tube-feeding products,” she said. “Furthermore, caregivers and tube-fed patients desire a whole food option. One mother said to us, ‘I read the label on my son’s tube feeding formula, and realized that I’m feeding my kid milk, high fructose corn syrup and a liquid vitamin every single day. I wouldn’t feed that to him if he could eat by mouth.’ She switched to real food blends and said it was the best decision she ever made.”

Johnson believes hospitals will need to reevaluate their policies prohibiting blended tube feeding, and perhaps their bacteria study will allay concerns about product safety.

“When sterile commercial formula replaced blended tube feeding back in the 1970s, we didn’t know that food contained more than vitamins and minerals,” she said. “We now understand a plant-based diet is high in phytochemicals with all their health benefits, various types of fiber that protect the colon and cardiovascular system, and a desirable mix of all components that promote intestinal health. Many scientists believe this explains why many patients with tube feeding intolerance get better when they switch to a whole food blend.”

Johnson and the Mayo Clinic team from Rochester, MN presented their research most recently at the international American Society for Parenteral and Enteral Nutrition Conference in Las Vegas.

Moving ahead, the team is planning a prospective multi-center study with the Cancer Center in Montgomery.