We all probably enjoy a protein shake now and then, but imagine if that was the only thing you ate for every meal, every day of your life. Such is the case for many children and adults who receive their nutrition through a gastrostomy tube (G-Tube). As if these patients don't have enough to deal with—feeding and swallowing disorders, brain injuries, metabolic and genetic disorders, etc.—they're more often than not pumped full of corn syrup, highly processed carbs, seed oils, and various chemicals found in products like PediaSure. In fact, most nutritionists and gastroenterologists recommend these unhealthy formulas, even though there are excellent real-food alternatives without all the chemicals. Why is that?
I decided to write about this based on personal experience. My five-year-old grandson Luke was born with a rare genetic disorder called IFAP syndrome, or Ichthyosis Follicularis, Alopecia, and Photophobia syndrome. It's often accompanied by intellectual disability, seizures, and short stature—all of which my grandson and his parents have to deal with on a daily basis. He's had numerous surgeries, and a scary heart infection that led to open-heart surgery to correct a congenital problem. Kids with IFAP have a difficult time growing and putting on weight. In Luke's case, he also had trouble swallowing and vomited a lot, which meant he was in danger of being malnourished and diagnosed with failure to thrive. The decision was made to insert a G-tube, which would give him a better chance to grow and develop. It's been a lifesaver for him, literally.
There are a lot of things his parents can't control, but getting healthy food into his body should be one of them. Unfortunately, they discovered early in the process that gastroenterologists and nutritionists push formulas like PediaSure, and insurance companies balk at paying for anything else.
Here's a list of ingredients for PediaSure's Grow & Gain:
Water, Corn Maltodextrin, Blend of Vegetable Oils (Soy, High Oleic Safflower), Sugar, Milk Protein Concentrate, Soy Protein Isolate. Less than 0.5% of: Vitamins & Minerals (Potassium Citrate, Calcium Phosphate, Potassium Chloride, Magnesium Phosphate, Potassium Phosphate, Calcium Carbonate, Ascorbic Acid, Choline Chloride, Ferrous Sulfate, dl-Alpha-Tocopheryl Acetate, Zinc Sulfate, Niacinamide, Calcium Pantothenate, Manganese Sulfate, Thiamine Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Palmitate, Copper Sulfate, Folic Acid, Chromium Chloride, Potassium Iodide, Sodium Molybdate, Sodium Selenate, Biotin, Phylloquinone, Vitamin D3, Vitamin B12, Menaquinone-7), Natural & Artificial Flavors, Cellulose Gel, Tuna Oil, Cellulose Gum, Monoglycerides, Soy Lecithin, Carrageenan, Potassium Hydroxide, Inositol, Salt, Taurine, Stevia Leaf Extract, L-Carnitine, and Lutein.
Compare that to blenderized meal-replacement alternatives like RealFood Blends:
Sweet Potatoes, Peaches, Turkey, Water, Extra Virgin Olive Oil, Green Beans
Other meals this company produces include healthy foods such as chicken, salmon, brown rice, and vegetables. You can smell the difference immediately when you open a pouch of their blenderized food. True to the name, it smells like... real food. Something you'd want to put in your mouth and stomach. And trust me when I say that if you're going to be vomited on, you'd rather have it be beef and carrots than that disgusting vanilla PediaSure. I gag just thinking about it.
Note: There are a number of companies in addition to RealFood Blends that produce blenderized foods, including Kate Farms, Liquid Hope, and Blended by Sarah. Many of them were founded by parents seeking healthy solutions for their own children.
And which would you rather eat? Unfortunately, the medical establishment and its insurance industry partners would rather have my grandson eat the PediaSure.
Health and Human Services Secretary. Robert F. Kennedy Jr. launched Operation Stork Speed last month to focus on infant formula. That's wonderful news, and long overdue, but the effort must go beyond infant formula and include enteral food.
It will be a heavy lift because there's big money in Big Forma. According to Fortune Business Insights:
The U.S. enteral nutrition products market size was valued at USD 2.84 billion in 2023. The market is projected to grow from USD 2.98 billion in 2024 to USD 4.86 billion by 2032, exhibiting a CAGR of 6.3% during the forecast period... The U.S. market is consolidated, with a few prominent players, such as Abbott, Nestlé, and Nutricia (Danone) operating with a robust product portfolio. Nestlé dominated the enteral nutrition products market in the U.S. in 2023.
Doctors tend to prescribe these formulas out of habit, and insurers prefer to cover them over blenderized real foods because the formula is cheaper, even though parents are increasingly demanding them.
For some bizarre reason, enteral foods are classified as durable medical equipment (DME), in the same category as hospital beds and portable toilets. Feeding pumps and syringes, yes, but food? Why is that categorized as equipment? At any rate, DME providers can be frustrating and scammy. A quick Google search for DME fraud yields pages and pages of reports about waste, fraud, and abuse involving these companies, which contract not only with private insurers but also with government programs like Medicaid and Medicare. In many cases, the markups they take defy belief—700% for one of my grandsons' enteral nutrition orders. (Maybe we need to get those DOGE kids to investigate?)
And there's no excuse for my son having to spend hours on the phone every month—poor customer service is legendary with DME companies—begging them to provide the food and supplies my grandson needs to live, only to be told that they'll only pay for PediaSure.
According to a recent commentary at BMJ Journals:
Blended diets have been found to have beneficial effects on gastrointestinal symptoms (eg, gagging/retching, vomiting, nausea, abdominal pain, constipation or diarrhoea) and therefore the use of blended diet as a part or as a sole type of nutrition for paediatric patients has been increased. Also, the use of blended food and drinks for tube feeding patients and their caregivers is perceived to be more ‘normal’, as it, in a way, demedicalises the feeding process. It is also associated with social benefits like the use of the real food, having more food/meal choices, emotional well-being of the child and better psychosocial interactions of whole family. In addition, the use of blended diets is also linked to sustainable nutrition.
A recent study at Boston Children's Hospital found many health benefits to blenderized food:
They found that rates of total annual ER visits, hospital admissions, and respiratory admissions were significantly lower in children who received blended diets than in those fed conventional formula. Specifically, total ER visits were reduced by 43 percent, total admissions by 53 percent, and respiratory admissions by 67 percent. These patients also reported higher satisfaction, less nausea, vomiting, abdominal pain, and diarrhea, and fewer total symptoms than their peers. Their intake of dietary fiber was higher than that of their peers, while their intake of vitamin D was lower. Both groups received plenty of folate, iron, and zinc.
They noted that formulas "tend to be rich in processed carbohydrates and saturated fat and lacking in fiber."
Back to my original question: Would you like to eat that every day of your life? Why would we want to pump children full of chemicals and other garbage when there are healthy alternatives? We're hoping our grandson won't need a G-tube forever, but in the meantime, blenderized food is the best nutritional option for him—and it gives him the best chance of tolerating a normal diet in the future.
Can we normalize that, please, and help doctors and insurers to get on the real food bandwagon?
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