The role of whole foods for enteral nutrition

John Bagnulo MPH, PhD. - Director of Nutrition for Functional Formularies
John Bagnulo MPH, PhD. - Director of Nutrition for Functional Formularies

Fruits, vegetables and grains that are unaltered or in their most natural state, with minimal processing and preservatives, are staples of a nutritious diet. The Academy of Nutrition and Dietetics reports that whole foods are necessary for successful aging, contributing to one's ability to maintain independence, functional ability, minimize disease and increase quality of life.

Whole foods play such a powerful role in disease prevention that including them in the diets of those chronically ill is crucial, especially for individuals that are tube-fed. However, most commercial tube-fed formulas are anything but whole as they are high in preservatives, chemicals and other additives. The Annals of Long-Term Care: Clinical Care indicates that many of these formulas lack crucial micronutrients despite containing an adequate provision of calories and protein.

However, according to EndoNurse, over half a million people in the United States use enteral feeding to maintain their health. Yet when patients rely on commercial formulas as their sole source of health, problems may occur. Instead of increasing independence, functional ability and minimizing disease, these formulas can sometimes produce health complications that detract from long-term patients' quality of life, of which can often be minimized by the introduction of a USDA-certified organic, whole foods formula.

These complications include glycemic issues and gastrointestinal intolerance, which can lead to digestive tract infections. There are a number of significant influences such as antibiotic use, medications, lack of direct sunlight and a compromised immune system function that can contribute to infection. Our medical society needs to understand how pivotal a role whole foods nutrition plays not only in prevention, but in treatment of the chronically ill. What most long-term, tube-fed patients are unaware of is that choices exist and that they can choose a whole foods enteral formula.

Three problems with commercial enteral formulas

Unfortunately, most commercial enteral nutrition and meal replacement formulas contain refined carbohydrates and sugars, corn syrup solids, omega-6 fatty acid-rich vegetable oils, preservatives, artificial colors and chemical additives. Because vegetable oil production requires an intensive chemical and mechanical process to remove oil from the seeds, all nutrient values are lost, which oxidizes and damages the quality of the omega-6 fatty acids.

  • Artificial ingredients. The heavily processed, artificial ingredients in commercial enteral formulas predispose patients to harmful, microbial pathogen overgrowth in their gastrointestinal tracts, increasing their chance for infection and viruses.

  • Damaging refined sugars. Furthermore, diets high in refined sugar and omega-6-rich vegetable oils are associated with diabetes, inflammation, low circulation and a reduced ability to heal.

  • Carcinogenic genetically modified grains. Commercial formulas contain genetically modified conventionally-grown grains, such as corn and soybeans, which require heavy pesticide and herbicide use in when in production. The World Health Organization even classified one herbicide – glyphosate – as a carcinogen. Why would we want to feed glyphosate to anyone, much less society's most vulnerable, chronically or critically ill long-term care patients?

Three reasons to choose whole-foods enteral formulas

Therefore, to reduce the risk of infection, disease and exacerbation of existing health conditions, considering the ingredient quality of enteral formulas is paramount. Choosing a whole foods, USDA-certified organic formula is the first step.

USDA-certified organic whole foods eternal formulas, developed by companies such as Functional Formularies, boast not only a high-quality ingredient list, but are also entirely plant-based, made of vegetables, legumes, grains and herbs. In comparison, highly refined commercial formulas focused only on calories, protein and fortified with vitamins and minerals for sole source nutrition, lack three of the greatest offerings made by plants to our diet: phytonutrients, fermentable fiber and omega-3 fatty acids.

  • Detoxifying, plant-based phytonutrients. Phytonutrients are synergistic compounds found in plants that promote optimal cellular function through detoxification, delivering beneficial anti-inflammatory effects.

  • Nourishing, organic fermentable fibers. Fermentable fibers from organic vegetables aid in slower digestion, allowing beneficial bacteria time to ferment in one's gastrointestinal tract, which helps to lower “bad” LDL cholesterol and blood glucose levels. Fermentable fibers also produce short chain fatty acids that nourish the gastrointestinal tract, enhancing nutrient and mineral absorption. Fibers from starchy root vegetables or legumes establish more diverse, beneficial bacteria than refined, flour-based fiber ingredients.

  • Anti-inflammatory omega-3 fatty acids. Unlike commercial formulas ridden with refined omega-6 fatty acids, Liquid Hopes contains organic flax oil, which is rich in omega-3 fatty acids. Extra virgin olive and coconut oils are other sources of omega-3 fatty acids. Omega-3 fatty acids are anti-inflammatory, protecting tissues and organs from infection, which support general brain and heart health.

Functional Formularies' adult whole foods meal replacement formula contains 450 calories, 23 grams of protein and 13 grams of fermentable fiber, while containing no added sugar, casein, soy, gluten, or corn, which can cause intestinal inflammation.

Overall, it's not difficult to understand why long-term care patients want to increase their quality of life. It is equally easy to comprehend how quality, real, whole foods ingredients can help them achieve this goal. However, what is not logical is how questionable, pesticide-GMO- and-preservative-laden ingredients equate to adequate nutrition levels for tube-fed long-term care patients. Adequate nutrition should not predispose patients to harmful, pathogenic gastrointestinal bacteria, making them more susceptible to infection and viruses.

Conversely, USDA-certified organic ingredients found in whole foods enteral formulas that are fermentable fiber concentrated, omega-3 fatty acid-rich, and free of added sugar, provide beneficial, easily absorbable nutrients and minerals that help to prevent infection. Proper nutrition will help to increase patients' vitality levels, making even the smallest strides toward independence, whether it be walking a few steps further, feeling less discomfort or having the energy to enjoy their loved ones' company, all the more realistic and attainable. An organic whole foods option CAN make this happen.

John Bagnulo, Ph.D., MPH is the director of nutrition for Functional Formularies.

Sources:

1. Brown KA et al. Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care: A Multilevel Case-Control Study. Ann Intern Med 2016 April 19
2. Durham, D. P., Olsen, M. A., Dubberke, E. R., Galvani, A. P., & Townsend, J. P. (2016). Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings. Emerging Infectious Diseases, 22(4), 608–616. http://doi.org/10.3201/eid2204.150455
3. Hunter, J. C., Mu, Y., Dumyati, G. K., Farley, M. M., Winston, L. G., Johnston, H. L., … Lessa, F. C. (2016). Burden of Nursing Home-Onset Clostridium difficile Infection in the United States: Estimates of Incidence and Patient Outcomes. Open Forum Infectious Diseases, 3(1), ofv196. http://doi.org/10.1093/ofid/ofv19
4. Vindigni, S. M., & Surawicz, C. M. (2015). C. difficile Infection: Changing Epidemiology and Management Paradigms. Clinical and Translational Gastroenterology, 6(7), e99–. http://doi.org/10.1038/ctg.2015.24
5. Vincent, C., Miller, M. A., Edens, T. J., Mehrotra, S., Dewar, K., & Manges, A. R. (2016). Bloom and bust: intestinal microbiota dynamics in response to hospital exposures and Clostridium difficile colonization or infection. Microbiome, 4, 12. http://doi.org/10.1186/s40168-016-0156-3
6. Khanna S et al. A Novel Microbiome Therapeutic Increases Gut Microbial Diversity and Prevents Recurrent Clostridium difficile Infection. J Infect Dis. 2016 Feb 8.
7. Vincent, C., & Manges, A. R. (2015). Antimicrobial Use, Human Gut Microbiota and Clostridium difficile Colonization and Infection. Antibiotics, 4(3), 230–253. http://doi.org/10.3390/antibiotics4030230
8. Pérez-Cobas, A. E., Artacho, A., Ott, S. J., Moya, A., Gosalbes, M. J., & Latorre, A. (2014). Structural and functional changes in the gut microbiota associated to Clostridium difficile infection. Frontiers in Microbiology, 5, 335. http://doi.org/10.3389/fmicb.2014.00335
9. Murphy EA et al. Influence of high-fat diet on gut microbiota: a driving force for chronic disease risk Curr Opin Clin Nutr Metab Care 2015 Sep;18(5):515-20.
10. Ghosh, S., DeCoffe, D., Brown, K., Rajendiran, E., Estaki, M., Dai, C., … Gibson, D. L. (2013). Fish Oil Attenuates Omega-6 Polyunsaturated Fatty Acid-Induced Dysbiosis and Infectious Colitis but Impairs LPS Dephosphorylation Activity Causing Sepsis. PLoS ONE, 8(2), e55468. http://doi.org/10.1371/journal.pone.0055468
11. Bengmark, S. (2012). Nutrition of the critically ill - emphasis on liver and pancreas. Hepatobiliary Surgery and Nutrition, 1(1), 25–52. http://doi.org/10.3978/j.issn.2304-3881.2012.10.14
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