Alpha Nutrition Formula
Alpha ENF has been used successfully for tube feeding sometimes long term, but additional nutrients and expert management are required.
There are many concerns when tube feeding with formulas replaces eating food. While Alpha ENF is suitable for tube feeding and may solve problems created by other enteral formulas, nutrient intake must be customized to suit the specific needs of each patient. Expert medical supervision is required. We recommend that a nutrient intake analysis is done at intervals and compared with RDIs. In addition, regular blood tests are recommended to assess nutrient absorption and metabolic status. This testing should include blood counts, vitamin B12, electrolytes, kidney and liver function tests including prothrombin measurement (usually by measuring the INR). Supplemental fats, Vitamin K1 and B12 are often required.
Various enteral feeding tubes are available, classified by site of insertion and location of the distal tip of the feeding tube. A tube into the stomach is best because the stomach tolerates more variations and concentrations of ingredients including hypertonic solutions. The stomach also provides valuable digestive functions and regulates small bowel activity. Vitamin B12 absorption requires the stomach, the presence of hydrochloric acid, and intrinstic factor. An empty stomach will atrophy and will become infected with microbes that cannot survive in a normally active stomach.
Feeding tubes placed in the small bowel are more problematic and should be avoided unless there is no alternative. Jejunal infusion often causes abdominal cramping and diarrhea. Tubes move, irritate the bowel wall, cause bleeding and promote infection.
Small-bore enteral feeding tubes are preferred but are more prone to clogging. Williams cites predisposing factors such as thick formulas with intact proteins, insufficient flushing, and incorrect medication administration, She recommends that tubes are flushed with 30 mL of water every four hours When feeding are intermittent tubes should be irrigated with 30 mL of water after each feeding. When medications are administered, tubes should be flushed with 15–30 mL of water before and after drug delivery. When several medications are being given at the same time, each one should be administered separately. The feeding tube should be flushed with at least 5-10 mL of water between medications.
Alpha ENF can be blended with warm water and used for tube feeding. The formula is complete out of the jar. Start with 50-gram servings every two hours or 6 times a day and increase until caloric needs are met - 50 gm is about 1/2 cup of formula. Mix in 1.5 to 2.0 cups of warm water.
Blend for 1 minute and administer. For the first few days it is best to add extra water to formula and administer slowly (e.g. take 20 minutes to add the complete serving). This gradual introduction allows the digestive tract to adjust to the input of pure nutrients.
In long term use, fat in the form of vegetable and fish oils can be added to increase caloric intake and complete a desirable fatty acid composition. You slowly can add vegetable oil up to one tablespoon per 100 grams of the formula. A combination of extra virgin olive oil and Canola oil in equal proportions is recommended. Fat intake can be increased to about 20 to 30% of daily caloric intake, if tolerated. Estimate vegetable oil requirement as 9 calories per gram of oil. Add omega 3 fish oil (salmon or blend of fish oils) to provide DHA daily intake of at least 500 mg. By adding oil, you can increase the energy intake profile toward carbohydrate 60% Fat 30 % Amino Acids 10% of daily calories.
Add oil after the formula has been mixed with warm water in the blender and then blend another 30-40 seconds at high speed. Administer promptly. If you mix the formula and let it sit, the oil will separate and a small amount of the less soluble nutrients will settle- a quick remix in the blender may be required.
Night feedings A feeding schedule that extends from 8 AM to 10 PM, for example, may work well. Sometimes, however, feedings are required overnight. An overnight fast of 8-10 hours may be well tolerated, but for many reasons blood sugar levels may drop during sleep. In normal circumstances hunger and thirst wakes a person who then eat and drinks according to body signals. If you are depending on tube feeding you may need to prepare a 50-gram serving and leave at the bedside in a shakeable container. Shake briefly to remix and administer.
If the formula is too concentrated (not enough water) the symptoms may be bowel cramps and possibly distension; dark yellow urine, dry mouth, dehydration. If the formula is too concentrated, bowel cramps may occur or mental fogginess, sedation or confusion might occur. This is uncomfortable but not harmful. If the interval between servings is too long, hypoglycemia might occur.
Problems with formula feeding are often solved by
1. adding extra water
2.increasing the time taken to administer the formula
3.reducing the dose per serving
4.increasing the frequency of servings.