Formula Feeding

The term “enteral feeding and enteral nutrition (EN)” means feeding enteros, the digestive tract. Of course, all normal feeding is enteric: food enters the mouth, is chewed, swallowed and digested by the digestive tract. Enteral feeding stands in contrast to parenteral feeding by venous infusion of nutrients, popular in hospitals.  You can assume that MDs who talk about enteral feeding are pointing to a variety of fomulas given by mouth or tubes inserted into the digestive tract .

Williams stated: “When oral intake is inadequate or not recommended for a prolonged period of time, patients may require an alternative method of feeding, either enterally or parenterally. EN offers several advantages over parenteral nutrition, including lower cost, greater convenience, decreased infectious complications, and enhanced host immune function. Another beneficial effect includes improved maintenance of GI mucosal structure and function, preventing gut atrophy and bacterial translocation.” 

Rationally formulated food (meal) replacement formulas should be ideal mixes of nutrients that eliminate most of the problems of wild diets that feature a chaotic mix of ingredients beyond anyone’s ability to measure or define.  Generalizations are misleading. Formulas vary a great deal. Often, one formula is successful and another is hazardous to your health. The trick to getting good results is knowing what formula to use in a given situation.

For example, I have discussed problems caused by food proteins and suggested that proteins, at the wrong place and wrong time, may be among the most common and the most ignored disease-producing agents. Recall that proteins are not really nutrients. Rather, these big molecules have to be digested into nutrient amino acids. The digestion of proteins plays a critical role in deciding the outcome of eating a meal. If food proteins are completely dismantled into free amino acids, everything should go wel as long as the amino acids can be metabolized. There are many metabolic reasons to avoid high protein intake and few reasons to support high protein intake.

If intact proteins and peptides pass through the digestive tract wall, you create a different set of serious problems: systemic immune-mediated disease may follow.  My bias is in favor of free amino acid formulas that avoid all the problems that proteins cause. I shudder at the though of milk, egg and soya proteins being delivered in large amounts orally or through a feeding tube to already sick patients.

DeLegge stated: We continue to investigate the efficacy of enteral nutrition therapy. After reviewing the interpretation by Stratton and Marinos   and by Koretz et al.   of clinical trials evaluating the efficacy of enteral nutrition, there were some similar and some different conclusions reached. These uncertainties point to the difficulty in assessing multiple small clinical trials in a meta-analysis, or making conclusions based on testing within a heterogeneous population. It would be difficult to believe that enteral nutrition support, across the board, would be effective for the outcome of one specific disease state (e.g. hip fractures). It would be more logical to believe that the use of enteral nutrition in malnourished patients would improve outcomes in most disease states. Although we may never have the appropriately powered prospective, randomized trial for all nutrition interventions, best practice can often be created from a review of the combined literature including retrospective, prospective observational and small randomized trials. The lack of a definitive prospective randomized trial does not mean a therapy does not work or should not be attempted. The potential benefit of that therapy must be weighed against the potential risks and costs of that therapy.`

Often, formulas are subjected to scrutiny that wild diets never receive. The first considerations are ingredient sources, quality and solubility. The second set of considerations is nutrient values and nutrient proportions. The third set takes into consideration the abnormal behavior of a disordered or diseased digestive tract than may be hypersenstive and react to food antigens or otherwise may have lost some of the adaptability and resilience of a normal digestive tract .

We have established that the gastrointestinal tract is a sensing, reactive device that monitors the material flowing through it. The basic principle of gastrointestinal tract management is to treat symptoms as information. When the gastrointestinal tract complains, adjust food intake until the complaints disappear. This stragey works for enteral feeding formulas.  The progression is often from oral feedings of formulas based on food materials (the cheapest, most available, most problematic) to partially hydrolysed formulas (more expensive, less available and not always tolerated), to elemental nutrient formulas ( more expensive, less available, but better tolerated when other formulas fail).

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Food & Digestive Disorders

Alpha Nutrition Program

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