Alpha ENF has been used successfully for tube feeding sometimes
long term, but additional nutrients and expert management are
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 intrinsic 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
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
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
adding extra water
increasing the time taken to administer the formula
reducing the dose per serving
increasing the frequency of servings.