Advocating for Patient-Led Recovery

To clinicians,

The Ethical Imperative: Support Patient Autonomy

The tenets of medical ethics call us to honor the autonomy of those we serve. When patients or their loved ones choose a path that includes evidence-informed nutritional therapy—even if outside the standard of care—we have an ethical responsibility to support them.

Supporting a patient’s chosen approach does not place the burden of responsibility on the clinician to endorse or defend that choice as part of the standard of care. Rather, it offers the opportunity to collaborate in a way that protects clinicians from liability by honoring informed consent and the patient’s right to self-direct their care. This approach is not combative—it is collaborative, and in service of our shared goal: improved outcomes and meaningful recovery.

Patient Autonomy is Foundational:

“The patient has the right to refuse and to choose their treatment.”

This letter is not a request for permission, but a call to partner in empowerment. We all want the same thing: for the patient to get better. Let’s work together towards this shared goal. You have the power to help them implement their chosen care strategy—and that support can make all the difference.

With deep respect and appreciation for your work and willingness to consider new models of care,

Cavin Balaster, CFNCFunctional Nutrition Counselor, Author of “How to Feed a Brain”

To clinicians,

Thank you for your continued dedication to healing and for being open to integrative approaches that can profoundly impact recovery outcomes. As you know, nutrition is foundational—every cell in the body, including those of the brain, relies on the building blocks we provide through food and supplementation.

In cases of brain injury or neurological decline, the right nutritional interventions can be transformative. As a clinician, you may hold the key to unlocking recovery by supporting protocols that include high-quality omega-3 supplementation and real-food enteral nutrition.

Fish Oil Supplementation

Omega-3s and Neuroprotection

High-dose fish oil, rich in EPA and DHA, has shown promise in supporting recovery from traumatic brain injuries. Peer-reviewed research and case studies demonstrate measurable improvements, including ventilator weaning and restored function, in patients who received therapeutic doses: 15 ml (about 13 g) twice a day — 30 mL/day of a high-quality fish oil. The therapeutic dose is the key here.[2] This is not an isolated case; other TBI survivors have obtained similar results, which you can read more about at feedabrain.com/omega.

In 2011, an article in Military Medicine, the official journal of The Association of Military Surgeons of the United States (AMUS), wrote that “…a comprehensive, coordinated research program to evaluate the multiple uses of n-3 FA [Omega-3 fatty acids] should be a high priority for the Department of Defense.”[1]

What About the Risk of Blood Thinning?

Concerns about blood thinning have been addressed in the literature, with data showing no deleterious effects at doses up to 6 g/day in healthy individuals. In fact, DHA does not significantly affect clotting markers or augment aspirin-induced inhibition of platelet aggregation. This aligns with findings from Hasadsri et al. (2013), who concluded that “DHA at doses up to 6 g/day does not have deleterious effects on platelet aggregation or other clotting parameters in normal individuals, and fish oil does not augment aspirin-induced inhibition of blood clotting.”[3]

We have organized much research on Omega-3s and their effects in preventing and treating brain injury at feedabrain.com/omega.

Real-Food Tube Feeding

Many standard formulas contain ingredients that may contribute to inflammation and hinder recovery. Patients can benefit from tube feeds based on whole foods, whether pre-made (see feedabrain.com/feeds) or home-prepared (instructions at feedabrain.com/gastric). These approaches are nutrient-dense and better aligned with functional nutrition principles for neurorehabilitation.

Real-Food Blenderized Tube Feeds

Surprisingly, most enteral formulas fed today contain processed ingredients like corn syrup, canola oil, sugar, corn maltodextrin, and soy protein isolate. Many of these ingredients have been shown to contribute to neurodegeneration and inflammation. These ingredients are not quality nutrition for anyone to live on—let alone someone who needs to heal after injury or throughout a disease process. Instead of using these feeds, we can use tube feeds based on real food nutrition to better support your patient’s recovery and health. A list of pre-made feeds that can be ordered online is available at feedabrain.com/feeds.

If someone is willing and able to create them from fresh ingredients, blenderized tube feeds can provide superior nutrients for brain health and recovery when compared to processed formulas. I have created a “Gastric Tube Feed Creation Instructions” handout, available at feedabrain.com/gastric.

Collaborating for the Patient’s Well-Being

Both you, and the loved ones of the person you are caring for, want the patient to get better—so I hope that you are open to allowing (or requesting) that your patients be administered fish oils and/or to be fed the real-food feeds outlined here.

Additionally, we are building a team of collaborative medical professionals to influence change. Together, we can make a positive change in the standard model of neurorehabilitation, and we can help to prevent neurological degeneration for everyone. If your heart breaks as you watch patients deteriorate on the currently-used feeds, I ask you to join us in this quest to improve hospital and gastric feed nutrition.

I have so much appreciation for your profession and the work you do for patients every day. Thank you for your time and attention. I hope this information will be useful to you in the treatment of your patients.

Sincerely,Cavin Balaster

Gastric Feed Instructions for Clinicians

Use the Blenderized Tube Feeding: Suggested Guidelines to Clinicians article and The Use of Blenderized Tube Feeding in Pediatric Patients: Evidence and Guidelines for Dietetic Practice to appropriately feed a patient a real-food blenderized feed.

The reference chart is taken from the article written by Laura Schoenfeld, MPH, RD concerning blenderized tube feeding in pediatric patients. If we change the word “parent” to “patient or support,” the same criteria apply to patients of any age. This is a list of minimum criteria to consider before switching a patient to a blenderized tube feed.

If the patient is a realistic candidate for these gastric feeds, we can order Feed a Brain–approved gastric feeds (feedabrain.com/feeds), or make or order premade meals to be made into feeds following the instructions outlined in the Gastric Feed Handout. For your convenience, all handouts can be found at feedabrain.com/research. In any case, high dosages of Omega-3s have been shown to be beneficial and neuroprotective, with numerous supporting studies at feedabrain.com/omega.

PDF

Gastric Feed Creation Instructions

Download the handout (PDF) — a guide for clinicians and caregivers on creating a blenderized tube feed.

Storage

If there is leftover after first feed, seal in a container and refrigerate for use within 24 hours. If the feed will not be used within 24 hours, freeze for later use.

I highly recommend the use of a high-quality blender like a Blendtec or Vitamix — both come with multi-year warranties and impressive capability. You can find recommended blenders at feedabrain.com/tools.

Amylase and Gastric Feeding

Gastric tubes skip the first stage of digestion—when food is chewed and mixed with saliva in the mouth. Saliva is important because it contains special enzymes, namely amylase, which breaks down complex carbohydrates into simple sugars to prepare the food for the next phase of digestion in the stomach. Because we are skipping this step, we want to add digestive enzymes to the gastric feed. For products designed to include important enzymes specifically for gastric feeds, see feedabrain.com/enzymes.

Hydration

For any of the benefits discussed above to be effective, it is very important to supply adequate hydration. Hydration helps move toxins out of the body, so we want to supply more than just enough to survive. Optimal water intake depends on many factors, including how much water is already in the foods consumed.

If we are supplying nutrition via a gastric tube, work with a qualified healthcare professional to determine the right amount. Jeremy Lampel, MS, RD, CDE, a registered dietitian and certified diabetes educator, suggests that for healthy adults, you can generally divide your weight in pounds by two and use that number as ounces of water per day as a minimum requirement.

Rule of thumb: Weight in pounds ÷ 2 = minimum daily ounces of water.

So a 160-lb adult should target at least 80 oz/day. In metric: weight in kg ÷ 30 = liters per day (e.g. 72.5 kg → ~2.4 L/day). Needs may increase with activity, climate, or other medical conditions—work with a qualified healthcare provider.

For nurses and dietitians, this Nursing Times article on hydration management is a useful read: “Maintaining hydration in enteral tube feeding.” You can find this and other important articles at feedabrain.com/articles.

• Depending on the amount of salt, bone broth may count toward hydration—a cup of unsalted broth can potentially count as a cup of water.

• Bone broth also contains protein.

Macronutrients

Macronutrients fall into three main categories: carbohydrates, proteins, and fats. While most of us can rely on appetite to guide protein requirements, Jeremy points out that protein requirements vary significantly depending on the stage of recovery. A patient may be unable to communicate or may have damage to brain areas that affect appetite. Work with your dietitian to determine requirements, especially for patients who cannot communicate or perceive their appetite.

One-on-one consultations are available at feedabrain.com/consult, and additional courses and resources are at feedabrain.com/education.

There are general guidelines and formulas that can be used to estimate needed macronutrient amounts, and we provide some ballpark estimates—but keep in mind these are only estimates of average needs for a healthy individual. Those in critical care can rarely be considered to have a “normal” metabolism. Jeremy has shared a handout he uses to inform patients of how macronutrients of their diets might be distributed for different conditions. Bring these guidelines to your dietitian or another qualified healthcare provider.

For your convenience, all printable charts can be found at feedabrain.com/handouts.

CB

About the Author — Cavin Balaster, CFNC

Cavin sustained a severe TBI — a Diffuse Axonal Injury — that left him with less than a 10% chance of recovery beyond a persistent vegetative state. He awoke from a coma unable to eat, walk, or talk, breathing through a tracheotomy and receiving nutrients through a PEG tube. After being steered toward a nutritional protocol, he began to regain mental clarity and studied physiology, nutrition, and neuroplasticity at Duke, Cal Poly, the University of Chicago, and Johns Hopkins. His mission today is to improve the standard model of neuro-rehabilitation by bringing together top brain and nutrition experts, organizing tools to optimize brain function, and working to improve hospital nutrition worldwide. Learn more at feedabrain.com and adventuresinbraininjury.com.

References

1. Lewis M, et al. “Therapeutic Use of Omega-3 Fatty Acids in Severe Head Trauma.” Military Medicine, 2011. doi:10.7205/MILMED-D-10-00446

2. Lewis MD, Bailes J. “Case study — recovery from TBI with high-dose omega-3 supplementation.” American Journal of Emergency Medicine, 2012. doi:10.1016/j.ajem.2012.05.014

3. Hasadsri L, et al. “Omega-3 fatty acids as a putative treatment for traumatic brain injury.” Journal of Neurotrauma, 2013. View source