Feeding Tubes

1) What is a Feeding Tube?

• A feeding tube is simply a tube doing from the stomach to the outside of the body so you are able to put nutrients directly into the stomach.
• You may still eat and drink with a feeding tube.
• Studies have shown that, in ALS, the earlier a feeding tube is placed the longer the survival rate.
• There are two types of ways to place a feeding tube which are discussed further below in this step
  • PEG most often used in the US
  • RIG often used in Europe
• An additional option is to get Mic-key button installed after a PEG or RIG is placed (about six weeks) if you prefer the button to the tube, Many prefer the tube, many prefer the button.

2) Why would I consider getting a feeding tube?

Answer: To give myself the nutrients and hydration it takes to heal.

• If you are having any difficulty with the feeding eating or drinking consider getting a feeding tube sooner versus later. See Section 3) below to find out if whether or not you need one.
• You want to get optimal nutrition and optimal hydration in order to slow, stop and reverse ALS symptoms. The feeding tube allows for this.
• The research shows that when feeding tubes are placed early that ALS life expectancy increases.
  • You are as able to get adequate hydration, protein, fats and the other nutrients your body needs to heal.
  • It is easier to maintain weight with the feeding tube, and weight is major factor in ALS.
  • You are able to get supplements into your body.
  • You are less likely to get aspiration pneumonia, a leading cause of premature death in ALS.

3) How do I know if I need a feeding tube?

If you have ONE of the following, then you likely need a PEG Tube

• I have difficulty swallowing that interferes with maintaining weight
• I am unable to drink 8 oz of water in 2 minutes
• I am unable to eat a main meal within 30 minutes
• I am choking on foods and/or liquids more often

Any of the above is a reason to schedule a feeding tube sooner, versus later.

4) I have none of the above symptoms. Why do I want to educate myself NOW about feeding tubes?

• Learn about feeding tubes as insurance.
  • You do not intend for your house to burn down, yet you purchase fire insurance.
  • You do not intend to ever get into an accident, yet you purchase car insurance.
  • You may not ever intend to need a feeding tube, yet just in case at any time in the future you do, you want to be educated about it.
• Learn about exactly what is involved so that you are prepared with all the information
• Remove all of the fear surrounding a feeding tube.
  • It is a simple procedure that is done in children and adults whenever they cannot get nutrition by mouth
  • Most PALS, after having a feeding tube placed are very happy to have it because it takes away the risk involved in choking, an enables them to get more nutrition easily.
  • It is easy to clean and maintain (just rinse with water after each feeding and wash with water (and mild soap if needed).
  • You may continue to eat and drink after the feeding tube is in place as long as you feel it is safe (no risk of choking).
  • If a feeding tube is no longer needed in the future, it can be removed easily.

5) What size feeding tube should I get?

• Call ahead to make sure you get a minimum of FR20. Anything than that is not adequate to get in supplements or blended food, which is the most nutritious option rather than prepared feeding tube formulas.
• Some prefer larger tube like FR24 because it is easier to get food and supplements in. Others prefer the FR20 because it fits their body better.
• If you have a smaller feeding tube – they can insert a larger one.

6) What types of feeding tubes are there?

Before surgery, whether you get a PEG or RIG:

• Call ahead to make sure they have in stock a minimum of and FR20 size. Smaller than that is not practical for blended meals nor getting in supplements, nor cleaning.
• Speak to the surgeon ahead of time to ask to put the PEG or RIG off to the side one way or the other and not exactly in the middle so as not to interfere with the body’s meridians.

PEG Tube

• Most common in the United States and many other countries
• A mild sedative is given so that a temporary tube can be placed in through the nose and out through the stomach. This is usually the safest way to place the tube and the tube is
• Does not require general anesthesia.
• Usually done by a gastroenterologist.
• Can last as long as 5 years before it has to be replaced.

RIG

• Radiologically inserted from the outside.
• Sometimes this is the best option if there are organs between the stomach and the skin.
• Common in some countries in Europe
• Must be replaced every 3 months.
• Inserted by a radiologist instead of a gastroenterologist.

Mic-key option

• Is a button that is less likely to interfere with clothing and sports.
• Some people prefer the tube and others prefer the mic-key
• Can be placed six weeks after a PEG or RIG

7) What do I eat following the feeding tube?

• The best option is blended foods you are used to eating already so there is no stress on your gut nor your immune system.
• You will want to add digestive enzymes to your meal, since the chewing process releases enzymes and that element is no longer
• The prepared feeding tube formula foods are mostly inadequate.
  • Blended food is the best option.
  • HLTH Code Vanilla, Liquid Hope peptide or Keto formula.
  • Kate Farms has too much sugar but is better than most.
  • Please avoid Ensure, Jevity and other sugar-filled feeding tube formulas. These are NOT good for balancing blood sugar and insulin, not good for healing the gut, and not good for healing the liver and not good for healing nerves and motor neurons.
• The Vitamix is a good quality blender at a reasonable price that will last many years.
  • Another option is BlendTech.
  • Usually the NutraBullet is NOT strong enough to blend meat and other foods and breaks down over time.
• See Clean Diet Step for more information on proteins, fats and supplements that you want to be eating.

8) Watch the following video on the basics of Feeding Tubes

Dr. Smita & Dr. Bhandari Feeding Tubes

Click Here To View The Recording Of Step 45 2024

Click Here To View The Recording Of Step 45 2023

With a better understanding of feeding tubes as an amyotrophic lateral sclerosis ALS treatment method, we hope that you will be able to reverse ALS symptoms from the neurodegenerative condition and enjoy a longer ALS disease life expectancy.

Check for Understanding and Completion of Step 45:

If you have checked all boxes, Congratulations! You have completed Step 45.

References:

ASGE Standards of Practice Committee, Kohli, D. R., Abidi, W. M., Cosgrove, N.,
Machicado, J. D., Desai, M., Forbes, N., Marya, N. B., Thiruvengadam, N. R.,
Thosani, N. C., Alipour, O., Ngamruengphong, S., Elhanafi, S. E., Sheth, S. G.,
Ruan, W., Fang, J. C., McClave, S. A., Zvavanjanja, R. C., Kamel, A. Y., &
Qumseya, B. J. (2025). American Society for Gastrointestinal Endoscopy
guideline on gastrostomy feeding tubes: summary and
recommendations. Gastrointestinal endoscopy, 101(1), 25–35.
https://doi.org/10.1016/j.gie.2024.08.044

Jamieson NC, Tadi P. Feeding Tube. [Updated 2023 Jul 24]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK559044/

Katzberg, H. D., & Benatar, M. (2011). Enteral tube feeding for amyotrophic
lateral sclerosis/motor neuron disease. The Cochrane database of systematic
reviews, 2011(1), CD004030. https://doi.org/10.1002/14651858.CD004030.pub3

Laasch, H. U., Wilbraham, L., Bullen, K., Marriott, A., Lawrance, J. A., Johnson,
R. J., Lee, S. H., England, R. E., Gamble, G. E., & Martin, D. F. (2003).
Gastrostomy insertion: comparing the options–PEG, RIG or PIG?. Clinical
radiology, 58(5), 398–405. https://doi.org/10.1016/s0009-9260(03)00058-8

Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors.
Nursing Skills [Internet]. Eau Claire (WI): Chippewa Valley Technical College;

Chapter 17 Enteral Tube Management. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK593216/

Sulistyo, A., Abrahao, A., Freitas, M. E., Ritsma, B., & Zinman, L. (2023). Enteral
tube feeding for amyotrophic lateral sclerosis/motor neuron disease. The
Cochrane database of systematic reviews, 8(8), CD004030.
https://doi.org/10.1002/14651858.CD004030.pub4© Copyright Healing Advocates

ProGas Study Group (2015). Gastrostomy in patients with amyotrophic lateral
sclerosis (ProGas): a prospective cohort study. The Lancet. Neurology, 14(7),
702–709. https://doi.org/10.1016/S1474-4422(15)00104-0

Rio, A., Ellis, C., Shaw, C., Willey, E., Ampong, M. A., Wijesekera, L., Rittman, T.,
Nigel Leigh, P., Sidhu, P. S., & Al-Chalabi, A. (2010). Nutritional factors
associated with survival following enteral tube feeding in patients with motor
neurone disease. Journal of human nutrition and dietetics : the official journal of
the British Dietetic Association, 23(4), 408–415. https://doi.org/10.1111/j.1365-
277X.2010.01057.x

The information we share is for educational purposes and should not be treated as medical advice.

© Copyright Healing Advocates Registry and Ministry