Food Dye Use in Enteral Feedings: A Review and a Call for a Moratorium

Abstract

Pulmonary aspiration of gastric contents is common in enterally fed patients. Tinting enteral feedings with blue dye is thought to aid the early detection of aspiration in hospitalized patients. The blue-dye method is popular despite evidence that it is not sensitive. Reports of absorption of blue dye from enteral feedings in patients with sepsis and other critical illnesses are increasing. The presence of blue and green skin and urine, and serum discoloration has been linked with death. FD&C Blue No.1 and related dyes have toxic effects on mitochondria, suggesting that dye absorption is harmful. This study reviews the literature on the dye method and dye pharmacology, reports the results of a survey of current dye use, and describes 2 recent deaths associated with blue-dye absorption. We concluded that the use of blue dye in enteral feedings should be abandoned and replaced by evidence-based methods for the prevention of aspiration.

Adsorption treatment and recovery of the hazardous dye, Brilliant Blue FCF, over bottom ash and de-oiled soya

“…The ban was imposed due to its severe toxicity particularly toward children. In humans its toxicity [1][2][3] includes carcinogenicity, reproductive and neurological disorders. Even trace amount of the dye effects living being with severe allergies [4] and unfortunately, so far, there has been no first aid treatment available for such ill effects.…”

Use of hen feathers as potential adsorbent for the removal of a hazardous dye, Brilliant Blue FCF, from wastewater

“…Earlier it was also used as a common food additive to color confectionary and dairy products but because of its toxic effects towards human and animals it was banned. It is carcinogenic [5], causes reproductive and neurological disorders [6,7], severe allergies [8], anaphylactic reactions [9] including rashes, swelling and trouble in breathing in human being. Even behavioural-convulsions [10], gastrointestinal tumors, blood-lymphoma, etc.…”

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with and without Blue-Dyed Food

“…Therefore, the endoscopist can be assured of reliable FEES results using regular, nondyed food trials. Some endoscopists may have considered changing to green food dye following reports of systemic problems with blue dye [1,[7][8][9]. There have been no studies in the literature, however, regarding the safety or sensitivity of using green or any other colored food dyes.…”

“…The rationale for dyeing food blue to identify aspiration appears to be based on tradition, intuition, acceptance, and assumptions rather than on objective analyses of available evidence [1]. Since blue is not a color found in oropharyngeal secretions, blue dye has been used to detect aspiration without feeding trials [2], as well as added to enteral feedings of critically ill patients [3,4] and to oral feedings of patients with suspected dysphagia [5,6], for over 25 years.…”

“…Since blue is not a color found in oropharyngeal secretions, blue dye has been used to detect aspiration without feeding trials [2], as well as added to enteral feedings of critically ill patients [3,4] and to oral feedings of patients with suspected dysphagia [5,6], for over 25 years. New concerns, however, have developed over both the safety [1,[7][8][9] and sensitivity [10][11][12] of blue dye use.…”