Real Food Blends

 

Let me begin this review by stating that I am strongly in favor of using real food for feeding tube meals.

I don’t know about you, but when I learned that there are specially crafted ‘medical liquids’ offered by pharmaceutical companies, and available only by prescription;  this  implied to me there was a superior aspect to these formulas.

I wasn’t sure how they were so special, and once I read the ingredient list for the formula I was prescribed when my tube was first placed, I was shocked and disappointed.

How is it even possible that pharmaceutical companies are able to  create and market products labeled as  ‘medical liquids’, when all they consist of  is mainly  corn maltodextrin, isolated milk or soy protein and canola oil, with some vitamins and minerals tossed in?

Clearly if a person is in need of having a feeding tube, the assumption that they are at risk is already established.  Food is fuel.  It is what keeps us alive. The quality of what we consume has a direct effect on how healthy we are!

I’ve been active in the online adult tube feeding community ever since I received my tube, and I can honestly say that there has not been one single person who said that they felt better, or were healthier when they used formula instead of a homemade blend or a commercial packaged blend, such as the meals offered by Real Food Blends.

I understand that for some, a feeding tube is placed due to difficulties breaking down food within the digestive system, and although  oftentimes  real blended foods can still  be used, as I have zero experience with this, it is not an issue that can be addressed by me here.

Here are the ingredient lists for some commonly prescribed commercial formulas for enteral nutrition: All of these have roughly 355-375 calories and 15-17 grams of protein per serving. The serving size ranges   from  one cup to 250 ml.

Abbott Nutrition’s Osmolite® 1.5 Cal

Water, Corn Maltodextrin, Sodium & Calcium Caseinates, High Oleic Safflower Oil, Canola Oil, Soy Protein Isolate, Medium-Chain Triglycerides, Magnesium Chloride, Potassium Citrate, Calcium Phosphate, Sodium Citrate, Soy Lecithin, Choline Chloride, Ascorbic Acid, Taurine, L-Carnitine, Carrageenan, Zinc Sulfate, dl-Alpha-Tocopheryl Acetate, Ferrous Sulfate, Niacinamide, Calcium Pantothenate, Manganese Sulfate, Cupric Sulfate, Thiamine Chloride Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Palmitate, Beta-Carotene, Folic Acid, Biotin, Chromium Chloride, Sodium Molybdate, Potassium Iodide, Sodium Selenate, Phylloquinone, Cyanocobalamin, and Vitamin D3.

Abbott Nutrition’s Jevity® 1.5 Cal

Water, Corn Maltodextrin, Corn Syrup Solids, Sodium & Calcium Caseinates, Canola Oil, Corn Oil, Soy Protein Isolate, Fructooligosaccharides, Medium-Chain Triglycerides, Oat Fiber, Soy Fiber, Potassium Citrate, Calcium Phosphate, Gum Arabic, Sodium Citrate, Magnesium Phosphate, Soy Lecithin, Magnesium Chloride, Carboxymethylcellulose, Ascorbic Acid, Choline Chloride, Potassium Chloride, Taurine, L-Carnitine, Zinc Sulfate, dl-Alpha-Tocopheryl Acetate, Ferrous Sulfate, Niacinamide, Calcium Pantothenate, Manganese Sulfate, Cupric Sulfate, Thiamine Chloride Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Palmitate, Folic Acid, Biotin, Chromium Chloride, Sodium Molybdate, Potassium Iodide, Sodium Selenate, Phylloquinone, Cyanocobalamin, and Vitamin D3.

Nestle’s NUTREN® 1.5

WATER, CORN SYRUP, MALTODEXTRIN, CANOLA OIL, SOY PROTEIN ISOLATE, SODIUM CASEINATE (MILK), AND LESS THAN 2% OF MEDIUM CHAIN TRIGLYCERIDES, CALCIUM CASEINATE, POTASSIUM CITRATE, CALCIUM PHOSPHATE, MAGNESIUM PHOSPHATE, SALT, SOY LECITHIN, CALCIUM CITRATE, POTASSIUM CHLORIDE, CHOLINE CHLORIDE, SODIUM ASCORBATE, CARRAGEENAN, TAURINE, L-CARNITINE, MAGNESIUM OXIDE, ZINC SULFATE, FERROUS SULFATE, DL-ALPHA TOCOPHERYIL ACETATE, NIACINAMIDE, CALCIUM PANTOTHENATE, DEXTROSE, MANGANESE SULFATE, PYRIDOXINE HYDROCHLORIDE, THIAMINE HYDROCHLORIDE, COPPER SULFATE, RIBOFLAVIN, BETA-CAROTENE, VITAMIN A PALMITATE, FOLIC ACID, CHROMIUM CHLORIDE, POTASSIUM IODIDE, SODIUM MOLYBDATE, SODIUM SELENATE, VITAMIN K1, BIOTIN, VITAMIN D3, VITAMIN B12

Need I go on?  Probably not … although I could…

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Real Food Blends currently offers four meal choices.  They have 330-340  calories, and  offer 11-14 g of protein per 237 ml meal.  Each meal has only 5-7 simple ingredients.

Three of four meal options

Three of four meal options

  • Orange Chicken, Carrots & Brown Rice

Ingredients: Orange Juice, Cooked Chicken, Carrots, Brown Rice, Grapeseed Oil, Water, Ginger, Roasted Sunflower Seeds. Contains 1 serving fruits & vegetables * Excellent source of protein * Good source of Vitamin A

  • Quinoa, Kale & Hemp

Ingredients: Grape juice, water, kale, hemp powder, extra virgin olive oil, quinoa & cinnamon. Vegetarian *  Contains 1 serving fruits & vegetables * Excellent source of protein * Good source of iron and calcium

  • Salmon, Oats & Squash

Ingredients: pomegranate juice,  water, squash puree, salmon, rolled oats, flaxseed oil. (Oats are certified gluten-free.) Contains 1 serving fruits & vegetables *  Excellent source of protein * Good source of iron * Salmon is a source of Omega-3 fatty acids

  • Beef, Potatoes & Peas

Ingredients: Pineapple Juice, Ground Beef, Potatoes, Peas, Grapeseed Oil. Each meal contains 1 serving fruits & vegetables * Excellent source of protein * Good Source of Iron

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Now, on to the review:

For the record, I have not consulted with Real Food Blends as to what this review should say, nor was I asked by them to review their products.

Real Food Blend meals are not organic.  Although I personally  practice using organic foods and ingredients whenever possible at home, I understand their stated reasons for not going the organic route with their meals, and am fine with it.

The Salmon meal is wild caught salmon, and this is important to me.

Salmon meal, Jofas clamp holding the 140 ml syringe (photo taken before I switched to gravity feed bottles)

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The packaging is adequate.  I honestly don’t have  better idea as far as how it could be improved (it’s not like I wish it were packaged in a different manner).

Any food that comes in pouch form has its inherent advantages and disadvantages.

I remember when RFB was still in the development phase, during the crowdsourcing campaign they showed a pouch with a portal that syringe tip could be placed in, to draw out contents.

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This was not implemented in the final design.  How it is actually packaged is a basic foil pouch, pleated bottom, tear strip at top.

I do not believe that the prototype pouch with the portal for syringe would have any measurable value to me, and would have been a detriment,  had it raised the price for the blended meals.

The pouches are very travel friendly.  I prefer a pouch over a hard sided carton or can.

The RFB website shows mealtime with the pouch open at the top, and syringe inserted drawing out the meal, one syringe at a time.

This method has its drawbacks.

The blends are thick, and they cling to the end of the syringe tip, and to anywhere the else on the syringe if it touches the inside walls of  the pouch.   It gets progressively more messy to draw up out of the open pouch.   And, the bottom has a pleat  that collects the blend in between the folds.

The pull strip at the top, almost invariably does not tear off completely, but that is common for me when I tear open pouches in general. In this review I show pouches with top torn.  But, what I normally do is snip the corner off with scissors, and squeeze the blend out.

Open meal package

Open meal package

Pouch is as deep as as standard syringe is tall

Pouch is as deep as as standard syringe is tall

When I found that  inserting the syringe down into an open food pouch was not working all that well for me, I began transferring the contents  into another container before beginning my meal.

If  I am going to be drawing the blend up into a syringe for a pushed meal, it helps to use a glass that has a concave dip  at its  bottom.  It makes it easier to suck that  last little bit up, as opposed to a glass or cup that has a flat bottom.

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I pour as much of the blend as will easily come out into a glass, or other container.  Then I heat some water in the kettle, and pour a bit into the pouch to get what’s left in the pouch out of the pouch.

I slosh the hot water around a bit to get the blend diluted, and pour that in with the rest of the blend.

After I’ve got as much blend out of the pouch as I can, I stir well with a small whisk.  (these RSVP endurance whisks are very durable, and have a bit longer handle than many do.  Love them! here’s the link on Amazon:http://amzn.to/2d6NAVW

To thin enough to gravity feed, more (preferably hot, or at least very warm) thin liquid must be added. If you wish  to add more calories, you can use a protein drink, whole milk, fruit juice, doesn’t matter.   The amount needed  seems to vary according to which meal it is.  The quinoa and beef blends tend to be thickest.  The chicken somewhere in the middle, and the salmon is the thinnest of the bunch.  I don’t know if this holds true always, but, with the meals I have used, this has been the case.

I’ve added  a video I made, which demonstrates preparing  Real Food Blends chicken for a gravity fed meal using the FIFO bottle.   The whisk I use is the one mentioned above.

The reason for the seemingly inexplicable attention paid to the bottom of the bottle after I fill it, is because this video was created to demonstrate the FIFO bottle which has a vented cap.  (the camera zooms in on this cap) You can do a search for this post to read more about the FIFO bottle, the publication date was January 13, 2017.  In real life, I would have taken more care to rinse out the pouch with some of the hot water so the full value of the meal would be consumed,  But when making the video, that was just one step too many, it was a challenge not blocking the camera as it was.  There is also another video in this January 2017 post showing a less diluted gravity fed Real Food Blends chicken meal.

For the salmon meal, I can add a little less than five ounces of liquid to thin with, and I can get  a nice, leisurely flow to gravity feed.  The chicken tends to require  six to seven ounces to make it thin enough, and the beef requires  a minimum of eight ounces.    (Your experience may be different, but this is at least a starting point.) It has been  a long time since I used the quinoa meal, and back then I was not gravity feeding.  All of these measurements are calculated using a heated liquid, which makes a difference.

My goal when I gravity feed is for a slow gradual trickle.  “Slow”  as in I have to check periodically to see if the level in the container  is moving down.  If you like  a faster delivery, then, of course more liquid is needed.  If you want to push your meals with a plunger, then less  thinning is necessary. You will find what works best for you.

Do I have a favorite meal variety?  It is hard to say.

I enjoy how the Orange Chicken, Carrots & Brown Rice blend smells, and the “aura” once inside me is nice too, due to the ginger.

The Salmon, Oats & Squash I like,  especially  because it is so good nutritionally.

The Beef, Potatoes & Peas  is new, and I have  only had it a couple of times.  It smells better than the salmon, not as enticing as the chicken. It is less vividly colored than the chicken.

The  Quinoa, Kale & Hemp I care for the least.  The color is blah (hemp will do that).  When I burp it, not so great.  The ingredients are great though! And, if I were a vegetarian, this would be a wonderful choice for me.

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The Real Food Blends website is not as user friendly as it could be.  Once one clicks on the “Shop” tab, there is no way to get back to the home page, you can’t get out by clicking on the logo, nor is there a “Home” button.  To get out of the shopping section, the back arrow of browser has to be used.

There is no direct link to FAQs (or any other topic) once in the shopping section. The FAQ section is located in a sub menu under the  “Our Meals” tab, rather than visible on the main page of the website.

Any time I’ve called them for help with changing an order or other reason, the customer service has been excellent.

 

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For those of you who live outside of the US, Real Food Blends has partnered with MyUS.com to offer convenient, fast international shipping to more than 225 countries. MyUS.com members receive deeply discounted shipping rates, exceptional customer service, 24/7 online access to their account, and access to other services.

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For U.S. Citizens

Many private and public insurance plans  cover Real Food Blends meals. (The HCPCS code is B4149.)

I have original Medicare for my insurance.  I have no other supplemental or “Medigap” insurance.  To not lose weight I need at least 1,800 kcal per day, which would work out to over 5 meal pouches a day.   I don’t  want to solely use Real Food Blends for every meal.  I enjoy having the flexibility to have other meal choices, and,  having any of the RFB meals for breakfast does not appeal to me at all.

If Medicare would cover supplemental feeding, I would be more inclined to move forward with obtaining coverage for it. But, with the Medicare requirements as they are at this time (no coverage for supplemental meals) I am not going to pursue it.

But, if you are interested in seeing if your insurance will cover the Real Food Blends, below is  information you will need specific to Medicare part B.

If you have original Medicare part B, this is the information your doctor will need to provide to them:

  •  Progress Notes/Office Visit notes (justification for Billing code    B4149)
  • A Prescription for  Real Food Blends: Prescriptions are required on a prescription pad for Medicare patients.
  • The doctor must specify the number of calories per day, your date of birth, and the ICD-10 CODE
  • Patient Face Sheet, with Height and Weight
  •  Diagnosis List with ICD-10 codes

Unfortunately, Medicare does not accept  a Letter of Medical Necessity in lieu of the above.

You will also need a Durable Medical Equipment company in your coverage area to deliver the Real Food Blends to you, once you obtain coverage.  If you live in a state that  requires DMEs  to participate in competitive bidding, not only will you need to find a DME that contracts with Real Food Blends, but that DME also needs to have won the bid for your area.

Importantly, Medicare WILL NOT REIMBURSE YOU if you purchase on your own, and submit the bill to them. Even if you have a prescription for it–not going to happen. Your Real Food Blends MUST come through a durable medical equipment company approved to service the area you live.

Yes,  that was a daunting list to wade through.   Private insurance companies might have less stringent requirements.

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I’ve purchased via Amazon, which is an authorized distributor for RFB, as well as from them directly.

Real Food Blends does offer a subscription plan for discounted recurrent deliveries, but the added shipping still brings the cost up.   At the time of me writing this, their site states that a one time purchase of a box of 12 meals costs $4.16 per meal.  And, with a subscription plan, that cost drops to $3.75 a meal.  However, this does not take into account the shipping.

Whether or not their shipping rates will change in the future cannot be known  They currently have  a sliding shipping scale.

A case contains 12 meals.

Sample pack (under $29) = $4.95

One case = $8.95

Two cases = $15.00

Three cases = $21

Four (or more) cases = a flat $25.

For a while I had a subscription plan with Real Food Blends, and, (for example) an order of four cases ended up costing me not $3.75, but $4.27 per meal.  This total cost included the flat $25.00 shipping fee averaged in.

I’m an Amazon “Prime” member,  and get free shipping.  Purchasing from Amazon costs me slightly more.   Free shipping (a relative term, I know) with two day delivery makes the added expense more acceptable because I’m not  locked into a set amount each month.

Because I make my own blends with my Blendtec blender,  I don’t  rely on RFB for most of my meals.   I do like having at least a couple of cases in the pantry for travel, or days when I just want something quick.

The cost is not outrageous for the convenience of having a shelf stable meal that only needs to be thinned to use.

Here is the link to their products on Amazon: http://amzn.to/2ctkXji

Here is the link to the Real Food Blends website:

http://www.realfoodblends.com/

 

The bottom line:

These meals are convenient, but, they’re not actually “ready to serve”  at least not for me.  They are quite dense and thick.  Even when I used the plunger method with a syringe, the thickness was too much, and I thinned them down some.

They are actually more difficult to dilute down to an appropriate consistency than commercial baby food is,  (it takes more vigorous stirring) and the cost of using them compared to baby food is around the same.  But, the advantage over baby food is that only one package needs to be opened, compared to needing several containers of the baby foods of one’s choice, to get enough calories and other nutrition.

I can see using them for most nutrition IF insurance picked up the majority of the cost.  But,  I would not really want to use them for breakfast.

I find them best suited for when I am traveling, or when there is nothing in the kitchen ready to blend up.

For travel , it is still not as simple as opening a pouch, though;  due to how thick of a puree the meals are. So, when I’m on the road, I still need to bring along a thermos of hot water, or have access to some hot water to mix in before I can use them.

The cost of a new high speed blender (Vitamix, Blendtec) would be paid for quickly if one took what they were spending on packaged meals such as Real Food Blends, or commercial baby food, and put it towards the purchase of a blender.

I purchased a new Blendtec via Amazon in December of 2012 for just under 400 US dollars. Even if RFB offered free shipping,  the monthly cost of five meals per day would work out to a little more than $560. With the $25 flat shipping rate the monthly total would be $585.

Once a blender is paid for , there is only the cost of groceries, and the nominal cost of electricity and  dish soap!

Learning to make blended meals for the tube is not difficult.  Although there is a learning curve, I feel it  is the better choice.

If my circumstances changed to where I no longer had the physical ability to blend my meals,  they most definitely would be my  choice instead of resorting to commercial formula.