Frequently Asked Questions

General Questions?

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Yes! More than 96% of insurances cover our products (Medicare, Medicaid, and many private insurances).

At Functional Formularies we have patient advocates available to help you gain insurance coverage for our products.  Please email us at: insurance@functionalformularies.com or call us at 937.433.HOPE (4673) and we will set up an appointment for you with a patient advocate.

Click here for Insurance information.

We are the first organic enteral formula to be approved by Medicare.

Liquid Hope:

  • HCPCS Code: B4149
  • Insurance Data Bank & Billing Code: 57858-0004-11*

Nourish:

  • HCPCS Code: B4149
  • Insurance Data Bank & Billing Code: 57858-0004-12*

Nourish Peptide :

  • HCPCS Code: B4161
  • Insurance Data Bank & Billing Code: 57858-0004-27*

Liquid Hope Peptide:

  • HCPCS Code: B4153
  • Insurance Data Bank & Billing Code: 57858-0004-28*

Keto Peptide:

  • HCPCS Code: B4153, B4161
  • Insurance Data Bank & Billing Code: 57858-0004-24*

** Medicare, Medicaid and health insurers may ask you to provide a National Drug Code/NDC number for insurance claims, billing or reimbursement purposes. Because our products are whole foods and do not constitute “drugs”, we have an Insurance Data Bank and Billing Code that you should use when asked for an NDC number for our products.

Yes but it may require a letter of medical necessity (LMN). Click here for DME providers by state.

What the medical profession has forgotten, for the most part, is that feeding tube formulas used to be prepared from real food and used to be the standard of care in hospitals and long term care facilities. Functional Formularies products meet all food safety requirements and meet all GRAS, HACCP, and CGMP standards. Functional Formularies products are produced in an FDA/USDA registered facility with a USDA inspector on site. They undergo thorough testing before they are released from the manufacturer. They are both shelf-stable, require no refrigeration, and have a two year shelf life. We believe we have the ideal real foods formulas that are a true meal replacement and can be someone’s sole source of nutrition.

An independent third party microbial assessment shows that there is no microbial growth on a 12 hour hang time at ambient room temperatures. A 2 year shelf life indicates that there is no microbial spoilage and no significant loss in nutritional value in unopened pouches stored at ambient room temperatures.

Under guidelines of our research laboratories, if Functional Formularies products are stored and handled properly at ambient temperatures of 60º to 70º degrees Fahrenheit, the maximum shelf-life is two years.

Is it OK for Functional Formularies products to sit outside in the heat for short periods of time?
Yes. Exposure to higher heats (75–100º+) for short periods of time will not negatively affect the nutritional values. The only time the nutritional values will begin to be affected is if the products are stored at high heat for extended periods of time (6–12+  months). If exposed to high heat for an extended period, the nutrient value may be decreased over time.​

My Functional Formularies products were delivered and sat outside in freezing temperatures and is frozen. Is it OK to use?
Yes. Freezing can be a very good way to preserve the nutritional value, texture, and flavor of many foods. As long as the food was grown in a high-quality way (for example, organically grown) the overall nutrient retention in a frozen food will remain high. In other words, the vitamins and minerals will keep well when food is frozen.

If you do find that your product has been frozen just store at ambient room temperature and it will thaw naturally. If you need a pouch right away, please thaw the unopened pouch gently. If you find that your product has been frozen, the product may separate a bit. The product is still perfectly good to use, just shake thoroughly or reblend in a blender to re-emulsify.

 

Liquid Hope and Nourish undergo regular nutritional assessment and lab testing. However, as with all real food products, the nutrient levels may vary a bit due to growing season, soil, and weather conditions. If you have a specific medical condition that requires you to be exact with certain nutrient levels, please discuss the use of this product with your medical team.

Any additions to Functional Formularies formulas should be cleared by your medical team.

It is our general approach to nutrition that foods should be nutrient dense in order to support health. Therefore, we highly recommend that foods added to our products be both nutrient dense and compatible with a patient’s physiology or ability to metabolize them.

We never recommend adding fruit juice or any refined sugars or sweeteners.  Many patients needing more fat or calories have had success using foods such as avocadoes or almond butter to increase the energy content as well as the percentage of calories from healthy fats.

Coconut butter and/or extra virgin coconut oil may also be excellent choices, but we suggest going slowly with their addition as they can rapidly change the viscosity of the formula and may also cause diarrhea if the amount added challenges the patient’s digestive capacity.

Most vegetables can work well as long as they are blended very thoroughly. Meats and/or poultry have been blended with Liquid Hope, but again, the extent to which they are liquified is critical.

One of the easiest additions to increase a patient’s protein levels, as well as adding beneficial flora, is to mix with a high-quality yogurt.  The yogurt, or kefir, should preferably be from goats, sheep, or grass-fed Guernsey or Jersey cows and should contain live cultures.  For those who tolerate dairy products, this may be both one of the easiest and most nutritionally rewarding additions. Redwood Hill Goat yogurt is a good example and is nationally distributed.

Liquid Hope and Liquid Hope Peptide utilize the anti-inflammatory effect and protein of almond butter. Patients with tree nut allergies should take caution.

Liquid Hope and Liquid Hope Peptide is free of:
• gluten
• soy
• casein/dairy
• corn

Nourish and Nourish Peptide do NOT have any common allergens.

Nourish and Nourish Peptide are free of:
• gluten
• soy
• casein/dairy
• tree nuts
• corn

Functional Formularies formulations do not use any genetically altered ingredients or preservatives. Our formulas have been independently tested for glyphosate and have no detectable glyphosates present. Our products are packaged in a BPA-free pouch and are certified organic by the USDA.

Switch over slowly to allow the body time to adjust to real food (ie; fiber) again. Most patients start by replacing ½ to one serving of their current formula with Functional Formualries products, as tolerated, until a complete switch over is achieved. Most caregivers report transitioning over the course of 7-10 days. That is just a general guideline. Everyone is different, so the patient will need to be monitored.

Use clinical judgement to titrate. For recommendations, please check with your medical team.

The transition to Functional Formularies formulas typically produces favorable changes in an individual’s stool consistency, often referred to by clinicians as a Bristol Stool Score, from soft and diarrhea-like to more solid and/or normal. This was confirmed by a study at Baton Rouge General Hospital.  The primary investigator, Dr Tracee Short, observed that burn patients using Liquid Hope had better and more normal stool scores than those using commercial formulas.  This is largely a function of our products not having any added sugar and having greater compatibility with the patient’s microbiota.

On rare occasions, some patients transitioning to Functional Formularies temporarily experience mild bloating.  This is also a function of the individual’s microbiota receiving fermentable fiber for the first time since receiving enteral support. It is almost always only a temporary symptom, with bloating dissipating after 1-3 days.

For patients with a history of loose, watery stools and the associated issues such as malabsorption, there is usually an increase in those biomarkers associated with iron status.  Improved absorption of micronutrients is a common change in those switching to Functional Formularies.  Improved absorption combined with more effective protein digestion and metabolism is one reason why children with failure to thrive respond favorably to Nourish.

Switching from a non-whole food blend to Liquid Hope and Nourish should be done step wise. Start with replacing half to one pouch of Liquid Hope or Nourish with half or one can/carton of non-whole food blend formula daily. Use clinical judgement to titrate. For recommendations, please check with your medical team.

By law, we are required to list the “ounces” and “grams,” which are measures of weight, not measures of volume, on the food label. Because the formula is made from real food, its density can vary and, as such, so can the volume of the formula in each pouch. Rest assured, each pouch contains 341 grams (Keto Peptide has 227 grams)  as measured on a gram scale.

All nutritional information stated on our website and packaging is correct.  It is calculated and tested per pouch, and the most accurate measure is 341 grams (227 grams for Keto Peptide) which is what our manufacturers use as a gauge of measurement on calibrated scales. Anything pouch below 341 grams (227 grams for Keto Peptide) is rejected.

The conversation of weight is a complex one due to the fact that our product, per food labeling laws, has to show 12 ounces (8 ounces for Keto Peptide) on the label. However, our products are not fluid ounces as most people expect, due to the viscosity. A glass measuring cup or syringe with ounce measurements is designed to measure only fluid ounces.  Our product, due to it not being “fluid” or thin as water, will only show 10 ounces (6 ounces for Keto Peptide).

We have done our best to offer accurate mL measures as a courtesy knowing that RDs are used to working with this measuring system.

Why are there variables in mL from pouch to pouch?

When it comes to measuring solids, weight (grams) is generally considered as more accurate than volume (mL). This is because the weight of a substance on Earth will remain constant even if its surrounding condition changes (e.g. if it gets hotter or colder). On the other hand, the amount of space (volume) occupied by a substance—especially if it is a liquid—can be affected by things like changes in temperature without the substance changing its form.

Yes. Our products have been tested down to 8 French NG tubes.

Liquid Hope has been used for other tubes that are 8 French or larger and Nourish works with tubes that are 6 French or larger.

Yes. Since our products are nutrient dense and high in calories and fiber, caregivers may need to deliver formula at room temperature, or they may need to “thin” the formula. If products are stored below room temperature, have patients bring formulas up to room temperature to allow for easier infusion. If there is a need to add water to the formula, use this rule of thumb as a starting point: add 10ml of water for every 60ml formula. Again, if adding water to the formula, you must re-blend before administering.

Please see our ‘People of Hope’ and our Facebook page for their personal stories!

If you receive ANY units that appear to be bloated, damaged or leaking to any degree, please contact us immediately at 937-433-4673 / Toll FREE: 1.844.631.8365 and/or send an email to office@functionalformularies.com. Do not open, consume, or wash any product that appears to be damaged. Though rare, damage may happen during shipping; under those circumstances, and with sufficient proof of damage, your product will be replaced by either your Durable Medical Equipment Company or Functional Formularies.

Due to the nature of our products, we cannot return any item to stock. After our product leaves our facility we cannot control how it is stored or cared for. We would never ship previously sold products to customers and we feel that you would not want us to do so. We recommend donating your unopened product to someone else who could benefit from it. We can direct you to our partner organizations that distribute our products to their communities.

Our products also can be used orally and make a great protein shake or can be included in many dishes.

Liquid Hope: LHWS124

Nourish: NWS124

Liquid Hope Peptide: LHPWS124

Nourish Peptide: NOUPWS124

Keto Peptide: KEWS124

Keto Sustain: KOCA106

Canadian Liquid Hope: LH224CA

Canadian Nourish: NOU224CA

Someone will be available to take your calls Monday–Friday 9–5pm, EST (excluding major U.S. holidays). Your call is very important to us, so if you receive a recording please leave us a message with your name and number and we will return your call within 24 hours. We can also be reached by email.

937.433.4673
TOLL FREE: 1.844.631.8365

Functional Formularies products can be used with most pumps. We recommend using the formula at room temperature. If the products are cool at all, even by keeping them in an air-conditioned room, the product will thicken. You may consider running the unopened pouch under hot water for a minute or two to thin the products down if needed.

The pump takes longer to prime than with commercial formulas, and it needs to be primed until it begins flowing.

If you are mixing formula with added water, you will need to re-blend it in a blender to make sure that the product is emulsified and does not separate. Some caregivers that we have talked with have noticed that if more than one pouch is prepared and administered at a time, even with adding water and blending it, there may be some settling depending on the length of feeding time. We recommend only one pouch being prepared at a time.

Infinity pumps tend to work better with blenderized formulas compared to Joey pumps.

95% of our customers have no issue with our real foods formula especially when using a 60 cc no-ring syringe bolus (syringe) feed. If using a bolus, it is necessary to use the syringe plunger. If your plunger has a rubber O-ring, these are nearly impossible to push down without a lot of force, a scenario some people mistake for our product not going through. Also, you might be interested in the Jofas Clamp. The Jofas is a 24″ flexible arm that holds a 60cc syringe. One end of the flexible arm has a clip that holds the syringe up to 24″ high. The opposite end has a C-Clamp that attaches to any flat surface up to 2″ thick.

If using a gravity feed bag you may want to look into a large bore gravity bag.

Feeding pump alarms and Errors:
http://www.feedingtubeawareness.org/troubleshooting/equipment/feeding-pump-alarms-and-errors/

Troubleshooting the infinity pump from a fellow tubie mom:
https://agirlandhertube.blogspot.com/2013/03/troubleshooting-moogzevex-enteralite.html

Converting a delivery set for a blended diet:
https://www.youtube.com/watch?v=6aukCU-sFhg

Pump troubleshooting:​
https://www.youtube.com/watch?v=VoiVj2n6Ddw

Yes, and the response has been resoundingly positive. Some examples:
LIQUID HOPE:

“Functional Formularies product is exactly the sort of formula that I have long looked, and hoped for. It offers the kind of positive experience – of both good nutrition and active participation in promoting one’s own health—that all of us need, particularly when we’re at our most vulnerable.”
~ James S. Gordon, MD
Founder and Director of The Center for Mind-Body Medicine and Food as Medicine conference.

“Wow this product is AWESOME!!! As an exercise specialist with over 20 years of professional experience I have never encountered a nutritional product quite like Liquid Hope. Simply put—it’s perfect and I can not wait to introduce Liquid Hope to all my clients.”
~ Brad Thorpe RTSm, MATCS
Creator of the Isometric Training System

“Finally, a formula that delivers the healing power of nutrition from organic, whole foods. This is the “food as medicine” nutrition support product that patients have been hungry for!”
~ Kathie Madonna Swift, MS, RDN, LDN, FAND
Swift Nutrition
Recently named by Today’s Dietitian as one of the top Registered Dietitians in the country who are “making a difference”.

“As consumers become more savvy about true, whole foods nutrition, they balk upon reading the ingredient list of common hospital-based meal replacement formulas. Yours fills the void nicely!”
~ Jeanne M. Wallace, PhD, CNC
Nutritional Solutions
Widely regarded as one of the nation’s most prominent experts in nutritional oncology.

“I cannot overstate what I feel to be the need for such a whole foods based product and I predict that once it is available, many, many physicians and other healthcare providers will jump for joy at the prospect of being able to offer their patients HOPE and a truly healthy option.”
~ Kristine Noonan RN CHHC
Board Certified Health Counselor Honor & Hope Wellness Center

“I have been working with people who have cancer for the last 13 years and been a nurse for over 30 years. I have been searching for a “whole food” based, nutrient dense formula to recommend to my patients my entire career! Liquid Hope is truly an answer to this prayer. There is NOTHING out there that is suitable for human consumption. Those products are filled with chemicals and sugar, which PROMOTE disease. People need “food” to assist the body’s innate quest to heal, strengthen the immune system, and support that process. It truly does give HOPE!”
~ Laurie McCracken, RN, OCN, HHC

“Thank you for thinking outside the box and developing products to help folks who are ill.”
~ Jean Schmidt
United States Congress

NOURISH:

“We are very excited that Nourish is finally on the market. Blenderized foods are a benefit for patients who have intolerances or are allergic to certain ingredients in standard enteral formulas. It is also a quality-of-life issue as some of the patients prefer natural, organic, and real foods. In addition, in our experience, tube-fed children especially experienced better GI tolerance, health, and well-being when using blenderized foods. Nourish, Functional Formularies’ new commercially available blenderized tube feeding formula, will alleviate a risk of inadequate or unbalanced nutritional intake, microbial contamination, and tube clogging when compared to blends made at home.”
~ Yuliya Rekhtman, MD
Associate Professor
Chief Pediatric Gastroenterology and Nutrition
Georgetown University Hospital

“Whole, nutritious, real foods should be a part of everyone’s diet, including and especially for children with feeding tubes. Just because someone has a feeding tube does not mean they need to be succumbed to solely eating formula with added sugar and other unwanted additives day in and day out. You try drinking those conventional formulas for the rest of your life! I am elated that there is finally a ready-to-feed formula out there for children, made from all real foods, is nutritionally complete, and with no added sugar, juice, or unwanted additives. As a dietitian providing blenderized formulas for children, I have seen the benefits of real food in a child’s growth, bowel function, skin and hair health, and overall nutrition status. I cannot wait to recommend Nourish to my patients!”
~ Robyn Felten MS, RD, LDN, CNSC
Medical Advisory Board – Functional Formularies

No. Our products are pre-blended/mixed in a sterile environment, no need for food preparation, handling, or mixing. No more concerns of guessing at nutritional amounts caregivers are providing patients. Additionally, ingredients are certified organic and of the highest quality and nutritional content. Deliver via syringe, gravity drip bag, or pump — the same as you would with any high kcal/high fiber enteral formula.

In our experience and vast amount of research, we believe sugar contributes to many of the disease processes. Because we work with a large number of folks who have compromised immune systems, are at risk for infections, have cancers, etc., we have made a very strong effort to provide the best nutritional support humanly possible. To this end, we consciously avoid the use of sugar and fruits containing high fructose levels in Functional Formularies products.

Fully formed and biologically active vitamin A is known as retinol or retinyl ester.  It is measured in both micrograms and International Units (IUs). The RDA for adults ranges from 700 to 900 micrograms (1mcg =3.33IUs) or approximately 3000 IUs and the tolerable upper level (TUL) of the safe range is 10,000IUs for pregnant women and all adults.  The body converts different carotenoids to vitamin A (retinol/retinyl esters) at varying rates.  This conversion is a function of the type of carotenoid consumed (beta carotene, alpha carotene, lycopene, lutein, etc), the individual’s nutritional status, and the individual’s genetics. There is wide variability based upon the fruit or vegetable source and an individual’s genetic expression for conversion.  In general, it takes approximately 18,000 to 36,000 IUs of mixed carotenoids to generate 3000 IUs of vitamin A in the form of retinol.

Carotenoid consumption has never been shown to generate vitamin A toxicity.  This is a function of a biological feedback loop where less is converted with higher levels of circulating vitamin A.  Additionally, and equally important, carotenoids are converted to vitamin A at low rates and at a much slower speed. Some carotenoids that are not converted may end up being stored in fat cells and can, at very high levels of consumption, generate a slight change in an individual’s skin color.  This increase in stored carotenoids is known as hypercarotenoidosis and is associated with a reduced risk of several forms of cancer.

The amount of carotenoids in Liquid Hope and all Functional Formularies meal replacements are not capable of generating any type of vitamin A toxicity. They are present at moderate levels and are from its sweet potato, carrot, and green vegetable content.

 

Yes. The gut is adaptive to real food and formula can be used for numerous diagnoses. Start slow and titrate, but the gut will likely adapt similar to any standard or specialty formula.

Transition from your current formula to Functional Formularies products in a step wise method. Substitute half to one pouch for half to one can/carton of your current formula as appropriate. Clinicians must use their clinical judgement, but research has indicated that “specialty/elemental” formulations are often tolerated/digested similar to standard formulations.

Functional Formularies formulas contain complete protein as defined by their protein sources offering all essential amino acids required by human metabolism.  Each formula contains a variety of whole food, plant-based ingredients that offer all of the 10 complementary amino acids in adequate quantities.

Although no one ingredient provides a complete protein, the combination of two or more plant foods has long been recognized by all government nutrition and medical organizations, as well as the World Health Organization, as an effective means of supplying all age groups with ample quality protein.

Our formulas utilize Vitamin D3 in the form of cholecalciferol. D3 naturally synthesizes in your skin during exposure to sunlight and it’s also a commercially prepared supplement made from the lanolin retrieved from washing lambs’ wool; therefore, it may not be considered vegan for some individuals based on their practices. Other than the D3, our formulas are vegan.

 

 

Nutritional Questions?

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Liquid Hope and Liquid Hope Peptide utilize the anti-inflammatory effect and protein of almond butter. Patients with tree nut allergies should take caution.

Liquid Hope and Liquid Hope Peptide is free of:
• gluten
• soy
• casein/dairy
• corn

Nourish and Nourish Peptide do NOT have any common allergens.

Nourish and Nourish Peptide are free of:
• gluten
• soy
• casein/dairy
• tree nuts
• corn

Functional Formularies formulations do not use any genetically altered ingredients or preservatives. Our formulas have been independently tested for glyphosate and have no detectable glyphosates present. Our products are packaged in a BPA-free pouch and are certified organic by the USDA.

Consistency and medication adjustment can be made through regular INR testing. Please check with your medical team.

Functional Formularies formulas contain complete protein as defined by their protein sources offering all essential amino acids required by human metabolism.  Each formula contains a variety of whole food, plant-based ingredients that offer all of the 10 complementary amino acids in adequate quantities.

Although no one ingredient provides a complete protein, the combination of two or more plant foods has long been recognized by all government nutrition and medical organizations, as well as the World Health Organization, as an effective means of supplying all age groups with ample quality protein.


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