Predigested or Hydrolyzed Infant Formulas and Their Uses

Babies with milk and soy allergies, and some babies with the potential for allergies need formula where the protein isn't going to cause them more problems. They need the amino acids that make up the proteins for their nutrition--but sometimes the intact protein can cause allergies or intestinal bleeding. So the formula protein has to be broken down (already digested or hydrolyzed) in order for these babies not to have a reaction. Because food allergies are triggered by the protein fraction of foods, these predigested formulas lessen the potential for allergies and improve formula tolerance for infants who have difficulty with milk and soy proteins.

Partially Digested Formulas

Two of the available formulas have proteins that are partially digested (or hydrolyzed), leaving some of the protein intact, which improves the taste. The Nestle variety is known as Gerber Good Start. It just has whey protein, and approximately 80 percent has been digested by trypsin, a pancreatic enzyme, while the other 20 percent of the protein is left intact. The Mead Johnson partially digested product is Enfamil Gentlease, which has a combination of both casein and whey as its protein source, with the proteins mostly digested by the enzymes from pork pancreas.

The fats, minerals, and vitamins for each of these products are similar to the routine formulas. The sugar for most of the Good Start formulas is lactose, because the company markets this formula as its routine formula with the additional benefit that it can help to prevent atopic dermatitis, a common form of allergy. Enfamil’s Gentlease and Good Start Soother both have reduced lactose, being intended for infants who are colicky and possibly sensitive to lactose, though that is a relatively uncommon situation.

Though the marketing and uses for the two formulas are quite different, one thing is the same for both. They should not be confused with the extensively hydrolyzed formulas and used for already existing food allergies, because that small fraction of intact protein can still cause problems for the infant with cow’s-milk allergy.

Completely (or Extensively) Digested Formulas

Extensively hydrolyzed formulas are more complex (and more expensive) formulas made by Abbott and Mead Johnson to be more easily absorbed. They are also potentially hypoallergenic formulas, which means they have little chance of causing any allergy. Here, the proteins are entirely casein that is digested into small chains of amino acids (six to eight or fewer) by pork pancreatic enzymes.  

But the extensive hydrolysis alters the taste as well. Because these formulas are intended for infants with significant digestive problems, and because those problems can be accompanied by lactose intolerance, the sugar is a corn syrup derivative, which can be absorbed when lactose can’t be digested. The vitamins and minerals again are similar to the routine formulas, with the exception that calcium is increased because of lactose’s absence.

Enfamil Nutramigen has a routine, long-chain fat that most babies can easily digest and absorb, so it is the company’s formula for babies who have allergies (or potential allergies) to both cow’s milk and soy. However, babies with specific problems of poor digestion and malabsorption require Enfamil Pregestamil, with 55 percent as easily absorbed medium-chain fats or Similac Alimentum with 33 percent medium-chain fats, which can be used for either absorption problems or treatment for milk and soy allergies.

Bottom Line

Partially digested formulas are excellent for babies with irritability and Gerber hopes parents will use it as routine formula (it's priced to compete with ths other routine formulas). Partially digested formulas should not be used for milk protein allergy. For a milk protein allergy, soy should be used, but if the baby also has a problem with soy, the extensively hydrolyzed formulas are the best, least expensive option. Certain extensively hydrolyzed formulas can also work for babies who have problems with poor absorption.

Dr. Stan Cohen 19 May 2015

Dr. Stan Cohen is one of our founders and our CEO as well as the Chairman of our Medical Advisory Board. Dr. Stan is an internationally recognized expert in pediatric gastroenterology and nutrition. He is a Read More

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