Hyping hydrolysates: All about hypoallergenic formulas

I want to admit my bias towards hydolysates up front:  I think they are magical. My son has been on hypoallergenic formula since he was about 3 months old, and the difference between FC on breastmilk/regular formula/soy formula and the hypoallergenic formula we ultimately switched him to was astounding. It was like the kid had received a spontaneous lobotomy. He was miserable for the first 10 weeks of his life, with terrible skin rashes, gas, stomach issues, and a personality that can best be described as the Grinch meets Chairman Mao; within 24 hours of switching him to hypoallergenic formula, he could have starred as the “after”  in a Harvey Karp instructional video. FC was truly the happiest baby on the block, thanks to Alimentum.

Still, I was concerned about the long-term safety of such a space-age, highly processed formula. The stuff smelled like regurgitated potatoes. (Although for some reason, FC loved it; up until a month ago, we still used a scoop of the stuff to flavor his hemp milk because he so adores the taste. But then again, he likes kiwi as well, and hates chocolate. I’m blaming FH’s taste genes.) And the whole “pre-digested” thing kind of skeeved me out. So, I did a little research, and the following is what I’ve found. Needless to say, I am by no means a doctor or have any background in science; this is just what I’ve gleaned from a layman’s perspective (with the slight advantage of a journalism background that focused on health issues), so take it all with a grain of salt. Or a grain of pre-digested protein. Your choice.

First, a definition: What are hydrolysates?

Basically, in kids who are allergic or sensitive to milk protein, the lower the molecular weight of a protein, the better. Casein hydrolysates like Similac Alimentum or Enfamil Nutramigen contain tiny, broken-down versions of milk protein, making it easier for milk-sensitive babies to digest. There’s another level of hypoallergenic-ness (yes, I made up that word, sue me) which you find in amino-acid based formula (Neocate); for some babies, even the infinitesimal amount of milk product in the hydrolysates is problematic. Since Neocate is only available by prescription, and the majority of kids with food sensitivities have success with the over-the-counter hydrolysates, we’re going to focus on these.

What are the nutritional differences?

Comparing nutritional labels, there doesn’t seem to be much difference between your average milk-based formula and a casein hydrolysate one. But a 2003 study in the American Journal of Clinical Nutrition did find that “the iron status of infants fed (casein hydrolysate formula) was lower than that of all other groups. The amounts of amino acids provided by hydrolysate formulas appear excessive compared with regular formula, which is reflected by high serum urea nitrogen… and high plasma amino acid concentrations.” The study authors suggest, in their conclusion, that a “reduced and more balanced amino acid content of hydrolysate formulas may be beneficial.” I’m not sure if the formula companies have changed the recipe since 2003, but I will look into it and get back to you.

The International Society of Infant Food Manufacturers has a good run down of the nutritional issues surrounding hydrolysates, but I’m well aware that there’s a bias against the formula organizations, so do with this what you will. They claim that “on the whole, available data suggest that there is no evidence that feeding (hydrolysate formula) impairs the growth and biochemical parameters of term infants. There is also no evidence of differences between infants fed (hydrolysates) and an adapted cow’s milk formula and/or human milk on growth parameters and biochemical parameters, except on indices of protein metabolism.”

What’s the deal on allergies?

A 2008 clinical report from the AAP suggested that hydrolysates may actually have a preventative effect against allergies:

The documented benefits of nutritional intervention that may prevent or delay the onset of atopic disease are largely limited to infants at high risk of developing allergy (ie, infants with at least 1 first-degree relative [parent or sibling] with allergic disease). Current evidence does not support a major role for maternal dietary restrictions during pregnancy or lactation. There is evidence that breastfeeding for at least 4 months, compared with feeding formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood. In studies of infants at high risk of atopy and who are not exclusively breastfed for 4 to 6 months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas compared with formula made with intact cow milk protein, particularly for atopic dermatitis.

It’s not clear in this synopsis, but reading through the entire study, it seems that both breastfeeding and use of hydrolysate formulas confer equal benefits in this particular case. Obviously, if you have a history of allergies and are able to breastfeed, it’s a no-brainer – why feed your kid expensive and atrociously smelly formula? But for those of us whose kids are unable to tolerate breastmilk due to severe allergies, or who cannot breastfeed for any other reason, but have a family history of allergies, the hydrolysates might be worth the cash.

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.

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7 thoughts on “Hyping hydrolysates: All about hypoallergenic formulas

  1. We tried a hypoallergenic formula when Lily was about two months old. We tried the Enfamil Nutramigen, and she took one sip, and refused to even try the rest! Thankfully, Target allowed us to return the opened canister. We didn't have any allergy issues, just really severe GERD, and someone recommended the hypoallergenic formula for severe GERD babies. I'll never know if it would have helped her or not, since she refused to drink it, but I am curious as to why it would be recommended for a baby with GERD, who has no allergy issues? If anyone knows anything about this, I'd love to know!

  2. @Fifi-

    Funny you should ask. One of the things that kept coming up in my research for this post was that hydrolysates are over-diagnosed. They are often prescribed for colic, and I would assume that some pedis see them as a “cure-all” which would make them recommend them for GERD. But actually, I would think a hydrolysate would be a bad thing for a GERD baby, b/c they tend to be thinner in consistency, and from what I recall from when they thought Leo had GERD (he didn't), we were told to thicken his feeds to help with that…

    I'm a bit torn on the over-diagnosing thing. On one hand, I believe colic is often just misdiagnosed food intolerance/other digestive issues, and these special formulas can help; on the other hand, there are a lot of reasons babies cry, and digestive issues aren't all of them, you know? These formulas can be very cost-prohibitive and I know of one acquaintance who switched formula 5 times in a week b/c she was looking for a “fix” for her daughter's perceived issues… obviously that just made it worse.

    I guess what I'm saying is – yep, you're right, if there is no allergy issue, I don't see a need for hypoallergenic formula – with the caveat that IF no other formula helps and you want to give one of these special ones a 48 hour try, just to see… then by all means go for it. These kids don't come with instruction manuals and sometimes it takes some trial and error!

    In your case though – I think your pedi was probably thinking Nutramigen was tolerated well in babies w/digestive issues, and it was probably her go-to. In your case, it wasn't the best choice.

  3. My son was on Pregestimil, another casein hydrolysate formula (but with MCT oil) for his liver disease. His doctors put him on it while he was hospitalized for his initial liver surgery. When we first smelled it, we figured there was no way he would ever drink something that smelled like a potato that had been growing in a 5th grade boy's gym socks.

    He.loved.it. Like couldn't get enough of it. We feel really lucky that he's done exceptionally well, given his diagnosis. While his great medical care has been the primary reason for this, his formula enabled him to overcome the nutritional challenges of liver disease. It met his nutritional needs in a way that nothing else could.

  4. In terms of the GERD thing… it is my understanding that many are starting to believe that colic is often caused by a milk protein allergy. Not all the time, but sometimes. So I think that is why GERD gets linked to recommending hydrolysate formula. But that is just off the top of my head from what I remember when we went through the whole “soy or hydrolysate” decision. (A had GERD and was allergic to milk).

  5. DOn't have experience with any of the hypoallergenic formulas, but also has a kid that doesn't like chocolate and loves kiwis!!

  6. This is sort of a tangent, but first off, hypoallergenic formula saved my daughter's life. Probably mine, too! (I don't believe she was allergic to cow's milk protein like they said because I gave up dairy and soy completely for two months and it made no difference. She was simply allergic to my milk–it does happen!) But Elecare was only covered by insurance when it was fed through an NG tube. Once we/ I (worked my ass off and) got her over her feeding aversion, even though she still required Elecare for survival, but because she no longer needed the feeding tube that went through her nose and down into her tummy, it was no longer covered. So we paid around $1000 a month for Elecare. What if a low income baby needs hypoallergenic formula but the family can't afford it? I'm confused because it does sound like it's over-prescribed (though from what I learned GERD can be exacerbated by underlying intolerances), yet it still isn't recognized as the lifesaver it is for some.

  7. I’m curious to hear if any moms who’s babies were having issues with their breast milk saw improvement with this formula. I’m heartbroken that I may not be able to breastfeed, but want the little one to stop being in so much pain over digestive problems!

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