The use of semi-elemental infant feeds by adults with food intolerance
John Scott explains what they are and how they can be used by adults with total food allergy/intolerance.
A refined taste
Semi-elemental (oligomeric) feeds contain hydrolysed protein (partially pre-digested to form simple peptides), simple sugars, glucose polymers or starch and fat, along with essential vitamins and minerals. This combination provides complete nutrition in a very easily digestible form which is sufficiently modified to prevent the body from recognizing it and reacting adversely to it.
The protein in elemental (monomeric) feeds is even more fully refined, to the point at which only individual amino acids remain, making it virtually impossible for the body to react to the protein that has been used, whether this is from milk, soya or meat.
Both types of feed can be a valuable resource for someone with food allergy or intolerance. They can be used to supplement a restricted diet, to maintain a sound nutritional base while foods suspected of causing a reaction are tested one at a time, or they can become the sole source of nourishment when problems caused by normal foods are overwhelming.
An unlikely success
Unfortunately, some adults who are allergic or intolerant to a large number of foods also have problems with the elemental and semi-elemental feeds that are manufactured for adults, yet many have found that they are able to tolerate those feeds which are intended for use by infants - Neocate (SHS) and Nutramigen (Mead Johnson), for example.
However, even with these feeds, several products may need to be tried before one is found that is suitable, and a feed which has proved to be well tolerated by one person may not necessarily be suitable for another. Each individual has a unique allergy/intolerance profile, so it is impossible to recommend any one particular feed. Only trial and error will reveal the best feed for each patient. (See below for a list of currently available infant feeds.)
Many medical professionals are opposed to adults consuming infant feeds under any circumstances, believing that the balance of nutrients contained in them is not suitable for an adult. Yet the differences between the adult and infant feeds are not large and the latter are arguably closer to the ideal balance of nutrients required by an adult than is the average British diet (only 8% of Britons eat a healthy diet). Moreover, an infant feed is undoubtedly preferable to a very restricted diet of just a few ordinary foods.
The protein requirements of adults who are using a hypoallergenic infant feed are, surprisingly, best met by feeds that are intended for children under six months old, as feeds formulated for children over 6 months now usually contain less protein because older children are expected to obtain protein from other food sources, as part of the weaning process.
'Neocate Infant', for example, contains 13 g protein per 100 g powder, whereas 'Neocate Nutra' contains only 8.2 g. However, the Pepdite feeds, by SHS, are an exception to this rule, with Pepdite+1 containing the same amount of protein as the infant version, Pepdite. The protein content of each feed is given in the list below.
Adults can, if necessary, live largely or even solely on elemental or semi-elemental infant feeds for many years. However, long-term exclusive use of one particular feed may eventually lead to a loss of tolerance to that feed, and, for this reason, it is preferable to alternate between two or more feeds, if possible. Certain batches of the same feed can sometimes also be less easy to tolerate than others, perhaps due to variations in ingredient sources.
Elemental and semi-elemental infant feeds can be ordered through any pharmacy and no prescription is necessary, although they are expensive. Some GPs are willing to provide prescriptions for them, where they are persuaded of a medical need.
If obtaining an elemental or semi-elemental infant feed without a prescription, pharmacists may ask what purpose the buyer has in mind for it, and I am aware of cases where rather intense questioning on the part of a pharmacist has given a customer the impression that they would not be able to buy the feed if it was intended for adult consumption. This, however, is definitely not the case!
The information presented here should provide those wishing to purchase elemental or semi-elemental infant feeds for adult use with sufficient information to allow them to assure any concerned pharmacist that they know what they are doing and, hopefully, to educate the pharmacist about the place that hypoallergenic infant feeds can have in the treatment and management of food allergy and intolerance in adults.
Scoop of the day
Elemental and semi-elemental infant feeds are supplied in powder form, but the scoop provided in each tin of feed is too small for adult use, and a standard eighth-of-a-cup measure is much more appropriate. This is roughly equivalent to a heaped desert spoon, but provides a more accurate means of measurement.
One level 1/8 cup measure or heaped desert spoonful (13 grams) of feed will meet the nutritional needs of an adult for 20-30 minutes, depending on the level of activity, and 5 x 1/8 cup measures (66 grams) will provide approximately 2 hours of nourishment. A sedentary adult of average size, who is using an elemental or semi-elemental feed exclusively, will need slightly more than one 400 gram tin of powder (30 x 1/8 cup measures) per day to maintain normal body-weight.
The water used to mix up the feed should be filtered and, ideally, should not be warmed but used at room temperature or chilled, to prevent the loss of vitamins and improve taste.
With most feeds, three measures of water are needed for each measure of powdered feed, which means mixing almost 2 cups (400 ml) of water with 5 x 1/8 cup measures of powder. A hand-held mixer is ideal for this purpose and will quickly produce a liquid with the consistency of whole milk.
The amount of feed taken at any one time, and the frequency of feeds, are obviously a matter of individual need, capacity and preference, although, initially, it may be best to take only very small amounts and to dilute these even further than recommended above.
It can be argued that the levels of some of the vitamins and minerals in infant feeds are inadequate for adults, and it might be advisable to supplement these. It is perhaps particularly important to add extra trace minerals, from a product such as Ultra Trace by Higher Nature (0800 458 4747). My own experience is that SpectraMin - a transparent, colourless liquid supplement - is the most easily tolerated of the mineral formulations, but this is only available directly from a limited number of alternative health-care practitioners.
Another important omission from many manufactured feeds is fibre and, whilst there are several forms of fibre available from chemists and health food outlets, most are likely to present tolerance problems for anyone who needs to use a hypoallergenic feed. The ideal product in this case may be pure Cellulose Powder from Allergy Research Group, available from Revital. This will normalize bowel function, easing both diarrhoea and constipation. (Pale, greenish stools are to be expected while only taking a semi-elemental infant feed and this is not a cause for concern.)
Enjoyed by all
As far as taste is concerned, elemental and semi-elemental infant feeds are not unpleasant and are easily adapted to, especially if served chilled. They are certainly a lot more palatable than adult versions of the same types of feed, some of which are so unpleasant that people who need to use them may be willing to agree to the fitting of a feeding tube in order to avoid the taste.
Because of their very refined nature, hypoallergenic feeds are always eagerly welcomed by the bugs that inhabit our mouths! To prevent causing an oral population explosion, it is best to drink the feed through a straw placed as far towards the back of the mouth as possible, and always to clean one's teeth immediately after each feed.
Elemental and semi-elemental infant feeds available as of July 2009
Mead Johnson. Careline: 0800 8834 2568
* Nutramigen 1 An extensively hydrolysed, casein-based, semi-elemental infant formula. 14 g protein per 100 g powder. Supplied n 400 g cans.
* Pregestimil A hydrolysed, casein-based, semi-elemental infant formula containing medium chain triglyceride (MCT) oil for easy absorption. 14 g protein per 100 g powder. Supplied in 400 gm cans.
* Nutramigen AA Elemental (amino acid-based) formula. This contains Lipil and 13.9 g protein per 100 g powder. Suppled in 400 g cans.
Nutricia (Cow & Gate and Adaptamil) Resource Centre. 01225 751098
* Pepti. (Cow & Gate) An extensively hydrolysed, whey-based, semi-elemental formula for cow's milk-intolerant patients. The carbohydrate blend contains 40% lactose. Only 11.6 g protein per 100 g powder.
* Pepti-Junior. (Cow & Gate) An extensively hydrolysed, whey-based, lactose-free, semi-elemental formula. May not be hydrolysed quite as extensively as the casein-based feeds, but some find it tastes better than casein-based feeds. Formulated for children over 1, but actually used with all ages from birth to adulthood. 14 g protein per 100 g powder
* Pepdite. An extensively hydrolysed, meat/soya-based, semi-elemental infant formula for infants under one. 13.8 g protein per 100 g powder. Supplied in 400 g cans. Fats per 100 g powder: 23.2 g total; 7.1 g saturated; 10.6 g mono-unsaturated; 4.4 g poly-unsaturated. 5% MCT.
* Pepdite 1+. An extensively hydrolysed, meat/soya-based, semi-elemental formula for children over one. 13.8 g protein per 100 g powder. Supplied in 400 g cans. Fats per 100 g powder: 17.3 g total; 6.7 g saturated; 7.6 g mono-unsaturated; 2.3 g poly-unsaturated. 35% MCT.
* Neocate (Neocate Infant). An elemental (amino acid-based) infant formula. Contains 13 g protein per 100 g powder. (User comments: "Palatable", "Lousy taste")
Abbot Nutrition (including Ross). Nutrition Helpline 0800 252 882
Abbot currently have no hypoallergenic infant feeds available in the UK, although they do market such products in other countries.
First Published in 2007. Updated 2009 and 2013.