With the emergence of the Compleat® Organic Blends enteral formulas by Nestlé Health Science, it is important to help consumers and clinicians understand how the formulas differ from the Liquid Hope® enteral formula. While both formulas contain organically grown whole foods and provide sole source nutrition for those requiring long-term enteral support, there are distinct differences that could influence a patient’s response.
The leading ingredients found in each formula are very telling of the most influential nutritional qualities. With the Liquid Hope® formula, the leading ingredient is chickpeas. Chickpeas provide the formula with a major percentage of its slow-release carbohydrate, plant-based protein, and fermentable fiber. The carbohydrate is almost entirely glucose-based, with very little fructose. Compleat® is sold in two organic formulas, Chicken-Garden Blend and Plant-Based Blend. With the Chicken-Garden Blend, mango puree is the leading ingredient. The Plant-Based Blend uses sweet potato as the leading ingredient, but pear puree is third, after water. This provides the bulk of the sugar content for each Compleat® formula. Both Compleat® formulas have 17 grams of sugar per 10oz.
Even more important than comparing the sugar content (17 grams in the Compleat® formula to 7.5 grams in an equivalent weight of Liquid Hope® formula) is comparing their fructose levels. Fructose is a very unique sugar that challenges the liver and increases oxidative stress. It is well established that higher levels of dietary fructose have been implicated in the promotion of a variety of chronic diseases. Although there is no added sugar in the new Nestlé Compleat® formulas (definitely a step in the right direction), the use of fruit purees results in significant fructose content. In the case of mango puree, at least half of the sugar will be in the form of fructose. Interestingly enough, Nestlé may have been aware that higher levels of fructose are an undesirable nutritional quality. Nestlé’s prior reformulation of the Compleat® formula used brown rice syrup as a sweetener. Brown rice syrup is an added sugar used as a sweetener by food companies that are avoiding fructose.
One thing worse than consuming significant amounts of fructose in a meal is consuming fructose in the presence of higher levels of omega 6 fatty acids in the same meal (2,3). Omega 6 fatty acids, also known as linoleic or arachidonic acids, are essential fats but the amount we require is very small. More dietary omega 6 fats than are necessary have been shown in studies to promote inflammation and create work for the liver. Although the new Compleat® formulas use olive oil as a source of added fat, each also includes canola oil. The canola oil and olive oil provide a large amount of monounsaturated fat (which is good), but each also contributes a fair amount of omega 6 fatty acids/linoleic acid. This is certainly better than what Nestlé has offered in the past in the way of added seed oils, so again it is only fair to identify progress. However, the Compleat® Chicken-Garden Blend formula lists dark chicken meat as the third ingredient after only the mango puree and water. Chicken is a very rich source of omega 6 fatty acids (containing both types-linoleic and arachidonic acid). In fact, when investigators conduct research in an effort to change subjects’ omega 3 to omega 6 ratio (always associated with a reduction in risk for chronic disease) they advise against eating chicken, especially the dark meat (4).
Lastly, in comparison there is significantly less fermentable fiber in the Compleat® formulas (3g vs 7.5g) versus a similar amount of the Liquid Hope® formula. The vegetable fiber in the Liquid Hope® formula is an important attribute. The fiber in the Liquid Hope® formula is the type associated with better glycemic control and improvements in the microbiome. Animals fed Liquid Hope® formula in a recent trial at The University of Pittsburgh Children’s Hospital showed remarkably higher levels of beneficial bacteria and less inflammation than those animals fed enteral formulas with less fiber and more sugar.
In summary, we are pleased to see that Nestlé has followed our lead and recognizes the value of an organic formula. Now we can only hope that this symbolizes a broader change in philosophy and a commitment to providing healthier products to consumers.
~ John Bagnulo MPH, PhD.
1. Compleat® is a registered trademark of Societe Des Produits Nestlé, S.A. Nutritional Medicinals, LLC, which is the manufacturer of Liquid Hope® formula, is not affiliated with Nestlé and does not endorse Nestle’s Compleat® formulas in any way whatsoever.
2. Shaya GE (2012) Contributions of Increased Dietary Linoleic Acid and Fructose to the Metabolic Syndrome. J Obes Weig los Ther 2:114. doi:10.4172/2165-7904.1000114
3. Mellouk, Z., Hachimi Idrissi, T., Louchami, K., Hupkens, E., Malaisse, W., Ait Yahia, D., & Sener, A. (2011). The metabolic syndrome of fructose-fed rats: Effects of long-chain polyunsaturated ω3 and ω6 fatty acids. I. Intraperitoneal glucose tolerance test. International Journal of Molecular Medicine, 28, 1087-1092. https://doi.org/10.3892/ijmm.2011.781
4. Young AJ et al. Blood fatty acid changes in healthy young Americans in response to a 10-week diet that increased n-3 and reduced n-6 fatty acid consumption: a randomized controlled trial. Br J Nutr. 2017 May;117(9):1257-1269. doi: 10.1017/S0007114517001003. Epub 2017 May 23.
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