HiPP Comfort or HA...what's the difference anyway?

Our 2-year-old daughter couldn't be happier with the fact that she is now a big sister.  What is not apparent in this photo is that she was at risk of developing allergies based on our family medical history and based on what we determined to be an early sensitivity to intact cow milk protein. While we did first try Holle's goat milk formula (which is a fantastic product that has just gotten a whole lot better in 2020 with added DHA and no palm oil), we ultimately found that we needed a hydrolyzed formula.

Lately, we have gotten a number of questions from families that either use or are considering using one of HiPP's "hypoallergenic" formulas with hydrolyzed whey protein: HiPP Comfort and HiPP HA.

HiPP HA stages PRE, 1 and 2 are considered to be "hypoallergenic" formulas. HiPP Comfort, on the other hand, is not specifically a hypoallergenic formulation but rather indicated for gassiness, colic and constipation.  There are, however, a number of important similarities.

What makes a formula “hypoallergenic” is actually the use of broken down or “hydrolyzed” milk protein called “hydrolysate.”  The intact cow milk protein structure is physically larger than the human breastmilk protein structure.  By breaking down the protein through the hydrolization process, the resulting protein is smaller and more uniform in size.  As such, your infant's body is less likely to react negatively to hydrolyzed protein.

Interestingly, HiPP uses the same 100% whey protein hydrolysate (86-87% broken down) for both HA and Comfort (albeit in slightly different quantities), which means Comfort is actually similar to a “hypoallergenic” formula in this sense. The casein portion of the cow milk protein is removed prior to hydrolization in the case of HiPP’s hydrolysate.  Some of the US "hypoallergenic" formulas, like Nutramigen from Enfamil, use protein that is more extensively hydrolyzed (over 90%) relative to the hydrolysate that HiPP uses. The next level up from these "hypoallergenic" formulas would be a pure amino acid formula, which HiPP does not offer.

In contrast to HA, which uses lactose as the primary carbohydrate, Comfort uses a blended carbohydrate base of starch, maltodextrin and lactose. Comfort is, therefore, often also called a “low-lactose” formula and can work particularly well with certain infants that are also sensitive to lactose levels.

We do, in practice, find that some parents seeking a “hypoallergenic" formula find success with Comfort, but this can often be explained by their infants doing better with the lower levels of lactose found in Comfort. When there is a family history of allergies or suspected milk protein sensitivities, we recommend HiPP HA. When you are seeking a formulation to deal with gassiness, constipation and lactose-related colic, we recommend Comfort.

Bottles & Burps has started to move away from the expressions "partially" or "fully" hydrolyzed when comparing Comfort versus HA from HiPP, as these are imprecise and often confused and interchanged terms. The reality is that the protein in HiPP Comfort and HiPP HA is 86-87% broken down. Some people would call this "partially" hydrolyzed and others would call this "fully" or "extensively" hydrolyzed.

The last significant area of difference between HiPP Comfort and HA is with respect to the fat blend.  HiPP HA, as with most other HiPP formulas, uses a combination of vegetable oils (palm oil, rapeseed oil, and sunflower oil).  HiPP Comfort, on the other hand, also uses beta-palmitate.  Beta palmitate is more closely related to the fat structures found in breastmilk and studies have shown that it improves (a) fatty acid metabolism, (b) calcium absorption, (c) bone density, (d) gut health, and (e) consistency.

Note: We like beta-palmitate and we look forward to HiPP using this fat structure more across its other formula lines (hint hint).

Sources: 

https://nutritionj.biomedcentral.com/articles/10.1186/s12937-016-0145-1

https://bottlesandburps.com/hipp-comfort

http://bottlesandburps.com/hipp-ha-pre

http://bottlesandburps.com/hipp-ha-1

http://bottlesandburps.com/hipp-ha-2