There are over 100 commonly used brand names of commercially prepared formula available, so there is no shortage of options to choose from when you and your doctor, or nutritionist, decide which formula is right for you. An easy way to distinguish all the different types of commercial liquid nutrition is by their fat, carbohydrate, and protein (or macronutrient) sources. Using this method, there are three different categories of formulas: standard, elemental, and specialized.

Standard formulas are the most commonly used by G-tube patients. They contain proteins that haven’t been broken down (intact proteins) and polysaccharides. The proteins are normally extracted from cow’s milk, soybeans, or protein isolates derived from other food sources. The carbohydrate component is typically glucose polymers, such as maltodextrin, modified starches, and all varieties of sugar. The fats for standard formulas are typically heat- or chemically-extracted from plant sources. They could also include fish oils or modified oils such as MCT oils taken from coconut and palm oils.

Standard formulas are intended for patients who are able to absorb and digest nutrients without difficulty. Their goal is to provide the entire spectrum of macro- and micro-nutrients necessary for human nutrition. The differences among standard formula brands and products come from proportions and sources of ingredients.

Here are some examples of typical macronutrient ingredients in standard formulas:

Carbohydrates:

  • Corn syrup solids
  • Maltodextrin
  • Hydrolysed cornstarch
  • Glucose
  • Fructose
  • Sucrose
  • Sugar alcohols

Proteins:

  • Casein
  • Whey protein concentrate
  • Milk protein concentrate
  • Soy protein isolate
  • Lactalbumin
  • Sodium, calcium, potassium, and magnesium caseinates

Fats:

  • Soybean oil
  • Corn oil
  • Canola oil
  • Palm kernel oil
  • Medium chain triglycerides (MCT) oil
  • Safflower oil
  • High-oleic sunflower oil
  • Borage oil
  • Fish oil
  • Monoglycerides
  • Diglycerides
  • Soy lecithin

Each brand of formula also includes micronutrients, vitamins, and minerals deemed to be essential for nutrition.

There are several standard formulas available in pharmacies, grocery stores, or online in the form or flavored oral supplements like Ensure, Boost, or Carnation Instant Breakfast. Also, some stores have generic, store brands of standard formulas at a cheaper price (Walmart has Equate, Target has Market Pantry Nutrition Shakes, etc.). They can be ready-to-go out of the can or in the form of powder, requiring reconstitution with milk or water. Taking 6-7 Ensure Pluses a day can get pricey–especially long-term–but you may be able to get your insurance company to reimburse you if you have a doctor’s prescription. Talk to your doctor about this.

Elemental formulas (also known as monomeric, hydrolysed, or chemically defined formulas) are different from standard formulas because their macronutrients have already been partly or fully broken down for those patients who have compromised digestive systems or nutrient absorption problems. These formulas are not commonly needed by oral cancer patients. J tube patients usually eat elemental formulas, and some G tube patients may be prescribed elemental formulas in certain instances.

While a standard formula typically has whole proteins, like casein, elemental formulas have broken down–or hydrolysed–versions of the casein in the form of amino acids. This allows the body to digest and absorb what it needs from the formula more easily. Just like in standard formulas, the goal of elemental formulas is to give a complete spectrum of macro- and micro-nutrients, however these formulas tend to be lower in fat because fat is harder for people to digest. MCT oil is commonly the fat of choice because it is absorbed, rather than digested.

Elemental formulas are not usually in stores, however they can be found online (abbottnutrition.com, amazon.com, and nestlehealthscience.com are good websites to check). Optimental, Pivot, Tolerex and Vivonex are all examples of elemental formulas. You can purchase them online, and you may be able to get insurance to cover the cost with a doctor’s prescription. You need to speak to your doctor or nutritionist before taking an elemental formula to ensure you’re getting the best nutrition. Here are common ingredients in elemental formulas:

Carbohydrates:

  • Cornstarch
  • Hydrolysed cornstarch
  • Fructose
  • Maltodextrin

Proteins:

  • Soy protein isolate
  • Crystalline L-amino acids
  • Hydrolysed casein
  • Hydrolysed whey protein
  • Hydrolysed lactalbumin

Fats:

  • Fatty acid esters
  • MCT oil
  • Soybean oil
  • Safflower oil
  • Fish oil
  • Sardine oil
  • Structured lipids
  • Soy lecithin

Specialized formulas are prescribed to address specific disease categories or profiles. It is quite possible for a doctor or nutritionist to prescribe a specialized formula to an oral cancer patient if the patient has diabetes or certain allergies. Standard formulas typically contain a lot of sugar. This is so that they can fit a high number of calories in a relatively small volume while staying liquid. This could become an issue for patients with diabetes mellitus or other problems with hyperglycemia. Although formula companies strive to keep their products ‘well-rounded’, in practice many formulas cause a sugar rush (‘glycemic spike’) and consequent comedown. So, specialized diabetic formulas have a higher percentage of fats with lower amounts of carbohydrates. The carbohydrates in diabetic formulas have a lower glycemic index so that the sugars are converted more slowly before they’re released into the bloodstream. These formulas also contain more fiber, to slow the breakdown of carbohydrates even more. Two prime examples of specialized formulas for diabetic patients are Glucerna and Boost Glucose Control. As stated earlier, these products are available over-the-counter (at pharmacies like Walgreens or you could order online), and you may be able to get your insurance to pay for it, or reimburse you, with a doctor’s prescription.

Another reason specialized formulas could be prescribed to oral cancer patients is because of allergies. Unfortunately, some of the most common food allergens (such as soy, milk, wheat, and corn) are major ingredients in a a large percentage of commercial formula. To meet the need for allergen-free products, there are lactose-free formulas for those with lactose intolerance (Ensure,