What is in formula?
Most infant formula comes from cow’s milk (the exception is soy formula), but a lot has to happen before it goes from the cow to the can and, ultimately, babies. The short, blunt version is that the manufacturing process literally takes cow’s milk apart and puts it back together again with some components left out and others added.
Cow’s milk is very high in saturated fat, which human babies have trouble digesting, and low in monounsaturates, the main fats in human milk. So the first step is to remove all the fat. The resulting skim milk is heated, then dehydrated if it’s going to be in powdered form. Then new fats, in the form of vegetable oil blends, are added along with proteins, milk sugar (lactose) and a long list of nutrients, vitamins and minerals that are required by federal regulation to approximate their levels in breastmilk.
Cow’s milk has three times as much protein as breastmilk. Calves need this because they grow so quickly, but for human babies it would put too much of a load on the liver and kidneys. Cow’s milk also has a higher proportion of casein to whey — the two kinds of proteins in mammal milks — than breastmilk does. So formula manufacturers must reduce the overall amount of protein and add extra whey to mimic the protein balance found in breastmilk.
Other ingredients prevent the mixture from separating or going bad. Some formulas have thickeners, and specialized formulas for premature babies have enhanced levels of nutrients. Any newly developed formula must meet a number of safety and nutritional standards, including clinical evidence that it is nutritionally adequate to promote normal growth.
What’s not in formula?
Human milk is a complex substance which, even now, is not fully understood. The list of known breastmilk components not present in formula is too long to go into fully and includes enzymes, hormones, growth factors and substances that fight infection and help develop the immune system.
Simply put, human milk is alive, says James Friel, professor of human nutrition at the University of Manitoba. “Some components are biologically active. They play a role that goes far beyond nutrition,” he explains. “For example, if you put an oxidant stressor — something like cigarette smoke — in breastmilk, it resists the stressor, and breastmilk does this better than formula even though formula contains more antioxidants. That strikes me as odd and I wish I understood it better.” Friel thinks it might one day be possible to add biologically active material to formula, but doesn’t expect to see this any time soon.
One important biologically active component of human milk is a protein called secretory immunoglobulin A (sIgA), which has the ability to bind to foreign substances (including harmful bacteria) so they can be eliminated from the body. It lines the wall of the gut, which is one of the main entry points for infection. Colostrum, the thicker milk that a mother’s body produces in the first few days, is especially high in sIgA.
Formula contains these little fighters as well, although they’re less plentiful and they’re bovine (cow) immunglobulins which are programmed to recognize micro-organisms that cause disease in cattle rather than humans, and operate in the bloodstream rather than the gut. Bottle-fed babies still develop immune systems, obviously, but they miss out on some of the early and long-term protection provided by sIgA.
The most immediate threat from lack of sIgA is during the first weeks of life, when a baby’s gut is vulnerable to infection. Advances in hygiene and sanitation, plus ready access to treatment, have made life-threatening gastrointestinal infections rare in Canadian babies. But they still cause considerable illness and many infant deaths in the developing world, where powdered formula is sometimes mixed with contaminated water.
Another biological capability, present in breastmilk but not formula, is the ability to alter itself. Breastmilk changes, both as the baby grows and during each feeding. Foremilk, which is produced at the start of each feeding, is relatively low in fat. As the baby sucks, the level of fat rises, satisfying him and lulling him into that blissful state a nursing mom loves to see. The fat levels of human milk also change in the baby’s second six months, when his growth rate slows. In recent years new formulas, called follow-up formulas, have been designed to more closely match some of the nutritional needs of an older baby.
How close is formula to breastmilk?
Both are milks that can sustain fledgling human life, but the similarity ends there. Nutrients in a man-made substance do not work the same way as they do in a naturally occurring substance. As dietitian Cristine Bradley, senior manager of medical affairs for Indiana-based formula maker Mead Johnson, puts it: “Compositionally, I’d call it apples to apples but functionally, it’s apples to oranges in many ways.”
A couple of examples: Iron was added to formula in the 1980s. However, the iron in formula is not nearly as well absorbed as that in breastmilk, so formula must contain considerably more for a baby to get the same amount.
Another example is nucleotides, which are the building blocks of DNA and RNA and help strengthen the immune system. After they were added to formula in the ’90s, Bradley says, the expected immunity benefit was not borne out. “There was some excitement about this for a while, but after inconsistent research findings it was generally agreed that this was not as promising as we first thought.”
What are they doing to improve formula?
Although formula is still fundamentally different from human milk, several significant improvements have been made in the past 30 years, including fine-tuning to improve the balance of proteins and the blend of fats. Manufacturers have added new varieties, including lactose-free formulas, special formulas for premature and ill babies, and hydrolyzed formulas with predigested protein, for infants with digestion problems.
The most recent innovation is the addition of two long-chain polyunsaturated fatty acids called DHA (docosahexaenoic acid) and ARA (arachidonic acid). Both play a key role in brain development and it has been theorized, though never proven, that the presence of DHA and ARA in breastmilk may explain why breastfed babies score higher than formula-fed babies on toddler mental development tests.
This past winter Canadian babies got their first taste of formula with DHA and ARA (made from algae and fungus, respectively). The question is, will these additives make formula-fed children smarter, as the “A+” in one product’s name implies?
Sheila Innis, a professor of paediatric nutrition at the University of British Columbia, says the clinical research is mixed. “I would be very cautious about making that statement for a healthy full-term baby. In one small study, 18-month-old babies fed formula with DHA and ARA scored higher as a group than babies fed standard formula, but four other larger studies showed no difference. The evidence is much clearer for premature babies, who are born without stores of these and other nutrients.”
What are the risks associated with formula?
There are risks associated with formula feeding. To help mitigate them, parents need to fully understand them.
Improper mixing: Formula should be mixed exactly according to directions. Some parents have made mistakes, sometimes because of literacy or language problems. Some have over-diluted powdered formula, which can lead to malnutrition, or failed to properly dilute concentrated liquid formula, sometimes in a misguided attempt to increase nutrients. The result can be dehydration and kidney problems.
Contamination: Formula manufacturers say their quality control and product safety are the tightest in the food industry. Still, any man-made food carries the risk of contamination. In recent years there have been several small, isolated outbreaks of serious illness and a few deaths (mostly premature babies or those with immune problems) caused by a bacterium called E. sakazakii which was found to have come from powdered formula. (The outbreaks prompted Health Canada to recommend liquid formula — which is less likely than powder to be contaminated — for bottle-fed babies who are immuno-compromised or in intensive care.)
The take-home message is that powdered infant formula is not a sterile product and must be handled and stored properly. Dawn Walker, a nurse and former executive director of the Canadian Institute of Child Health, says that one of the most common infant feeding questions she hears is, “Can I reheat formula?” “The answer is no,” Walker says. “Once formula has been warmed up for use, if you reheat it, bacteria growth increases exponentially. It’s very risky.”
Illness: Statistically, formula-fed babies are more likely to get colds, ear infections, milk allergies, diarrhea, urinary tract infections and bacterial meningitis. How much more likely? That’s hard to say. Obviously, few babies (formula fed or not) get meningitis, so the risk is very low to begin with. With more common illnesses like ear infections, other factors also increase the risk — such as whether mom smokes or the child is in group daycare. One large study of two- to seven-month-old babies found that the risk of ear infection increased with the proportion of formula in the child’s diet; those fed entirely on formula were twice as likely (13.2 percent) as those who breastfed exclusively (6.8 percent) to have had an ear infection in the past month.
Bottle-fed infants are also at greater risk for becoming overweight; they grow and gain weight more quickly and, on average, are less lean than breastfed babies. One large German study of five- and six-year-olds found a 4.5 percent rate of obesity among those who had been bottle-fed, compared with 2.8 percent for breastfed children. Since it’s mom or dad who decides how much goes in the bottle and when, a formula-fed baby may not learn to read his body’s signals as easily as one who nurses on demand. Stephanie Atkinson, professor of nutrition in paediatrics at McMaster University, comments, “I’m concerned that there may be some kind of metabolic programming going on that may explain the increased rates of obesity in formula-fed children.”
Another concern is that formula-fed children may face an increased risk for developing Type 1 diabetes. Some studies have found a higher incidence in children who were exclusively formula-fed or who were breastfed for less than three months. Other research has found that early exposure to cow’s milk increases the likelihood of developing a type of antibody that can be found in children with diabetes. No clear link has been established, but a major ten-year international study was launched in 2002 to compare the rates of Type 1 diabetes in babies fed standard formula versus those fed hydrolyzed formula.
When you add up all the risk factors, it sounds daunting. However, trying to predict the likelihood that any one child will get any one illness is impossible. Likewise, lower risk is no guarantee; some breastfed babies get ear infections and some bottle-fed babies don’t. And let’s face it: There are a lot of healthy adults walking around who were raised on formula.
If we look at formula as a medical intervention, a way to nourish a baby when breastmilk is not available, it stands up fairly well. The problem is that this substitute became a competitor. And formula simply can’t compete with human milk. Here’s how James Friel views it: “We’ve been making formula for over 100 years and I’ve spent 20 years of my life trying to make formula better. All the people I’ve dealt with in the industry are honest, hard-working and dedicated. In spite of that, we are still unable to make formula that comes very close to human milk and, for me, that’s a disappointment. We try to break human milk down into its components and put it back together again, but it really doesn’t work that way.”
Formula’s greatest achievement may be that, although it still doesn’t really compare to human milk, it has become a reasonably safe substitute that has improved over the years. Perhaps that is all it ever can be.
This is for the moms who use artificial baby milk instead of breastmilk to feed their babies and for some reason take offense to my bulletins, blogs, etc. Sometimes the truth hurts. But I am NOT trying to pick a fight, I am trying to educate women about the health and welfare of their babies!!!
I am surprised that people have chosen to take such offense about an obvious truth, breast IS BEST. I never once made any type of claim to be better than anyone because I breastfeed. All mothers do what they think is best and that is the best we can do. No one is perfect, I’ll be the first to admit that I am not :) If reading the facts about breastfeeding is that upsetting for you then you should probably shield yourself from the truth to prevent further upset. You also should probably stop reading my blog, bulletins, etc. because I am a breastfeeding counselor and advocate. You can simply remove me from your friends list, blog roll, or whatever so you won’t even be tempted.
I never said that breastfeeding was the only acceptable way to feed a baby. For me, yes, it is the only acceptable way, but I want to do what is healthiest and natural for my child. If other mothers choose to use artificial baby milk then sobeit. To each his own. I simply state facts. I am not on any type of “high horse.” I think that the lack of breastfeeding education and support in our country is what has led to such a decline in breastfeeding initiation rates so I make every attempt to put out the good word about breastfeeding everywhere I can! I have a lot of childless friends and MANY have replied to me with thanks for all the articles and information I put out there. I am sorry that you don’t feel this information is of any benefit to you. But I see this as no reason to attack me.
In addition to this – I don’t make anyone feel anything. We are all adults here and chose how we respond to certain situations. If someone feels bad, they choose to feel bad. I think it’s great that you think I have some kind of magical power to control how other people feel, but unfortunately I don’t. If I did, I would make sure everyone cared enough to do the research about all the health risks involved with formula feeding. It’s a fact, there are in fact very many things wrong with infant formula in comparison to breastmilk. In fact, the World Health Organization recommends that babies receive artificial baby milk as the FOURTH option for food.
#1.Breastmilk via the mothers breast
#2.Expressed bm in a bottle from the mother
#3.Banked bm from a donor
#4.Artificial baby milk.
This not something that I made up to create controversy on the subject. Breastfeeding is the healthiest and best choice for babies. There are no questions about it. Will a child survive on artificial milk? Certainly! But are there risks involved? Absolutely! And is it 100% safe? Absolutely NOT! Do a little research before you state your opinions as fact.
Me stating facts about the benefits of breastfeeding and the risks associated with formula feeding have NOTHING to to with postpartum depression. And as far as postpartum depression goes, guess what? You’re gonna LOVE this! Breastfeeding helps with that too!
See article here
In the future, try to refrain from lashing out at someone who is simply stating facts on a subject that upsets you. I seriously have done nothing wrong here. I am only trying to help educate and promote breastfeeding.
Love, peace and breastfeeding,
The FDA has found in tests of canned infant formula that the plastic linings of the cans are leeching Bisphenol A into the formula IN MUCH HIGHER LEVELS (according to EWG) THAN FOUND TO CAUSE SERIOUS ADVERSE AFFECTS IN ANIMAL TESTS.
There is a string of corruption following the use of this chemical…read on……AND PASS IT ON!!!!!!!
Infant formula was designed to be a medical nutritional tool for babies who are unable to breastfeed. Formula does not fully meet the nutritional and immunity needs of infants, leaving their tiny systems flailing. An infant’s immune system has three aspects: her own immature, developing immune system; the small component of immunities that passes through the placenta during natural childbirth (and to a lesser degree with premature births and cesarean sections); and the most vast and valuable, living portion that is passed on through mother’s milk on an ongoing basis. Remove any of these components and you take away a vital support structure.
This brings us face to face with the safety and effectiveness of infant formula as a breast milk substitute. Is formula actually as safe as we have been led to believe? In fact, the answer is a resounding “no.” In fact, the use of infant formula doubles the risk of infant death for American babies.
While the dangers of formula feeding aren’t something you’re likely to hear in your doctor’s office, the conclusions can be derived through an examination of the available scientific research on infant mortality in the United States and across the world. There are studies showing artificial feeding’s impact on overall infant death rates in both developing and undeveloped countries. While studies offering comparative death rates are not available for industrialized regions, there are numerous studies providing comparative occurrence rates for many illnesses and disorders in the United States and other industrialized nations. Many more reports are available extolling superior survival rates and decreased illness rates among breastfed infants, but only those with solid numbers are useful here. We can assemble the statistics from these studies to build a firm picture of the ratio of infant deaths for U.S. formula-fed babies against those who are breastfed.
And for any skeptics, here are the numbers in black and white: http://www.babyreference.com/InfantDeaths.htm
This was in Feb of 2006…
The Abbott health care company is recalling hundreds of thousands of bottles of infant formula distributed nationwide because they might not have enough vitamin C.
The recall is for approximately 100,000 32-ounce plastic bottles of Similac Alimentum Advance liquid formula and approximately 200,000 bottles of Similac Advance with Iron, Abbott spokeswoman Tracey Noe said Friday.
The bottles, distributed by Abbott’s Ross Products division, are missing a special layer that keeps air out of the bottle, Noe said. When the oxygen enters the bottle, it causes the level of vitamin C to decrease over time, she said.
If infants drink formula without enough vitamin C for two to four weeks, they could start exhibiting symptoms of vitamin C deficiency, which include irritability with generalized tenderness, the company said in a release. So far, Abbott has received no medical complaints.
The Similac Alimentum Advance has stock code 57512, lot number 401895V and use-by 1 May 2007 printed on the back of the bottle; the Similac Advance with Iron has stock code 55961, lot numbers 40177RH or 40172RH and use-by 1 November 2007. Some of the bottles may have been included in Similac Advance Hospital Discharge Kits — stock code 58986 and lot number 41699D5 are printed on the back of the bear tag attached to the kit.
Abbott, formerly known as Abbott Laboratories, is based in suburban Chicago.
Consumers with questions can contact Abbott’s Ross Products division at 800-624-3412.
February 23, 2006
A recall is being conducted by Mead Johnson Co. for its GENTLEASE powdered infant formula, lot number: BMJ19, use by 1 Jul 07. This lot was found to contain metal particles of up to 2.7 millimeter in size.
No illnesses have been reported to date. However, in the rare instance that an infant were to inhale the infant formula into the lungs, the presence of these particles could present a serious risk to the infant’s respiratory system and throat.
Any injuries associated with this problem would be likely to show up within three to four hours. The symptoms could be varied depending on whether there is damage to the throat or lungs.
Damage to the throat or lungs may include coughing, difficulty swallowing or difficulty breathing.
If you may have fed this lot of GENTLEASE to your baby, and you have any concerns about your baby’s health, you should contact your baby’s physician immediately.
There were approximately 41,464 24-ounce cans of this lot of recalled product distributed, beginning on December 16, 2005, through many major retail stores across the country, so the consumer should concentrate on the code on the can rather than on the place of purchase.
The affected products can be identified by the lot number and expiration/use by date embossed on the bottom of the can of BMJ19, use by 1 Jul 07.
Mead Johnson and the Food and Drug Administration are currently investigating how the metal particles got into the infant formula.
Consumers who have a can of this batch of GENTLEASE powdered infant formula should not use the product and should contact Mead Johnson at 888-587-7275 immediately. -30-
This was in 2002. This is only one among MANY reasons that breastfeeding is the safer health choice for your child. This is just terrifying. What’s worse is knowing that because these formula’s are man made, at any point in time this could happen again. Is your child’s life worth this kind of risk?
FDA ALERTS PUBLIC REGARDING RECALL OF
POWDERED INFANT FORMULA
The Food and Drug Administration today is alerting the public to the voluntary recall of powdered infant formula announced by Wyeth Nutritionals Inc., Georgia, Vermont. Certain lots of powdered infant formula manufactured between July 12 and September 25, 2002, may be contaminated with Enterobacter sakazakii. E. sakazakii is a foodborne pathogen that can in rare cases cause sepsis (bacteria in the blood), meningitis (inflammation of the lining of the brain), or necrotizing enterocolitis (severe intestinal infection) in newborn infants, particularly premature infants or other infants with weakened immune systems. No illnesses have been reported to date in connection with this contamination.
The powdered infant formula was distributed nationwide in retail stores and amounts to approximately 1.5 million cans. The affected products can be identified by an expiration/use by date, embossed on the bottom of the can of: 07 28 05, 08 28 05 and 09 28 05. The products also can be identified by a six-digit character embossed on the bottom of the cans. The first four characters include: K12N through K19N; L07N through L30N; and N03N through N25N. The products include:
* Baby Basics by Albertson’s Infant Formula with Iron 2 LB (908g)
* Baby Basics by Albertson’s Infant Formula with Iron 1 LB (454g)
* Baby Basics by Albertson’s Soy Infant Formula with Iron 2 LB (908g)
* Baby Basics by Albertson’s Soy Infant Formula with Iron 1 LB (454g)
* Baby Basics by Albertson’s Formula for older infants with iron 1 LB. 15.7 oz (900g)
* Kozy Kids Infant Formula with Iron 16 oz (454g)
* Kozy Kids Soy Infant Formula with Iron 16 oz (454g)
* Hill Country Fare Infant Formula with Iron 32 oz (2 LB) 908g
* Hill Country Fare Infant Formula with Iron 16 oz (1 LB) 454g
* Hill Country Fare Soy Infant Formula with Iron 32 oz (2 LB) 908g
* Hill Country Fare Soy Infant Formula with Iron 16 oz (1 LB) 454g
* HEB Baby Infant Formula with Iron 32 oz (2 LB) 908g
* American Fare Little Ones Infant Formula with Iron 2 LB (908g)
* American Fare Little Ones Soy Infant Formula with Iron 2 LB (908g)
* American Fare Little Ones Formula for Older Infants with Iron & Calcium 1 LB 15.7 (900g)
* HomeBest Soy Infant Formula with Iron 2 LB. (908 g)
* Safeway Select Infant Formula with Iron 2 LB (908g)
* Safeway Select Infant Formula 2 1 LB 15.7 oz (900g)
* Healthy Baby Infant Formula with Iron 2 LB (908g)
* Healthy Baby Infant Formula with Iron 1 LB (454g)
* Healthy Baby Soy Infant Formula with Iron 2 LB (908g)
* Healthy Baby Formula for Older Infants with Iron 1 LB 15.7 oz. (900g)
* Walgreens Infant Formula with Iron 16 oz (454g)
* Parent’s Choice Infant Formula with Iron 2 LB (908g)
* Parent’s Choice Infant Formula with Iron 16 oz (454g)
* Parent’s Choice Soy Infant Formula with Iron 2 LB (908g)
* Parent’s Choice Soy Infant Formula with Iron 35oz (1 kg)
* Parent’s Choice 2 Infant Formula with Iron 1 LB 15.7 oz (900g)
The contamination was first detected during a special E. sakazakii sampling FDA conducted at the Vermont facility. This special sampling and analysis is being conducted at all major, domestic manufacturers of powdered infant formula.
Consumers who have purchased the powdered infant formula are urged to return the product to the place of purchase for a full refund. Consumers with questions may contact Wyeth at 1-888-526-5376.