EDITOR’S SUMMARY: It’s a shame to have to worry about inferior ingredients unknowingly festering in your baby’s food source. Understandably, while you may feel overwhelmed, and would rather not have to traverse through the multiple nooks and crannies of the latest health scare, or processed-food nightmare of “what’s in it now?” … The details of the food your little one consumes at this precious stage of life are not to be skirted over.
By Liz Quinn
Being a new parent can be as stressful as it is joyous, bringing with it enough decisions to make your head spin at a vulnerable, often sleep-deprived time. When it comes to your baby’s food of choice, while it’s true that many moms breastfeed (83.2% nationally; 48% globally) at least in the very beginning, with only around 25% of babies exclusively breastfed by six months of age, you may end up needing to supplement or even switch to formula at some point.
With so many formula options out there (assuming it’s not a time of shortage), it can feel daunting to have to choose something as important as your baby’s wellspring of nourishment, especially if it’s their exclusive source. The good news if you’re in this camp is that the Food and Drug Administration (FDA) does regulate nutrients in infant formula, including “minimum amounts for 29 nutrients, and maximum amounts for nine of those nutrients.” It’s getting into the finer details–organic, DHA-added, cow’s milk, soy, and sugars, etc.–that can feel like an arduous journey into information overload.
Let’s get right to it—yes, breast milk is best. It’s been dubbed “liquid gold,” and there’s no denying it’s a wonder of nature. That said, it doesn’t work for everyone. You may be a mom with residual problems from prior surgery; you may have nipple or milk supply issues, or perhaps you’re struggling with the logistics that pumping can demand as you’ve returned to work. You may have a baby who just won’t latch to your breast, or you may have adopted a little one. Whatever the reason, formula can be a literal lifesaver.
Between recalls and shortages, recent years have been rough on parents dependent on baby formula. In February 2022, Abbott, the country’s largest manufacturer of baby formula, closed its Michigan factory in response to concerns over contamination of Cronobacter, after several infants ingesting their formulas were reported to have fallen ill from it—two of whom died.
Cronobacter is a bacteria found naturally in the environment, but in rare cases, it can make infants, especially vulnerable ones, very ill, potentially causing sepsis (a dangerous blood infection) and even meningitis (swelling of the brain and spinal cord).
And in just the first few months of 2023, there were two recalls from formula manufacturing giants Enfamil and Gerber, due to Cronobacter contamination concerns, affecting some 145,000 cans of formula for Enfamil alone.
With so many safety issues, choosing a formula can put a tremendous amount of pressure on you as a parent. But there is a bright side if you’re a formula family: Manufacturers are paying more attention than ever to the components of their products, trying to mimic the good stuff breast milk provides.
Arguably, the best thing about breast milk is its ability to adapt to your infant’s specific needs. Breastfeeding not only provides nourishment, but also offers a valuable exchange of information between you and your baby, as an infant’s saliva actually gets into the milk ducts. This prompts your body to customize the next “batch” of milk to your baby’s needs. It’s why the appearance and consistency of breast milk can change drastically from feeding to feeding, even within the same day.
While nursing, your body can generate specific antibodies if your baby, you, or even family members are sick. In humid weather, the water composition in your milk may increase to keep your baby hydrated, and your breasts are so wise that they can increase melatonin content in milk at night to help your baby sleep.
Attempting to Mimic the Real Thing
While formula manufacturers are far from replicating this level of customization, they are getting better at mimicking other aspects of breast milk. One of the components recently added to formula is something called human milk oligosaccharides (HMOs). Not to be confused with GMOs (genetically-modified organisms), HMOs appear to be an essential element of breast milk. They are the third largest solid component of human milk, and include over 150 different molecules, yet are not digestible, indicating that their presence influences the gut and entire immune system.
Replicating HMOs is especially challenging because there are so many different types, yet so few of each, that when scientists try to isolate them, it’s difficult to obtain enough of each kind to study. Even when they are able to get a hold of enough molecules, HMO structures are complex, making them hard to create synthetically.
Although scientists are able to replicate some HMOs, not all of them are necessarily good for all babies. Because currently just two have proven safe, effective, and easy to create, most formula brands include only those: 2’-FL and lacto-N-neotetraose. Yet 20% of moms don’t produce 2’-FL in their milk at all, and as most things in nature tend to have a purpose, there is concern that this molecule is absent for a reason, indicating that not every infant may benefit from it.
Another element whose presence elicits debate is DHA. Although you might not have heard of DHA by its mouthful of a name, docosahexaenoic acid, you may have heard of its benefits. DHA is an omega-3 fatty acid that helps comprise the brain and eyes, and its existence in breast milk has led some manufacturers to add it to formula. However, the common method used to extract DHA can be cause for concern.
Most formula-makers get their DHA from single-cell oil, extracted “using the toxic chemical hexane from laboratory-grown algae,” according to the Cornucopia Institute, an organic watchdog group.
It’s assumed by the formula industry that during processing, toxic hexane residues evaporate from the oils before they reach your baby’s bottle. However, scientists have found hexane residue in some other oils, so there’s no guarantee. Hexane’s effects on consumers have not been studied, but similar hydrocarbon solvents have been shown to affect human development, namely neurologically.
Federal regulations of organic foods prohibit hexane-extracted ingredients, yet some organic-labeled baby formulas contain DHA. After a complaint was filed in 2006, United States Department of Agriculture (USDA) employees decided that fatty acids violated federal standards and should be banned from organic-labeled products. However, one USDA manager, heavily lobbied by the formula industry, overruled their decision.
In 2010, the Obama administration announced that fatty acids DHA and ARA would no longer be allowed in organic formulas, however, they still can be found to this day. So if your baby depends on formula, you’re left to rely on your own label scrutiny when it comes to DHA inclusion.
If DHA is something you want in your baby’s diet, but the hexane issue concerns you, a couple of options remain. You can add it separately with a DHA liquid supplement. Nordic Naturals offers a Baby DHA made for infants as small as five pounds. Their product is non-GMO, sourced from wild Arctic cod, and their processing method is hexane-free. If the potential mercury exposure concerns you, they use third-party testing to ensure potency and purity, and you can even view a certificate of analysis for your specific batch by entering the lot number on their website.
Alternatively, if you don’t want to deal with supplementation, you can look for the one formula that sources from organic egg yolks rather than hexane extraction: Baby’s Only Organic Dairy with DHA & ARA. This particular formula is a toddler formulation, but Dr. Bridget Young, known as the “Baby Formula Expert” on her YouTube channel, reassures parents that toddler formula will likely work just fine for infants. Be that as it may, it’s always best to consult your own doctor for your baby’s specific situation.
Dr. Young isn’t just another voice on YouTube, she’s an assistant professor at the University of Rochester in the Division of Breastfeeding and Lactation. She was also the lead author of a recent study of infant formula with troubling findings.
Sugar … Of Course
Young’s team found that 59% of infant formula sold in the U.S. has been lactose-reduced, a formulation that should be used only for babies who medically need to avoid lactose—a much smaller population than 59%. The issue with lactose-reduced formula is that when manufacturers remove lactose, they tend to replace it with carbohydrates, such as corn syrup or corn syrup solids.
Corn syrup solids are different than corn syrup itself. They’re created by dehydrating corn syrup until the water content reaches 10 percent, in order to be usable in powdered products. Unlike high fructose corn syrup (HFCS), no fructose is added to corn syrup solids, so their glycemic index isn’t as high as HFCS. However, it's still much higher than lactose—the sugar in breast milk that babies’ bodies are designed to ingest.
The glycemic index (GI) is a measure of how fast carbohydrates affect blood sugar levels. Since corn syrup solids are essentially glucose (sugar), they have a glycemic index value of 100, whereas lactose has a GI value of 46. From “Let's Talk About Sugar! Carb Sources in Infant Formula”
“This means that glucose increases blood sugar levels at twice the rate of lactose … Sugar in the form of lactose is metabolized much more slowly and can help maintain stable blood sugar and insulin levels. While babies may be able to safely handle the increased ‘glycemic load’ that comes from corn syrup solids, we know that humans aren’t designed to consume such a fast-acting carbohydrate in infancy.”
In addition to the physiological issue, non-lactose carbohydrates are significantly sweeter than lactose, potentially changing a baby’s taste to prefer and crave sweeter foods. They are also associated with changes in the microbiome, higher risk of obesity later in life, and the formation of biofilms on teeth.
While it’s wonderful that many options exist for babies with specific atypical needs, if your baby doesn’t fall into one of those categories, you may be buying unnecessarily modified formulas that, while generally safe, could be damaging to your infant’s long-term health.
Don’t Label Me!
Actually, please do. When you head to the baby formula aisle, it’d be nice to have the labels clear, complete, and forthcoming. However, that’s not necessarily the case with infant formula.
The European Union (EU) bans the use of corn syrup solids in baby formula, but in the United States, if you’re a concerned parent, you’re left to scrutinize formula labels on your own, and the FDA doesn’t help make this an easy task. Recently, the FDA changed labeling guidelines to require companies to list “added sugars” (those added during processing rather than naturally occurring in food) separately, below total sugar content. Yet, inexplicably, unlike other foods, manufacturers are not required to include the sugar content of baby formula on the label at all.
This policy is so baffling that it caught the attention of a Chicago NBC affiliate, prompting them to take seven popular formula brands for independent testing at a local lab. Their results found that the two formulas with the highest sugar content were Enfamil Premium and Parent’s Choice, coming in at 13.5 and 12.4 grams per serving, respectively. This equates to approximately 3 teaspoons of sugar per serving.
At least those two formulas use lactose. While lower in total sugar content, Similac Advance Organic Complete Nutrition contained sucrose—another type of sugar banned in Europe over childhood obesity concerns. Similac Soy Infant Formula with Iron contained a whopping four types of sugars, including sucrose.
Why should you care about sucrose? It’s a super-sweet sugar that can trigger dopamine release and cause cravings. It doesn’t take a Ph.D. in nutrition to understand that setting your child up in infancy to crave sugar could have lifelong consequences.
While you won’t find the sugar content listed on your baby formula, your best bet is still to look at the label to see if the list of ingredients include carbohydrates, such as corn syrup solids or plain ol’ sugar, even if it’s organic. Similarly, keep an eye out for the word “hypoallergenic” on formula labels since that designation is for infants with a cow milk protein allergy—a condition that only applies to approximately 1.3% of infants.
Soybean Red Alert
Another type of formula that’s unnecessary for most babies is soy. A 2011 study published in “Paediatric and Perinatal Epidemiology,” found that girls fed soy-based formula in early infancy had a 25% higher risk of menarche (a girl’s first period) in early adolescence compared to that of cow milk formula-fed infants.
In 2018, another study looked at female infants fed breast milk, cow milk formula, and soy formula, and the findings revealed that the soy formula-fed girls had “developmental trajectories consistent with responses to estrogen exposure.”
And boys … What is their response to soy? Evidence conflicts here. Some data indicate that soy formula has no effect on the sexual development of boys, but even those researchers concluded that more study was advised. This seems like a no-brainer, given that infancy is a particularly formative time for future development.
Baby boys experience a surge of testosterone in the first six months of life, with levels similar to those of adult men, so it would seem an especially vulnerable time in terms of hormone exposure. However, there isn’t a tremendous amount of data on the subject.
A years-long study of Filipino men found that “those who gained weight rapidly during the testosterone surge [in infancy] matured earlier, were taller, had more muscle, were stronger and had higher testosterone levels,” indicating that this period in your infant’s development is important to his later years.
As for those later years, a Harvard School of Public Health study of 99 males found that the more soy foods a man ate, the lower his sperm count. Scientists have also found that concentrations of certain phytoestrogens in soy formula-fed babies were 13,000 to 22,000 times higher than typical oestradiol concentrations in early life.
Oestradiol is a female sex hormone, the strongest of the three estrogens and responsible for the development of the female reproductive system. The study was quite small, but you’d think such findings would merit immediate further research.
If you needed more to be concerned about when it comes to soy, say hello to manganese. This mineral is present in breast milk, but scientists have recently found that the amount can be 32–1000 times greater in baby formula than its concentration in breast milk. What’s the big deal? Manganese is also a heavy metal that, in excess, can seriously affect child neurodevelopment.
Again, unlike European guidelines that have a limit on manganese content in formula, the FDA has a minimum requirement but not a maximum limit for the heavy metal. While this is a potential issue for many types of formula, researchers found the highest concentrations in soy and the lowest in cow and goat milk formulas. Considering that your baby’s brain doubles in size during the first year of life, a potential neurotoxin is worth avoiding.
While further study of infant soy exposure is merited, until more is known, what you can be sure of is that cow’s milk formulas are closer to human milk; if your little one seems to tolerate this kind, it’s best to steer clear of soy.
Digging Deep for a Closer Match
For some manufacturers, however, even cow’s milk isn’t close enough to breast milk. Companies TurtleTree and Biomilq are trying a different method: working with human mammary epithelial cells in a bioreactor to recreate breast milk production outside of the body.
Much like the way epithelial cells function inside a woman’s breast—absorbing nutrients on one side of the layer and releasing milk out the other side—inside the bioreactor, “[mammary] cells arrange themselves in a layer, nutrients are absorbed from the cell culture media beneath the cells, and human milk flows out above.”
All formula companies aspire to come as close to breast milk as possible, but it’s a tough market to break into. Nearly 90% of baby formula is controlled by just a few companies—Abbott Nutrition (Similac), Mead Johnson Nutrition (Enfamil), and Nestle USA/Perrigo Company (Gerber). However, several small companies are standing out by working to advance formula composition with new technology and scientific discoveries of breast milk.
One of those companies is ByHeart, a relative newcomer to an industry that hasn’t had a new FDA-registered player in over a decade. The monopoly on formula played a large part in why the shortage of 2022 was such a devastating problem in the first place. Abbott alone provides approximately 40% of the entire country’s formula supply, so when their Michigan factory shut down, it forced parents to look elsewhere for formula. In doing so, many found ByHeart.
ByHeart is the first new FDA-registered infant formula to come along in 15 years. It’s the only U.S. formula to stray from skim cow’s milk, instead using organic, grass-fed whole milk, and their ratio of whey to casein (80:20) is similar to that first, rich breast milk known as colostrum. Their products are also free of potentially troublesome ingredients such as GMOs, soy, corn syrup, and gluten.
ByHeart completed its own large clinical trial in which parents reported positive results such as less spit-up, more efficient weight gain, and easier digestion with their formula. The company conducted the trial itself, but they claim it was designed to “meet and exceed the rigorous requirements set by the FDA.”
If you’re looking for a third-party arbiter of the product’s safety, you can find that in the Clean Label Project (CLP), a nonprofit organization that lab-tested ByHeart’s formula, awarding them not only the first U.S. infant formula “Clean Label” certification, but also the “Purity Award”—the highest certification possible. The CLP screened the formula for various heavy metals and pesticides, checking for some 400 contaminants in all, and ByHeart claims to screen for over 700 on its own.
In Your Hands
Now if you’re feeling ambitious, another option is to make your own baby formula. While mainstream medicine and media are inclined to slam homemade as being dangerous, you can find recipes created with precision by experienced nutritionists.
The Weston A. Price Foundation offers a cow-milk-based formula created by nutritionist Dr. Mary Enig, or you can try a goat milk-based formula like this one, created by a nutritionist (and father of eight!) who says goat milk “more closely resembles the protein, fat, and carbohydrate structure of breast milk than literally any other ingredient.”
If you’re interested in going homemade, before changing formulas, consult with your health care practitioner to discuss your baby’s specific needs. If you decide to give it a try, be sure to keep your workspace and kitchen utensils, appliances, and containers used in the formula-making process, extremely clean and sanitary to avoid contamination.
So rest easy, Mama, while the choices can make your head spin, there are options—from homemade varieties, to formulas that avoid nasty ingredients, and provide clean nourishment to your little one. Check those labels, and stay away from products that include corn syrups, additives, or unnecessary specializations, and you should be in good shape.
Published on August 10, 2023.
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