Formula Perfection and Additives: Forever Imperfect

Maureen MinchinBottle Feeding, breastmilk, Commentary, General News, Infant Formula, Infant Health, Milk Hypothesis

Milk Fats and Fictions 

Forever Imperfect Formula 

Protected by the ignorance or silence of health professionals, gullible and trusting parents have always believed infant formula to be perfect, a totally safe replacement for women’s milk. Why? Because infant formula has always been marketed as perfect. One company still claims to have “the perfect mix of science and love,” dreamed up by the US company American Home Products/Wyeth long before its valuable S-26 brand was sold on to multiple owners. (Who are now re-branding in some parts of the world, while clinging to the S-26 name.)

Perfection cannot be improved upon, by definition. Yet infant formula keeps on being changed – and most people assume, perfected – by the addition of yet another ingredient that mimics what has always been in breastmilk. And that new ingredient always “closes the gap” to breastmilk; or, more modestly, makes a highly processed powder “closer to” – or even “closest to” – the world’s only truly universal, utterly fresh, uniquely personalised, local liquid baby food. How close really? What are a few of the additives over time?

  • In the 1980s US companies pioneered all-vegetable oil formulas, denouncing “animal fats’ (like milk fat) as atherogenic and harmful, laden with cholesterol, then a bogey for heart disease, now recognised as important in brain development and immunity.
  • With great fanfare taurine was added, initially by Wyeth, to formula products lacking it, with inferences of improved eyesight (though there was no admission of defect in previously taurine-deprIved infants, and seemingly no comparative research of long term outcomes of different formulas for adult sight.)
  • Then it was nucleotides, the marketing of which persuaded parents that formulas provide immune protection, though the evidence for higher infection rates in FF infants continues unabated. (The subsequent scientific judgement about nucelotides is that their addition had been valuable for marketing, but unnecessary, and cost-inflating. And Mead Johnson’s initial concerns about Abbott/Ross possibly “hyperstimulating the immune system” didn’t stop MJ adding some nuceotides shortly afterwards.)
  • And as well there were the 1990s industry-wide experiments with fish, algal, and fungal long chain polyunsaturated fatty acids (LCPUFAs) to remedy a significant longstanding omission from the diet of artificially fed infants – an omission that dated back to removal of cod liver oil from their diet after damaging excesses when ‘modern’ formula were introduced while supplements continued. Lack of omega 3 fats needed for normal brain growth almost certainly contributed to the spectacular rise in  inflammatory disease and brain disorders in nations adopting formula feeding…

Yet despite the frequent new additives, few health professionals or parents realised that formula has always been imperfect. None of the changes altered community perceptions, or caused regulators to punish false and misleading advertising, or to mandate longterm research into outcomes for those reared on those older ‘perfect’ formulas – most with the same brand names as the newer ‘perfect’ formulas, all too often..

There have been many other alterations to this always ‘perfect’ product.

With the benefit of hindsight, some changes seem to have been unwise, such as using egg, wheat, corn and peanut oil in infant formula.  Not all of those experiments have been discontinued.  It is probably not coincidental that all the worst major allergens have been fed to neonates. Certainly it was not perfect to use milk proteins to micro-encapsulate oils for allergy formulas!

Some changes remain controversial because the effects of adding a bovine version of something known to work in breastmilk are still largely unresearched in infant formula. Lactoferrin is a case in point.[i]

Some changes were clearly beneficial and were long overdue, like the addition of selenium, and the ongoing decrease in protein and calories (clearly linked to the obesity epidemic in WEIRD nations), and the changes to osmolality and amino acid ratios.

Personally, I think that if something is proven useful, it should be in all formulas, and no formula should contain ingredients not yet proven useful (except to inflate profits). And patent law should not be allowed to make important inclusions impossible.

The formula industry funds much research, varying in quality from excellent to appalling, but almost always blinkered by invalid assumptions.[ii] Patent applications are often useful summaries of what they think and plan.[iii]

Of course most changes to formulas do have a rational basis, first in theoretical science and rat or mouse or pig feeding studies, followed by small-scale short-term studies in healthy normal newborns – most recruited to a study only after some weeks of earlier feeding which is rarely recorded. Companies can’t afford obvious mistakes, and take great care to try to avoid them, for altruistic and commercial reasons alike. They (and anyone who cares about babies) want formula to be as good as it can be; industry formally acknowledges that formula is inferior to breastfeeding (while communicating not by much, or even ‘not really’, in their marketing).

Most modern formula is indeed adequate to grow babies within what seems like a normal range of variability: after all, a century of formula use has created that range! It is not toxic or poisonous, and anyone who uses such extreme language is not a credible commentator. But while milk from a breast is the epitome of local fresh gourmet food, formula is its polar opposite. And parents and health professionals alike need to realise that any change creates a new ongoing experiment. Outcomes of unmonitored experiments can be unfortunate. More about that in the next post.

Those who are interested in imperfect formulas’ shapeshifting over time, and other fatty issues, should read Milk matters: infant feeding and immune disorder or its e-book version, Infant formula and modern epidemics: the milk hypothesis. It is only the latest/likely new addition that I will comment on next: the milk fat globule membrane fats and proteins, loosely described as MFG or MFGM.  For with these, at least one company is blatantly misleading parents yet again. And formula is “even closer to breastmilk” yet again. (Maybe, maybe not.)

Endnotes

[i] For an update on what is currently known or believed, see Demmelmair H. Prell C, Timby N, Lönnerdal B. Benefits of Lactoferrin, Osteopontin and Milk Fat Globule Membranes for Infants. Nutrients 2017, 9, 817

[ii] See below a quote or two from the Mead Johnson website: https://www.meadjohnson.com/pediatrics/us-en/products/about-enfamil-enspire

“Lactoferrin is a major protein in breast milk that binds to iron and supports healthy gut bacteria. However, the interaction of Lactoferrin and iron in our formulas has not been studied in this regard.” WHY the heck not?

Binding iron is only one part of the process. Iron needs to be released to receptors, or infants could be iron deficient. Do human receptors recognise bovine lactoferrin, which is not identical to human? Does this affect the absorption ratios of other minerals like zinc? Part of the reason lactoferrin binds iron is to reduce its availability in the gut where it fosters the growth of pathogens. Iron absorption in infants varies during infection. What effect on these processes does bovine lactoferrin have? Are we sure that some infants may not be harmed?

Having said that they haven’t studied their own formulas in this regard, MJ  adda, “As a reminder, our formulas are inspired by breast milk which has Lactoferrin.” Being “inspired by breastmilk” doesn’t justify assuming anything about how different industrially-produced ingredients behave and interact in very different foods – and then marketing an additive assumed to be useful, while ignoring a possibility of harm, however small. Every formula that puts lactoferrin in needs to be tested by brand and comparatively, and the results reviewed and published.

[iii] Infant formula with probiotics and milk fat globule membrane components
http://www.google.com/patents/WO2011069987A1?cl=en