An excerpt about formulas and obesity, from pages 37-49 of Milk Matters: infant feeding and immune disorder. Also e-book Infant formula and modern epidemics: the Milk Hypothesis
The previous section of this first part of the 800+ page book discussed the ways that breastmilk directs and supports normal infant development. The subsequent pages after this extract discuss other influences on cognitive and neurobehavioral development. Page numbers have been left under the footnotes, which have been colored so as to separate them from the ongoing text, and headers and paragraph headings removed; so too some copyright illustrations.
There is probably a better and simpler way to do all this, did I possess sufficient computer expertise, but this is readable. And the rest of this book contains much more startling information, if this excerpt is of interest to you.
“..before industry (or any doctor or parent or formula advocate) suggests that the formula-fed baby’s altered blood chemistry, or lack of key human hormones, or lesser brain growth, makes no difference, they need to prove that. I do not have to prove anything. A priori, if human hormones are in breastmilk, an infant deprived of them is disadvantaged. That makes this an issue of formula safety as well as adequacy: how dare formula makers claim to provide all necessary nutritional support for the immune system, when they don’t include ingredients that affect both nutrition and immunity?
The extent of this breastmilk support and the ways it affects normal physical development seem to me to be more likely to be under-estimated than exaggerated. Consider infant obesity, one form of dysnutrition, as an example.
A recent ‘systematic review and meta-analysis of risk factors for childhood overweight identifiable during infancy’109 compared ‘ever breastfed’ UK children with ‘never breastfed’ ones from a wide range of studies. Such a study should result in little or no difference
107 Hinde K, Skibiel KL, Foster AB, Del Rosso L et al. Cortisol in mother’s milk across lactation reflects maternal life history and predicts infant temperament. Behavioural Ecology 2014; DOI: 10.1093/beheco/aru186. Published online 31 Oct 2014. Report in NY Times 6 Nov 2014 http://www.nytimes.com/2014/11/06/science-in-a-mothers-milk-nutrients-and-a-message-too.html
108 Verd S, Garc.a M, Guti.rrez A, Moliner E et al. Blood biochemical profile of very preterm infants before and after trophic feeding with exclusive human milk or with formula milk. (PMID:24576499) Clin Biochem 2014 47(7–8):584–87
109 Weng SF, Redsell SA, Swift JA, Yang M, Glazebrook CP. Systematic review and meta-analysis of risk factors for childhood overweight identifiable during infancy. (PMID:23109090) Arch Dis Child 2012, 97(12):1019-1026 DOI: 10.1136/archdischild-2012-302263
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being shown, because so many children in any UK ‘ever breastfed group’ would have been formula-feeding within days or weeks. Despite this, there was an almost 18% increased odds ratio for overweight in those ‘never breastfed’. The findings were further minimised by taking the exclusively formula-fed as the scientific norm and so stating that ‘ever’ breastfeeding decreased the odds ratio by 15 per cent. The review’s conclusion – ‘A moderate protective effect of ever breastfeeding on subsequent development of child overweight’ – can be misunderstood as meaning that short durations of breastfeeding are good enough. Comparing ever – versus never – breastfed data may be concealing the fact that the protective effect of breastfeeding against obesity may be almost non-existent for very short periods, like a week, and massive for longer periods. Or may depend on exclusive breastfeeding at a critical developmental stage.
Weng et al quoted one study that ‘found a significant decrease in the odds of overweight at2 years of age for infants breastfed for more than 6 months compared with those breastfed for less than 3 months.’110 (Again, the figure would have been greater were the breastfed the scientific norm: formula increases risks, breastfeeding does not decrease them.) But what we need – and do not have – are studies of solely formula-fed children versus children breastfed exclusively and then partially for differing periods of time. Basic science suggests there may be greater risks of obesity in children according to the mode of breastfeeding as well as the composition of the infant formula.
Why? We know that there are many other ways in which artificial feeding may create obesity: not only the products fed, but also the ways they are fed. Studies show that direct breastfeeding results in better appetite control, for example, when compared with bottle-feeding– regardless of the content of the bottle.111 Relevant sections in Chapter 3 of this book outline plausible mechanisms for the obesogenic effect of too much protein and the wrong fats over time in two or three generations. And of course the insulin and other hormones and enzymes and growth factors in breastmilk may well play a part in programming infant carbohydrate metabolism for life. Regardless, the existence of effects is indisputable: one meta-analysis of nine studies with more than 69,000 participants showed that breastfeeding reduced the risk of obesity in childhood significantly: or rather, that being formula-fed increased the risk by 25 per cent.112
Of course when obese women breastfeed, after birthing heavier babies, the impact of their lifelong obesity will affect comparative risk in the next generation, as both higher birthweight and maternal obesity increase the risk of infant obesity. The rate of obesity among breastfed
110 Weyermann M, Rothenbacher D, Brenner H. Duration of breastfeeding and risk of overweight in childhood: a prospective birth cohort study from Germany. Int J Obes 2006;30:1281–7.
111 Li R, Fein SB, and Grummer-Strawn LM (2010) Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? Pediatrics 2010; 125(6): e1386–93.Also Di Santis KI, Collins BN, Fisher Jo, Davey A. Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from a bottle? Int J Behav Nutr Phys Act 2011; 8:89. See also Li R, Magadia J, Fein SB, Grummer-Strawn LM. Risk of bottle-feeding for rapid weight gain during the first year of life. (PMID:22566543) Arch Pediatr Adolesc Med 2012;166(5):431–36.112 Arenz S, Rückerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity – a systematic review. Int J Obes Relat Metab Disord. 2004; 28(10):1247–56.
children will rise. Rates of obesity among the artificially fed should decrease a little with the latest lowering of formula protein levels and changes in fat blends. (Although differences in body composition will remain.) Thus differences in infant obesity by mode of feeding may be reduced, while the baseline population risk remains elevated from what it would have been without formula feeding in either generation. But the mother’s obesity may be due to her own infant feeding history. Bottle feeding in the previous generation may have made the next breastfed generation more like the bottle-fed. Clearly, breast or bottle-feeding has measurable impacts on usual bodily development. When industry claims outcomes closer to a breastfed norm, we need to know that the norm has not been distorted by bottle feeding past and present.
But there is other evidence of small but even more disturbing bodily differences between children who are breastfed and those who are formula-fed, whether the formula is milk- or soy-based. The most publicised concerns – but not necessarily the greatest concerns – relate to soy formulas.
Soy formulas and infant development
Soy formulas contain plant-based substances that mimic the natural hormone oestrogen (referred to as phyto-oestrogens or isoflavones). Concern about possible effects on child reproductive development and thyroid function has caused them to fall from favour with paediatric groups. But is soy formula any worse than cows’ milk formula?
Millions of acres in America are devoted to growing soy beans, and almost every processed food in America contains some soy product. They are a hugely important and cheap food source. Perhaps for this reason, researchers from the Arkansas Children’s Nutrition Center, working for the United States Department of Agriculture (USDA) Agricultural Research Service based in Arkansas (a major soy producer) would seem to have a vested interest in finding that soy formulas are not inferior to (i.e., no worse than) bovine milk formulas. Certainly they conducted, and are continuing, some extensive research into the question; their articles113 indicate that they found soy and bovine formula to have roughly comparable (if slightly different) effects.But along with groups of infants fed on soy- and cows’ milk formula, they included a partially breastfed control group, unlike some prominent industry researchers who argue that new formulas should only be compared with older formulas, not with breastmilk.114
113 Gilchrist JM, Moore MB, Andres A, Estroff JA, Badger TM. Ultrasonographic patterns of reproductive organs in infants fed soy formula: comparisons to infants fed breast milk and milk formula. J Pediatr. 2010Feb;156(2):215–20; Badger TM, Gilchrist JM, Pivik RT, Andres A et al. The health implications of soy infant formula. Am J Clin Nutr. 2009; 89 (5):1668S–1672S; Jing H, Gilchrist JM, et al. A longitudinal study of differences in electroencephalographic activity among breastfed, milk formula-fed, and soy formula-fed infants during the first year of life. Early Hum Dev. 2010 Feb;86(2):119–25
114 Transcripts of the November 18–19 2002 meeting of the USDA Food Advisory Committee on Infant Formula make enlightening reading. Go to http://www.fda.gov/ohrms/dockets/ac/cfsan02.htm to download these. One speaker stated that ‘if you want to study a new formula, you should study it in comparison with old formulas, and not with some group that we think might represent ideal growth.’ Another thought that ‘fifty years of formula experience … with reasonable [sic] good outcomes’ meant that comparison with breastfed infants was unnecessary. Do parents want reasonably good, or the best possible, outcomes?
I find their results deeply disturbing, even if the numbers in each group, and the reported outcome effects, are small. In fact, their articles could have been summarised as: ‘Both cows’-milk formulas and soy formulas are clearly inferior to breastmilk.’
These researchers began by asserting accurately that ‘The extent to which adequate nutrition from infant diets differentially influences developmental outcomes in healthy infants has not been determined.’115 In English: we don’t know yet how different types of formulas affect normal healthy babies. Note that well: after one hundred and fifty years –fifty of ‘modern’ whey-dominant formula – we still don’t know. Cognitive and reproductive development was never measured when formulas were being assessed for safety and efficacy in the past. Which makes it hard to know if nutrition is indeed ‘adequate’ except in the simplest terms of ‘enough nutrients to keep babies alive and gaining weight’.
Back to the Arkansas studies. In one, the researchers used ultrasound to assess thedevelopment of breast buds, uterus, ovaries, prostate, and testicular volumes in forty breastfed (BF), forty-one milk-fed (MF) and thirty-nine soy-fed (SF) four-month-old infants. And this study found that:
Among girls, there were no feeding group differences in breast bud or uterine volume. MFinfants had greater mean ovarian volume and greater numbers of ovarian cysts per ovary than did BF infants … [Among boys] there were no feeding group differences in prostate or breast bud volumes. Mean testicular volume did not differ between SF and MF boys, butboth formula-fed groups had lower testicular volumes than BF infants.116
I found that alarming. Differences in ovarian and testicular development evident at four months of age? What might be the effects by the time these children reach puberty, if they are being programmed already to develop differently? Do they reach puberty earlier than breastfed children? It is astonishing how many popular discussions117 of the reality of premature puberty omit any discussion of infant feeding as a likely influence, despite all that is now accepted about the programming effect of early nutrition, its effects on other bodily growth, and the higher prevalence and earlier onset of early puberty in those groups.
In fact, in America the age of onset of puberty has been dropping steadily through the bottle-feeding twentieth century. ‘Boys now reach puberty up to two years earlier than experts had believed,’ says the New York Times, reporting on a major study just released bythe American Academy of Pediatrics.118 That is two years earlier than the generally accepted age of eleven and a half years. Meanwhile, one in ten Caucasian-American girls and one in five African-American girls are now beginning breast development before the age of eight! 119
115 Gilchrist JM, et al., op. cit.
117 e.g., Christopher L. Girl, you’ll be a woman soon. The Saturday Age, Good Weekend magazine, September 7, 2013, pp.12–15.
118 Herman-Giddens ME, Steffes J, Harris D, Slora E, et al. Secondary sexual characteristics in boys: data from the pediatric research in office settings network. (PMID:23085608) Pediatrics 2012, 130(5):e1058–68.40
|eight! 119 (African-American communities have low breastfeeding rates.120) Is this linked to differences in early breast development associated with soy? 121 Early puberty increases cancer risk, and has been associated with depression.122 What might be the effects by the time these children are seeking to have their own children, perhaps thirty years on? Could this contribute to Western epidemics of infertility, polycystic ovary syndrome (PCOS) and low sperm counts? Does it contribute to the development of insufficient mammary gland tissue? Is it part of the reason for the rise in increasingly early and aggressive reproductive cancers? Are these Arkansas children – and their children – to be followed up for the next sixty years? You’d hope so. Did their parents even know the results for each child? What effect does that have on the family? What ongoing support is in place?
footnote123 [Figure 2-2-6 Declining age of puberty 1840–1980. © Wenda Trevathan is here in the book]
119 Steingraber, op. cit. p. xv.
120 AAP. Pediatric Nutrition Handbook 5th edition May 2012. p. 87; Currie D. Breastfeeding rates for black US women increase, but lag overall: Continuing disparity raises concerns. The Nation’s Health 2013; 43 (3): 1–20. http://thenationshealth.aphapublications.org/content/43/3/1.3.full?sid=fd5bf00f-a218-43b0-9490-a40921f3b011
121 Zung A, Glaser T, Kerem Z, Zadik Z. Breast development in the first 2 years of life: an association with soybased infant formulas. J Pediatr Gastroenterol Nutr. 2008; 46(2):191–5
122 Whittle S, Yücel M, Lorenzetti V, Byrne ML et al. Pituitary volume mediates the relationship between pubertal timing and depressive symptoms during adolescence. (PMID:22071452) Psychoneuroendocrinology 2012, 37(7):881–91.
123 Trevathan W. Ancient Bodies, Modern Lives. How Evolution has shaped women’s health. (OUP 2010) p. 24. Used with permission.
Any study of forty children is too small to enable population conclusions to be drawn.Perhaps it is true, as the soy researchers clearly believe, that we needn’t worry more about soy formulas than we should about bovine formula. In 2001 a study was published124 which also asserted that the outcomes of feeding soy and cows milk to infants in the period 1965–78 were similar in young adults, although there were some differences in menstrual bleeding and discomfort among those fed soy, which the (male) researchers thought of little importance. The adolescents involved might not agree. Because ‘Exposure to soy formula does not appear to lead to different general health or reproductive outcomes than exposure to cow milk formula’ the researchers felt that ‘our findings are reassuring about the safety of infant soy formula.’ This was yet another study with no exclusively breastfed controls. So because cows’ milk is safe, so is soy? Logical?
Only if you live in a society that depends on artificial feeding. That cows milk and soy outcomes may be similar means little, if both deviate from the biological norm! Both formulas lack GnRH (gonadotropin releasing hormone) made by the breast and fed in milk, and known to suppress ovarian function.125 I agree with these researchers that ‘the few positive findings [the differences in menstruation] should be explored in future studies,’ and suggest that they try to find a set of normal controls! For after all, bovine milk can contain significant amounts of more-bioactive oestrogen analogues derived from pasture and stock feed (which can include soy). Do the cows supplying milk for infant formula eat soy their stockfeed and supplements? Quite possibly.
Despite the similarities in outcomes, soy formula use is actively discouraged by paediatricians, on the basis of quite reasonable speculation about possible effects, while bovine milk formula remains under investigated and assumed to be safe, without such public speculation about likely, possible and known effects. These studies indicate such effects do exist, as much for bovine milk as for soy. The Australian National Health and Medical Research Council (NHMRC) 2013 Infant Feeding Guidelines are typical of the current medical consensus and double talk:
A number of concerns have been raised about soy-based infant formulas, on the basis of possible physiological effects of isoflavone compounds on the infant’s developing neuroendocrine system. [True. We can’t recommend them because we don’t want to be responsible for any harm.] There is no clear clinical or scientific evidence to support the position that these compounds are harmful [so if you’ve used them don’t worry] although no long-term studies have conclusively documented the product’s safety in infants.126 [So perhaps you shouldn’t use them.]
This is having one’s cake and eating it too, trying to keep everyone happy. Until the major companies move out of soy, the position will be ‘hazard unproven’. If and when industry
124 Strom BL, Schinnar R, Ziegler EE, Barnhart KT et al. Exposure to soy-based formula in infancy and endocrinological and reproductive outcomes in young adulthood. (PMID:11497534) JAMA 2001;286(7):807–14 DOI: 10.1001/jama.286.7.807
125 Angier N. Mother’s Milk Found to Be Potent Cocktail Of Hormones New York Times May 24, 1994. http://www.nytimes.com/1994/05/24/science/mother-s-milk-found-to-be-potent-cocktail-of-hormones.html
126 NHMRC. Infant Feeding Guidelines for Healthworkers. 2013. p.81.
does, which will be when some other cheap alternative has emerged, soy-based formula may be denounced as a bad idea, not to be discussed, a mistake like gluten in infant formula, or beef hearts, or peanut oil. But soy is still necessary at present, because many children react badly to bovine formula, so industry and US paediatricians127 won’t let it go just yet.
Australia’s NHMRC agrees:
It is appropriate to use soy infant formula in the management of galactosaemia. Its use may also be appropriate for infants who cannot consume dairy-based products for cultural or religious reasons.128
Oh, and has anyone seen long-term studies showing no proof of harm from bovine formula?
I’d say both soy and bovine rely on the same long-term ‘evidence’: ‘look at the survivors (not too closely, mind), they were fed brand X and they are all ‘normal’ in a society where reproductive dysfunction, allergy, heart disease, obesity and so on are normal.’
So far as I can see, and I have looked, there is as much (which is to say as little) evidence of the long-term safety of cows’ milk formulas as there is of soy, if one wears historical glasses. Without the Arkansas agricultural scientists’ defence of soy, we would not have evidence that by as young as four months some aspects of infant reproductive development are already affected by bovine milk formulas as well as soy. I look forward to the longterm studies on these children who by four months of age were deviating from the (poorly defined and not exclusively) breastfed norm of reproductive tissue development at that early age. Think about this in relation to the concept of programming, the fact that early small changes can set development off on a different path (see page 62).
The Arkansas scientists concluded:
Our data do not support major diet-related differences in reproductive organ size as measured by ultrasound in infants at age 4 months, although there is some evidence that ovarian development may be advanced in MF-fed infants and that testicular development may be slower in both MF and SF infants as compared with BF. There was no evidence that feeding SF exerts any estrogenic effects on reproductive organs studied.129 [Other possible effects and organs were not studied.]
To me, this is a classic example of putting the best gloss on bad news. Who decides what differences at four months of age are major and minor? Any change in reproductive development, including advanced ovarian and delayed testicular development, sounds pretty major to most parents. They might prefer to read a clearer conclusion, such as:
Both milk- and soy-formula-fed infants are already deviating slightly from the more normal reproductive development of partially breastfed infants by as young as four months of age, although at that age, in these forty children, the deviations were not considered
127 Cohen S. What to Feed Your Baby: cost-conscious nutrition for your infant. (Rowman and Littlefield 2013).Cohen makes it clear that questions of cost make soy indispensable in WIC programmes, through which almost half of America’s infant formula is distributed. Does this contribute to social inequity?
129 Gilchrist JM et al. op. cit.
major. However, there is some evidence that ovarian development may be advanced in MF-fed infants and that testicular development may be slower in both MF and SF infants as compared with partially BF infants, which would be of concern to parents, as any deviation from normal growth parameters can be progressive over time. We did not have data from a group of exclusively breastfed infants for comparison, hence we have not mapped normal reproductive growth rates. Further research over the lifespan must be a priority. Meanwhile breastfeeding should be encouraged for these as for many other reasons.
The precautionary principle always suggests that until we know for certain that formula is safe it should be used only when there is no better alternative. (But there always could be, if women’s milk was valued as it should be.)
One other thing struck me. The Arkansas soy researchers wrote that ‘there were no significant feeding group effects in anthropometric or body composition’. But there should have been such differences by four months,130 as breastfed infants typically grow along different parameters to babies fed infant formula. Breastfed babies are fatter at three months, and leaner at twelve months, than formula-fed ones. That’s why growth charts have been altered.131 And why industry has dropped the level of protein in formula lately. (See page 263.)
But no such effect was detected in these groups. Was the sample size too small to detect growth differences? Or was it the fact that none of these three groups was clearly defined? How much formula did the breastfed consume? Reading the study carefully, it is clear that the breastfed infants may have been comp-fed,changing gut flora and with it, growth. Only 23 per cent of infants in the soy-formula-fed group had actually been fed soy formula from birth; 45 per cent switched to soy feeding within four weeks, and 32 per cent between four and eight weeks. Only 54 per cent of the bovine-formula-fed were so from birth; 41 per cent switched from breastmilk to cows’ milk formula within four weeks, and 5 per cent switched between four and eight weeks. So many of those soy- and cow-milk-fed babies were breastfed as well as formula-fed, and the soyfed might have got some cows’ milk as well.132
What a muddle. It seems possible that all three groups included some infants who had been breastfed for a month (but none exclusively)! Perhaps growth differences would have shown up in properly defined groups.That in turn would raise the question of whether much greater differences in reproductive tissue (as well as growth) might have been evident had the control group been completely breastfed from birth and the formula-fed never breastfed, or the sample size larger. An
130 Gale C, Logan KM, Santhakumaran S, Parkinson JR, Hyde MJ, Modi N. Effect of breastfeeding compared with formula-feeding on infant body composition: a systematic review and meta-analysis. Am J Clin Nutr 2012; 95(3):656–9.
131 de Onis M. Update on the Implementation of the WHO Child Growth Standards. World Rev Nutr Diet 2013; 106:75–82. (PMID:23428684)
132 How many stopped breastfeeding because free formula was on offer, I wonder? Will they regret doing so?
optimist would hope that a larger sample might cause the differences to become nonsignificant, that perhaps these were an aberrant or atypical sample of susceptible infants. Working from basic science and first principles, I would say the opposite would be more likely: the differences would be greater. Perhaps even ‘major’. Pilot studies are underway,133 half a century after soy became a commonplace formula.
A larger study was funded, but without many other large, totally independent, studies involving exclusively breastfed infants as controls, we won’t know. Who will fund those studies? And if they’re not funded, do we assume formula is safe, or warn parents of the possible risks? Even the word ‘risk’ is inflammatory when linked with infant feeding. (But not with any other avoidable risk our babies face.134)
So is soy worse than cows’ milk?
At this stage of the debate, as with reproductive development, there seems to be little evidence that soy formula is uniquely worse than cows’ milk formula, just plenty of evidence that both are inferior to women’s milk. One expert US panel135 that examined this concluded that ‘there is minimal concern for adverse effects on development in infants who consume soy infant formula’. All the same, reading the full report on which this conclusion was based makes for great unease. As they say:
Infants fed soy infant formula are reported to consume as much as 6.2 mg/kg bw/day of total genistein, thus a 5 kg infant would consume ~30 mg/day of total genistein. Blood levels of total genistein in infants fed a soy infant formula diet can exceed those reported in young rats or mice treated with genistein during development at dose levels that produced adverse effects, i.e., early onset of sexual maturation, altered estrous cyclicity and decreased litter size.136
The Report of the National Toxicology Program (NTP) goes on to note that other oestrogen analogues can indeed be found in babies fed on cows’ milk formulas:
The finding of equol being more readily detected in infants fed a cow milk-based formula [compared with infants fed soy or breastmilk] is not unexpected given that cows can
133 Bernbaum JC, Umbach DM, Ragan NB, Ballard JL, Archer JI, Schmidt-Davis H, Rogan WJ. Pilot studies ofestrogen-related physical findings in infants. Environ Health Perspect. 2008 Mar;116(3):416–20.
134 Smith JP, Dunstone MD, Elliott-Rudde ME. ‘Voldemort’ And Health Professional Knowledge Of Breastfeeding– Do Journal Titles And Abstracts Accurately Convey Findings On Differential Health Outcomes For Formula Fed Infants? ACERH Working Paper Number 4 December 2008. Accessible online. acerh.edu.au/publications/ACERH_WP4.pdf See Appendix 2.
135 McCarver G, Bhatia J, Chambers C, Bernbaum JC, Umbach DM, Ragan NB, Ballard JL, Archer JI, Schmidt-Davis H, Rogan WJ. Pilot studies of estrogen-related physical findings in infants. Environ Health Perspect. 2008 Mar;116(3):416–20. Clarke R et al. NTP-CERHR expert panel report on the developmental toxicity of soy infant formula. (PMID:21948615) Birth Defects Research. Part B, Developmental and Reproductive Toxicology
2011, 92(5):421–68. Can be downloaded from http://ntp.niehs.nih.gov/ntp/ohat/genistein-soy/soyformula/Soy-report-final.pdf
136 NTP Brief on Soy Formula, Sept 16, 2010. p. 41. Available at: http://ntp.niehs.nih.gov/ntp/ohat/genistein-soy/ SoyFormulaUpdt/FinalNTPBriefSoyFormula_9_20_2010.pdf
produce equol from either the formononetin found in red clover or daidzein found in soy (King et al. 1998). 137
The stated reason why the National Toxicology Program’s official concern level is ‘minimal’is simply because no scientific evidence exists:
While these types of adverse effects have not been reported in humans during 60 years of soy infant formula usage, adequate studies of the reproductive system have also not been conducted on girls or women following use of soy infant formula during infancy. Thus, the data in humans are not sufficient to dismiss the possibility of subtle or long-term adverse health effects in these infants.138
Not sufficient indeed, especially in America, where (as we have seen) the age of puberty onset has been dropping, along with rising rates of uterine dysfunction and falling sperm counts, all in concert with babies exposed to both formula-feeding and petrochemical pollution. I strongly recommend, indeed urge, all my readers to buy a copy of Raising Elijah: protecting our children in an age of environmental crisis, by Sandra Steingraber.139 As she makes clear, small changes can be significant. I did not find it surprising that two of the NTP’s expert panel wanted to raise the level of stated risk above ‘minimal.’ Nor that with industry representation on the panel, they could not do so.
But, like concern about many other formula ingredients, the concern about soy is not what happens immediately, but what may be the results of such early tiny changes over a lifetime. There may be an association between being fed soy formula as a baby and prolonged more painful menstruation,140 for example, and uterine changes such as fibroids.141 I have not seen studies of endometriosis or PCOS that looked at early childhood feeding patterns, but would be interested to see if that recent plague is more common in those soy-exposed as children.
Soy researchers ask about infant brains
These same Arkansas scientists decided to ‘compare the effects of the major infant diets on the development of brain electrical activity’ during periods of quiet wakefulness at three, six, nine, and twelve months. Three groups of forty infants, who had been fed soy or cow formulas, or breastmilk, for six months, with other foods added after that, were studied.
Their conclusion opens up serious questions about the safety of all artificial feeding for neurological development:
The development of brain electrical activity during infancy differs between those who are breastfed compared with those fed either milk or soy formula, but is generally similar for formula-fed groups. These variations in EEG activity reflect diet-related influences on the development of brain structure
137 ibid p. 38.
138 ibid p. 41.
139 Steingraber S. op. cit.
140 Strom BL, Schinnar R, Ziegler EE, Barnhart KT et al. op. cit.
141 D’Aloisio AA, Baird DD, DeRoo LA, Sandler DP. Association of intrauterine and early-life exposures with diagnosis of uterine leiomyomata by 35 years of age in the sister study. Environ Health Perspect. 2010 Mar;118(3):375–81. Erratum in: Environ Health Perspect. 2010 Mar;118(3):380
and function that could put infants on different neurodevelopmental trajectories along which cognitive and brain function development will proceed.142
A remarkably brave and honest statement. Both soy and bovine formula make for different brain development. Yet when asked about this research, one of the leading authors replied by email, ‘I think parents who feed their children formulas, whether soy or milk, should not worry about any adverse effects.’143 Neat evasion of the question, even if I agree with him that there is little point in such families worrying about what cannot now be changed for their children!
But did anyone think they heard him saying ‘There is nothing to worry about, there are no adverse effects of soy formula.’? He didn’t. And the journalist didn’t press him to. Or ask if he’d feed it to his kids! Thus community ignorance of the impact of formulas on brain development is maintained.
Other researchers have pointed out that ‘The primary concern of the ACNC (Arkansas Children’s Nutrition Centre) would appear to have been the alleged health dangers arising from the isoflavone content of the soy protein isolate used in soy formula’ and then gone on to say that ‘in none of their reports to date has the ACNC acknowledged the potential problem associated with the [high] Manganese content of soy formula.’144
Should we be concerned, not about those already using formula, for whom we can do nothing, but about those yet to do so? The last trimester of pregnancy and the first two years of life are crucial for brain development. As Belfort et al summarised,
During that time, the brain develops rapidly through the processes of neurogenesis, axonal and dendritic growth, synaptogenesis, cell death, synaptic pruning, myelination, and gliogenesis. These developmental processes build on each other over time so that a small disruption in any of the processes may have wide and long-lasting effects on brain structure and function.145
There is ample evidence that breastfed babies’ brains develop differently from those of formula-fed babies, as we have already seen. These Arkansas researchers have themselves recently published a study146 showing that the brains of breastfed babies at three and six months respond differently to speech compared to the brains of formula-fed babies. (Again, this is despite feeding being defined in ways that would tend to minimise the visible effect.
142 Jing H, Gilchrist JM, et al. A longitudinal study of differences in electroencephalographic activity among breastfed, milk formula-fed, and soy formula-fed infants during the first year of life. Early Hum Dev. 2010 Feb;86(2):119–25.
143 Badger: see http://www.reuters.com/article/2012/06/01/us-babies-soy-formula-idUSBRE8501BZ20120601I agree that there is no point in parents worrying if already feeding soy. But other parents will choose soy needlessly if scientists make soothing noises whenever disturbing news is reported. Whoever suppresses truth is responsible for the consequences.
144 Schuck SEB, Emmerson N, Abdullah M, Crinella FM. Soy-based infant formula associated with increased risk for ADHD. In Preedy VR, Watson RR, Zibardi S (eds), op. cit. (Wageningen Academic Publishers 2014) p. 638
145 Belfort MB, Rifas-Shiman SL, Kleinman KP, Guthrie LB et al. Infant feeding and childhood cognition at ages 3 and 7 years: Effects of breastfeeding duration and exclusivity. (PMID:23896931) JAMA Pediatr 2013, 167(9):836–44.
146 Pivik RT, Andres A, Badger TM Effects of diet on early stage cortical perception and discrimination of syllables differing in voice-onset time: a longitudinal ERP study in 3 and 6-month-old infants. Brain and Language 2012, 120(1):27–41. DOI: 10.1016/j.bandl.2011.08.004
And despite the groups excluding all but healthy term infants, on whom the effects should be less than for preterm or sick infants.) The researchers concluded that ‘the observed processing differences among diet groups may indicate that infants are on unique diet-associated paths of neurodevelopment.’ Where do those paths lead? Another study has produced evidence that with soy formula there are effects on gender-role play in children at the age of forty-two months.147
Ongoing studies have shown other effects even in middle childhood.148 Autism researchers suggest a relationship between soy-based infant formulas, manganese neurotoxicity and symptoms of ADHD,149 while others are concerned about the impact of neurotoxins produced by gut bacteria which are not found in exclusively breastfed children (for more on autism see page 444). The different sleep patterns of breastfed and artificially fed infants150 will result in developmental differences. The legacy of lead solder in infant formula cans and water supplies may affect a new generation. The absence of breastmilk’s many hormones will certainly affect brain development. A huge range of differences between formulas could have differing effects on brain development. A finding that breastfeeding possibly ‘protects against’ the development of ADHD151 needs to be re-investigated to ascertain which formulas most commonly produce it, and why. Especially when researchers have concluded that
The most likely scenario is that infant ingestion of soy-based formula would not, in itself, precipitate full-blown (i.e., diagnosable) ADHD; however, the work reviewed here suggests that over-absorption of Mn could act to lower the threshold for the expression of ADHD symptoms in individuals who may be vulnerable, based on genetic and/or epigenetic influences.152
I could go on endlessly here, but the picture is clear: formula-fed kids are not going to develop as they would have if they had been breastfed.153 And no one can predict how important will be the deviation from the normal expression of their genome, whether major or minor. It seems to me that there is little reason to be over-optimistic about the outcomes, when the US Centers for Disease Control and Prevention (CDC) reports that
147 Adgent MA, Daniels JL, Edwards LJ, Siega-Riz AM, Rogan WJ. Early-life Soy Exposure and Gender-role Play Behavior in Children. Environ Health Perspect. 2011;119(12):1811–16.
148 Whitehouse AJ, Robinson M, Li J, Oddy WH. Duration of breast feeding and language ability in middle childhood. (PMID:21133968) Paediatric and Perinatal Epidemiology 2011, 25(1):44–52.
149 Crinella FM Does soy-based infant formula cause ADHD? Update and public policy considerations. (PMID:22449212) Expert Review of Neurotherapeutics 2012, 12(4):395–407.
150 A topic which is a book in itself: I suggest reading anything by Dr James McKenna or Dr Helen Ball. See bibliography.
151 Mimouni-Bloch A, Kachevanskaya A, Mimouni FB, Shuper A et al. Breastfeeding May Protect from Developing Attention-Deficit/Hyperactivity Disorder. (PMID:23560473) Breastfeed Med 2013; 8(2): DOI:10.1089/bfm.2012.0145. Available at http://online.liebertpub.com/doi/full/10.1089/bfm.2012.0145
152 Schuck SEB, Emmerson N, Abdullah M et al. Soy-based infant formula associated with increased risk for ADHD. In Preedy V, Watson RR, Zibadi S (eds), op. cit. (Wageningen Academic Publishers 2014) p. 639
153 Oddy WH, Li J, Robinson M, Whitehouse AJO. The Long-Term Effects of Breastfeeding on Development in Özdemir O (ed), Contemporary Pediatrics 2012. ISBN 978-953-51-0154-3 DOI: 10.5772/34422 Open access. Available at http://www.intechopen.com/books/contemporary-pediatrics/the-long-term-effects-ofbreastfeeding-on-development
between 13 and 20 per cent of US children ‘experience a mental disorder in a given year and an estimated $247 billion is spent each year on childhood mental disorders’.154
There has long been stiff resistance to the idea that formula affects children’s cerebral cognitive development, and reassurances that children develop within normal limits with maybe just a small advantage to the breastfed. Few people have questioned how much those ‘normal limits’ have been influenced by past formula feeding. But by 2012 the fact that infant formula reduces potential is accepted by those studying the question in any scientific way. Some of that information is reviewed later (see 2.7.6) To cite just one source: the UK Millennium Cohort has produced a number of studies confirming that breastfeeding is associated with improved cognitive development, particularly in children born preterm;155 that longer duration of breastfeeding, at all or exclusively, is associated with better educational achievement at age five;156 and that longer duration of breastfeeding is associated with fewer parent-rated behavioural problems in children aged five years.157 That’s in a country where only 1 per cent of infants are solely breastfed to 6 months of age.
Despite the dearth or total lack of exclusively breastfed babies in most studies reviewed, and the failure to compare them with exclusively formula-fed babies, there is clearly an effect on brain development (which of course affects everything else). We simply don’t know how big the effect is. Nor do we understand all the influences and mechanisms involved. END of excerpt, p.48 For more information go to http://infantfeedingmatters.com
THERE IS MUCH MORE ABOUT ALL THESE ISSUES ELSEWHERE IN THE BOOK. IF YOU CAN’T AFFORD THE QUALITY HARDBACK, RETAILING AT NEAR COST PRICE, YOU CAN CERTAINLY AFFORD THE E-BOOKS THAT MAKE UP THE HARDBACK.
IF YOU ARE A RESEARCHER OR A HEALTH PROFESSIONAL YOU SIMPLY CANNOT AFFORD TO BE IGNORANT OF WHAT THIS BOOK CONTAINS. INFANT FORMULA LITIGATION MAY WELL DWARF THE TOBACCO WARS IN COMING DECADES.
AND IF YOU SUFFER FROM ALLERGIES, ARE PLANNING TO HAVE A CHILD, OR ALREADY HAVE A MISERABLE BABY OR CHILD, PLEASE READ AT LEAST THE SMALLER SECOND E-BOOK, CALLED CRYING BABIES AND FOOD IN THE EARLY YEARS.