Creating a ‘perfect’ breastmilk substitute: reality and myths.

Foreword by Katherine A Dettwyler


Chapter 3: Infant formula, past, present and future.

3.1 Background to a nutrition revolution.
The ‘infant formula’ story begins

3.2 Making cows’ milk safe enough to use industrially.
Concentrating and preserving milk
Drying and powdering milk
‘Clean’ milk and official support for ersatz substitutes
Changes in infant feeding equipment and technology

3.3 Scaling up production propaganda for the ‘perfect’ substitute.
How did artificial feeding come to be accepted?
How war helped artificial feeding
Mathematics and paediatrics
‘Experts’ undermine breastfeeding
Women’s changing roles
Not so perfect?
Built-in obstacles to breastfeeding: healthworkers as formula advocates

3.4 Going global: perfecting formula feeding 1950s-1980s.
What type of formula where?
The decline of breastfeeding, and the growth of popular marketing
Emerging allergy
Humanising the industrial product: the power of language
Co-option, co-operation, corruption and copping out: capturing healthcare
Expanding choices and consequences: liquid or powder, when, where?
Invisible risk

3.5 Basic ingredients: Protein.
Problems and potential
Curds and whey
From pig-swill to infant formula!
Whey to go: how it is processed
How much protein is too much?
Protein quality issues
What caseins?
Potential consequences of excess caseins
FIF or FOF? Whey, casein, follow-on formulas and complicated choices
What does all this mean for protein intakes from FIFs?
Why higher protein for Follow On Formulas anyway?
Specific protein changes: cysteine, taurine, carnitine…
Processing effects on proteins
Individual whey proteins
Protein degradation products: another concern?
Bad reactions: protein and allergy
Partially or extensively hydrolysed protein in formula?
Growing babies or Michelin men?
Overall dietary protein intake per day
Protein in the twenty-first century
Milking mothers for human protein
Soy protein based infant formulas and their problems
Soy protein formula and other oestrogen mimics
Other proteins and infant formula: make your own?
But wait, there’s more: milk protein in mothers’ diets before and after birth

3.6 Basic Ingredients: Formula fats and fictions.
Animal or vegetable fats for formula?
Swallowing cholesterol
Impacts of processing fats
A fishy tale of fungi and algae and eggs
Gold from oil: Martek’s miracle
Structured oils as sources of LCPUFAs
The USA goes for Gold (fats in formula)
Peanut oil and allergy
Contaminants and GE foods in fats and oils
Genetic engineering and pesticide residues in oils
Tropical oils: not GM, but allergenic
Fat blends and brain problems
What will we ever know about fats in formula?

3.7 Basic ingredients: Carbohydrates including FODMAPs.
Early formula carbohydrates
Sucrose scares
Corny solutions
Lactose intolerance
Carbohydrates feeding bowel bugs
An internal brewery? What food for bugs?
Conclusions about carbohydrates?

3.8 Additives – intended and unintended.
Metals in milk: iron
Ups and downs: selenium, chromium, molybdenum as examples
For better or worse

3.9 Unavoidable contaminants.
Metals in milk: lead
Metals in milk: copper
Metals in milk: aluminium, manganese
What water can add
Radiation by-products
Chemical pollution of breastmilk and formula
Stock feed and contamination
Stock feeds and allergy?
Microbial contamination of formula products
Controlling contamination
Progress in reducing bacterial risks at last
Who really knows what baby is getting to drink?
So what can parents really see when a baby is bottle-fed?

3.10 The drive to regulation: health and trade concerns.
The growth of knowledge about infant feeding
Improving infant formula
Decreasing renal solute load and hypernatraemia
UK Guidelines
Towards US regulation
The Syntex disaster and the Infant Formula Act of 1980
Regulation or self-regulation?
The role of a regulatory agency
UK developments
Codex and Standards
The International Code
Setting compositional standards
Enforcement and inspection

3.11 The 1980s: bettering breastmilk.
‘Fortifying’ breastmilk
What’s in a name?
Impacts on research of formula exposure of breastfed children
The NEC epidemic: ‘a disease of medical progress’?
The allergy plague emerges
Mental functioning and allergy
Industry and Allergy
Viral disease and breastfeeding: HIV
The first reported cases of breastmilk transmission of HIV
Response to the first cases
Learning from past mistakes
Current WHO recommendation
What choices in 2015?
Help or hindrance
Viral disease and breastfeeding: HTLV-
The take home message about HTLV
Modernity and prudery

3.12 Making or marketing immunity?
Baby biotics
Benefits to industry
Addition and subtraction: improving infant formulas or profits?
Would organic formula be better?

3.13 Selling the stuff, or marketing matters.
The infant feeding culture
Of course breast is best…
Consequences for poor families everywhere
Growing the world market
Marketing new products, and evading the International Code?
So what is infant formula? Australia, NZ, America and the Code
Decline of an old marketing strategy?
Targeted marketing: formulas for supplementation of breastfed babies

3.14 Genetic engineering and infant formula: inevitable?
Genetically engineered ingredients
Genetic engineering of new ingredients
Animals as manufacturing sites
Finding a lactoferrin factory
Plants and microbes as factories
Of rice and men and mining
How pure is pure?
Concerns about recombinant additives to formula
Recombinant growth hormone and infant formula
The impossible dream: avoiding GM and GE

3.15 Infant formula in the twenty-first century.
Measuring formula realities and processing effects
So new additives for infant formula?
Different formula stages under six months?
The use of nanotechnology

3.16 Is matching breastmilk possible or necessary?


[Contents of Book Three]

[Back to Milk Matters: the book]