Over the years, many sad stories, but were there happy endings? I often wonder about outcomes long term. One in particular. Were you the midwife who attended both my infant feeding and allergy and IBLCE exam prep workshops with your newborn baby more than 20 years ago? Workshops were held in Armadale around three weeks apart, and in the first your baby was so unsettled that I ended up teaching with baby upright in the sling, so that you and everyone else could concentrate. Afterwards I asked if there was a history of milk allergy in the family. (Your baby’s distended tummy and behaviour was so characteristic of the exclusively breastfed baby with gut distress that I associate with neonatal cows milk exposure.) And you told me that your baby could not have been exposed, after discussion about the family history of allergy, your paediatrician prolonged parenteral nutrition rather than expose your baby to cows milk formula. Baby had been preterm, and needed more than your milk. So I asked if any fortifier had been given. You replied that he had made sure that they “only used the human milk fortifier.” Which of course was nothing more than cow’s milk and a few minerals. You were shocked and appalled to hear that. When I said that for baby to settle, you would need to avoid every trace of milk in your diet, you agreed to try. Three weeks later you brought back a very different baby, who slept peacefully beside you when not being breastfed. I would really like to hear how life has worked out.
Why? This was a clear case of the Mead Johnson so-called “human milk fortifier“ label misleading not only the mother but a paediatrician. (I commend the Nestle decision not to use that misleading title, but to label their hydrolysed additive simply FM22.)
I write this now because the global breastfeeding movement (hear me WABA? BAA? USBC?) needs to stop the misleading label of “human milk” this or that being wrongly applied. Talk of “human milk oligosaccharides” (HMOs) going into infant formula is just lies. Human milk oligosaccharides exist nowhere other than in human milk, where there are perhaps 200 different ones, all interactive.
Structurally identical analogues of just two of these 200 HMOs are being made by genetically modified organisms on a industrial scale, for addition to infant formula. These industrial microbial products are NOT human milk oligosaccharides. They are synthetic, genetically-modified microbial, analogues of HMOs that will carry traces of their industrial production, traces that are not present in women’s milk. And note that the organisms will have been genetically modified to produce the sugars – which is what oligosaccharides are, after all. At a stretch, because all definitions are elastic, these GMMOs (genetically-modified-microbial oligosaccharides) could be called nature-identical oligosaccharides. But we have no idea what choosing two of 200 does to their biological function in the child consuming them in a very different cow’s milk mix. Some studies suggest they may be of some slight benefit. Others show little or none. The fact that in breast milk, a very different mixture, these are important antimicrobial agents does not mean that synthetic analogues are proven beneficial for formula-fed infants. Any company making that claim needs to prove beyond doubt that the extra cost these will add to formula is justified.
Personally, I suspect that this is a repeat of the nucleotide story. Industry scientists NOW accept that the addition of nucleotides to infant formula was never necessary, and conferred no new benefit to the infant. It did however increase the cost of formula, and was used to claim – or at least cleverly imply – that formula now had the immune benefits of breastmilk. Many of the parents who believe that there is little or no difference between breastmilk and formula were convinced by that misleading advertising of nucleotides.
And again, it was US companies which led the misleading advertising campaigns. (read all about it in Milk Matters.)
Scientists and researchers need to be scientific – precise, accurate – in how they talk about oligosaccharides. There are human milk oligosaccharides, and there are synthetic analogues produced by genetically modified organisms: the latter are microbial or synthetic oligosaccharides. Regulators need to insist on clarity. Using the value of oligosaccharides in womens’ milk to undermine breastfeeding (by implying that these important ingredients can now be found in infant formula) is both false and misleading under any common sense interpretation of marketing regulations. What 200 oligosaccharides do in the breastfed baby is not what two synthetic analogues can or may do in formula-fed babies. There may be benefits, but these need to be proved in entirely formula-fed populations, not – as is usual – in infants previously breastfed before enrolment in the study. For all we know there may also be risks, stemming not only from the action of the oligosaccharides in vivo, but also from failures in manufacturing and purifying the extracted product.
I don’t know enough about the manufacturing process to speculate on that further. But I do hope that regulatory authorities adopt a more critical approach to the marketing of oligosaccharides than they ever have to the marketing of the so-called “fortifiers” for human milk, which I think of as contaminants, for adulterants, or perhaps more neutrally, additives. The very term “fortifier” is an unjustified slur on women’s milk – which does not need strengthening. It is not an accurate term, but a marketing claim that undermines women’s confidence in their milk. it should be eliminated from the nutrtion lexicon. Or so I think! What has been your experience? Tell us on Facebook.