This is a guest post by Laura Creek Newman, RD, critically examining health claims about infant formula made by Meghan Telpner, "Nutritionista", in her recent article What's Lurking In That Baby Formula? This article is cross-posted from the Winnipeg Skeptics blog.
I am going to preface this with my background. I am a registered dietitian practicing for four years, largely in all areas of adult health. I am not an infant feeding expert, though I have recently been working in pediatrics and did have significant and evidence-based training in the area through my schooling and internship. I am also a mom of a 17-month-old; a mom who breastfed exclusively for six month and continued past a year. I am also a mom who had trouble breastfeeding and could not pump enough to bottle feed once I went back to work. I'm a mom who used formula. From my training and my own experiences feeding my daughter I do not belong to any particular camp: I believe breast is great when you can, but ultimately a baby needs to eat and baby formulas are the next best thing.
First off, I want to clarify something: genetically modified organisms (or GMOs) are everywhere. They are the bread we buy, the animals we eat, the vegetables I planted in my garden.
All of them. No, I don't work for Monsanto. Pretty much every food crop humans have cultivated since humans learned to cultivate crops is genetically modified. This is due to selective breeding at the hands of skilled farmers or gardeners who cross-bred different plants or animals to create new varieties. They breed together organisms that have the same desirable characteristics for many generations until they reliably get a new strain of that organism. For example, say you have red petunias and white petunias, but you want pink. One would breed the red and white together; if some flowers come out pink, you would take those and breed them together, but you wouldn't breed them with the flowers that turned out white or red. Over time, one will get more and more pink flowers until they're all pink. And voila! You've created a new strain of pink petunia. You can thank these millennia-old techniques for helping produce strawberries, bananas, and the dozens of varieties of peppers and heirloom tomatoes we happily devour today. Our rapid technological advances in the last half century, particularly decoding the genomes of many organisms, have allowed us to speed up this process by picking out and only planting seeds that carry the desired genetic traits while leaving the rest. We have also been able to modify some of the traits in the lab to improve disease resistance, remove toxic substances, and improve the nutritional profile of foods. It is this latter part that has some people scared of "frankenfoods". Would these plants "naturally" have genes that make them super-resistant to drought, for example? Perhaps not. The important question to ask is: does this change in the genetic structure make the food unsafe? (The answer is no).
This article gives a good overview of the subject. Whether you choose "organic" or not, your food definitely has been genetically modified somewhere through its history before arriving on your plate.
This brings me back to the article at hand. It is listed under the category "healthwashing" on the website. The author posits that most of the ingredients in conventional baby formulas, even many organic baby formulas, are unhealthy, thus making these products unfit for baby. While formula companies have used (and may still use) unethical marketing practices, this does not comment on the safety of their products. Infant formulas are some of the most heavily regulated and monitored food products (
source,
source) in the United States (similarly in Canada). There are several erroneous and potentially harmful comments made in this article and I would like to address them.
Human breast milk is our best way to understand an infant's nutritional needs. Breast milk contains about 42% carbohydrate as lactose (milk sugar), 50% fat (as a mixture of fatty acids, mainly palmitic acid), and about 7% protein with 67 kcal/100 mL (source:
Krause's Food, Nutrition, and Diet Therapy 11th Edition, Mahan, L.K. & Escott-Stump, S., 2004, 8:221). From this, we assume that this is what infants require to grow properly, so infant formulas are designed to mimic as closely as possible this nutrient profile. In contrast, cow's milk contains 30% carbohydrate, 50% fat, and 20% protein, and also has 67 kcal/100 mL (
ibid.); soy milk contains 21% carbohydrates, 44% fat, and 35% protein with 33 kcal/100 mL (
source). Cow's milk is chosen as the primary base for infant formulas due to its similar nutrient and caloric profile to human milk. However, it requires processing and additional ingredients (particularly carbohydrates, vitamins, and minerals) to make it safe and appropriate for human babies.
The author first highlights an ingredient list for a soy-based formula from Similac: the author notes the first ingredient is corn syrup solids, the second is "genetically modified protein".
This infant formula contains 42.6% corn syrup solids, followed by genetically modified protein. You wouldn't eat that. If you can choose another option, choose another option!
It is unclear if the protein is in fact genetically modified, but as demonstrated above, this is likely not a safety issue. Soy protein isolate is protein extracted from soy meal that is 90% pure: this means that it is at least 90% soy protein with very little fat and carbohydrate. Infants do not require as much protein as adults and too much can be detrimental, so formula manufacturers use this product to most accurately control the proportion of protein in the final product. As for corn syrup solids, they "are defined by the FDA as dried glucose syrup (in which the reducing sugar content is 20 DE or higher. Corn syrup solids are generally recognized as safe (GRAS) as direct human food ingredients at levels consistent with current good manufacturing practices (21 CFR 184.1865)." (
Source.) In essence, it is dehydrated corn syrup where the sugars are glucose and short glucose chains. It has a relatively low sweetness level compared to sucrose (corn syrup solids: 23–28, sucrose: 100). By comparison, lactose (milk sugar) has a sweetness level of about 16 (
source), so corn syrup solids are slightly sweeter but comparable. Some type of sugar (short molecules) is needed for the carbohydrate source as it is harder for babies to digest starches (large molecules) and they get the energy too slowly, which can slow down their growth. As this example is of a soy-based formula, the manufacturer has to use a plant-based carbohydrate instead of lactose to make it appropriate for babies with lactose intolerance, galactosemia, and vegan/vegetarian babies
*. As for the author's comment "you wouldn't eat that", well, the reader probably wouldn't eat/drink many things that an infant would, including
any infant formula or breast milk. What one adult may or may not eat or find appealing is entirely subjective and not a useful commentary on infant nutritional products.
The second formula discussed by the author is Nestle Good Start, a standard infant formula and industry leader. The comments are as follows:
Partially hydrolized whey protein: Whey protein comes from cow's milk, which is one of the most common food allergies in children. Allergic reactions can include diarrhea, hives and swelling of the lips.
See above for why cow's milk is used as the base for most infant formula. It is true that it is the most common allergen among children, however, it is also one of the most likely allergies to be outgrown by the child's fifth birthday, unlike peanuts, tree nuts, and shellfish, which also make the list.
Corn maltodextrin: Corn maltodextrin is a food additive often found in snack foods like chips and crackers. Given that 80% of corn grown in Canada is genetically modified, it's safe to assume that this cheap food additive comes from GMO corn and not the organic kind. It's also a sweetener.
See above for the issues around GMO foods; there is no evidence to show that GMO-derived ingredients are hazardous to health. Organic maltodextrins are also available. Maltodextrins are short-to-medium starch molecules (up to 20 glucose molecules per chain) made by a similar process to corn syrup solids (
source,
source). The sweetness varies from no sweetness to mildly sweet; the relative sweetness factor ranges from 6–21 (recall that
the sweetness of lactose is 16). For this reason, maltodextrins are not primarily sweeteners and may not impart any sweet taste to a food at all. The primary characteristics of maltodextrins are: high solubility, easy and rapid digestibility (high glycemic index), low sweetness, provision of smooth and full texture to foods (
source,
source). The author is correct that this ingredient is heavily used in many processed foods, particularly in the "snack foods and beverages" category. She is also correct that this is a "cheap" (inexpensive) ingredient. However, as the skeptics' mantra states: correlation does not equal causation; the presence of this ingredient in a snack food does not demonize that single ingredient. In the same vein, if water, bananas, or organic rolled oats appear as ingredients in a "junk" food, it does not mean that any of those things are inherently bad or unhealthy. Maltodextrins have found their way into baby formula for several reasons. First, they are inexpensive, and it would be naïve to deny that food manufacturing companies are not continuously looking for lower cost ingredients. Second, and most importantly, the aforementioned characteristics of these starches are very desirable for a baby formula. Their high solubility means that powdered formula will dissolve easily and fully without lumps; this makes it easier and tastier for a baby to drink. The fast and easy digestion is easier on a baby's developing intestines than regular starches and gives baby the quick energy he or she needs. The low sweetness factor makes the formula taste more like breast milk and helps avoid getting babies hooked on the really sweet flavour that comes from other sweeteners like honey, maltose, and sugar.
Soybean oil: Soybean oil is cheap, which means it's found in virtually all processed foods. Like corn, unless otherwise noted, it most likely comes from GMO sources. It's a highly unstable oil, so food manufacturers partially hydrogenate it to raise the melting point and stabilize it so it won't turn rancid. The result? An altered chemical structure and, in many cases, trans fats.
Again, see above for safety concerns around GMO foods. The author is correct again in noting that, like corn and corn-based ingredients, soy is an inexpensive ingredient, and likely the cheapest source of fat available (partially due to
high subsidies to producers). Historically, soybean oil was hydrogenated to make it more stable, and this had the negative side effect of increasing trans-fats (which are known to
increase LDL cholesterol, decrease HDL cholesterol, and increase risk for cardiovascular disease). Since label reporting of trans-fats in foods and ingredients became mandatory in 2006, food producers have generally moved to breeding low linolenic acid varieties of soy that produce a more stable oil without hydrogenation (
source,
source). Further to this, hydrogenated oils are not allowed to be used in infant formulas 14. Similarly to breast milk, infant formula does contain a small amount of trans-fat (around 2–3%;
source,
source) but a large portion of this is naturally occurring from cow's milk (gut microbes in cows produce a small amount of trans-fat during digestion that is passed on to cow's milk). Thus, it is unlikely that infant formulas contain much, if any, commercially hydrogenated trans-fats.
Palm olein: Research has shown that babies can't properly digest palm oil — in fact, it reacts with calcium, causing the formation of "soaps" in the baby's intestines, leading to hard stools and lowered bone mass.
Palm olein is a fat that is high in palmitic acid as well as a source of oleic acid (
source). It is often used to mimic the fat profile of human milk, of which the primary fat is also palmitic acid. Here the author's concerns regarding the addition of palm-based fats to infant formulas are not entirely unfounded. There is some controversy over the use of this ingredient as several published studies (
source,
source,
source) have demonstrated lower fat absorption and lower bone mineral density in infants up to 6 months of age who are fed palm olein-containing formula compared to peers not fed this formula. On the flip side, several other studies note that these differences are still within normal range for normal term infants (
source,
source) and that these differences likely do not persist once infants start solids and/or become toddlers (
source),
source). In a nutshell, some differences may exist, but they do not appear to affect a child's long-term bone mass.
High oleic safflower oil or high oleic sunflower oil: Safflower/sunflower oils are extremely common in packaged foods (read: cheap) are very high in pro-inflammatory omega-6 fatty acids. If these oils are harmful for adults, why would we feed them to babies just after birth?
Similarly to palm olein, high oleic sunflower/safflower oils are added to formula to provide oleic acid, a mono-unsaturated fatty acid present in human milk. Standard versions of these oils are high in omega-6 fatty acids which can be pro-inflammatory and may have an impact on health (though this is generally in context of inadequate omega-3 fatty acid intake, combined with excessive calorie consumption, etc). The high oleic versions are actually quite low in omega-6 fatty acids; 100 mL of standard oil contains 65.7 g poly-unsaturated fat (mostly omega-6), while the high oleic version contains 3.8 g poly-unsaturates per 100 mL (
source). The author's argument here is void. Finally, I would like to return to my much earlier statement that there are
many things that adults would not care to ingest, but that does not
necessarily make them unsafe for infants.
Choosing the right milk/formula for one's infant can be stressful and challenging as all parents, including myself, want to do right by our kids and give them the best possible start to life. I do believe that breast milk is fantastic and should be treated as the first choice; I applaud people who go to great lengths to try to give their infants breast milk (through lactation consultants, medications, or milk donors) but these options can be stressful, terribly time consuming, and often expensive, and milk donors are frequently unavailable in most parts of the country. Given this, there are so many reasons why parents may need and/or want to use formula. When it comes to making decisions about infant nutrition, make sure you are consulting qualified sources, including registered dietitians practicing in the area of pediatrics, pediatricians, and infant feeding experts (hint: look for an MD, RD, RN and/or PhD behind the person's name; if it's not there, be wary). Infant nutrition is a totally different ball-game from adult nutrition so you want to make sure your sources are truly informed in this area; please exercise caution when taking advice from articles like the one I have referenced.
The infant formulas available today in Canada are
safe and proven to produce healthy babies. There is no "healthwashing" about it, and do not let an unqualified person convince you otherwise.
* It should be noted that in cases of cow's milk protein allergy, soy formulas are not recommended as a standard formula replacement due to the high rate of soy allergy among cow's milk allergic children. Instead, extensively hydrolyzed cow's milk formulas (where the protein is highly broken down to the point where it no longer produces allergy symptoms) are recommended.
Sources:
- http://www.popsci.com/article/science/core-truths-10-common-gmo-claims-debunked
- http://www.fda.gov/AboutFDA/Transparency/Basics/ucm336546.htm
- http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048694.htm
- Krause's Food, Nutrition, and Diet Therapy 11th Edition, Mahan, L.K. & Escott-Stump, S., 2004, 8:221
- http://en.wikipedia.org/wiki/Soy_milk#Health_and_nutrition
- http://www.grainprocessing.com/food/maltodextrins-corn-syrup-solids.html
- http://owlsoft.com/pdf_docs/WhitePaper/Rel_Sweet.pdf
- http://www.althealth.co.uk/help-and-advice/nutrition/maltodextrin/
- http://en.wikipedia.org/wiki/Maltodextrin
- http://en.wikipedia.org/wiki/Agricultural_subsidy#United_States
- http://en.wikipedia.org/wiki/Trans_fat#Health_risks
- http://extension.agron.iastate.edu/soybean/uses_lowlinsoy.htm
- http://en.wikipedia.org/wiki/Soybean_oil
- http://www.codexalimentarius.org/input/download/standards/288/CXS_072e.pdf
- http://www.issfal.org/statements/pufa-recommendations/statement-2
- http://www.ncbi.nlm.nih.gov/pubmed/16582027
- http://www.ncbi.nlm.nih.gov/pubmed/12728082
- http://www.ncbi.nlm.nih.gov/pubmed/9710840
- http://www.ncbi.nlm.nih.gov/pubmed/15342879
- http://pediatrics.aappublications.org/content/106/6/1355.abstract
- http://www.ncbi.nlm.nih.gov/pubmed/15990636
- http://en.wikipedia.org/wiki/Sunflower_oil
