Breastfeeding is not an option for you…Now what?

Answers for mom's who want to but can't breastfeed.

There is no question that breastmilk is the best choice for babies and there is no supplement that comes even close. However, some new mothers have unexpected life situations that make breastfeeding impossible. So what are some of the issues surrounding formula to be aware of in order to make a decision on which one to choose?

Some of the issues to look at with commercial brands include allergenicity, iron, DHA, going organic, and convenience. The homemade formulas, while not advocated by the FDA, may be preferable in some instances. This will be briefly looked at further on in this article. If after reading this article you feel that a custom formula is what will best suit your child, please talk with us about creating a safe and effect formula (www.springseternal.com).

Commercial Brand Issues:

Allergenicity – This may or may not be a concern for you, but in some cases, infants can be allergic to cow’s milk proteins in dairy-based formulas, and some infants may react to the soy in soy-based formulas.

In some families, there is a lot of atopic disease, which means that there is an issue with allergy, eczema, or asthma or other allergic hypersensitivity. This can increase the risk of infants developing similar issues. If one parent has atopic disease, there is a 37% chance that infant will develop it. If both parents have atopy, then the infant has 62-85% chance depending on the parents’ clinical pictures (Chandra, 2000). In susceptible families early exposure to cow’s milk proteins can also increase the risk of the infant or child developing diabetes mellitus (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992).

If you are adopting, you might see how the child was doing on the formula they were receiving already. Ask if they are thriving on what kind of formula, and if there are issues with digestion, rashes, constipation, loose stools, excess gas or pain, vomiting, and ask about their general immune health.

Hypoallergenic formulas like Alimentum or Nutramigen might be your first choice either if allergenicity is a chief concern or if baby is not thriving. They are also called hydrolyzed or elemental formulas, because they have been pre-digested and therefore less allergenic.

If your infant reacts to the hypoallergenic formulas, your last options would be to consider soy formulas or homemade formulas. Soy formula is the least popular option because it has phytoestrogens (affecting hormones) and goitrogens (affecting the thyroid). However, soy formulas might be your choice if you are uncomfortable with the homemade formulas or you find them impossibly inconvenient.

Iron and DHA - There are iron-fortified formulas and low-iron formulas. The low-iron fortified formulas do not have enough iron according to the FDA, but they were made available to babies that seemed to do poorly with constipation, diarrhea or colic. If your child does better on low-iron fortified formulas, make sure you are informing your physician and ask about monitoring for iron status. DHA/ARA (docosahexaenoic acid/ arachidonic acid) formulas are also somewhat conflicting in terms of benefits. DHA/ARA and other long-chain polyunsaturated fatty acids (LC-PUFA’s) are healthy fats. It does seem clear that DHA is beneficial. However, the real question is whether the source of DHA is as absorbed and as beneficial as human breastmilk DHA. Martek Biosciences Corp. manufactures DHA and ARA from a novel source of algae and soil fungus. “The oil is then separated from the dried biomass by hexane extraction and centrifugation and/or filtration, followed by winterization. The hexane phase undergoes additional centrifugation/filtration to remove solids then the winterized oil is heated and treated with acid. Subsequently, the oil is treated with caustic, centrifuged, bleached and deodorized.” Sam Zeller, Ph.D. - Martek Biosciences Corporation, Food & Drug Administration Agency Response Letter, GRAS Notice No. GRN 000137

The processing appears extremely artificial and some infants do not absorb this source of fat, developing oily stools and diarrhea. Earth’s Best has been trying to deal with the fishy smell that is causing some babies to refuse the formula with this DHA/ARA source in it. On the other hand, some clinical studies seem to support their benefit. A consideration is to choose an organic brand that does not use DHA/ARA sourced from algae and fungus, such as Baby’s Only Organic formula (by Nature’s One), marketed as a toddler formula to encourage breastfeeding, but is indeed an infant formula. Fish oil is not used in infant formula because preterm infants supplemented with fish oil weigh less or had lower weight for length during their first year of life compared to infants given a formula without the fish oil (Carlson 1992).

Organic formulas – this makes sense in order to avoid the hormones, pesticides, and steroids that might be found in non-organic formulas. Although there are not many brands yet available in Canada more labels are continuing to appear on shelves. Options are definitely on the rise. You can also buy online (babyorganic.com is one source).

A nutritional comparison chart is available online at:
www.naturesone.com

The highest amount of sugar is found in Similac Organic. PBM Nutritionals makes President’s Choice brand (available in Canada), Parent’s Choice, and Bright Beginnings, so all have similar formulations. As stated earlier, The Baby’s Only Organic is the only brand whose DHA/ARA is not manufactured by Martek Biosciences Corporation.

Homemade formula concerns:
The chief concerns of homemade formulas are the renal solute issue and the lack of regulation. However, having had patients whose infants react very strongly to all commercial brands, homemade formulas have been a viable option. If deciding to go with a homemade formula, you might want to have some the following considerations.

Infections – many homemade formulas are based on raw milk. Raw milk is not pasteurized and in many ways this is a benefit. You still have many of the live enzymes that make raw milk beneficial. However, you do still take the risk of tainted milk from infectious organisms. While this doesn’t rule out raw milk necessarily, you might really consider visiting the farm or researching the health and the care of the animals from which you source the milk.

Nutrient level requirements – another concern with some homemade formulas is the lack of complete nutrient level requirements. The FDA specifications, while not perfect, are still a standard, and they state that all the formulas require the following (and in some, require a maximum dose): protein, fat, linoleic acid, vitamins A, D, E, K, C, B1, B2, B6, B12, niacin, folic acid, pantothenic acid, calcium, phosphorus, magnesium, iron, zinc, manganese, copper, iodine, sodium, potassium, chloride, and if not including cow’s milk must also contain biotin, choline and inositol. Have a look at your recipe and ensure that it contains all of the necessary requirements.

Renal solute issue – straight cow’s milk or goat’s milk has a high salt or electrolyte content that can damage infants’ kidneys. If it is not being diluted, it is not a good recipe.

How to find a homemade formula – there are many complex issues when trying to optimize a homemade formula for your child’s needs and it is best to have the guidance of a professional. Seek out the advice of a Naturopathic Doctor who specializes in pediatric care or another professional who is aware of the issues mentioned above.

To summarize, organic formulas are the best bet, with the hypoallergenic formulas a consideration in the case of allergy. If your infant reacts to these formulas, consider soy or a homemade recipe. Contact us if you have questions or need advice on homemade formulas.
Dr Nari Pidutti
Springs Eternal Natural Health Clinic
604.737.0012
www.springseternal.com

References:

Chandra RK. Food allergy and nutrition in early life: implications for later health. Proc Nutr Soc
2000; 59:273-277

Mayer EJ, Hamman RF, Gay EC, et al. Reduced risk of IDDM among breastfed children. The
Colorado IDDM Registry. Diabetes 1988; 37:1625-1632

Karjalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of
insulin-dependent diabetes mellitus. N Engl J Med 1992; 327:302-307

Carlson, SE, Cooke, RJ, Werkman, SH et al. “First year growth of preterm infants fed standard compared to marine oil n-3 supplemented formula.” Lipids. 1992; 27:901-907