What Do The Ingredients In Baby Formula Actually Mean For Infant Health?

IRA FLATOW: Now I’m going to read you a list of ingredients on a package. Whey protein concentrate, corn syrup, vegetable oils, lactose, corn maltodextrin, safflower oil, milk protein isolate. I could go on naming dozens of more ingredients in this product. Would you feel comfortable consuming this product yourself? Well what about feeding it to your baby?

Because these ingredients come from the back of cans of baby formula from American baby food companies. Whey, vegetable oil, and lactose in layman’s terms are actually just carbohydrates, fats, and proteins, the stuff every infant needs, right, for a well-balanced diet. So why does it feel like you need a PhD in nutrition to understand what you’re feeding your baby?

It’s one reason why many parents are choosing European formula brands. They say they trust the European companies to be more transparent, use organic ingredients over their FDA approved US counterparts. And word on the street among parents, if you talk to them, is that European brands are “cleaner” and therefore healthier for baby.

But is there any truth to this claim? There’s a private Facebook support group with over 13,000 members discussing the merits of European formulas and how to best safely import them for personal use. So for all you sleep deprived parents who find yourselves awake at 2 AM searching the internet for answers, we’ve decided to bring in some science experts to help us out.

Joining me to share with what data that says about the difference in infant formulas and what everything on those ingredients list actually mean for your baby are my guests. Let me bring them on now. There’s Dr. Anthony Porto a pediatric gastroenterologist, associate professor at Yale School of Medicine. Welcome to Science Friday.

DR. ANTHONY PORTO: Hi.

IRA FLATOW: Dr. Bridget Young a PhD and clinical researcher at the University of Rochester Medical Center and founder of the blog babyformulaexpert.com Welcome to Science Friday.

DR. BRIDGET YOUNG: Hi. Nice to be here.

IRA FLATOW: Dr. Porto what are the basic nutritional ingredients that infants need to survive? How many are there?

DR. ANTHONY PORTO: Well, when you think about it, since most children at birth for the first at least four to six months of life will get the nutrition either from breast milk or infant formula. And infant formula is made to have all the necessary ingredients. So you need, as you said, carbohydrates or sugar, protein, fat, and other minerals and micronutrients.

IRA FLATOW: Mm-hmm. Dr. Young I know you actually have a PhD in nutrition, maybe you’re the only one who can understand what’s on these labels because I counted over 60 ingredients in one can on the back of the labels of one can of formula. Do they give babies everything they need or more than everything they need?

DR. BRIDGET YOUNG: Well, a little bit of both. So all formulas in Europe and especially in the US are very, very safe and have everything a baby needs to grow just perfectly fine from birth all the way up to when they’re ready for solid foods. So the FDA, our regulatory agency in the United States, sets minimum requirements for the number of macronutrients, which are protein and carbohydrate and fat, and micronutrients which are your vitamins and minerals. And so all formulas have that same base.

Some specialty formulas add– and I call these kind of sexy ingredients that are things that are found in breast milk that as research progresses and as formulation companies are able to replicate some of these individual ingredients they become present in some formulas. And those are usually the source of a lot of marketing. So things like– I’ve got scary sounding words, but like lactoferrin or milk fat globule membrane which is a mouthful, are things that aren’t required in infant formula but are present in some infant formulas based off of those types of ingredients being present in breast milk.

IRA FLATOW: Now I talked to a number of mothers who have infants on formula and you know this is anecdotal research and it’s sort of what I mentioned in the intro about people talking to each other. And one of the things they kept saying over and over again is why is there sugar or corn syrup in my formula, you know? And is my baby going to get a sweet tooth and get used to wanting to have sweet things?

DR. BRIDGET YOUNG: Yeah. Well that’s a great question. And I tell you, I hear that question all the time too. Well, the simple answer of why is there sugar in some baby formula is sugar is a carbohydrate. So babies absolutely need carbohydrates to grow. The main carbohydrate in breast milk is lactose. And actually most standard infant formulas provide lactose as the carbohydrate as well.

There are actually many options of formulas that are what, in neo-medicine, we call “lactose reduced” where they take some of the lactose out. And so they have to replace it with something because the baby needs a set amount of carbohydrates. And infants are not just super tiny adults. They can’t have things like vegetable fiber or complex carbohydrates. They’re not capable of digesting those. They need something simple that their body can break down for nutrients.

So if the baby’s not having lactose, there’s actually a really limited number of other carbohydrates an infants can digest. And that includes glucose based sugars like corn syrup is the most common and sucrose, which is table sugar. So while it seems a little scary they are perfectly safe to feed a baby. And there has to be something in there if you take the lactose out. So that’s why you see it in a lot of formulas and there are a lot of situations for individual babies who may need either a temporary or a permanent amount of lactose reduction in their diet.

IRA FLATOW: I get it. I’m Ira Flatow. This is Science Friday from WNYC Studios, talking with Dr. Bridget Young and Dr. Anthony Porto about baby formulas. If you have a question, our number is 844-724-8255, 844-Sci-Talk. Dr. Porto, the big trends these days is parenting and I mentioned this at the beginning choosing the European formula brands over the USDA approved ones. Why is this happening?

DR. ANTHONY PORTO: That’s a good question. You know we– I’m a pediatric gastroenterologist, and my partner and I were looking at what the trends were and we saw anecdotally in our offices that people as you said were trying to use these formulas. We did a survey in a large practice in New York City and about 20% of those who are formula fed were using and importing European formulas.

As you said, the thought was that they were doing it because there’s stricter standards in the European Union as well as higher quality. And I think one of the things that came up when we looked at it in our study was that there was, why are sugars other than lactose being used? And what’s interesting when you look at the type of formula. So what we did was we did Google searches and we used a search engine called DuckDuckGo, which is a search engine that’s very rigid and won’t give you certain responses based on what you’ve searched before.

And what we found was that most of the information on European formulas were blogs or stores trying to sell, and these were usually third party vendors. And when we looked at the reasons why they were doing that again it was the stricter regulations and the use of lactose in what usually is said is most of the formulas. When you looked at what was being imported, what was being imported were the intact protein.

So what we were just talking about, there are different types of proteins and most infants will do well on intact cow’s milk based protein formulas and in the United States most of those formulas are also lactose containing. We use the other types of sugars or carbohydrates when it’s a more broken down protein or for a low lactose formula. And so, for instance, that basically means that most infant formulas are made with lactose and that is usually what’s being imported. What’s not being imported right now are the other more specialized formulas for kids say with cows milk protein allergy.

IRA FLATOW: All right we’re going to take a break. Lots of calls coming in 844-724-8255. Talking about the science of baby formula and nutrition. Your questions, you can also tweet us at scifri. Stay with us. We’ll be right back.

This is Science Friday. I’m Ira Flatow. We’re talking this hour about how to parse the ingredients in baby formula. What does it mean for infant health? What’s the difference between European and American formulas with Dr. Anthony Porto a pediatrician and professor at Yale School of Medicine Dr. Bridget Young PhD and a clinical researcher university Rochester Med Center founder of the blog babyformulaexpert.com website.

And speaking of websites, I mentioned this in passing earlier there is a private Facebook group, there’s at least one of them that has over 13,000 members where they discuss the merits of European formulas, how to best safely import them for personal use. People in these groups are talking about how they can import these specialty formulas Dr. Porto that you talked about, but give us the other flip side of the coin here. What risks do you run if you import the formula?

DR. ANTHONY PORTO: Sure. I think the most important thing is that the guidelines and the regulations in both Europe and the United States are good. What is concerning is when the European formulas are brought to United States and how they’re brought to the United States. So if they’re brought outside that chain of command, the good manufacturing practices that’s part of these acts is lost.

We don’t know if these formulas when they’re brought here are kept at the correct temperatures, which could lead to vitamin deficiencies in the formula. We know that at extreme temperatures you can have low vitamin A and C, protein may be less soluble. And so these are all concerns that we are unable to follow when you purchase formula. And formulas manufactured in the US what happens is the formula is made and every step of the way until it gets to the consumer is regulated and formulated.

IRA FLATOW: And when I talk to mothers they say, you know, I’m worried about the formulas just sitting on the dock for days or weeks or whatever and going bad. Right Dr. Young?

DR. BRIDGET YOUNG: Yeah and I think rightfully so because I mean Dr. Porto is absolutely correct when once you cross that ocean the regulations don’t necessarily apply. The FDA regulates our formulas here, and the European Commission regulates European formulas there within their own boundaries. Another potential risk that parents take on to use a European formula is it’s every parent’s worst nightmare that there’s a formula recall of the formula that they’re using. And if you’re using a European formula, it can kind of be, for lack of a better word, out of the system once it’s exported. So you may not necessarily receive information that that formula has been recalled, which recalls are very unusual and they don’t happen often, but if they do you want to be sure that you receive information about it.

DR. ANTHONY PORTO: In addition, the mixing instructions for these typical European formulas are different than the standard in the United States. So you want to make sure, since most of these labels are not in English, that the patients and the families understand that it’s a one scoop in one ounce mixture versus a two to one which happens in most the American formulas, or if they’re using a scoop from an old formula they may have, it could lead to concentration issues either low calorie or high calorie that could lead to vomiting and electrolyte imbalances.

IRA FLATOW: You have to do a lot of homework if you’re going to use a formula that is in German or you have to go to the website where it gets translated to look at it.

DR. ANTHONY PORTO: Right.

DR. BRIDGET YOUNG: Right.

IRA FLATOW: Let’s go to Denver, Colorado talk to Kate. Hi welcome to Science Friday.

KATE: Hi Thanks for taking my call.

IRA FLATOW: Hi. Go ahead.

DR. ANTHONY PORTO: Sure.

KATE: So the reason that I’m calling and I’m hoping the guests can speak to it is I’ve been doing a lot of research. I supplement breastfeeding with formula but I do have some concerns about the highly processed oils that are used in most of the formulas that I can find. I have bought some European formulas as well but they all seem to contain like palm oil, sunflower oil, safflower oil. And I think there’s been some emerging research about the chemicals that are used in the processing of those oils and whether or not they can make the Omega 3s and 6s unstable and what the effect might be on a baby’s developing brain.

IRA FLATOW: Dr. Young, you want to start, take a whack at this?

DR. BRIDGET YOUNG: Oh it’s such a great question and Kate, congratulations on your baby and keep rocking breastfeeding.

KATE: Thank you.

DR. BRIDGET YOUNG: It is so hard to be a new mom these days. I can talk a little bit to that but the first thing that I always emphasize is all of the oils that we have available to us for formula usage in the US and in Europe for that matter have been really well studied to be safe. And I know when it’s your baby you want, of course, the absolute, absolute best.

And when we put together a fat blend, because it’s always a blend of different oils for formula, it’s a really delicate balance because you want to have just the right blend of fatty acids in a total blend that does its best to replicate breast milk. Now we can never actually replicate breast milk, and breast milk is a little different from mom to mom but we know roughly what we’re shooting for to be sure the baby gets all the fatty acids that they need. So basically you can’t just give all of one new oil or all of another oil. It has to be this balanced blend.

And because the FDA regulates safety so rigidly it takes– there’s basically only certain options for oils that can be put into baby formula. So while researchers such as myself are always actively studying breast milk and trying to improve and optimize how we feed our babies, it takes a long time to be able to incorporate that research into new ingredient availability. But I will say that with the oils that we do have available in the US, you have a lot of really great options.

As a practitioner I help work with families who are having formula tolerance issues, I feel very, very safe and comfortable with the options that we have. And then there is a little bit of variability if you want to pick and choose a little bit. Of course, we have some organic options in the US so at least you have an organic source of an oil if that’s important to your family.

And then for example, the Similac brand of formulas and some of the generic brand of Similac they don’t use any palm oil in their blend. So families that are looking to avoid palm oil for either sustainability issues or potential constipation issues you do have that option to kind of pick and choose along with your pediatrician to pick an oil blend that’s best for your baby. So I know that wasn’t exactly the answer you were hoping for but I hope that’s helpful.

IRA FLATOW: Because one of the things that mothers were telling me about the European formulas is that they believe they have more organic ingredients than American formulas have in them. Let’s go to Bill in Tallahassee. Hi Bill. Welcome to Science Friday.

BILL: Thank you very much. I just wanted to ask about, we’re talking a lot about beneficial bacteria and the implications of the beneficial bacteria in actual breastfeeding and the implication that would have for the infant mortality rate for poor black women as opposed to using formula.

IRA FLATOW: So you want to know how you can make up for the lack of bacteria in breast milk in the formula.

BILL: Right. Yeah. We have a little controversy here in Tallahassee where a black physician is asking about the benefit of formula as opposed to teaching poor black women to breastfeed and have healthy breast milk.

IRA FLATOW: OK. Let me see. Dr. Porto?

DR. ANTHONY PORTO: Sure. I mean, this is a great question. And I think when you think about it, breast milk in general is still– formula is really always trying to bridge that gap between formula and breast milk to make sure it’s comparable because the gold standard really is breast milk. And so breast milk as we know, has not only the adequate nutrition for the first six months of life, but also has also the immunogenic properties that are very, very helpful. And so I think to your point, we know we do add some prebiotics and we do add some ingredients to formula but right now I would say that again the breast milk has always been the gold standard and what formula always tries to compare itself to, to have these extra ingredients to help make things as the gold standard, which is breast milk.

IRA FLATOW: I know there’s some people– mothers were telling me they add their own probiotics to the food that they feed their babies. I have about a minute left. Dr. Young, Dr. Porto what is the holy grail for formula that we don’t have yet and is it possible to achieve it?

DR. ANTHONY PORTO: Sure I mean I think I would say briefly I think that we right now with research going on and Dr. Young alluded to and spoke about, really the gold standard is really to have these kids grow and get adequate nutrition. And I think that both the US and Europe is doing a really good job to make sure that we keep on enhancing and trying to get to that gold standard of breast milk. And also I think education on how to breast feed and sort of to make sure that parents have support as much as possible to make that choice.

IRA FLATOW: All right. Thank you very much. Thank you both for taking time to be with us today. Dr. Anthony Porto pediatrician and associate professor at the Yale School of Medicine and Dr. Bridget Young a PhD and clinical researcher university of Rochester Medical Center and founder of the blog babyformulaexpert.com. Thanks for taking time to be with us today.

DR. ANTHONY PORTO: Thank you.

DR. BRIDGET YOUNG: Thanks Ira.

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