"Chemicals" In Breastmilk: A Primer

Lactoferrin. Lysozyme. Endocannabinoids. The next time you read a scare article about the "chemicals" we're putting into our babies, think of this: somebody near where you live, probably right down your street, is pouring these particular chemicals into the bodies of the most vulnerable humans. Infants. Newborn babies.

Who's doing this horrible thing?

Nursing mothers. All those chemicals are important components of human breastmilk. (Lactoferrin binds to iron, boosting iron uptake and taking it away from invading bacteria and fungi who require it. Lysosyme works with lactoferrin to attack the cell walls of some bacteria. Endocannabinoids stimulate suckling and appetite.)

Here's another myth you can throw out, the perfectness of breastmilk. It can be deadly. "For every six months that an HIV-positive women breastfeeds, there is about a 4 per cent chance of the infant becoming infected. Despite this low infection rate, it's estimated that breastfeeding is responsible for up to half of the 640,000 HIV infections in infants each year."

Of course, only those who believe in every silly and ignorant internet article on milk, written by people who not only have no knowledge of science, but fear what they don't understand, subscribe to myths like those. Intelligent people, like my readers, know that when you see an article decrying "chemicals" in food, you can stop reading immediately without any worries that you might be missing some useful information. And they know that despite the risks, exclusive breastfeeding for at least six months is still the greatest single gift a mother can give her infant.

Too few mothers, even in the western world, breastfeed exclusively for six months, however. "[I]n the US, just 11 per cent of babies are exclusively breastfed up to the age of six months. In the UK, the figure is just 3 per cent." Mothers in developing nations face widespread beliefs that formulas are somehow better than breastmilk for infants, even though contaminated water supplies mean that formula-fed babies can be six times more likely to die in the first two months.

All these quotes and statistics come from an important article in New Scientist magazine, Making formula milk more like mum's, by Jo Whelan, from the July 14, 2008 issue.

Whelan's overall point is that while persuading mothers to breastfeed is crucial, the worldwide lack of consistent breastfeeding means that improving baby formulas so that they more closely resemble breastmilk will also save many lives and produce far healthier infants and adults in the long term.

Yet even that is subject to the very fears about science that produce the idiot myths that already infest the internet. Better formula will depend on duplicating the kind of human proteins that include the "chemicals" I mentioned in the first paragraph and many others. Today this is such a difficult and expensive bit of technology that nobody in the third world could expect to see any of them. Few wealthy Americans could even afford this enhanced formula.

There is one possible source:

The only way to mass-produce human proteins is to genetically engineer other organisms to make them, and plants are emerging as the most practical option. At least seven human milk proteins have already been produced in modified food crops, mainly potatoes and rice, with more in the pipeline. The leading company in this area is Ventria Biosciences of Sacramento, California. It is growing rice in Kansas which contains human milk proteins which, it hopes, can be added to infant formula and oral rehydration salts.

Rice is particularly attractive, as it rarely causes allergies in humans and is often used as a weaning food. However, several giant agribusiness and food companies have protested at Ventria's plans. The fear is that these transgenic crops could end up in our food chain.

Yep, it's the "dread" genetic engineering raising its head again, threatening to give babies healthier food. Because of the fearmongering that already exists, it's unlikely that any of these proteins will be created this way in any foreseeable future.

I certainly can't guarantee that these proteins, these techniques, these innovations are the absolute right way to proceed. Nobody can say that about any advance, made by any means. In a world in which tomatoes, er, I mean jalapeños, may be dangerous, or thought to be dangerous, or may at some time in the future prove to be dangerous, people are suspicious of everything even while demanding and devouring new and unfamiliar foods every day.

In a world with food shortages leading to riots, with crops being taken out of the food supply to turn into fuel, with obesity at an epidemic in westernized countries, with people being gulled and duped by flagrantly ignorant advice about diet, nutrition, and food, we need more understanding, innovation, and productivity and far less fear and nonsense.

Lactose-Free Infant Formulas

Dr. Peter Nieman writes for The Calgary Herald, found on Canada.com a useful reminder for mothers who may need to stop breastfeeding their baby, either temporarily or permanently.

For babies who have troubles digesting these standard starter formulas, a change can be made to a lactose-free formula -- which are usually identified by the letters LF (lactose free) on the label. Lactose is a form of sugar and it's important to know that the true incidence of lactose intolerance and colic is regularly overestimated.

The proteins in breast milk are 60 per cent whey and 40 per cent casein. Cow's milk-based formulas are predominantly casein-based.

Sometimes, a mother may switch from a starter formula to one which contains no lactose and soy protein. This "double switch" is frowned upon because it becomes harder to determine the cause of digestive upset. Also, some experts believe soy-based formulas carry potential dangers, a concern that has not been definitively established yet.

In the U.S. there are several major brand names that have milk-based but lactose free varieties.

Enfamil Lactofree LIPIL.



Similar Sensitive (formerly Similac Lactose Free).





Parent's Choice Lactose-Free Infant Formula.

Lactose Intolerant Quadruplets

In the So You Think You Have Troubles Category...

Jill and Kyle Williams are the parents of quadruplets. They did it naturally, too, with no fertility drugs.

When Jacque Hillman of The Jackson Sun called, all four of the almost one-year-olds had a stomach virus. Jill was sick, too.

The next day a tornado hit and the Williams' power went out.

Just daily life with Ace, Hensley, Hudson and Avery is a trial. All four are teething. They have developmental problems, a consequence of all being premature. It's not clear from the article whether their lactose intolerance is also from being premature. Premature babies are often born LI because the lactase enzyme is one of the last bits to develop in the ninth month of pregnancy. Usually premature babies get their lactase very quickly after birth, however.

In the Williams' case:

Avery takes two or three bottles a night, and although she doesn't stay awake long, it means that Kyle and Jill are often up during the night. Sometimes the couple has to shop for Enfamil for lactose-intolerant babies through every Wal-Mart, Walgreens and Kroger store in Jackson to find enough.

The quads go through 24 bottles a day. And 48 diapers.

New Labeling Rules Proposed in the UK

The UK's Food Standards Agency (FSA) announced new regulations it proposes for the labeling of baby formula, according to an article on NutraIngredients.com by Alex McNally.

The FSA said under the guidelines only a small number of health and nutrition claims will be permitted on packaging for formula milk.

Lactose only, lactose free, added long chain polyunsaturated fatty acids (LCP), reduced risk of allergy to milk proteins and nutrition linked to nucleotides, taurine and oligosaccharides will be the only claims allowed.

Restrictions on marketing and promotion will outlaw directly targeting formula to new parents. Promotional material for infant formulas will not be able to feature text or images relating to pregnancy, including pictures of children under six months of age or images inciting a comparison to breast milk.

Rosemary Hignett, the FSA's head of nutrition, said the measures would protect mothers and babies.

She said: "The guidance provides clear direction to industry on the action they must take in order to comply with the new regulations. The new controls will provide the protection that mothers and babies need and deserve."

Despite the precautions, an activist breastfeeding group, Baby Milk Action, denounced the regulations as "an inadequate response and will continue to put UK mothers and babies health at risk in favour of the interests of the formula milk industries."

Activists in many parts of the world continue to battle makers of formula for trying to persuade new mothers to discontinue breastfeeding for the "ease" of using formula. I'm certainly sympathetic to this cause. I've always championed breastfeeding for any mother capable of doing so.

However, I'm perhaps more sensitive than the breastfeeding activists to those mothers whose babies' allergies, diseases, surgeries, or other ailments prevent them from breastfeeding and require them to rely on formula. Complete and completely informative labeling on those formulas are a must.

If the rules proposed are inadequate in this regard, then by all means work to change them. But get the labeling on the formula first before you argue about the larger policies.

UK Sets Standards for Allergy Formulas

A press release announced that Act Against Allergy, an independent international taskforce of allergy experts, set forth standards and guidelines for the diagnosis and management of cow's milk allergy (CMA) in infants in the UK. The guidelines were published in the journal Archives of Disease in Childhood.

In their paper, the Taskforce recommends against the use of soy, especially in infants under six months old, due to the risk of secondary intolerance which can be present in up to 60% of CMA infants. Alternative mammalian milks, such as sheep, buffalo, horse, camel or goat, present an even higher risk of cross-reactivity and are not recommended at all in CMA. Furthermore, milk substitutes based on grains, legumes or nuts, such as rice, oat, pea or almond milk, are to be avoided in infants and young children due to their poor nutritional profile. According to the Act Against Allergy Guidelines, the only milk alternatives recommended for the effective management of CMA are specialised hypoallergenic CMA formulas, namely eHF's and AAF's.

AAF is the only formula type recommended for all degrees of CMA severity (i.e. mild, moderate and severe). These formulas are based on amino acids, the building blocks of protein, which are considered virtually incapable of provoking an allergic reaction, while providing optimal nutrition for of the infant. Immediate usage of AAF is also recommended in infants with suspected CMA showing failure to thrive - insufficient weight and/or length gain - in order to rapidly stabilise the infant's physical development.

In cases of mild to moderate, but not severe, CMA, the Taskforce advises that an eHF may be sufficient. When milk proteins are broken down (hydrolysed) into smaller fragments - as happens in the production of eHF's - their ability to provoke an allergic reaction is reduced. However, if symptoms do not improve sufficiently on an eHF, an AAF should be considered.

The SHS / Nutricia portfolio of hypoallergenic infant formulas is the only range of products that fully covers all degrees of CMA severity (i.e. mild to moderate and severe). The portfolio also includes the only AAF that is globally available and the most extensively clinically validated.

The guidelines are similar to those promoted by the American Academy of pediatrics.

The full guideline manuscript is available at: http://adc.bmj.com/.

More information on the Act Against Allergy Taskforce is available at: http://www.media.actagainstallergy.com/.

Colic and Dairy Allergy

"A baby with colic cries inconsolably for hours at a time for at least three weeks," explains Dr. Allan Stillerman of Allergy & Asthma Specialists, PA in Minneapolis, MN.

That's miserable for all concerned. Even worse is the simple truth that nobody really understands what causes colic.

But this press release from Nutricia North America, identifies a possible correlation. Colic may be related to a dairy allergy.

Babies with a milk allergy can experience a variety of symptoms, such as diarrhea, vomiting, gas, skin rash, wheezing, low or no weight gain or an overall failure to thrive.

"A milk allergy can be treated by either eliminating milk proteins from the nursing mother's diet or replacing the typical milk-based formula with an amino acid-based formula such as Neocate(R)," says Dr. Stillerman.

It should not surprise anyone at this point that Nutricia North America is the manufacturer of Neocate.

Which is probably why they throw in this line:

Babies who are allergic to milk cannot process the milk protein chains found in milk- based baby formulas and are usually allergic to soy as well.

"Usually" allergic to soy? More like "sometimes." About 25% is the figure I've seen.

An expensive specialty formula like Neocate is normally not the solution to a dairy allergy. It can certainly help in those cases in which the baby is indeed allergic to both milk and soy, although other alternatives exist as well. And there's some hope:

The good news is if your baby is not allergic to milk, she likely will outgrow the colic in about three or four months.

Is Stillerman correct when he associates colic with dairy allergies? Appears so. A check of the medical literature reveals that a connection is suspected by many pediatricians.

What is known about infant colic?, by M. L. Cirgin Ellett. Gastroenterol Nurs. 2003 Mar-Apr;26(2):60-5.

Review of the infant colic literature suggests there are at least five possible explanations-cow's milk/soy protein allergy or intolerance; immature gastrointestinal system; immature central nervous system; difficult infant temperament; and parent-infant interaction problems consisting of either the transfer of parental anxiety to the infant or the inability of the infant to give clear cues about needs to the caregiver. It is likely the cause of infant colic is multifactorial because it has proven to be so elusive.

A prospective 10-year study on children who had severe infantile colic, by F. Savino et al. Acta Paediatr Suppl. 2005 Oct;94(449):129-32.

There was an association between infantile colic and recurrent abdominal pain (p=0.001) and allergic disorders: allergic rhinitis, conjunctivitis, asthmatic bronchitis, pollenosis, atopic eczema and food allergy (p<0.05). ... Our findings confirm that severe infantile colic might be the early expression of some of the most common disorders in childhood.

Clinical inquiries. What is the best treatment for infants with colic?, by C.A. Crotteau, S. T. Wright, and A. Eglash. J Fam Pract. 2006 Jul;55(7):634-6.

Several small studies report some benefit from use of a hypoallergenic (protein hydrolysate) formula, maternal diet adjustment (focusing on a low-allergen diet), and reduced stimulation of the infant.

At one time, many years ago, the notion that lactose intolerance was a cause of colic was raised by some doctors. Although it is not considered a major cause, there is some evidence that treating breastmilk with lactase drops can help.

Improvement of symptoms in infant colic following reduction of lactose load with lactase, by D. Kanabar, M. Randhawa, and P. Clayton. J Hum Nutr Diet. 2001 Oct;14(5):359-63.

These findings suggest that infant colic may have a multiple aetiology, and that in a significant number of cases the immediate cause is transient lactose intolerance, in which cases pretreatment of feeds with lactase can result in considerable symptomatic benefits.

However, there are far fewer studies connecting colic with lactose intolerance than with a cow's milk protein allergy.

Baby Formula Comparison Charts

There is no one right way to imitate mother's milk in a baby formula. And that's not even looking at the fundamental question of whether it is to be cow's milk-based, soy-based, or based on hydrolyzed proteins. A multitude of nutrients can be added and those in a variety of portions and amounts. The complexities are enormous and each family has to decide for themselves which combination works best for their child, and for their budget.

The Nature's One firm makes baby formulas. I don't know anything about them; this is not a recommendation or endorsement, nor do I have anything against them.

What I can say is that they feature a nutritional comparison page that offers charts in Abode's .pdf format that compare their formulas' nutrient composition against a number of other brand name formulas in the categories of dairy, soy, and organic formulas and oral electrolytes.

The charts look to be both comprehensive and informative. It may be useful to print them out and study them for guidance when you look into the question of formulas for your baby.

Sam's Club Announces Enfamil-Like Low-Lactose Baby Formula

A press release from Wal-Mart's giant Sam's Club announced that the warehouse club would market an exclusive low-lactose baby formula.

Baby formula company PBM Products, LLC, and Sam's Club, a division of Wal-Mart Stores Inc. , and one of the nation's largest warehouse clubs, have introduced new Member's Mark^® Gentle Infant Formula. Available exclusively at Sam's Club, the new formula is easier to digest than standard cow's milk-based formulas.

Babies react differently when trying standard infant formulas. Many experience reactions to these formulas that may include general fussiness during or after feeding, gas, or bloating. Health-care professionals often advise parents to switch to a different type of formula. In the past, these recommendations may have included switching to a lactose-free, cow's milk protein-based formula or a soy formula.

Now, Member's Mark offers a "gentle" formula that contains partially broken down whey protein and one-fourth the lactose in standard formulas. Member's Mark Gentle offers the benefits of the recommended protein source of cow's milk without sacrificing all the lactose, a carbohydrate that occurs naturally in breast milk. The new formula contains other nutrients found in mother's milk, including choline, DHA, and ARA, key nutrients associated with infant mental and visual development.

...

Member's Mark Gentle:

• Is fortified with iron and contains all the vitamins, minerals, and nutrients required for a healthy baby's first year

• Is enriched with 17 mg of DHA and 34 mg of ARA per 100 Calories- the same levels as Enfamil^® Gentlease™ LIPIL^® -- at a savings of up to 50 percent*

• Is manufactured to exacting FDA standards in the only ISO 9001:2000- certified, infant formula-manufacturing facility in the United States

...

*More information and a savings calculator are available at the newly designed Web site, www.membersmarkformula.com/

Seems to be a mighty narrow market niche to me, but then what is Sam's Club for but to find narrow market niches that other retailers can't afford to serve.

Speaking of which, if you don't belong to a Sam's Club but you like the sound of this formula, you should out Enfamil^® Gentlease™ LIPIL^®, the original they are obviously trying to match.

Dairy Allergies Damage Parents Too

Act Against Allergy sent out a press release titled Cows' milk allergy in infants causes considerable distress to entire family.

Here's some of what it said:

Cows' milk allergy (CMA) has considerable negative effects on the family unit, as exposed by findings from an international survey. In addition to coping with the disturbing physical effects of the condition on the child (including vomiting, diarrhoea, failure to thrive and eczema), 70% of parents of children with CMA said that it makes them feel guilty and distressed and 82% said that it has caused them to lose sleep.¹

...

Dr Martin Brueton, an Act Against Allergy Advisory Board Member and Emeritus Paediatric Gastroenterologist at Chelsea and Westminster Hospital, London, UK, commented: "Having a child with cows' milk allergy can be very stressful for parents. The average baby with cows' milk allergy may suffer from an array of symptoms, from skin rashes to gastric problems, cries a lot and often shows problems with weight gain. Parents feel helpless as the instinct to feed their infant even more milk - usually the infant's sole food source - compounds rather than solves the problem. Until the child is properly diagnosed and put onto a suitable milk substitute, the impact on the parents and the family as a whole is considerable."

In the survey, commissioned by Act Against Allergy, further impact on family life was revealed. As a direct result of having a child with CMA, half (49%) the respondents have missed work, over a third (38%) have argued with their partner and 39% said the lives of other children in the family have also been disrupted.¹

(1) Telephone Survey among 1,000 European Parents of Children Aged 0-3 Years and 505 healthcare professionals (HCPs), spread equally across the UK, France, Germany, Italy and Spain. KRC Research, November/December 2005

More specific findings of that survey include:

▪ 82% of parents say that their child's CMA has caused them to lose sleep.

▪ 70% of parents say their child's CMA makes them feel guilty.

▪ Half (49%) of parents say they have had to miss work because of their child's allergy.

▪ Half (49%) say their child failed to thrive as a result of CMA.

▪ 39% say the lives of other children in the family have also been disrupted.

▪ 38% claim that CMA has caused arguments with their partners.

Who is Act Against Allergy?

Act Against Allergy is an interactive communications programme designed to increase the awareness of cows' milk allergy in infants, spearheaded by an International Taskforce of experts in the field and sponsored by SHS International.

The Act Against Allergy website is www.actagainstallergy.com and features a wealth of information on CMA, including interactive tools for parents such as an online clinical diary to track their child's progress, a forum to share experiences with other CMA parents and an 'Ask the Expert' section enabling direct interaction with the Chair of the Act Against Allergy taskforce.

I checked the site out. It is actually sponsored by the makers of Neocate Infant Formula and other specialty formulas for babies who cannot have milk- or soy-based formulas because of allergies. Even though it is a commercial site, it appears to have solid, reasonable information, without especial biases. You can also ask questions in their forums about your individual problems.

They are correct about lactose intolerance, something that also impresses me, since that's rare.

Lactose intolerance is a popular but not-evidence based diagnosis in crying babies, but primary lactose intolerance at this age is almost non-existing, and secondary lactose intolerance is at this age very transient and related to infectious GE or caused by CMA as primary factor.

You should check them out and decide for yourself.

Just a small point. I don't mind reading press releases. (You should never have to. Only trained professionals can put themselves through that agony.) I know enough to throw out the hype and keep just the parts that actually offer some useful information. They are not easy to write. I know. I've done many myself. But putting a completed press release out to the public shouldn't be that tough.

Yet, apparently it's too tough a job for the supposed professionals. The one at EurekAlert was so curtailed that it left off half the release, including all the footnotes. Even so, the morons kept the footnote numbers in the text, inviting you to search all over for something that wasn't there. The one I quoted was from ANP Pers Support, which is a joint venture of ANP and PR Newswire. Their release was complete. Almost. They managed to leave out all the % signs from the entire survey, making it almost unintelligible.

Hey, Act Against Allergy. Get your money back!

Similac Sensitive R.S. Lactose-Free Formula

Abbott's Laboratories has just announced an expanded, improved line of Similac® infant formulas. The latest additions to the Similac family include Similac Sensitive™ and Similac Sensitive R.S.™ – both designed to address common feeding problems such as fussiness and gas – and Similac® Go & Grow™, designed to help older babies get the nutrition they need as solid foods are introduced into their diets.

Their press release says:

Similac Sensitive is made with a unique blend of carbohydrates that helps reduce fussiness and gas due to lactose sensitivity. Research shows almost half of all babies with feeding issues are switched to a tolerance formula, like Similac Sensitive, by three months of age.¹ Similac Sensitive provides moms a new alternative to address these feeding challenges.




Similac Sensitive R.S., made with added rice starch, is a new formula specifically designed to help reduce the frequency of common spit-ups. According to the American College of Gastroenterology, almost all infants reflux or regurgitate a portion of their feeding at one time or another.² Similac Sensitive R.S. has been clinically shown to reduce the frequency of spit-up by 54 percent.³

1 ACNielsen HH Panel 2000-2003, Ziment 2002-2003.
2 Marsha Kay, MD, “Common Gastrointestinal Problems in Pediatric Patients.” The American College of Gastroenterology, http://www.gi.org/patients/gihealth/pediatric.asp.
3 Among healthy 2-month-old infants, compared to standard formula. Clinical Study AJ68, February 2001, Ross Products Division, Abbott Laboratories, Columbus, Ohio.

One other possibility for those with dairy allergy concerns is Go & Grow.

Another new formula from Abbott, Similac Go & Grow, is specially designed for the needs of growing babies, ages 9 to 24 months. Similac Go & Grow offers balanced nutrition for older babies as solid foods and milk are introduced into their diets. Similac Go & Grow provides at least 25 vitamins and minerals and more than 30 percent of the Daily Value of calcium, iron and vitamin C in just one 8-fluid-ounce sippy cup. Similac Go & Grow is available in both milk- and soy-based formulas, and will replace Similac® Advance® 2 and Isomil® Advance® 2 as the Similac solution for improved toddler nutrition.

Suggested retail price for Similac Sensitive is $13.79 for 12.9-ounce Powder, $24.99 for 25.7-ounce Powder, $4.49 for 13-fluid-ounce Concentrate and $5.99 for 32-fluid-ounce Ready To Feed (RTF). For Similac Sensitive R.S. the suggested retail price is $5.99 for 32-fluid-ounce RTF. Similac Go and Grow's suggested retail price is $10.99 for 12.9-ounce Powder and $19.99 for 24-ounce Powder.

The information about Sensitive or Sensitive R.S. isn't up yet at the website. However, this page about Similac® Lactose Free Advance at the Ross Labs site may be of help, and you can search for the other Similac products from there.