Adding anything that contains iron to human milk will result in there
being non-protein bound iron in the milk. Lactoferrin will continue to
bind the iron in the human milk, but the added iron will be available
to any ambient bacteria and if there are E.coli present they will be
able to use the free iron.  The effect of lactoferrin is to make the
iron in human milk unavailable to ambient bacteria and ensure that the
iron is transported actively across the cell membranes of the
epithelium in the small intestine so the child can use it.  If the
added iron results in the child getting a diarrheal illness, then
absorption of the iron in the breastmilk and all other nutrients in
the breastmilk may be impaired due to the inflammation of the
epithelium.
If the child does not have diarrhea, there will still be a
microscopically detectable inflammation present, but it should not
have much effect on the child's absorption of nutrients.  As I
understand it, it's not so much that lactoferrin's actual workings are
affected, as the fact that its protective mechanism may be
insufficient to defend the child from pathogens fed by the other milk
in the gut.  Iron gets bound to lactoferrin in the breast, not in the
child's digestive tract.

About 70% of the iron in human milk is absorbed by the baby during the
passage of the milk through its gut.  The rest is excreted in stools
still bound to lactoferrin, so even what the baby doesn't absorb is
not available to bacteria.  In contrast, less than 20% of the iron in
formula milk is absorbed, leaving 80% of it available for bacteria to
feast on.  There is a lot more iron present in formula than in
breastmilk but the ultimate iron dose received by the baby is probably
not very different due to the differences in absorption.

Iron is among those nutrients we probably weren't meant to ingest in
large amounts in our food in early life.  We are meant to get a
generous load at birth, from allowing the umbilical cord to remain
intact and undisturbed while baby is on mother's chest, with mother
reclining, so the baby is about at the same height as the placenta
before it is expelled.  There is a significant difference in the
ferritin levels of one year old children depending on whether their
cords were clamped in the first two minutes after birth, or later.
Premature cord clamping makes it necessary to think about children's
iron levels in the latter part of the first year of life.  Sometimes
it can't be avoided but most of the time it can.  Gay Palmer's book
about complementary feeding has an excellent chapter about iron in the
diet of young children, I recommend it highly.

Rachel Myr
Kristiansand, Norway

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