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Breast vs. bottle takes new turn
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By comparing new formula additives to mother's milk, companies mislead women,
critics say

By Julie Deardorff
Tribune staff reporter

March 4, 2003

When a new infant formula appeared on store shelves in the U.S. last year,
some scientists and pediatricians said it could narrow the nutrient gap
between formula and breast milk.

Since then, however, breastfeeding activists have grown increasingly incensed
over the new products, saying manufacturers mislead mothers and undermine
efforts to promote breast-feeding, which is the consensus gold standard in
infant nutrition.

The new ingredients in the formula had been sought for years, ever since
scientists discovered that certain fatty acids found in breast milk and food
are key building blocks for a baby's brain and eyes.

But for those who work to support breast-feeding, the existence of a formula
that compares itself with breast milk in its advertising means breast-feeding
is again under attack. They are especially angry that wording on the cans
claims that the formulas, Enfamil Lipil and Similac Advance, contain
nutrients found in breast milk.

Some believe formula companies' marketing practices are an attempt to
sabotage breast-feeding and hook more women on the bottle. The formula
industry routinely donates samples to new mothers when they leave the
hospital or delivers formula directly to the doorstep.

"The jury is out whether these additives provide anything for these babies,"
said Marsha Walker, a nurse and executive director of the National Alliance
for Breast-feeding Advocacy. "They have not shown the addition of the fatty
acids do anything in terms of growth, intelligence or anything else, but they
are marketing it so mothers think their babies will be smarter. The standard
is breast milk."

Until more tests are done, Walker and some other breast-feeding promoters
want the new formulas pulled from store shelves.

Firms want a choice

Both U.S. formula companies say the science backs their claims that the
formulas work and offer an alternative mothers should have.

The companies readily admit breast milk is best but also say women who can't
breast-feed or choose not to deserve a choice.

"We're advocates for the best nutrition for infants. If a mom decides not to
breast-feed, there should be no guilt or fear that her baby is not getting
the best nutrition," said Gail Wood, spokeswoman for Mead Johnson
Nutritionals, maker of Enfamil Lipil.

Breast milk, a complex substance that scientists are slowly coming to
understand, contains the perfect formula of fat, sugar, water and protein for
the vast majority of infants in their first months. Many babies digest it
more easily than formula, and breast milk contains antibodies to protect
infants from bacteria and viruses and to help them fight off infection and
disease. Studies show that infants who have received mothers milk have higher
scores measuring visual acuity and cognitive development, including IQ, said
Paula Meier, director for clinical research and lactation at
Rush-Presbyterian-St. Luke's Medical Center.

"Artificial formulas can never duplicate breast milk, a comment that every
formula company packages into its materials," Meier said. "However, one
formula may have advantages over another."

"It becomes a breast-feeding issue when the general public is made to feel
that the new formulas are closer to breast milk and that infants can receive
the same benefits as if they had breast-fed," Meier said. "This is not the
case. Human milk has so many interdependent biochemical systems--many of
which catalyze each other, have multiple functions and change over the weeks
and months of lactation according to infant needs."

While breast-feeding is best, many mothers choose not to breast-feed, are
unable to or want something to supplement it. Some pediatricians say this
group of women should have the health and developmental benefits of the two
fatty acids, docosahexaenoic acid (DHA) and for arachidonic acid (AA).

Whether or not they really work when added to formula is still a matter of
intense debate and study. Even the precise amount of DHA and AA that should
be added to formula is uncertain. The two major U.S. baby formula companies,
Mead Johnson and Ross Products, a division of Abbott Laboratories, use
different amounts in their products.

So far, the evidence has shown that premature babies benefited from the
enhanced formula more than full-term babies. During the last trimester of
pregnancy through the first two years of age, tremendous amounts of DHA and
AA are deposited in the brain and the retina of the eye. A baby born
prematurely is missing many of the benefits of the nutrients.

Better results in preemies

"The science is certain. It works," said Susan Carlson, a professor of
nutrition at the University of Kansas, who has been studying long-chain fatty
acids in infants for two decades. In 1982 she published a paper that showed
babies fed formula had lower levels of DHA in their blood than babies fed
human milk. Since then her work has mainly shown the formula benefited
premature infants. "In the meantime, scientists are doing more research
defining the optimal level. Unfortunately that is not at all clear."

Frank Greer, a professor of pediatrics and nutritional sciences at the
University of Wisconsin Medical School, said the long-term benefits are "very
questionable and remain to be proven. Information is especially lacking for
infants who are initially breast-fed" and then switched to the formula.

Before approving the formulas last year, the Food and Drug Administration
debated for five years whether to permit the addition of DHA and AA because
of differing views on how much should be added and on the possible sources of
the fatty acids. The DHA amounts in breast milk differ according to the
mother's diet, and even geography. Meanwhile, initial sources of DHA from
fish oil turned out to contain other fats that hindered babies' physical
growth.

But a small biotechnology company, Martek Biosciences, which sells products
from microalgae, came up with a DHA and AA blend made from purified algae and
fungi.

In 2001 the FDA gave DHA and AA approval as Generally Recognized as Safe. By
February of 2002, Mead Johnson launched Enfamil Lipil, the first U.S. infant
formula to contain Martek's oils. In April, Ross Products followed with
Similac Advance. Of the two products, Mead Johnson's Lipil has the higher
level of the two fatty acids. Both products are more expensive than regular
formula.

Now, a committee of the Institute of Medicine, through the Food and Nutrition
Board, is conducting a 24-month study of the safety procedures for evaluating
the new ingredients, according to Paula Trump, senior program officer and
director of the study. The board also wants to get formula companies more
involved in tracking adverse effects of the product.

A major responsibility

"Formula is a food, but it's a special kind because it's an infant's sole
source of nutrition," said Dr. Richard J. Deckelbaum, director of the
Institute of Human Nutrition at Columbia University and chair of the
Institute of Medicine committee. "By the age of 1, the majority have had
infant formula even if they're breast-fed. So it's a major responsibility to
make sure the product is safe."

Dr. Timothy Wall, a Naperville pediatrician, said he always recommends
breast-feeding.

"But of course, some choose not to, so I do recommend the enriched formulas,"
said Wall, a member of the executive committee of the Illinois Chapter of the
American Association of Pediatrics. "My overall advice to parents is use it
if you can afford the difference in price, but don't be afraid of
ill-effects. But if you really want to improve your baby's intellect in a
more certain way, while enhancing their immune system, consider
breast-feeding."


Copyright (c) 2003, Chicago Tribune




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