Thanks for the comment on iron in breast milk substitutes.

Almost every breast milk substitute is fortified with iron.  It has been
known for some time that this is essential to avoid anemia and to prevent
neurodevelopmental impairment.  More and more we are realizing that the old
low-iron formulations (including condensed milk and whole milk) are
inadequate and should be replaced by high-iron substitutes to protect
infants from injury:  this is not surprising, it took breastmilk millions
of years to evolve, even the most hardworking and industrious formula
company would have difficulty competing.

The second point is that in blinded (or masked) studies parents have been
unable to detect much difference in gastrointestinal symptoms between low-
and high-iron formula.  Even if there were a proven difference, I am sure
if given the choice between loose stools and neurodevelopmental impairment
they would choose the former.

The issue of supplementing breastmilk is more complicated and I am not sure
which way the literature will go.  For now I would recommend that low-iron
breastmilk substitutes not be routinely stocked by healthcare institutions.

In summary, iron deficiency is endemic in Canada and, if mothers choose not
to breastfeed, low-iron formulas, condensed milk and whole milk should be
strongly discouraged in infancy (as per Canadian Pediatric Society
recommendations).  We should campaign to ensure that the community and
retail trade are aware of this recommendation.

Khalid

Khalid Aziz
Memorial University of Newfoundland