Infant Formula or Breast Milk: Is there a difference?

A tremendous has been written regarding the benefits of both breast-feeding and breast milk. From neurodevelopmental benefits in speech development to improved mucosal immunity and the subsequent incidence of infectious diseases such as otitis media, respiratory illness and diarrhea, to the subtle behavioristic changes brought about by bonding skin-on-skin and suckling from the mother’s breast, the advantages of breast-feeding have been promoted and elevated from a matter of opinion to in many cases an institutional policy. One of the more obvious reasons for opting to breast feed would include the following brush with common sense: What better food for a baby but the milk produced by his or her mother? In the age of synthetic and artificially produced food, hair, nails, skin, organs, happiness, longevity and more, why not an artificial breast milk?

Enter powdered or liquid infant and newborn formula. Infant formula is a mixture of protein, fat, carbohydrate vitamins and minerals developed as a substitute for breast milk. Infant formula is produced by the likes of Nestlé, Mead Johnson, Ross, Gerber, Wyeth and others under the scrutiny of the United States Food and Drug Administration, designed for babies from premature to 1 year of age. From the age of 1 year on the ability to handle a larger protein load allows for the introduction of cows milk.

The evolution of artificial breast milk or infant formula began in the early 19th century with the establishment of first wet nurses giving way to “dry nursing” with a variety of available milk based products. Dry nursing took a giant leap forward with the development of the artificial nipple by Elijah Pratt in 1845. From there, the science, analysis and monitoring of artificial formulations to feed newborns accelerated to where we are today. We have cow’s milk based protein formulations, soy based formulations, formula with iron, without iron, formula with docosahexanoic acid (DHA) and arachidonic acid (ARA) or without it, and many more.

The question posed by this article is as follows: Does breast-feeding offer an advantage to growing babies developing into children then into adolescents and into adulthood all other factors being equal? By that, is it a stretch to offer some relationship between adult disease and breast feeding versus formula feeding some thirty to fifty years earlier?

Because of the extent of the literature related to this subject, I’ll break it up into three or four articles covering as much literature and as many relevant topics as possible. From the outset, relating an exposure such as breast feeding or infant formula to disease some years later is without a doubt going to be fraught with mixed results. Confounding between the exposure and outcome of interest is at best a tricky business and at worst impossible. For example, the association between breast feeding versus infant formula feeding and the subsequent development of otitis media or ear infections necessarily needs to account for other (usually older) children in the house, daycare exposure, parental smoking, family history of allergies, cleft palate, and other possible exposures predisposing to otitis media or ear infection. At that, a paper showing an association between infant formula feeding and subsequent predisposition to otitis media without taking into account the aforementioned known predisposing factors listed above, may gain popular support because it lends credence to the opinions of some; however, it needs to be viewed for what it is: a flawed analysis. Also, the results may now be obsolete as infant formula has evolved over the years.

The debate over the benefits of breast feeding over the use of infant formulas has also ignored one subset of feeding practices: The breast expressed (using a breast pump) but bottle fed baby. Is it strictly the breast milk or the practice of putting baby to breast?

Flaxseed Oil

I’m currently watching a lot of television as a new addition to the family is feeding every two hours. Babies are amazing little things. Their tiny feet and hands and innocent little pursed lips and occasional open eyes distract from the time warp one enters. They have the uncanny ability to blur the distinction between waking and sleeping or even days of the week. We’ve literally been living in cycles of two hours with no distinction between day and night. Needless to say, I turn to the television on some of my watches.

I became interested in a Bravo Network show the other night called “Top Chef” as one of the panel of “judges” or “experts” in cooking and food claimed that flaxseed was effective at reducing cholesterol in humans and foods with flaxseed were good for those wishing to lower their cholesterol. I paused and scratched my head. Maybe I had missed something?

Flaxseed is rich in fiber if taken whole and if crushed into an oil, is very high in Alpha Linolenic Acid, an 18 carbon Omega-3 fatty acid. Flaxseed oil is also called “linseed” oil and has been used in industrial and commercial processes for ages. As an aside, flaxseed oil is also rich in monounsaturated fatty acid as well as the saturated fatty acid palmitic acid.

The question comes down to an examination of the scientific evidence that an 18 carbon Omega-3 fatty acid (alpha linolenic acid or ALA) will lower cholesterol on its own (that is no dietary changes other than adding the fat supplement have been made). Flaxseeds are high in fiber and impart a fiber load with the consequent cardioprotective properties of any dietary fiber if eaten whole and chewed; however, for most foods, whole flaxseed is not consumed in significant amounts and flaxseed oil or flaxseed supplements with ALA are what the Top Chef is referring to.

A recent study published in the Journal of Nutrition (2006 Nov;136(11):2844-8) did a very slick experiment with double blinding and lots of daily ALA in the test supplements.
What they found was as follows: Lipoprotein levels were no different between groups, LDL, HDL and total cholesterol was unchanged after 26 weeks. In their words,

“In conclusion, ALA does not decrease CVD risk by altering lipoprotein particle size or plasma lipoprotein concentrations.”

So be careful what your Top Chef tells you!