Why are breastmilk and formula not the same?
Is formula the same as breastmilk?
There are some people out there that argue that there is no difference between breastmilk and formulas now that so many “improvements” in formula have occurred. At the biochemical level, formula is not the same as breastmilk, not even close. If you take a look at a can of formula and the list of ingredients, it is patently obvious that breastmilk contains at least 20 times more “ingredients” than formula. Breastmilk contains live cells, stem cells, white cells, immune factors and antibodies which cannot be added formula and that’s just the beginning. In every other situation people would readily admit that powdered milk which is then re-constituted with hot water is not the same as fresh milk.
Formula and breastmilk are not at all the same, not even close.
Formula company advertising has tried to convince parents for years that their formulas are the same are the same as breastmilk. Photo 1 shows an ad, probably from the late 1890s or early 1900s, which states, in French “Artificial Milk Feeding”, using the word normally used for “breastfeeding” (allaitement). Sneaky no?
And what else does it say? “le seul lait stérilisé identique à celui de la femme” : The only sterilized milk identical to a woman’s milk!!!!
So by the beginning to the 20th century, formula was being advertized as just like breastmilk. This has always been essential to formula company advertising because otherwise it would be difficult to convince people to use formula not only in situations where it is medically indicated but also massively and unnecessarily as it is used now. Formula being “just like breastmilk” has even become a way to compete among different formula brands using words like “closer to breastmilk than ever”.
What does the next photo tell us?
It states that “our formula” has been around since your great great great grandmother’s time and then goes on to list all the improvements since that time. But this ad was printed in the 1990s before:
- DHA (docosahexaenoic acid), and arachidonic acid (ARA) – compounds which have always been in breastmilk, which have not been added to formulas until recently and which now that they have been added have been found not to have the same effect as when they are in breastmilk. Because just adding stuff to formula doesn’t mean it works in the same way as the ingredient works in breastmilk.
- The protein content of formulas was reduced and even at this time formulas still contain too much protein.
- Before nucleotides were added to formula (they made a big deal out of this too, though the importance of nucleotides in formulas has yet to be shown to do much of anything at all).
- Before oligosaccharides, the famous prebiotics, that formula companies have made such a big deal about in the last decade. Oligosaccharides has always been in breastmilk
- Before probiotics which mothers are buying by the handful. Breastmilk always contained probiotics.
- Before most “special formulas” were made for things like spitting up and “allergy”.
Think about what this means. It means that formulas that were touted as “just like breastmilk” in the 1890s as well as 1990s was “improved” by all sorts of changes since then. It means that if these changes were so important to babies’ health, then what about all the babies who received “unimproved formulas” all the way back to your great great great grandmother’s time? These formulas were inadequate, even harmful.
And what about all those hundreds of other compounds in breastmilk which have not been added and which will never be added? And those compounds yet to be discovered. Breastmilk is a very complex, living fluid and we are just beginning to understand how complex as we discover new ingredients.
Let’s start off by saying that a mother’s milk is unique, depending on that mother and that baby
Yes, it is true, every mother makes milk which is different than any other mother. That is because like all physiological fluids (blood, for example) milk varies from person to person. As an example, the amount of sodium in your blood may vary quite widely, normally, by as much as 15%, depending on how thirsty you are, how much sodium was in your lunch and other factors as well. That’s just one example.
We know also that colostrum, the first milk, is very different to the later milk. Very different. Yet formula companies and many doctors tell us that formula is a good milk for babies to drink during the first few days.
Aside from the much heralded nucleotides, formulas contain no antibodies. But antibodies are only one of many immune factors that are present in breastmilk that are not present in formulas. Breastmilk contains lactoferrin that is so important to immunity that the formulas are jumping on the lactoferrin bandwagon to discover how to include it in their products. And breastmilk also contains these immune factors: lysozyme (and enzyme that attacks bacteria and kills them by destroying their cell wall), mucins, lactadherin, bifidus factor and many others. And probably many others are yet to be discovered. These immune factors do not just sit there, they work together, in a beautiful cooperation, like the instruments in a symphony orchestra, to protect the baby according to which bacteria, viruses or funguses the baby may be exposed to. Even if the immune factors could be added to formulas, they would not have this “cooperation” as they cannot react to infection, because it’s the mother, through her breastmilk who produces these immune factors in response to infection. Breastmilk is a living, dynamic fluid.
Breastmilk has alpha lactalbumin, which in the presence of fats in the body, is changed to HAMLET (human alpha lactalbumin made lethal to tumour cells), no relation to the Prince of Denmark, which exercises broad anti-tumor activity against many different type of cancer and lymphomas
And breastmilk varies from morning to evening, from day to day, from week to week. Because of this, it will never be duplicated by any formulas.
Furthermore, breastmilk is full of anti-inflammatory factors, which decrease inflammation. Inflammation, on its own, can cause tissue damage and inflammation occurs in the presence of the battle of immune factors against bacteria or viruses. Because of the huge numbers of “good” bacteria in the intestines, breastmilk prevents this inflammation which normally would occur when immune factors fight microbes, saving tissue damage of the gut, and probably one of the reasons breastfeeding premature babies are less likely to get a serious, potentially life-threatening condition called necrotizing enterocolitis.
There are dozens, if not hundreds of immune factors and other important components in breastmilk that are not present in formulas. Just to mention two more; one, an important recently discovered immune factor: milk fat globule membranes. Oh, this is hot and the formula companies are working feverishly to include milk fat globule membranes into their milk. If they ever manage, they will tell us how important this immune factor is, hoping we will forget that all the other formulas before the new one didn’t have milk fat globule membranes. And the other? Stem cells, the mind boggles thinking how stem cells in breastmilk could be used to help in clinical medicine.
But see my article in Scientific American from 1995 . The article explains how breastfeeding protects babies against infection and why it is important to keep babies breastfeeding when the mother has an infection, including the common infection I get emails about all the time, methicillin resistant Staphylococcus aureus (MRSA). Yes, the sick mother protects her baby if she continues breastfeeding.
Also hot these days is the microbiome, all the bacteria that are part of you. Formula fed babies and breastfed babies have different bacteria in their intestines and elsewhere. And what difference does it make? The microbiome may determine the child’s:
- Development including neurological and cognitive development
- Immune function
- Protection against various pathogens
- Digestive function
- Stress levels
- And who knows what else? We are just beginning to plumb the secrets about the difference your microbiome makes
- “We are only beginning to appreciate the potential health benefits that could be accrued from this venture across diagnostic, preventative and treatment realms. We look forward with great anticipation to this transformed appreciation of how our microbial wealth during early life primes for health in adulthood.”
Are there things in formula that should not be there?
Of course, here is a quote from an article about aluminum in formulas. Shelle-Ann M Burrell, Christopher Exley. There is (still) too much aluminium in infant formulas BMC Pediatrics 2010; 10:63. These authors are not crazed breastfeeding radicals. In their article, they write “Infant formulas are integral to the nutritional requirements of preterm and term infants”. Well, I disagree with infant formulas being integral to the nutritional requirements of preterm and term infants. Breastfeeding is integral, yes, but not formula. But then they go on to say “While it has been known for decades that infant formulas are contaminated with significant amounts of aluminium there is little evidence that manufacturers consider this to be a health issue. Aluminium is non-essential and is linked to human disease. There is evidence of both immediate and delayed toxicity in infants, and especially preterm infants, exposed to aluminium and it is our contention that there is still too much aluminium in infant formulas.”
For those who are fond of exotic foods, infant formulas have been found on occasion to contain:
- Rat hair
- Beetle parts and beetle larvae
- Pieces of glass
- Melamine—due to adulteration of milk by greedy people
Do humans make mistakes?
Of course they do. And over the years there have been dozens of recalls of formula due to mistakes made in the manufacture of formula. Here is just one example:
So? Formula just like breastmilk?
What an incredible statement. Anyone who says such a thing is either completely ignorant of the biochemistry of breastmilk and formula and doesn’t know what they are talking about or is plain saying nonsense for political reasons. And if formulas and breastmilk are that different, then they have very different effects on the baby and the mother. Just pretending it ain’t so doesn’t make it so.
And these differences do not make a difference for the baby or the mother? Seriously? Here is the truth: You don’t take the normal, physiological and have to prove that it is better than the artificial. Formula feeding is an intervention, and in medical terms, you have to prove an intervention safe before it can be recommended as routine us, as in infant feeding. In fact, most women these days “cannot breastfeed” because they are undermined in their ability to do so. Hospital routines around labour and birth, separation of mothers and babies, early introduction of bottles and poor advice from health professionals results in most mothers who “cannot breastfeed”. If they had normal births, and good help from the beginning, most such mothers would be very successful breastfeeding.
And one more thing, last but certainly not least. The act of breastfeeding is different from bottle feeding. Breastfeeding is a close intimate, physical and emotional relationship between two people in love.
For an interesting short film on how breastmilk is so different.
Need breastfeeding help? Make an appointment at our clinic.
Copyright: Jack Newman, MD, FRCPC, 2017