A Natural Family Online Special Report:
The deadly influence of formula in America
By Dr. Linda Folden Palmer
Editor’s Note: This groundbreaking analysis from noted author, health educator and advocate Dr. Linda Folden Palmer is the first time a health expert has published an examination of the available scientific research comparing the death rates of formula-fed and breastfed babies. While the results hold no surprises for breastfeeding educators and advocates, the study may prove to be a rude awakening for the millions of Americans who have bought into the myth that infant formula is a perfectly safe breast milk substitute. We’ve summarized Dr. Palmer’s detailed research for our cover story here. Read the full text with footnotes and references.
Read the follow-up article on optimizing the health of formula-fed babies.
Discuss! Why do you suppose so many parents choose formula despite its dangers?
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Homebirth or hospital? Cloth or disposable? Early exposure to large numbers of other children? Extreme or relaxed sanitation? Pets in the house?
The answers to the swirl of questions surrounding the birth of a baby are not simple. There are no overall right or wrong answers. Parenting involves a huge number of choices, starting from before conception and reaching through childhood and beyond.
In many cases, we don’t have the time or energy to investigate and choose from all the available options. We opt for the status quo or simply what seems easiest for our families. Other times, we do not have the luxury of choice; circumstance prevails. Traveling in a car with our children, for instance, is a risk that most of us take because we have little choice.
Still, many major parenting decisions, including the decision to breastfeed or use infant formula, remain conscious choices for most parents. What’s often missing from this decision are the facts. Sure, we’ve all heard that “breast is best” -- but what are the solid statistics? Is infant formula the perfectly safe breast milk substitute we’ve been led to believe?
The deadly influence of formula
Infant formula was designed to be a medical nutritional tool for babies who are unable to breastfeed. Formula does not fully meet the nutritional and immunity needs of infants, leaving their immune systems flailing. An infant’s immune system has three aspects: her own immature, developing immune system; the small component of immunities that passes through the placenta during natural childbirth (and to a lesser degree with premature births and cesarean sections); and the most valuable, living portion that is passed on through mother’s milk on an ongoing basis. Remove any of those components and you take away a vital support structure.
This brings us face to face with the safety and effectiveness of infant formula as a breast milk substitute. Is formula actually as safe as we have been led to believe? In fact, the answer is a resounding “no.” In fact, the use of infant formula doubles the risk of infant death for American babies.
While the dangers of formula feeding aren’t something you’re likely to hear in your doctor’s office, the conclusions can be derived through an examination of the available scientific research on infant mortality in the United States and across the world. There are studies showing artificial feeding’s impact on overall infant death rates in both developing and undeveloped countries. While studies offering comparative death rates are not available for industrialized regions, there are numerous studies providing comparative occurrence rates for many illnesses and disorders in the United States and other industrialized nations. Many more reports are available extolling superior survival rates and decreased illness rates among breastfed infants, but only those with solid numbers are useful here. We can assemble the statistics from these studies to build a firm picture of the ratio of infant deaths for U.S. formula-fed babies against those who are breastfed.
Why do U.S. babies die?
Total U.S. births in 1999: 4,000,000
Total U.S. infant deaths in 1999: 28,000
So how does formula play into these deaths? Let’s look at some of the common causes of infant death and see what current research has to say on the involvement of infant formula.
Sudden Infant Death Syndrome (SIDS) Studies have found a five-fold risk of infant death from SIDS for American formula-fed babies.
Heart, circulatory and respiratory failure Scientists worldwide have documented higher blood pressure among formula-fed infants, as well as more apnea and episodes of oxygen desaturation, inferior body temperature regulation, less growth and longer hospital stays.
Necrotizing enterocolitis Researchers in the United Kingdom have confirmed that formula-fed infants develop necrotizing enterocolitis six to 10 times more often than breastfed babies.
Diarrhea A summary article for industrialized nations demonstrated an average of triple the risk of diarrhea for formula-fed babies. The risk in China and Israel is reported as slightly less than triple; in Scotland, the risk is five-fold; and a doubled risk is measured in Canada.
Respiratory illnesses It is clear that respiratory infections are at least triple in the United States for formula-fed infants. The death rate is likely to be even higher, since some of these studies note that both the severity and extent of respiratory illnesses are considerably higher once they occur.
Cancer A joint study between the United States and Canada on neuroblastoma, a common childhood cancer, revealed a doubled risk for children who did not receive breast milk for more than one year. This study is consistent with several other childhood cancer studies in other nations.
Low birth-weight and pre-term birth A U.S. study performed at George Washington University Hospital found 2.5 times the number of infections among formula-fed infants in the intensive care unit than among those receiving human milk. Another study at Georgetown University Medical Center also found more than double the number of infections in very low birth-weight infants not receiving human milk. A San Diego study found twice as many infections in pre-term, formula-fed infants compared with infants who received human milk.
It is worth noting that the eye damage that can occur in very low birth-weight infants, retinopathy of prematurity, occurs only half as often in infants who receive some breast milk. Even a disorder as apparently unrelated to feeding methods as inguinal hernia has been discovered to occur twice as often in artificially fed infants and even more frequently when compared with infants who are exclusively breastfed.
Congenital abnormalities Twenty percent of U.S. infant deaths are attributed to birth defects. While death certificates often list the initial abnormality as the cause of death, infection is actually the final factor in many of these deaths. We have already seen how drastically infection rates and deaths are reduced by breastfeeding. It is clear that the youngest and weakest infants are the ones who are most strongly endangered by infant formula’s inadequacies.
For example, infants born with phenylketonuria (PKU), a defect in handling a certain protein in the diet, need specialized supplementation to breast milk in order to prevent mental retardation and other difficulties. Yet a study demonstrated that infants who had been breastfed before being diagnosed with PKU fared far better than those who had been fed on formula. The greatest complications for infants with cystic fibrosis are lung infection, decreased oxygenation and malnutrition – all of which are recognized to be complicated by formula feeding.
Complications of pregnancy and birth Complications of pregnancy and birth produce a wide range of injuries and problems for babies. Infection, insufficient neurological recovery and inadequate oxygenation lead to many infant deaths. Artificial feeding certainly has some degree of impact on mortality in these cases.
Accidents It seems logical that accidents happen equally among artificially and naturally fed infants. Figures bear this out. One paper actually measured accidental injuries between breast- and formula-fed infants, finding an equal number in both.
The big picture
The relative risk for formula feeding in many categories was clearly defined by studies. We are able to select conservative but appropriate rates, as seen in the table below.
Calculating Formula’s Final Impact
Cause of death Actual U.S. infant deaths (1999) Relative risk for formula-fed infants Estimated
IMR for breastfed babies Deaths if all were breastfed Deaths if all were formula-fed Lives saved if all were breastfed
Congenital abnormality 5500 1.5 1.1 4400 6600 1100
Prematurity 4500 2.5 .643 2570 6430 1930
SIDS 2700 4 .27 1080 4320 1620
Complications of pregnancy & birth 2400 1.25 .533 2135 2670 270
Respiratory distress & infections 1750 4 .175 700 2800 1050
Accidents 850 1 .213 850 850 0
Bacterial infection 700 3 .087 350 1050 350
Circulatory problems 650 1.5 .13 520 780 130
Necrotizing enterocolitis 400 8 .022 90 710 310
Diarrhea 300 2.5 .043 170 430 130
Meningitis 100 3 .014 55 170 45
Cancer 100 2 .02 80 160 20
SUBTOTALS 19950 2.075 3.25 13000 26970 6955
All other 8050 2 1.6 6440 12880 1610
TOTALS 28000 2 4.7 18665 37335
IMR 9.4 9335
Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live births, from 0 to 12 months of age.
Based on the current U.S. infant death rate of 6.7 and an average breastfeeding rate of 50%, the American infant mortality rate would climb to 9.4 if all infants were formula-fed and would drop to 4.7 if all were breastfed. Twenty-two nations with high rates of breastfeeding have infant mortality rates below 5, while the United States ranks higher in infant death than 41 other nations. Clearly, lower rates for the United States are a possibility.
The ugly truth about formula
From the above statistics, we see that formula feeding costs American babies more than four additional lives per thousand. The final relative risk for formula feeding comes out to 2 – that’s double the risk of death for American infants who are fed with formula, compared with babies who are fed naturally.
A multitude of studies demonstrate that when breastfeeding is accompanied by formula supplementation, illness and death rates are much closer to those of babies who are fully formula-fed. Studies also reveal conclusively that the longer breastfeeding lasts, the greater the measurable difference in illness and death rates.
Answering the detractors
Criticisms are often spread about studies that find increased illness and death rates associated with formula feeding. For just this reason, each later study aggressively attempts to take into account any factors that have been purported as distorting previous study outcomes. These research papers address as many aspects as possible, from maternal education, to smoking, to income level, to day care usage and many more possibilities. The results continue to reveal the risks of formula feeding.
It’s commonly said that formula feeding does not risk lives in industrialized nations where education and medical advances prevent increased deaths. The evidence is quite to the contrary. Some insist that the blame for the United States’ relatively high infant death rate lies with underprivileged communities. Again, it has been shown that elevated death rates among U.S. blacks cannot be attributed to poverty. Hispanic Americans rank similarly to African-American populations for socio-economic factors, but they match non-Hispanic whites in their lower infant mortality rates. The difference is not socio-economic; rather, the difference is in rates of formula use versus breastfeeding.
A New York study sought to establish the connection between education, income and infant survival. It concluded strongly that the number of illnesses is increased by two to three times in formula-fed babies regardless of socioeconomic status or level of parental education. A later study in Israel confirmed the effects of formula feeding across all classes and education levels. The most recent analysis of this issue, again performed in the United States, reiterated that higher illness rates among formula-fed or formula-supplemented infants “did not differ among income groups.”
And beyond the first year
While the extent of breast milk’s health protection declines with age, a great number of studies demonstrate the continued survival advantage of breastfeeding through the second year and beyond. A World Health Organization study of less-developed countries found a doubled risk of death in the second year of life for those weaned prematurely or never receiving breast milk. A study in The Netherlands found a strong correlation between the extent of breastfeeding and the number of illnesses in children. Significant protection from breastfeeding was noted during the first three years of life. Other studies show a sizeable increase in illnesses throughout all of childhood for those who were never breastfed or prematurely weaned. In fact, an increased risk of death throughout life has been well documented for people who were formula-fed. Higher blood pressure, more heart disease, obesity, diabetes and artery disease, a nearly doubled rate of Crohn’s disease and tripled rates of celiac disease have all been associated with early formula feeding.
What your doctor doesn’t tell you
Pediatricians spend much time frightening parents with 1 in 100,000 risks from vaccine-preventable diseases when parents question the utility and safety of vaccines. “Would you want to risk the life of your child?” they demand. Yet these very same professionals offer formula samples with the other hand – when the magnitude of health risks associated with the use of formula is 500 times greater.
Parenting is all about making choices and weighing risks and benefits. Many parents need to make the riskier choice of formula feeding in order to balance other factors that benefit the family. Yet some parents who have lost their children, possibly based on pediatric advice condoning or encouraging formula-feeding, would surely wish that they had been informed of the very real risks related to using formula. ↓
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| Name: inny | Date: Mar 29th, 2006 4:27 AM |
| wow, thanks for this info. So glad I breast fed my kids up till they were 2. ↑ |
| Name: Melissa | Date: Mar 29th, 2006 5:48 AM |
| thought that everyone one this forum would like to know this info. it really makes me happy that i'm breastfeeding too. i hope that someone that isn't sure will read this and help make up their minds ↑ |
| Name: 3 time nursing mom | Date: Mar 29th, 2006 6:33 AM |
Melissa,
I agree. There is so much wonderful information like this available, but yet I understand that many new mommy's don't know how to access it, and only rely on the information that is given to them by their family, friends, and doctors. That in itself would not be so bad. But since we are only now starting to walk away from a time when Formula companies seemed to 'rule the roost', our family, friends, and even doctors don't seem to be all that knowledgeable and/or supportive.
Too often I hear the words "My baby was on formula and (s)he turned out just fine. It's really what ever you want to do." However if we keep up the information railroad, hopefully that statement will in time cease to be so common.
Thanks for posting this.
I especially think the last two paragraphs make a valid point. ↑ |
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