The Deadly Influence of Formula in America.
(Part 1)

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By Dr. Linda Folden Palmer
First published on Natural Family Online

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.

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 these 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.

The relative risks of formula

It is clear that feeding infants artificial formula instead of breastfeeding increases their relative risk of death. A number of studies point to this fact. Table 1 shows figures from two studies measuring infant mortality risks during certain age ranges. A risk number of 3 in the chart represents three times the risk of infant death for infants who are artificially fed.

While the numbers in the charts reflect any amount of breastfeeding during the study period (and not necessarily exclusive breastfeeding), nearly all studies mention that during the first six months, exclusive breastfeeding produces much higher survival rates than partial breastfeeding. No studies refute this assertion. Figures for each age range listed here do not include children who died prior to reaching that age group. Figures reflect infants who received no breast milk or had weaned prior to reaching the reported age group versus those who received any breastfeeding through that age.

Table 1 clearly demonstrates that the disadvantages of formula are most devastating in the earliest months. Significant disadvantages for formula continue throughout the year-long study period.

Suggested Relative Risks for Infant Deaths

No Breastfeeding or Any Breastfeeding Ending Before Designated Age Ranges vs. Breastfeeding Through Designated Age Ranges (1,2)

A relative risk of 13 here means that a child who was not breastfed through the time period has thirteen times the risk of dying during his first year as a child who had received any breast milk through that period.

The studies cited in the next table compare no breastfeeding with 12 months of breastfeeding, each deriving a relative risk of death over the full first year.

Suggested Relative Risks for Infant Deaths

No Breastfeeding vs. Any Breastfeeding for 12 Months (3-7)

Infant Mortality Rates (IMR) are the number of infant deaths per 1,000 live births, from 0 to 12 months of age. A relative risk of 5 here means that an infant who receives formula statistically faces five times the risk of dying as an infant who is partially or completely breastfed.

* These values are calculated from numbers provided in the studies, with averages weighted by percentages of total deaths occurring in each age range. More than two-thirds of deaths occur during the first month.

While the United States has a current infant mortality rate of 6.75 per thousand, many countries have rates approaching 100, with 16 of 225 reporting nations suffering well over 100 infant deaths for every 1,000 children born.(8) The nations in the above table with lower infant mortality rates can thus be seen as somewhat comparable to the United States.

Factors influencing high infant death rates include malnourished mothers, high numbers of births per mother with short spacing between births, poor weaning foods, the early use of cow’s milk, inadequate medical attention and supplies, poor sanitation leading to high infection rates and a rapid spread of infectious disease, and limited education about methods of limiting infection and the spread of disease.

Why do U.S. babies die?

Below are the percentages and total numbers of U.S. infants who die from various leading causes, according to the 1999 National Vital Statistics Reports. (9,10)

Numbers account for 70 percent of total infant deaths

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)

Sudden Infant Death Syndrome (SIDS) accounts for a full 10 percent of U.S. infant deaths. Several studies performed in the United States and other industrialized nations reveal increased risks of SIDS among babies who receive formula instead of breast milk. In the table below, the 2002 Scandinavian study takes into account variables thought to have affected the 2000 U.S. study, finding even stronger risks associated with formula.

The most recent U.S. study (2003) takes advantage of the lessons from these earlier studies to raise confidence in its final results. Its finding of five times the risk of infant death from SIDS for formula-fed infants seems to be the most powerful statistic yet.

Studies Demonstrating Relative Risks of Infant Death from SIDS
Formula-Fed vs. Breastfed (11-17)

A relative risk of 5 here means that an infant who receives formula statistically faces five times the risk of dying from SIDS as an infant who is breastfed.

Heart, Circulatory and Respiratory Failure

Premature infants and those with circulatory abnormalities often display one or more warning signs of potential death, including inadequate oxygenation of the blood, apnea (episodes where breathing stops) and high blood pressure. Studies illustrate the dangers of formula for these infants. One study observed better body temperature and superior oxygenation in pre-term infants receiving breast milk. Formula-fed infants demonstrated many episodes of inadequate oxygenation and some apnea, both of which were not seen among the breastfed infants. A Scottish study found significantly better blood pressure among naturally fed infants.

Three U.S. studies are available examining feeding methods for infants with early circulatory problems. One study reported that more than half of infants with congenital heart disease lost oxygenation during bottle feedings, while none did so while breastfeeding. Another study also dealing with heart disease found infants’ growth to be significantly inferior and their hospitalizations to be longer when they were fed formula. A third study of very low birth-weight infants found twice as many episodes of inadequate oxygenation among formula-fed infants as in those who received breast milk.

Heart and Circulatory Disease in Formula-Fed vs. Breastfed (18-22)

Necrotizing Enterocolitis

Necrotizing enterocolitis is a severe intestinal inflammatory disorder that affects around 4 percent of low birth-weight babies and 1 percent of full-term infants. About one-third of low birth-weight infants and 20 percent of full-term infants who contract this disorder die. While necrotizing enterocolitis is reported to be responsible for 1.4 percent of infant deaths, many more unconfirmed cases are likely to be responsible for some portion of infant deaths reported as caused by prematurity.

In the United Kingdom, it was discovered that confirmed cases of necrotizing enterocolitis occurred in three times as many infants who received no breast milk as in those who received both breast milk and formula. For infants who exclusively received breast milk, necrotizing enterocolitis occurred six to 10 times less often than among wholly formula-fed infants.

Necrotizing Enterocolitis (23)

Diarrhea

A World Health Organization (WHO) study revealed a risk of diarrhea for formula-fed babies in developing nations averaging more than six times that of breastfed babies. 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 (2.8); in Scotland, the risk is five-fold; and a doubled risk is measured in Canada.

While one study noted nearly twice the risk of developing diarrhea for artificially fed infants in Brazil, other studies have demonstrated that the risk of actually dying from diarrhea was an astounding 14 to 15 times greater. The latter studies demonstrated not only that the artificially fed infants suffer higher rates of illness, but also that the severity and duration of their illnesses are even greater when they do occur and result in proportionately more deaths. This same assertion is demonstrated in a study from India, where formula-fed infants suffer six times the death rate, once diarrhea occurs, as breastfed infants with diarrhea.

Four separate studies in the United States all deduce a doubled risk of diarrhea for formula-fed babies. The U.S. studies also reiterate the well-established factor of greater severity and extent of illness once diarrhea does occur among formula-fed babies. Death rates for formula-fed U.S. infants who get diarrhea may be three times higher or more than their breastfed contemporaries.

The table below collates the reported risks of diarrhea for formula-fed infants from many studies.

Diarrhea Risks for Formula-Fed vs. Breastfed (24-40)

Respiratory Illnesses

Numerous studies document higher numbers of respiratory infections among formula-fed infants than among those who are breastfed. 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.

Respiratory Illness Risks for Formula-Fed vs. Breastfed (41-50)

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, with results ranging from 1.45 to 4 times the risk for developing various common childhood cancers for formula-fed babies.

Childhood Cancer Risks for Formula-fed vs. Breastfed (51-56)

Dr. Linda Folden Palmer consults and lectures on natural infant health, optimal child nutrition and attachment parenting. After running a successful chiropractic practice focused on nutrition and women's health for more than a decade, Linda's life became transformed eight years ago by the birth of her son. Her research into his particular health challenges led her to write Baby Matters: What Your Doctor May Not Tell You About Caring for Your Baby. Extensively documented, this healthy parenting book presents the scientific evidence behind attachment parenting practices, supporting baby's immune system, preventing colic and sparing drug usage. You can visit Linda's Web site at www.babyreference.com.

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Dr. Mercola's Comment:

It is good to see that attention is being given to the importance of breastfeeding. Breastfeeding your newborn is the best way to give her all the nutrients she needs to develop into a strong, healthy child.

I encourage every mother who is able to breastfeed her newborn. However, there are cases when a woman may be unable to breastfeed for physical reasons. In these cases, it’s important to recognize that ALL soy formula is worse than worthless for human infants and is nearly guaranteed to cause problems down the road. What are some of the problems associated with soy formula? Well, for starters it:

• Will adversely affect hormone levels, as it has been associated with reduced testosterone levels
• Will impair thyroid function through isoflavones present in the formula
• Increases the risk of behavioral problems
• Will expose infants to up to 2,000 times higher estrogen content
• Has potentially high concentrations of aluminum and manganese

Soy formula is generally given to infants who aren't breastfeeding and have trouble taking regular cow-milk-based infant formulas. While I am no fan of these formulas either, they tend to be safer than soy formula. However, the cow-milk-based formulas are derived from pasteurized milk. If you haven't heard by now pasteurized milk is not good for you or your baby.

Fortunately, you can use raw milk to produce a terrific infant formula, but, again, remember that breast milk is ALWAYS best.

1. Palloni et al., "The effects of breast-feeding and the pace of childbearing on early childhood mortality in Mexico," Bulletin of the Pan American Health Organization (Mexico) 28, no.2 (Jun 1994): 93-111.

2. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality, "Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis," Lancet 355, no. 9202 (Feb 2000): 451-5.

3. J.P. Habicht et al., "Does breastfeeding really save lives, or are apparent benefits due to biases?" American Journal of Epidemiolofy 123, no. 2 (Feb 1986): 279 -- 90.

4. D.K. Guilkey and R.T. Riphahn, "The determinants of child mortality in the Phillipines: estimation of a structural model," Journal of Development Economics (US and Germany) 56, no. 2 (Aug 1998): 281-305.

5. P. Tu, "The effects of breastfeeding and birth spacing on child survival in China," Studies in Family Planning (China) 20, no. 6 (Nov.-Dec. 1989): 332-342.

6. Palloni and M. Tienda, "The effects of breastfeeding and pace of childbearing on mortality at early ages," Demography (US) 23, no. 1 (Feb 1986): 31-52.

7. S.P. Srivastava et al., "Mortality patterns in breast versus artificially fed term babies in early infancy: a longitudinal study," Indian Peadrics (India) 31, no. 11 (Nov 1994): 1393-6.

8. The World Fact Book, http://www.odci.gov/cia/publications/factbook/rankorder/2091rank.html

9. National Vital Statistics Report, 49, no. 11 (Oct 12, 2001): 1-12.

10. National Vital Statistics Report, 50, no. 16 (Sep 16, 2002): 1-12.

11. F.R. Hauck et al., "Sleep environment and the risk of Sudden Infant Death Syndrome in an urban population: the Chicago infant mortality study," Pediatrics (US) 111, no. 5 (May 2003): 1207-1214.

12. B. Alm et al., "Breastfeeding and the sudden infant death syndrome in Scandinavia, 1992-1995," Archives of Disease in Childhood (Sweden) 86 (2002:400-402.

13. K.L. McVea et al., "The role of breastfeeding in sudden infant death syndrome," Journal of Human Lactation (US) 16, no. 1 (Feb 2000): 13-20.

14. J. Schellscheidt et al., "Epidemiological features of sudden infant death after a German intervention campaign in 1992," Eur J Pediatr (Germany) 156, no. 8 (Aug 1997): 655 -- 60.

15. R.E. Gilbert, "Bottle feeding and the sudden infant death syndrome," British Medical Journal (England) 310, no. 6972 (Jan 14, 1995): 88-90.

16. H.S. Klonoff-Cohen et al., "The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome," JAMA (US) 273, no. 10 (Mar 1995): 795 -- 8.

17. R.P. Ford et al., "Breastfeeding and the risk of sudden infant death syndrome," International Journal of Epidemiology (New Zealand) 22, no. 5 (Oct. 1993): 885-90.

18. A.C. Wilson et al., "Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study," BMJ (Scotland) 316, no. 7124 (Jan 1998): 21 -- 5.

19. C.H. Chen et al., "The effect of breast- and bottle-feeding on oxygen saturation and body temperature in preterm infants," Journal of Human Lactation (Taiwan) 16, no. 1 (Feb 2000): 21-7.

20. J.B. Bier et al., "Breast-feeding of very low birth weight infants," Journal of Pediatrics (Rhode Island, USA) 123, no. 5 (Nov 1993): 773-8.

21. V.L. Combs and B.L. Marina, "A comparison of growth patterns in breast and bottle-fed infants with congenital heart disease," Pediatric Nursing (USA) 19, no. 2 (Mar-Apr 1993):175-9.

22. B.L. Marino et al., "Oxygen saturations during breast and bottle feedings in infants with congenital heart disease," Journal of Pediatric Nursing (USA) 10, no. 6 (Dec 1995): 360-4.

23. A. Lucas and T.J. Cole, "Breast milk and neonatal necrotising enterocolitis," Lancet (UK) 336, no. 8730 (Dec 22-29, 1990): 1519-23.

24. H. Palti et al., "Episodes of illness in breast-fed and bottle-fed infants in Jerusalem," Israel Journal of Medical Science (Israel) 20, no. 5 (May 1984): 395-9.

25. C.G. Victora et al., "Infant feeding and deaths due to diarrhea. A case-control study," American Journal of Epidemiology (Brazil) 129, no. 5 (May 1989): 1032-41

26. P.W. Howie et al., "Protective effect of breast feeding against infection," British Medical Journal (Scotland) 300, no. 6716 (Jan 6, 1990): 11-6.

27. H.P. Sachdev et al., "Does breastfeeding influence mortality in children hospitalized with diarrhoea?" Journal of Tropical Pediatrics (India) 37, no. 6 (Dec 1991): 275-9.

28. M. Beaudry et al., "Relation between infant feeding and infections during the first six months of life," Journal of Pediatrics (Canada) 126, no. 2 (Feb 1995): 191-7.

29. P.W. Yoon, "Effect of not breastfeeding on the risk of diarrheal and respiratory mortality in children under 2 years of age in Metro Cebu, The Philippines," American Journal of Epidemiology (Philippines) 143, no. 11 (Jun 1996): 1142-8.

30. M. Lopez-Alarcon et al., "Breast-feeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under six months of age," J Nutr (Mexico) 127, no. 3 (Mar 1997): 436 -- 43.

31. J. Golding et al, "Gastroenteritis, diarrhoea and breast feeding," Early Human Development (England) 49, suppl. (Oct 29, 1997): S83-103

32. Z. Fu et al., "Exclusive breastfeeding and growth of infants under 4 months in China," Wei Sheng Yan Jiu (Center for Public Health Information, Chinese Academy of Preventive Medicine) 29, no. 5 (Sep 2000): 275-8.

33. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality, "Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis," Lancet 355, no. 9202 (Feb 2000): 451-5.

34. P. Gianino et al., "Incidence of nosocomial rotavirus infections, symptomatic and asymptomatic, in breast-fed and non-breast-fed infants," Journal Of Hospital Infection (Italy) 50, no. 1 (Jan 2002): 13-7.

35. M.M. Escuder et al., "Impace estimates of breastfeeding over infant mortality," Rev Saude Publica (Brazil) 37, no. 3 (Jun 2003): 319-25.

36. G.O. Vieira et al., "Child feeding and diarrhea morbidity," Journal of Pediatrics (Brazil) 79, no. 5 (Sep-Oct 2003): 449-54.

37. K.G. Dewey et al., "Differences in morbidity between breast-fed and formula-fed infants," Journal of Pediatrics (Davis, USA) 126, no. 5, pt. 1 (May 1995): 696-702.

38. P.D. Scariati et al., "A longitudinal analysis of infant morbidity and the extent of breastfeeding in the United States," Pediatrics (USA) 99, no. 6 (Jun 1997): E5.

39. A.L. Wright et al., "Increasing breastfeeding rates to reduce infant illness at the community level," Pediatrics (Tucson, USA) 101, no. 5 (May 1998): 837-44.

40. J. Raisler et al., "Breast-feeding and infant illness: a dose-response relationship?" Am J Public Health (Ann Arbor, USA) 89, no. 1 (Jan 1999): 25 -- 30.

41. H. Palti et al., "Episodes of illness in breast-fed and bottle-fed infants in Jerusalem," Israel Journal of Medical Science (Israel) 20, no. 5 (May 1984): 395-9.

42. C.G. Victora et al., "Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil," Lancet (Brazil) 2, no. 8554 (Aug 1987): 319-22.

43. Pisacane et al., "Breastfeeding and acute lower respiratory infection," Acta Paediatr (Italy) 83, no. 7 (Jul 1994): 714-8.

44. M. Lopez-Alarcon et al., "Breast-feeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under six months of age," J Nutr (Mexico) 127, no. 3 (Mar 1997): 436 -- 43.

45. A.C. Wilson et al., "Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study," BMJ (Scotland) 316, no. 7124 (Jan 1998): 21 -- 5.

46. J.A. Cesar et al., "Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study," British Medical Journal (Brazil) 318, no. 7194 (May 1999): 1316-20.

47. 47. A.L. Wright et al., "Increasing breastfeeding rates to reduce infant illness at the community level," Pediatrics (USA) 101, no. 5 (May 1998): 837-44.

48. 48. O.S. Levine et al., "Risk factors for invasive pneumococcal disease in children: a population-based case-control study in North America," Pediatrics (USA) 103, no. 3 (Mar 1999): E28.

49. 49. M.D. Blaymore Bier et al., "Human milk reduced outpatient upper respiratory symptoms in premature infants during their first year of life," Journal of Perinatology (Providence, USA) 22, no. 5 (Jul/Aug 2002): 354-359.

50. V.R. Bachrach et al., "Breastfeeding and the risk of hospitalization for respiratory disease in infancy: a meta-analysis," Archives of Pediatric Adolescent Medicine (USA) 157, no. 3 (Mar 157): 237-43.

51. X.O.Shu et al., "Infant breastfeeding and the risk of childhood lymphoma and leukaemia," International Journal of Epidemiology (China) 24, no. 1 (Feb 1995): 27-32.

52. Bener et al., "Longer breast-feeding and protection against childhood leukaemia and lymphomas," European Journal of Cancer (UAE) 37, no. 2 (Jan 2001): 234-8.

53. F. Perrillat et al., "Day-care, early common infections and childhood acute leukaemia: a multicentre French case-control study," British Journal of Cancer (France) 86, no. 7 (Apr 8, 2002): 1064-9.

54. J.L. Daniels et al., "Breastfeeding and neuroblastoma, USA and Canada," Cancer Causes and Control (USA, Canada) 13, no. 5 (Jun 2002): 401-5.

55. G.P. Mathur et al., "Breastfeeding and childhood cancer," Indian Pediatrics (India) 30, no. 5 (May 1993): 651-7.

56. M.K. Davis, "Review of the evidence for an association between infant feeding and childhood cancer," International Journal of Cancer (USA) 11, supp. (1998): 29 -- 33.