Q: I am breastfeeding our first baby. Recently, I was put on a medication that was safe for me, but not for the baby. I was also exhausted and had to stop breastfeeding for a few days. I asked my husband to buy some formula. He came home totally confused about the many choices out there. Initially, I thought most formulas were quite similar, but now I am confused too.
A: There is no doubt at all that breastfeeding is, and always will be, the best way to nourish a baby. I tell mothers that breast milk gets three medals - gold, silver, and bronze - if there were a competition.
One of the main benefits of nursing a baby for as long as possible is the fact it is natural. And once nursing is fully established, most mothers do not have to worry as much about cost or ingredients. (Both the Canadian Pediatric Society and the American Academy of Pediatrics recommend exclusive breastfeeding for at least 6 months and ideally as long as one year.)
Most expectant mothers assume they will breastfeed their babies. This may explain results from a recent national poll by the marketing firm Leger: only 24% of moms are concerned about how they will feed the new baby. In fact, among the top concerns for expectant moms, feeding the baby ranked at 20%, labor and delivery at 80%, life after the baby at 77%, and sleepless nights at 56%. The survey also showed that moms in Alberta were more concerned with which clothes to buy for their new baby as opposed to what to feed him or her.
The Leger poll also showed that 38% of moms thought all formulas were basically the same. This is a startling discovery to many clinicians, when one considers all the competition and marketing methods employed by various makers of baby formulas, in an era known as the information age.
Over the past few years, there have been trends in adding things to formulas such as essential fatty acids (known as DHA and ARA), probiotics, nucleotides, and prebiotics. There is also talk of adding synbiotics in the future. But what are these products and do they justify the extra cost?
A probiotic is a live micro-organism that is also found in breast milk in the form of bifidobacteria. Currently in Canada, there is only one formula with added probiotics: Good Start® Natural Cultures. At this point, the Natural Cultures formula is unique in Canada, but it is anticipated other formula companies will follow suit by adding probiotics to their products. In fact, in the US there are already a number of competing formulas with added probiotics including the product Enfamil A+. (In Canada, Enfamil A+ was the first to add DHA; its competition soon followed suit. Currently, it contains no probiotics.)
Probiotics come in various forms: it is analogous to using the term "dog". There are many different species of dogs and each species is known for a particular characteristic. In other words, not all probiotics are the same. The two top probiotic species used in foods in North America are bifidobacteria and lactobacillus. First described in the early 20th century, by Nobel laureate Eli Metchnikoff, probiotics have been researched in such depth that consensus regarding some benefits is sufficient to put them to use clinically, such as the inclusion in formulas.
Probiotics work mostly in the small intestine where these "good bacteria" offer key benefits such as modifying the risks for allergies, enhancing some mineral absorption, reducing lactose intolerance, enhancing immune defenses, and shortening diarrhea. More work needs to be done before experts agree on the role probiotics play in reducing cholesterol and perhaps obesity.
Prebiotics, on the other hand, are not live bacteria and work mainly in the large bowel. These non-digestible oligosaccharides are mostly a form of carbohydrate that stimulates the growth of good bacteria (such as bifidobacteria) in the large bowel. Prebiotics also aid in enhancing mineral absorption, especially calcium. Proponents claim they reduce the risk of inflammation, enhance immunity, change the stool ph, and lead to better regularity. In fact, the makers of the formula Similac have chosen to add prebiotics to their product instead of probiotics.
A synbiotic is a product that includes both probiotics and prebiotics. Some nutrition experts claim there may be a reason to use synbiotics in formulas in the future, in the hope to deliver the best of both worlds to a formula fed infant.
With all of these trends behind us and more additions to formulas anticipated in the future, it is no wonder the Leger survey also discovered that almost half of the moms surveyed found labels on formulas to be very confusing. The same may be true, and perhaps even worse, for a father out there at midnight, shopping for a formula on behalf of his tired wife at home who is unable to fully succeed with breastfeeding.
Practically the best advice for expectant moms is to plan ahead. By this I mean to see breast milk as the absolute ideal, but also be realistic knowing that the majority of mothers do not end up feeding their babies exclusively on human milk for the first 6 months of life. Since breast milk contains a probiotic, using a formula with added probiotics can be regarded as safe and beneficial. The immune benefits associated with bifidobacteria especially stand out and are confirmed by Health Canada's own regulatory research.
Most of the formula companies have their own websites offering more information, but it is important to verify questions with one's own nurse, nutritionist, or physician. Or when these clinicians are in short supply, at least verify and confirm data with other online resources such as Health Canada. For more information on the benefits of added DHA and ARA, see the archived section in www.healthykids.ca.
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