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Formula Supplements & Additives

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Bottle of milkFormula companies are always looking to improve their product and strive to make their brand as close to breastmilk as possible. In an attempt to accomplish this, many add DHA, ARA, nucleotides, probiotics, and in some cases, prebiotics, to their formulation. It is important to note that breastmilk is a living fluid and contains hundreds of nutrients that can not be reproduced by any commercially prepared formula.

 What are DHA (docosahexaenoic acid) and ARA (arachidonic acid)?

  • DHA and ARA are fatty acids (polyunsaturated fats) found normally in breastmilk which aide in brain and eye development. For infants, breastmilk is the best source of DHA and ARA. The DHA used in infant formula is obtained from fermented microalgae and the ARA from soil fungus. Both are extracted using hexane, a neurotoxic chemical, which has raised much concern over the safety of these additives
  • The Cornucopia Institute states, "Hexane is a chemical by-product of gasoline refining. It is used not only as an extraction solvent for edible oils, but also as a solvent for glues, varnishes, and inks and as a cleaning agent in the printing industry. Hexane is a neurotoxin and a hazardous air pollutant." Some adverse reactions that have been reported include: diarrhea, vomiting, bloating, gastrointestinal discomfort, rashes, and seizures. Because of this, Cornucopia and the National Alliance for Breastfeeding Advocacy have petitioned the Food and Drug Administration for a warning label to be placed on infant formulas containing DHA and ARA laboratory oils. (Learn more about hexane in infant formula by visiting The Cornucopia Institute's: Replacing Mother: Infant Formula Report.)

What are nucleotides?

Nucleotides are molecules that are the building blocks of Ribonucleic acid (RNA) and Deoxyribonucleic acid (DNA) and are naturally found in breastmilk. Nucleotides are necessary in energy metabolism, maturation and development of the gastrointestinal tract and helps to support the immune system. Human milk contains more nucleotides than cow's milk, thus requiring companies to add nucleotides to their formulation. Research has shown that the nucleotides added to infant formula have resulted in a decreased risk of diarrhea and increased response to vaccinations against H. Influenzae tybe b and diptheria toxoid.

What are probiotics?
The World Health Organization defines probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host” (FAO/WHO, 2002). The American Academy of Pediatrics (AAP) defines probitics as, "An oral supplement or a food product that contains a sufficient number of viable microorganisms to alter the microflora of the host and has the potential for beneficial health effects" (AAP, 2010).
Probiotic bacteria promote the growth of healthy bacteria in the gastrointestinal (GI) tract by competing for nutrients and thereby reducing the growth of harmful bacteria. Probiotics support the immune system and can also be found in yogurt and other dairy products. Probiotics are susceptible to high temperatures therefore be sure water temperature is not over 100°F when mixing formula.
Currently, there are only two infant formulas (both powdered formulas) that contain a probiotic.

What are prebiotics?
Prebiotics are oligosaccharides (carbohydrates) that feed the beneficial bacteria (probiotics). The AAP defines prebiotics as, "A nondigestible food ingredient that benefits the host by selectively stimulating the favorable growth and/or activity of 1 or more indigenous probiotic bacteria" (AAP, 2010).
These carbohydrates cannot be digested by humans. Prebiotics are present in human breastmilk and support the immune system. According to the American Academy of Pediatrics, "The prebiotic bifidus factor in human breast milk is species specific, and other oligosaccharides may not have the same efficacy. Similarly, the probiotic in breastfed infants' intestinal tract is bifidobacter, and other probiotics may not provide the same function." The AAP concludes that more studies are "needed before the efficacy of adding prebiotics to infant formulas can be determined" and "supports the addition of prebiotic products to infant formulas designed as follow-up formulas meant for infants aged 5 months and older."
Is Vitamin D supplements necessary in the formula fed infant?
Vitamin D helps prevent a condition called rickets which causes softening of bones in children and can potentially lead to fractures and deformities. Vitamin D may reduce the risk of osteoporosis and may help prevent infections, autoimmune diseases, cancer and diabetes.
The Academy of Pediatrics recommends that all infants who consume less than one liter (approximately 34 fl oz) of vitamin D enriched milk or formula per day should be supplemented with 400 international units (IU) of Vitamin D beginning within days after birth (2008). This is double the amount that was previously recommended. 
Breastmilk does not provide a sufficient source of Vitamin D, therefore, the AAP recommends vitamin D supplementation to be be initiated within DAYS of birth for breastfed infantsVitamin D content in breast milk averages 22 IU/L in a vitamin D-sufficient mother and only 11-38 IU/day for an exclusively breastfed who does not receive adequate sun exposure. 
All formulas are regulated by the FDA. According to the FDA, “all manufacturers of infant formula must begin with safe food ingredients, which are either generally recognized as safe (GRAS) or approved as food additives for use in infant formula.” Information on FDA regulations for infant formula and food ingredients and packaging may be found at and
 DHA and ARA in Infant Formula - Linked to Infant Illness
Boehm G, Jelinek J, et. al. Prebiotics in infant formulas. Journal of Clinical Gastroenterology. 2004 Jul; 38(6 Suppl):S76-9. 
Gutiérrez­Castrellón, P., Mora­Magaña, I., Díaz­García, L., et. al. (2007). Immune response to nucleotide­supplemented infant formulae: systematic review and meta­analysis. British Journal of Nutrition, 98: S64­S67 
Ebrahim, G. (1998). Breastmilk Nucleotides. Journal Tropical Pediatrics 44(6): 318-319 
Hanson, L. (2004). Immunobiology of Human Milk: How Breastfeeding Protects Babies. Texas: Pharmasoft Publishing.
Lara-Villoslada, F., Olivares, M, Sierra, S. et. al. Beneficial effects of probiotic bacteria isolated from breast milk. British Journal of Nutrition (2007), 98, Suppl. 1, S96–S100.
Riordan, J., & Wambach, K. (2010). Breastfeeding and Human Lactation (4th ed.). Sudbury, MA: Jones and Bartlett Publishers.
Shafai, T. Routine Supplement of Prebiotics and Probiotics to Newborn Infants Is Not Recommended. PEDIATRICS. 2009 March; 123(3):e543 -e544 
The Cornucopia Institute: Questions and Answers About DHA/ARA and Infant Formula
Thomas, D. & Greer, F. Clinical Report: Probiotics and Prebiotics in Pediatrics. PEDIATRICS 2010 November; 126(6): 1217 -1231 
Wagner CL, Greer FR; American Academy of Pediatrics Section on Breastfeeding; American Academy of Pediatrics Committee on Nutrition, “Prevention of rickets and vitamin D deficiency in infants, children, and adolescents,” Pediatrics, 2008 Nov;122(5):1142-52. Erratum in: Pediatrics. 2009 Jan;123(1):197
Walker, M (2011). Breastfeeding Management for the Clinician (2 edition). Boston: Jones and Bartlett Publishers.


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