In the decade between 2006 and 2016, prescriptions in the U.K. for infant formula for babies with cow's milk allergy rose sixfold, resulting in a sevenfold increase in National Health Service spending on nondairy specialty formulas, yet there's no evidence that the true prevalence of the condition has increased.
So, what's going on? Why are pediatricians recommending nondairy formulas at such an increased rate if there's no need? According to a recent paper 1 by Chris van Tulleken, Ph.D., honorary senior lecturer at University College London, the discrepancy appears to be driven by makers of infant formula.
"Allergy to cow's milk protein may be acting as a Trojan horse for the $50 billion (£40billion; €44billion) global formula industry to forge relationships with health care professionals in the U.K. and around the world," Tulleken writes. 2
"Experts believe these relationships are harmful to the health of mothers and their children, creating a network of conflicted individuals and institutions that has wide ranging effects on research, policy and guidelines. Potential overdiagnosis of the allergy can also have negative effects on breastfeeding."
Milk Allergy Prevalence Has Remained Steady for Past Decade
I've written numerous articles about the influence of funding, and this appears to be a powerful example of what happens when you allow industry to pay for the creation of medical guidelines. According to Tulleken, there's no evidence showing that milk protein allergy has become more common. In fact, studies published in 2007 3 and 2016 4 reveal no significant rise in prevalence.
• In 2007, research estimates of cow's milk protein allergy ranged from 2 to 7.5 percent. According to the authors, "Differences in diagnostic criteria and study design contribute to the wide range of prevalence estimates and underline the importance of an accurate diagnosis ..."
• By 2016, incidence of cow's milk protein allergy was estimated to be between 5 and 7 percent in formula-fed babies, and 0.5 to 1 percent in breastfed babies.
At this time, the authors warned that widespread confusion about the differences between lactose intolerance and milk allergy among physicians was a problem that "could result in unnecessary dietary restriction."
As explained in this paper, "The currently accepted nomenclature is determined by the mechanism likely to be producing the symptoms, with cow's milk allergy being immune mediated and lactose intolerance not immune mediated. An infant with suspected IgE-mediated milk allergy will require testing for specific IgE to milk (skin prick test or blood tests)."
Guidelines Funded by Formula Makers Have Led to Overdiagnosis of Milk Allergy
According to Tulleken, overprescription of nondairy formula appears to be the result of industry funding the guidelines used to diagnose dairy allergy. He also warns that formula makers place undue emphasis on the need to stop breastfeeding as part of the diagnostic strategy.
Between 2007 and 2017, six milk allergy guidelines were published. On two occasions, the guidelines were directly funded by infant formula makers. The remaining four guidelines had contributing authors who had received funding from formula makers.
The end result is guidelines that are so vague they could apply to all children. For example, the symptoms listed in Allergy UK's guidelines 5 are so broad and universal that milk allergy can easily be diagnosed in completely healthy babies.
As noted by Dr. Gary Marlowe, vice chair of City and Hackney Clinical Commissioning Group, 6 "Virtually every single infant could potentially be diagnosed using these symptoms." Formula makers also influence prescribing behaviors through sponsored education.
While organizations responsible for educating patients and medical professionals about milk protein allergy appear independent, most in fact receive funding from formula makers. In the U.K., these include Allergy UK, the Allergy Academy and the British Society for Allergy and Clinical Immunology (a professional society of allergists). As reported by Inverse: 7
"According to the World Health Organization's International Code of Marketing of Breast-milk Substitutes, 8 published in 1981, companies that make milk substitutes are not supposed to directly educate mothers, create conflicts of interest or advertise through health systems.
But based on the information van Tulleken presents, it seems that infant formula manufacturers are finding ways to exert a strong influence on how doctors diagnose and treat patients.
'I obviously work within a high-tech medical system, but I see firsthand that we need to be really aware of the harm we can do and the immense influence industry has over our profession,' van Tulleken tells Inverse. 'No one is more vulnerable than a breastfeeding infant and their parent to industry exploitation' …
[S]ince the only way to confirm a non-IgE cow's milk protein allergy is for a baby to completely switch to a substitute before retesting their tolerance, the baby formula industry benefits from creating and sponsoring guidelines that are more generous in the use of milk substitutes.
In the service of these guidelines, the industry overstates the importance of stopping breastfeeding during this process.
'The basic research that provides the evidence that an infant can get a serious allergy through allergens in breastmilk is really, really weak,' says van Tulleken. 'We have a profusion of guidelines and educational programs for patients and doctors with so little investment in understanding the science of what is going on.'"
Many Formula Makers Violate International Code of Marketing
A February 2018 Save the Children report 9 also reveals formula companies are directly violating WHO's international code of marketing by bribing health care workers with gifts and incentives to promote the use of formula. According to the report:
"Marketing activities of Nestlé, Danone, RB (Mead Johnson), Abbott, Kraft Heinz and FrieslandCampina routinely violate a World Health Organization code set up to stop aggressive marketing to new mums."
"The wide availability of industry funded online information promoting nonspecific symptoms potentially indicating cow's milk allergy as a diagnosis in exclusively breastfed infants" is of particular concern, Tulleken notes.
Women who avoid dairy to protect their nursing child run the risk of not being able to produce sufficient breast milk. According to Tulleken, "Although there is evidence that cow's milk and other food proteins can be transferred from mother to infant in breastmilk, the quantities transferred are likely to be too small to cause symptoms in most infants."
Worse, many will simply stop breastfeeding altogether and start using nondairy formula instead. These tactics have very real and potentially life-threatening health ramifications.
Save the Children notes that infant formula advertisements often include false health claims, and according to Tulleken, data suggests formula feeding may be responsible for the death of 16,000 infants each year in the Philippines alone.
According to Save the Children, 823,000 infant deaths could be prevented each year, worldwide, if babies were universally breastfed.
As of 2016, a mere 40 percent of infants under the age of 6 months were being exclusively breastfed, worldwide. Only 33 countries have breastfeeding rates higher than 50 percent, while 68 nations have rates below 50 percent. 10
Women who want to breastfeed but are told they cannot also have an increased risk for postnatal depression, Natalie Shenker, Ph.D., cofounder of Hearts Milk Bank, says. 11
A related concern is recommendations that include "top up feeds" with formula for exclusively breastfed infants. Chi Eziefula, senior lecturer in the department of global health at Brighton and Sussex Medical School told Tulleken, "By definition, exclusive breastfeeding does not include the use of formula for top-up feeds. Such wording creates a guideline-approved niche for the formula product that could interrupt breastfeeding."
There's a Coordinated Campaign Against Breastfeeding
Moms have, and still are, told there's "no difference" between bottle feeding and breastfeeding , yet nothing could be further from the truth. There is very little similarity between the two, from a nutritional perspective. Unfortunately, marketing materials have a way of giving mothers the false idea that formula may actually provide better nutrition.
Thanks to growing awareness of the science behind the "breast is best" slogan, breastfeeding rates in the U.S. have risen dramatically in recent decades, from a low of 24 percent in 1971 to 81 percent in 2016. 12 However, this effective pro-breastfeeding slogan has now been usurped and turned into "fed is best" 13 — meaning, as long as your baby is well-fed, it doesn't matter if it's breast milk or formula.
A bioethical argument published in the journal Pediatrics in 2016 even advises pediatricians it's time to stop referring to breastfeeding as something "natural." 14 This trend suggests there's a coordinated effort underway to dissuade women from breastfeeding . Even more obvious evidence that such a campaign is being waged specifically in the U.S. occurred this past summer.
WHO has set a global goal to get 70 percent of infants exclusively breastfed for the first six months by 2030, and to achieve that, the World Health Assembly (the decision-making body of the WHO) introduced a nonbinding resolution this past spring to encourage breastfeeding around the world.
The resolution stressed that decades of research show breast milk is the healthiest choice, and urged governments to rein in inaccurate or misleading marketing of breast milk substitutes. In a move that shocked the world, the U.S. delegates opposed the resolution, demanding that language calling on governments to "protect, promote and support breastfeeding" be deleted. 15
The American delegates even threatened countries with sanctions lest they reject the resolution. 16 While witnesses at the assembly meeting claim they saw no evidence of formula makers trying to wield their influence, there's no denying they've spent a lot of money lobbying to protect their market share, which means minimizing the importance of breastfeeding.
According to a MapLight analysis, 17 the three leading formula companies, Abbott Laboratories, Nestle and Reckitt Benckiser, have spent $60.7 million lobbying lawmakers in the U.S. over the past decade.
Formula Feeding Linked to Increased Obesity Risk
Your child's gut microbiome can influence his or her immune response to a number of environmental pathogens as well as pharmaceutical drugs , including vaccinations. Research has also linked the variety and makeup of gut bacteria to specific health benefits and health conditions, including the elimination of chemical toxins, mental health, 18 obesity , 19 Types 1 and 2 diabetes 20 and brain diseases .
One of the easiest ways to support or decimate your microbiome is through your diet, and research has found an association between feeding infants formula and a change in gut microbiome that encourages obesity. 21 The study 22 in question looked at how bacteria in an infant's digestive system affect the burning and storage of fat, and how the infant body uses energy.
More than 1,000 infants were included, and mothers reported the amount of breastfeeding, and the timing of when formula and solid foods were introduced. Stool samples collected from the infants at 3 to 4 months and again at 12 months were tested for a variety of gut bacteria.
By age 3 months, nearly half the women were exclusively breastfeeding their infants, 16 percent fed only formula and approximately 33 percent fed a combination of breastmilk and formula. 23 Data from stool samples revealed:
- The highest level of beneficial bacteria at 3 months and at 1 year was found in infants who were exclusively breastfed
- Exclusively formula-fed infants had the least variety of bacteria and a proliferation of microbes more commonly found in older children and adults
- Exclusively formula-fed infants had nearly double the risk of becoming overweight as compared to those who were exclusively breastfed
- Those fed both breastmilk and formula had a lower risk than those exclusively formula-fed, but they still had a 60 percent greater risk of becoming overweight than exclusively breastfed babies
Lead author Meghan Azad, Ph.D., assistant professor at the University of Manitoba, explained that breast milk contains complex sugars needed to feed specific types of bacteria, which in turn affects how a child's body burns and stores fat. 24
In breastfed infants, the beneficial bacteria Bifidobacterium were introduced into the infant's gut helping to digest oligosaccharides present in the breastmilk. Once solid foods were introduced, microbiomes more closely resembling adult varieties began to grow. The study found when a more adult variety of gut microbiota was present at an earlier age, it was associated with an increased risk of obesity. 25
That formula may increase a child's risk of obesity also makes perfect sense when you look at the list of ingredients. Infant formula can contain as much sugar as a can of soda, and this processed fructose has none of the benefits of the natural sugars found in breast milk. Instead, just like soda, it comes with a long list of adverse metabolic effects, raising your child's risk for obesity, diabetes 26 and related health problems, both in the short and long term. 27
Most formulas also contain a number of other questionable ingredients 28 — including genetically modified organisms 29 (GMOs), synthetic vitamins, inorganic minerals, excessive protein and harmful fats — while lacking vital immune-boosting nutrients found in breast milk.
Health Effects — Breastfeeding Versus Formula Feeding
Aside from benefiting your baby's gut microbiome and lowering his or her chances of obesity, breastfeeding has also been shown to confer many other health benefits to your baby, including:
• Natural immunity — Breastfeeding initially provides passive immunity as antibodies from the mother are passed through breast milk to the infant. Researchers have also found breast milk has a unique capacity to stimulate the infant's immune system with long-term positive effects. 30
• Reduced risk of blindness in preemies — Retinopathy of prematurity causes blindness in 10 percent of severe cases occurring in premature infants. More than half of children born before 30 weeks' gestation are affected and the condition blinds 50,000 children worldwide.
An analysis suggests the incidence of severe disease, and thus blindness, could be reduced by 90 percent if all premature infants were fed breast milk. 31 The researchers theorize the effect may be from the antioxidant and immune protective properties found in breast milk.
• Reduced risk for sudden infant death syndrome — In one study, breastfeeding reduced the risk of sudden infant death syndrome in children by 50 percent at all ages through infancy. 32
• Improved cognitive development — Babies breastfed for nine or more months exhibit greater cognitive development than those who have not been breastfed, 33 and researchers found babies exclusively breastfed exhibit enhanced brain growth through age 2. 34
• Reduced allergies — In one study of over 1,200 mothers and babies, exclusive breastfeeding prevented the development of allergic diseases and asthma . 35
Compared to breastfed babies, studies have shown bottle-fed babies have: 36
- A 14 times higher hospitalization rate
- Double the risk of infant death
- Fourfold higher risk of sudden infant death syndrome
- More frequent and more severe upper respiratory infections and gastrointestinal problems
- Higher rates of jaw misalignment and related problems, such as breathing problems, snoring, sleep apnea and speech impediments
Avoid Soy Formula at All Costs
While I typically refrain from using the word "never," I make an exception when it comes to soy infant formula. Never feed your child soy-based formula . The potential for harm is just too great. Unfortunately, soy formula is usually recommended when milk allergy or sensitivity is suspected, which makes the industry's influence all the more disturbing.
Soy infant formula accounts for about 12 percent of the U.S. formula market, 37 despite the lack of evidence to support its use. As noted in the British Journal of General Practice, 38 babies diagnosed with milk allergy should not be given soy-based formula before the age of 6 months due to its estrogenic effects.
Indeed, soy milk and soy formula contain up to 4,500 times more plant estrogens than breast milk or cow's milk, and studies have shown serum estrogen levels are significantly higher in soy-fed babies. I believe giving your child soy at any point is simply too risky, so I would not recommend using it for 6-month and older babies either.
Soy formula — which provides an estrogen amount equivalent to three to five birth control pills per day 39 — has been linked to a number of troubling side effects, including: 40
Altered age of menarche in girls
Uterine fibroids, endometriosis and tumors
Disrupted thyroid function due to altered iodine uptake
Inhibited testosterone in infant boys, which may impede appropriate male development 41
Disrupted reproductive function
According to the British Journal of General Practice, 42 "There is also a risk of cross-reactivity: Up to 14 percent of those with IgE-mediated cow's milk allergy also react to soya and up to 60 percent of those with non-IgE-mediated cow's milk allergy." (The same paper also warns that rice milk is also not recommended for children younger than 4.5 years due to the risk of arsenic contamination.)
Healthy Options for Mothers Who Cannot Breastfeed
If you cannot breastfeed, your best bet is to make your own homemade infant formula using raw milk. In the video above, Sarah Pope discusses the differences between different kinds of milk, such as cow's milk and goat's milk, and why cow's milk is actually preferable. She then demonstrates how to make two different formulas, including a meat-based formula for infants with milk allergy.
Pope, who runs The Healthy Home Economist website, is a local Weston A. Price Foundation (WAPF) chapter leader for Tampa, Florida. If you're unsure of where to obtain organic, raw grass fed milk, visit RealMilk.com . Ideally, you'll want to make fresh formula every day. It can be safely frozen, though, so you could make a larger batch to last a few days.
Milk-Based Formula Recipe and Instructions
The following raw milk recipe will yield 36 ounces of formula. In her video, 43 Pope also makes a number of substitute suggestions for various circumstances such as allergy to certain ingredients, indigestion or constipation. In the event a baby does better on raw goat milk, a modification of the ingredients 44 is necessary to adjust for the nutritional differences.
1. Warm 1 7/8 cups of filtered water (to get this amount, measure out 2 cups of water and remove 2 tablespoons) over medium heat
2. Add 2 teaspoons of grass fed beef gelatin and 4 tablespoons of lactose to the water; occasionally stir until dissolved
3. Place 2 cups of raw organic whole cow's milk into a clean glass blender. Add remainder of ingredients to the blender:
• 1/4 cup of liquid homemade whey (for instructions, see Pope's video)
• 2 to 3 tablespoons of raw cream
• 1/4 teaspoon acerola powder
• 1/4 teaspoon bifidobacterium infantis (a probiotic)
• 2 teaspoons Frontier Brand nutritional yeast flake
• 1/2 teaspoon high-vitamin fermented cod liver oil (see important information about fermented cod liver oil below the meat-based formula recipe). You could substitute the cod liver oil with wild-caught Alaskan Salmon oil or krill oil
• 1 teaspoon expeller-pressed sunflower oil
• 1 teaspoon extra virgin olive oil
4. Remove the pot of water from the stove. Add 2 teaspoons of coconut oil and a 1/4 teaspoon high-vitamin butter oil to the water to melt. Once melted, add the water mixture to the blender ingredients and blend for about three to five seconds
5. Pour the blended ingredients into glass jars or glass baby bottles and refrigerate. Before feeding, warm the formula by placing the glass bottle in a pot of hot water. A baby bottle warmer can also be used. Never microwave infant formula, as this will destroy many valuable nutrients and enzymes and pose a burn risk
A Note on Milk Proteins — A1 Versus A2 Milk
The next recipe Pope demonstrates is for a meat-based formula using liver, suitable for babies who cannot tolerate milk. Keep in mind that many symptoms of milk intolerance are caused by A1 casein, a type of lectin associated with leaky gut and autoimmune disorders.
Casein A2 is the normal protein in milk, 45 present in sheep, goats, water buffalos and some Jersey cow's milk. Unfortunately, most cows today are casein A1 producers. The A1 protein is metabolized in your gut to make beta-casomorphin, which can attach to the beta cell of your pancreas and incite an autoimmune attack. 46
Many who believe they're lactose intolerant are actually just responding to the casein A1 in the milk. So, before jumping to conclusions, you could try using raw milk obtained specifically from A2 producing Jersey cows to see if it makes a difference.
You'd have to talk to your farmer or raw milk provider to find out whether the cows are A1 or A2 producers. Holsteins are A1 producers and should be avoided. Using A2 milk would be a good idea even if your child does not show signs of milk intolerance, as the A1 casein can be a problematic lectin.
It can, however, be more difficult to find. That said, if you have a choice, I would suggest opting for A2 raw milk. The other alternative is goat's milk that only has A2 casein.
Meat-Based Formula for Infants With Milk Allergy
For a demonstration, see Pope's video above. Brand recommendations and other shopping tips can be found on WAPF's website, where these recipes are also listed. There you can also find other variations, including a formula using goat's milk, as well as instructions for making homemade whey. 47
Pope also offers shopping recommendations on her website, noting Radiant Life Company sells many the ingredients necessary for milk-based formula. 48 The following recipe will yield 36 ounces of formula.
1. Chop 2 ounces of organic grass fed beef or chicken liver into small pieces
2. Gently simmer the liver pieces in 3 3/4 cups homemade chicken or beef broth , until thoroughly cooked
3. Pour the liver broth into a clean glass blender. Blend for several seconds to liquefy the liver, then let cool. Once the liver broth has cooled, add the remaining ingredients:
• 5 tablespoons of lactose (if your child is allergic to lactose, substitute with glucose)
• 1/4 cup organic homemade liquid whey (if your child has intolerance to whey, you may leave it out)
• 1/4 teaspoon bifidobacterium infantis (a probiotic)
• 1/4 teaspoon acerola powder
• 1 tablespoon coconut oil
• 2 teaspoons extra virgin olive oil
• 1 teaspoon expeller-pressed sunflower oil
• 1/2 teaspoon high-vitamin fermented cod liver oil and 1/4 teaspoon high-vitamin butter oil (please see caveats listed below). You could substitute the cod liver oil and butter oil with wild-caught Alaskan Salmon oil or krill oil instead
4. Blend for a few seconds on low speed, until well-mixed. Pour the blended ingredients into glass jars or glass baby bottles and refrigerate
5. Before feeding, warm the formula by placing the glass bottle in a pot of hot water. A baby bottle warmer can also be used. Never microwave infant formula, as this will destroy many valuable nutrients and enzymes and pose a burn risk
Important notes and caveats about these recipes:
• Fermented cod liver oil is a recommended ingredient in Pope's recipes, which may be dangerous for babies. Laboratory testing has revealed the product tends to be prone to rancidity, may contain added vegetable oils, and lack vitamin K2 and CoQ10 .
The concentration of vitamins A and D can also vary significantly from one batch to another, as cod liver oil is not regulated or standardized. 49 Unless you can verify the purity of the cod liver oil, I'd recommend using wild-caught Alaskan Salmon oil or krill oil instead.
• The Weston A. Price Foundation's baby formula recipe suggests butter oil is optional, but Dr. Price himself recommended always pairing cod liver oil with butter oil, which contains vitamin K2 (MK-4). I recommend tweaking the recipe by making butter oil a requirement if you're using a certified pure fermented cod liver oil.
Nutrition Facts for Homemade Formula
According to WAPF, their homemade formulas provide the following amounts of critical nutrients per ounce:
|Homemade formulas||Chloride||Choline||Inositol||Iodine||Vitamin K1||Vitamin B5|
Raw cow milk
Raw goat milk
The following chart shows how the three homemade formulas compare in terms of other nutrients, and how they stack up against breast milk:
|Breast Milk||Cow's Milk Formula||Goat Milk Formula||Liver-Based Formula|
Fermented Dairy Protects Your Heart