All parents want to give their children the best life possible. This starts at birth, when parents must decide to breast- or bottle-feed their newborn.
But it's getting harder for parents to make educated decisions as a result of marketing efforts by formula companies that critics say are not only misleading, but actually contravene international regulations that are endorsed by Canada, but not properly enforced.
Formula companies are adding new ingredients, such as omega fatty acids and, more recently, probiotics, to enhance the appeal of their products and make a variety of health claims.
Some mention the product's "tummy friendliness" and, in the case of a probiotic formula, how it will contribute to a baby's healthy digestive tract flora.
One company boasts on its website that its formula contains supplements that will boost brain development and help children get a higher IQ.
These claims are designed to subtly undermine public health officials who say breastfeeding is best and convince parents that formula feeding is just as good as breastfeeding, if not better, said Elisabeth Sterken, director of the Infant Feeding Action Coalition Canada.
"There's considerable deception," she said.
Bottle is best?
There is no substantive evidence showing that the added ingredients boasted about on formula labels actually make any difference to a baby's development.
Yet, formula companies continue to add these extra ingredients, said Dr. Frank Greer, professor of pediatrics at the University of Wisconsin and past chair of the American Academy of Pediatrics committee on nutrition.
A few years ago, companies started adding omega fatty acids, like docosahexaenoic acid (DHA) and arachidonic acid (ARA) to formula, accompanied by phrases mentioning how they "contribute to your baby's normal brain and eye development."
Now those fatty acids are nearly universal in formula products, despite no compelling reason for adding them, Greer said.
"The evidence is not that good that it does that much for you," he said.
In 2008, Health Canada permitted companies to add the probiotic Bifidobacteria lactis to formula.
While not yet universal, there are several formulas, including varieties sold by Nestlé and President's Choice, supplemented with the probiotic and stating on the label that it contributes to healthy gut flora. Nestlé also sells a variety of formula containing a prebiotic known as galacto-oligosaccharides (abbreviated as GOS), which the company's website says are "naturally found in breast milk."
These products cost substantially more – sometimes double the cost – of regular, run-of-the-mill formulas.
But parents may not be getting their money's worth.
Greer co-wrote guidelines in 2010 for American pediatricians on the subject of probiotics and prebiotics in infant formula. After reviewing the available evidence looking at the effects on babies when probiotics are added to infant formula, Greer and his co-authors concluded that there's no compelling benefit.
And no good reason for parents to choose pricey probiotic formula over breastfeeding or a regular formula brand.
"The overall health-benefit efficacy of adding probiotics to infant formula remains to be demonstrated" in large, rigorous medical studies, the authors wrote.
Some studies have shown probiotics in formula may provide a limited benefit to children with rotavirus.
Many of the studies that do find some small benefit linked to probiotics were conducted by researchers who have financial ties to formula companies, Sterken noted. She said it's a common theme that makes unbiased research into infant formula hard to find.
The Canadian Paediatric Society declined an interview and said it had no experts available who could speak about probiotic formula. The group has faced criticism in the past for accepting money from formula companies.
Nestlé declined a request for an interview, but in an e-mail said that its probiotic formula helps the digestive system, has allergy prevention benefits, is easy to digest, produces soft stools and supports normal brain, eye and nerve development. It said research backs up those claims.
Loblaw Cos. Ltd. did not provide an interview, but said in a statement its President's Choice brand probiotic formula is "designed to be like breast milk" and that it has been approved by Health Canada.
Making a direct comparison
Armed with these supplemental ingredients, several formula varieties now declare on product labels that it's "Our closest formula to breast milk." Direct comparisons between formula and breast milk are not permitted under the International Code of Marketing of Breastmilk Substitutes, a document that Canada officially signed.
The Canadian Food Inspection Agency sent a letter to industry in 2007 stating formula companies are "encouraged not to make a reference to breast milk on a label or advertising of infant formula, other than a statement regarding the superiority of breastfeeding or that breast milk is the optimal method of feeding infants."
So why are companies openly comparing their products to breast milk?
Well, Canada may have signed the international code, but didn't incorporate it into law. For that reason, companies are able to push the limits and make misleading claims about the supposed benefits of their brand of formula, Sterken said.
Many groups, including UNICEF Canada, have been urging the federal government to live up to its promise to abide by the international code. Sterken said the federal government has abdicated its responsibility to parents on this issue.
"We don't see very much monitoring or enforcement on the part of Health Canada or the CFIA in terms of how these products are marketed," she said.
The marketing tactics of formula companies seem to be working. While 90 per cent of women in Canada start breastfeeding when their children are born, only 14 per cent exclusively breastfeed at six months, even though current recommendations state babies should only have breast milk for the first six months of life.
The bottom line
Greer said that parents don't need to be confused. If they choose to formula-feed their babies, there's no need to shell out extra money for an expensive probiotic, omega brand that isn't backed by solid evidence.
"Personally, if I were a parent, I'd go with the cheapest option," Greer said
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