Formula 101

Nov 30, 2019

Breastfeeding is unequivocally and undoubtedly the best option for providing the highest quality nutrition for your child’s growth and development. Our body’s integral systems from cognitive to immune are building the foundation they’ll exist on forever in those first few years of life, and breastmilk is often a marker for long term health. And while even we ourselves at Kopia either hope to breastfeed or do breastfeed, we also recognize that it is unrealistic and unfair to put that kind of expectation and pressure on all families, when above all else what we know to be true, is that everyone is different and deserves respect for their personal choices. What we also know to be true is that it is entirely possible to have a healthy formula fed baby and created this guide to help empower parents on what the key differences are, why you might choose to use formula, and how to find the best one for you and your family.

Breast Milk vs Formula: The Key Differences

Before we discuss reasons one might use formula, it’s helpful to understand the basic differences between breast milk and formula.

From a purely nutritional makeup standpoint, the truth is that breast milk and formula are more alike than not because formula is regulated by governing bodies and required to be composed of the key nutrients naturally found in breastmilk - protein, fat, carbohydrate, vitamins and minerals.

Protein: Both breast milk and formula contain protein, a key macronutrient that aids in your baby’s development. In formula, the protein source is usually either from whey or casein, found in dairy, or from plant based sources like soy.

Tip: For dairy based formulas where whey and casein are the protein sources, you may want to look for a 60% whey, 40% casein split as that is closest to the nutritional makeup of breastmilk.

Carbohydrates: Lactose is the carbohydrate energy source found in breast milk. Formulas may use lactose from dairy as well, but also regularly use a variety of sugars (that turn into carbohydrates) for their carbohydrate source, including brown rice syrup, corn syrup, sucrose, or maltodextrin.

Tip: If your child is lactose intolerant or the formula you’ve chosen does not use lactose, you may want to look at the dextrose level of the various sugars in the formula to understand the impact it may have on your child’s blood sugar or health.

Fat: The fat content in breast milk can fluctuate from one mom to the next, and contain a variety of fatty acids. The most abundant usually include palmitic acid, oleic acid, and linoleic acid. Formula uses a blend of different oils to provide a fat content similar to the average breast milk; palm oil, coconut oil, soy oil, sunflower oil, and safflower oil are most common.

Tip: “The palm oil used in formula (a source of palmitic acid) acts differently when in formula compared to breast milk,” explains Dr. Nicole Glynn of Getzwell Pediatrics, “While the palmitic acid in breast milk is easily digested, in formula the palmitic acid from palm oil is digested differently and can bind to calcium in the gut, creating calcium soaps. These calcium soaps can lead to digestive discomfort, such as gas and constipation. This is just one of the reasons that should you choose to use formula, it’s so important to find the right one for your baby.”

Prebiotics: Both breast milk and formula also include a crucial element known as prebiotics. This indigestible fiber feeds good gut bacteria and is vital in maintaining proper gut health which decreases your child's chance of developing chronic illness. Dr Glynn breaks this down for us: “Breast milk contains Human Milk Olligosaccharides (HMOs), a complex non-digestible carbohydrate that nourishes and develops a healthy biome. Not only do HMOs feed the healthy gut bacteria, they also improve gut barrier function and therefore enhance the immune system.”

Formula can include one or both of Fructo-oligosaccharides (FOS) or Galacto-oligosaccharides (GOS), which also support the microbiome and immune system. Because these fibers are not digested, they’re able to travel to the colon, where they sustain the positive bacteria that create a healthy, balanced immune system.

Tip: Some formula's have specific FOS/GOS ratio's that have been shown to result in fewer episodes of physician-diagnosed upper respiratory tract infections, fewer incidents of fever, and ultimately fewer antibiotic prescriptions.

Vitamins: The vitamins a child receives from breastmilk is directly from the mother’s body and can change based on what that child needs.“Breast milk is a naturally occurring food produced by the body for babies that is easily digested and comes complete with antimicrobial properties to keep your baby healthy,” Dr. Glynn tells us about this wonder food. “It contains immune boosting components that respond to your baby’s saliva and adapt the breast milk to address any detected illness by increasing the production of specific protective antibodies. As the baby grows, breast milk nutrient content will tailor itself to the baby’s developing needs. Breast milk contains all the appropriate nutrition for a growing baby, except for vitamin D and occasionally iron.” The vitamins in formula and in the majority of all other supplements sold throughout the world come from manufactured sources, and while they provide the necessary nutrients, their quality does not match that of breastmilk.

Why We Formula Feed & Why All Reasons Are Valid

Given what we know about the value of breast milk, why, you might ask, would anyone consider using formula? Good question - and there are a number of equally good answers.

A Note on Marketing: Living in the 21st century, you can't underestimate the influence of marketing. Infant formula is a growth industry, and the commerce value is expected to exceed $103 billion by 2026. The corporations manufacturing and selling formula have played a large part in this product's dynamic upswing. "Introduction of innovative packaging, premiumization, new changes in ingredient mix are driving the Infant Formula Market growth. This, coupled with the delivery of effective communication on product offerings, is expected to benefit the long-term growth of the market." Doctors share responsibility here as well; according to a recent report from MarketWatch, "...physicians [also] recommend the use of infant milk then follow-on-milk owing to their superior nutritional value and...is the best substitute for breast milk."

Marketing tactics have become more aggressive as financial stakes have increased; major companies - including Nestle, Abbott, Mead Johnson, and Wyeth (now owned by Nestle) - have been accused of using legally questionable advertising claims to encourage new mothers to use formula unnecessarily. Governments worldwide have taken notice of these aggressive marketing pushes and have created legislation to counter these effects accordingly. The famous boycott of Nestle in the 1970s led to the development and adoption by nations worldwide of the UNICEF/World Health Organization (WHO) International Code of Breastmilk Substitutes (The Code) in 1981. The Code sets guidelines and restrictions on the marketing of breastmilk substitutes, reaffirming governments’ rights to take necessary action in implementing and monitoring these guidelines. To promote and protect the practice of breastfeeding, many countries have implemented policies that restrict corporate marketing strategies targeting mothers. These policies have led to increased breastfeeding in many countries, though greater progress is still needed.

Underserved Communities:

“It’s really important to recognize that breastfeeding is NOT free. The process takes a physical and mental toll, and there are substantial financial costs in keeping the mother’s body healthy enough to continue nursing.”-Miracle Oros, breastfeeding mother

It’s a known fact that minorities and marginalized communities are both more likely to work in industries that do not offer adequate maternity leave and less likely to have the resources necessary to continue breastfeeding once they return to work. Consequently these mothers are statistically more likely to turn to formula out of necessity.

Family Dynamics: Mothering is hard work, and breast-feeding can sometimes complicate an already difficult situation. Using formula allows other members of the family - dads, siblings, grandparents, even trusted caretakers - to help with feedings when mom needs a break. Formula can also be a lifesaver should a new mom want or need to return to work.

“I loved that Amélie could drink out of a bottle, allowing my husband or somebody else to feed her,” reveals Miriam, a mom with experience breastfeeding as well as formula feeding. “It relieved the fear I had that she would starve without me.”

Health Considerations:

1. Milk production can be a real issue for some women. Kopia recommends that any woman who is struggling with breastfeeding and has the necessary resources seek the advice of a lactation consultant, but there are a few tried and true tips below that might help the milk flow.

Pump after feedings to increase supply. Power pumping (1 hour block of frequent pumping) at least once a day has been known to encourage production.
Eat more! It takes an extra 500 calories A DAY to produce breast milk, so make sure you’re getting enough good, nourishing foods, mama.
Fluids, fluids, fluids. Dehydration is the enemy of milk production, so make it a point to drink lots of quality, filtered water.
Herbs - nature’s pharmaceuticals have been used for thousands of years to increase breast milk supply. Fenugreek, goat’s rue, malunggay, and blessed thistle are just a few. Please consult your trusted medical resource for guidance.
Check the baby for a tongue or lip tie. Babies who have difficulty latching or staying latched, have poor weight gain, or show frustration at a slowing milk flow may have a tongue or lip tie impeding their ability to easily breastfeed. Fortunately, this issue is usually correctable with a minor surgery known as a frenotomy. Please consult your pediatrician or trusted medical resource for more information.

2. Sleep deprivation is probably one of the primary reasons women turn to formula. There’s no shame in wanting to get a good nights sleep and though studies suggest that breast-feeding actually increases sleep duration for new parents, every mother’s journey is different. Formula is a safe and appropriate choice when sleep deprivation becomes a mitigating factor in a mother’s physical and mental health. Anxiety related to breastfeeding is also extremely common, and may become overwhelming enough that a mother chooses to use formula in order to relieve her apprehension and be more present for her baby.

3. A less openly discussed but just as valid reason to use formula is postpartum depression (PPD). Many, many women will experience mental and physiological symptoms following the birth of their baby, and 10-20% will develop clinical PPD. The stigma that surrounded this condition is just beginning to lift and women are realizing that there are resources available to help them and options to ease their burden - formula being one of those options. “If you are experiencing difficulties with breastfeeding and it is affecting how you are coping emotionally, then, yes, supplementing with formula as needed may be part of the answer,” says Julie Lamppa, A.P.R.N., a certified nurse midwife at the Mayo Clinic.

PPD is not the only recognized medical issue that can affect a woman’s ability to breastfeed. There are many other maternal medical conditions that can impact breastfeeding, including but not limited to thyroid conditions, obesity, polycystic ovarian syndrome (PCOS), and other endocrine/hormone disorders. In some medical situations, the cure is more problematic than the disease; breast milk contains traces of any medication a mother takes, and for that reason it’s important to be sure that any prescription or over the counter drugs or herbs necessary for the mother’s health won’t harm her baby.

You Don't Want To: And of course, there is always the possibility that a mother simply does not want to breastfeed, for whatever reason. That is her absolute right and her choice should be honored; all mamas deserve the opportunity to forge their own path.

Why Breastfeeding Mothers Need Formula, Too

We’ve looked at a lot of reasons why formula alone might be the best choice for a new mother, but there are also instances where breastfeeding mothers might need to have a trusted brand of formula at the ready. Birth complications can upend a mother’s breastfeeding plans, and in those instances being caught off guard leaves you at the mercy of whatever formula the hospital has readily available.

Maternal circumstances that could complicate breastfeeding include a caesarean section (c-section), a traumatic labor or postpartum hemorrhage, a history of breast surgery, and/or insufficient glandular tissue. These are all legitimate medical issues that might interfere with a woman’s ability to breastfeed. Most - if not all - hospitals will allow a new mother to bring formula with her when giving birth, so even if breastfeeding is the goal, it doesn’t hurt to be prepared. It’s a good idea to call the hospital where you plan to deliver before you give birth to ensure you’re allowed to bring your own formula, or if planning a home birth, to have some on hand.

Tip: Even if you plan on breastfeeding after birth, it's worth having formula on hand that you have fully vetted and feel comfortable with in case of circumstances that unexpectedly complicate or prevent breastfeeding. Call the hospital where you're giving birth to see what type of formula they provide and if you can bring your own.

There are also instances wherein it’s in the baby’s best interest to formula feed. Some mother’s just take longer for their milk to come in, and the baby may require nourishment before breast milk is accessible. Babies with jaundice, low blood sugar, or excessive weight loss might require an outside source of nutrition, at least temporarily. These conditions can play into each other and though babies are built to withstand up to a 10% weight loss in their first few days of life, dehydration can exacerbate any additional medical issue - including jaundice and hypoglycemia - making it prudent and wise to take advantage of a healthy, clean formula until the mother’s milk comes in or the baby stabilizes. One of our moms experienced this firsthand when her third child wasn’t gaining weight quickly enough. “It felt a bit weird for me to use formula at the time, after so many years spent breastfeeding,” she admits, “But when I saw the good it did her, my concerns faded.”

How to Choose: Top Things to Consider When Purchasing Formula

“I was concerned about what was in the formula I was buying and did a lot of research ahead of purchasing. I really didn’t want any unnecessary added sugars, no palm oil, and it had to be organic.” - Miriam, mother and formula user

Choosing a formula can be a high-stress concern for new parents, but don’t worry, we’re here to help. As previously stated, all formulas provide the same nutrition, regardless of their ingredients. Due to mandates by governing bodies like the FDA & European Commission, parents can expect that any formula they choose will meet their baby’s nutritional needs. There’s a lot of room for quality variation within those standards, however, and we’ve come up with some important factors to consider when deciding on the quality of your baby’s first food.

Ingredients: Our first tip - and we can’t stress this enough - is to read the label. As we said, infant formula is considered a full feed food and is therefore heavily regulated by your local governing body; consequently, this product is required to meet specific nutritional criteria as well as be labeled per their guidelines. Given those regulatory guidelines, the nutrition label won’t vary widely from formula to formula but the ingredient list will - start there, and don’t be afraid of words you don’t know.

Formulas are required to use the scientific names in lieu of common names for vitamins and minerals. Look for which, if any, ingredients are organic, what type of sugar is included or added, what type of oils they use for the fat source, and if there are any ingredients added beyond what is required - for example, artificial preservatives or sweeteners. If you need additional help understanding the scientific names often found in formulas, you can head to “Our Nutrition” page and read about each ingredient.

Sugar is worth specifically calling out because many companies add it as a sweetener, rather than as a carbohydrate source. Sugar is a naturally occurring element in many whole foods, including fruits, vegetables, grains, and dairy, and in these sources is rarely problematic. Added sugar, however, can have real consequences to a baby’s health, and it’s never too early to begin an eating regiment that prioritizes healthy, whole foods. To that end, be sure to check both the ingredient list to understand the form of sugar added, in addition to the nutrition panel (Nutrition Facts) to see the amount your baby will consume per serving. Sugar is required to be listed in both total and added amounts on the nutrition panel. Total sugar includes naturally occurring sugars, such as lactose, combined with any added sugar, which should generally only be included as a sweetener, binder, or carbohydrate.

The American Academy of Pediatrics recommends that children under the age of 2 consume less that 25g of sugar per day, but again, the best resource for nutrition information is your own instinct and your personal physician or wellness advocate.

Organic vs conventional: Perhaps the most important tip we can give is to buy organic. The USDA provides organic certification to companies selling within the US while SKAL provides organic certification to companies selling within the EU who meet the standards of organic practice and submit the mandatory applications and fees. It’s possible to source ingredients from countries outside of the US and still maintain a USDA organic certification, however it is NOT possible to have a USDA organic certification for milk sourced from Europe due to their stance on antibiotic usage. (Essentially, the US does not allow any antibiotics to be used in organic certified dairy while the EU allows sick cows to be pulled from production, treated accordingly, and held out of production until all medication residues are naturally eliminated before being put back into production on farms.) Organic certification can be costly and difficult to attain, so it is possible for a product to be organic without having the official title; conversely, thanks to audits that are few and far between, it is possible for a product to be certified organic without actually regularly meeting the standards. The best way to be sure you are buying a quality product is to reach out to the company and make inquiries. If they’re not willing to answer your questions, that’s a sign they don’t know, don’t have proper documentation, or prefer to keep information private.

Your child’s age: A child’s age is another significant factor when selecting a formula. In the United States, we have infant formula and toddler formula, while in the EU they offer different stages of formula based on age. Infant formula in the US is for babies 0-12 months while toddler formula is 12-36 months. Depending on the country in the EU, Stage 1 is typically 0-6 months, Stage 2 is typically 6-12 months and Stage 3 is typically 12 months+. These different stages are not required in the US, and it’s possible for your child to have one formula their entire first year of life, assuming it is approved by your local governing body, i.e. it meets nutritional guidelines. The nutrients in the different stages of EU formula change slightly depending on the company and country of origin, but the primary difference is in the amount of iron and the whey to casein ratio.

Dr. Bridget Young, a research clinician studying breast milk composition and infant growth patterns at the University of Colorado, explains that the United States tends to abide by a “more is better” approach when it comes to nutritional additives in formula and consequently, “US formulas have iron concentrations well above the maximum allowable concentrations set by the EU.”

That said, in the US, the FDA gives a range for each nutrient and it is ultimately the company that decides where to hit within that range. It’s a good idea to have a conversation with your child’s medical practitioner when settling on a formula, particularly if your child has medical concerns that potentially make them vulnerable to iron deficiency.

Special needs: If your child has a special need - such as a growth deficiency, heart disease, malabsorption syndromes, and problems digesting fat or processing certain amino acids - consult your physician for the best formula to address this issue. Unfortunately, there aren’t a great deal of options when it comes to these specialized formulas but finding the right physician or wellness advisor can play a key role in finding alternatives to ensure your child is getting the nutrients they need for healthy growth and development.

Allergies: Allergies have become an issue of critical importance in formula selection as our understanding of gut health and the role it plays in maintaining a healthy immune system develops. If your child has an intolerance or allergy to a specific ingredient, seek out alternatives. There are many different milk bases to choose from, including soy, cow, goat, etc., and it might be necessary to experiment before finding the right kind of formula for your baby. Allergy testing for specific ingredients can be provided by your doctor, should that become necessary.

Doctor recommended: We are huge believers in a parent’s intuition and listening to your child. Our children always tell us what they need. Consulting a trusted physician can be an important part of making a decision but it’s worth noting that if your physician recommends something that doesn’t sit well with you, it’s okay to seek a second opinion or lean into your intuition. It’s also worth noting that lobbying is prevalent amongst the food and drug industry and labels that promote doctor approval or accreditation amongst a specific group of professionals does not mean it is superior.

Environmental impact: Environmental impact might also play in part in your choice of formula. If environmental impact is important to you, consider palm oil sourcing, farming practices, whether it is organic or conventional and production/manufacturing.

A Note From Our Founder

*When I first began creating Kopia, something I heard a lot was, “Why not just make plant based formula? Aren’t cows bad for the environment?” Years of research and experience in organic agriculture have assured me that, no, cows are not bad for the environment. Regenerative agriculture, which requires a healthy ecosystem of rotating crops and animals, has been proven to not only restore soil health but also to actually draw carbon out of the atmosphere and put it back into the soil, potentially reversing climate change. Factory farming is undoubtedly the issue. More importantly, a child’s development is directly impacted by their health and because they are so vulnerable to toxic exposure in their first few years of life, I would argue that while you should seek out products that are conscious of their environmental impact, having that be the deciding factor in what formula you choose is not conducive to your child’s wellness. The goal of any infant or toddler formula is optimal nutrition that works to promote the wellness and development of your child. Healthy children create a healthy planet.*

The Different Milk Types: How to Choose Between Plant Based, Cow, or Goat Milk

Infancy is a delicate time, where cognitive, bone, gut, and immune systems are all developing. Studies now recognize that, “…appropriate initial bacteria colonization of the gastrointestinal tract, and good nutrition from the time of conception until the second year of life (the first 1,000 days), may profoundly affect our health during infancy and childhood through adulthood.” Consequently, it’s essential to listen to your child’s body when determining what is best digested by them. Ideally, you want a formula that causes these sensitive body systems the least amount of stress while providing the most high-quality, necessary nutrients in order for them to properly develop and achieve long term health. There are many sources of information in regards to what kind of formula is best, but ultimately, you will need to decide what works well with your child’s body. The first and best way a child’s body communicates its nutritional needs is through their poop. Regularly check your child’s diaper if you suspect something is wrong, because there’s a lot of information to be found in a baby’s fecal matter. Color, consistency, frequency, and the presence of other fluids, such as blood or mucus, will give you a lot of information about your child’s health.

We’ve said it before, but it’s important enough to reiterate - all formula provides the same nutritional makeup regardless of ingredients. Since nutritional guidelines are so strictly regulated by governing bodies, no one type of formula can call itself nutritionally superior to any other, because that’s simply not true. Formula guidelines mandate that any nutritional deficiency be corrected with additives in order to meet the requirements of the regional government (USA, EU, etc.). So whatever type of formula you choose can be based solely on the needs of your child’s body, without you having to be concerned about nutrition.

Now, this doesn’t mean all formulas are the same. While the nutrition in every formula is whole and sound, there are differences in their chemical structure and production that may make a difference in your child’s health.

Non-Dairy Formula: These types of formula are typically made from rice or soy. Both rice and soy can be heavily sprayed crops, so it’s important to seek out organic when possible.

Tip: Rice can contain high levels of arsenic so proceed with caution when looking into a rice based formula, as arsenic has been linked to childhood obesity and chronic illness. If you're choosing a rice-based formula, call the company and ask where they source and what their arsenic levels are.

While heavy metals are a natural part of the earth’s crust and consequently inescapable in any crop grown in soil, it’s important to limit a baby’s exposure to these toxic elements as much as possible in their younger years, when so much crucial growth is occurring. “Because their cells are turning over at such a rapid rate, nutrients and toxins have more of an impact on their development,” explains Erin McDowell, a pediatric emergency medicine physician at Rainbow Babies and Children's Hospital in Cleveland, Ohio. Unfortunately, there are no current federal limits for arsenic in most foods, but there are some steps you can take to limit the amount of arsenic in your baby’s formula. Studies show that brown rice contains more arsenic than white rice and that rice not grown in India or the south-central region of the United States - where arsenic was heavily applied to control boll weevil population in cotton fields - is less likely to be high in arsenic. Again, don’t be afraid to call the company and ask questions.

Dairy Formula: The two primary sources of dairy formula are cow and goat milk, and while there are some differences we’ll discuss, it really comes down to which type of dairy you feel most comfortable feeding your child and whether or not they have an allergy.

Tip: While dairy likely shouldn’t be consumed long term, the good news is that the human body is actually most equipped to process dairy in the breastfeeding stage. Babies produce lactase enzymes in high amounts, allowing them to more easily process their mother’s breast milk. Lactase enzymes begin to decline between ages 3-5 and sharply drop in later childhood. This is why most babies will have no trouble digesting their mother’s breast milk or a cow-milk based formula.

There are, of course, instances when a baby is not able to properly break down lactose - premature babies, for example, are more subject to this issue - and in those situations, goat milk formula is an option.

Tip: While goat milk does contain lactose, it can be easier for the body to digest, especially in little bodies showing signs of discomfort from cow’s milk. Goat’s milk contains smaller fat globules than cow’s milk, which enables more efficient enzymatic breakdown.

This means that when the milk reaches your baby’s gut the curd is smaller and consequently gentler on your baby’s digestive system.

Both cow and goat milk have a whey to casein ratio of 20 to 80, while breast milk has a 60 to 40 ratio.These ratios can be tinkered with, and some formula companies will add whey to bring the ratio closer in line with that of breast milk. This is a strategy Kopia adopts as well.

Written by Quintanna Kesler-McGrath

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Erika's Product Recommendations

"Because Kopia formulas are the obvious recommendation to accompany this post, I wanted to instead add a note about the importance of breastfeeding. Both myself and Kopia as an organization understand how important breast milk can be to a child’s evolving health. Breastfeeding offers amazing benefits to a growing baby, including protection against viral infections, ear infections, diarrhea, obesity, some childhood cancers, asthma, allergies, SIDS, and diabetes. Breast milk is a well established immunity builder, from the initial antibody-rich colostrum to the fatty, sweet milk that nourishes a baby into childhood. Studies bear out that breastfed children are generally less likely to experience illness and consequently have fewer hospitalizations and doctor visits. You should absolutely exhaust all avenues in attempting to breastfeed your children before turning to formula.

That said - it is ABSOLUTELY possible to have a happy, healthy formula fed baby. In some cases, formula is the only way to achieve that goal, and every mother’s choice should be celebrated. Healthy babies need happy mamas and happy mamas need to know that they are feeding their children the best nutrition they possibly can. This is why every mother should have access to a high-quality formula that provides their baby with the nourishment they require to thrive. While all formulas provide the same level of nutrition regardless of ingredients, not all formulas are equal. Quality ingredients will go a long way in sustaining your baby’s health, so if Kopia isn't a fit for you, I recommend finding a formula that prioritizes organic, non-gmo, non-inflammatory ingredients. Make sure your babies are receiving the proper nutrition as dictated by their pediatrician or other medical and wellness advocates, and don’t be afraid to supplement when necessary. Consult your trusted medical or nutritional guides about adding in vitamins, minerals, or probiotics. The journey to wellness has more than one path, and whichever one you choose for your child, Kopia is here to offer support."

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THE STATEMENTS MADE IN THIS ARTICLE HAVE NOT BEEN REVIEWED OR APPROVED BY THE FDA OR EUROPEAN COMMISSION. THE STATEMENTS MADE IN THIS ARTICLE ARE NOT MEANT AS MEDICAL ADVICE AND SHOULD NOT BE TAKEN AS SUCH. CONSULT YOUR PHYSICIAN BEFORE MAKING DECISIONS REGARDING YOUR FAMILY'S HEALTH.

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