Nov 05 , 2020
Calling all history buffs! We were so glad to hear that many of you enjoyed our blog post on the history of breastfeeding in the US. The topic of formula, in particular, seemed to be a hot topic among many mamas.
So for this week, we’re doing a deep dive into the history of formula in the United States, starting in the mid-1800s to today.
Just a friendly reminder that while we are advocates for breastfeeding and encourage 6 months of exclusive breastfeeding and continued breastfeeding for a year as the AAP recommends, we understand that it’s not always possible or desired to breastfeed your little one. Every mom is different and has their own story and unique needs and using formula can be a great option.
Let’s get started!
German scientist, Johann Granz Simon, publishes the first chemical analysis of human and cow’s milk. This becomes the basis for formula nutrition science and stays that way for many decades.
. He noticed a couple things:
- cow’s milk had more protein and fewer carbohydrates than human breast milk
- larger curds of cow’s milk (they are naturally smaller in human breast milk) were linked to the digestion problems many babies were experiencing.
Doctors then recommend that water, sugar and cream be added to cow’s milk so that it is more digestible for babies.
German chemist, Justus von Leibig, develops the first baby formula—a powdered mix of wheat flour, malt flour, potassium bicarbonate and heated cow’s milk. This is a hit in Europe and by 1869, becomes available in the US for $1.
Nestle’s Infant Food also becomes available in the US, and is sold for $.50. Their powder is made of malt, cow’s milk, sugar and wheat flour.
Unlike Leibig’s formula that requires cow’s milk, Nestle’s formula is the first completely artificial formula available in the country.
Several competitors hit the market, presenting consumers with variations of cow’s milk modifier formulas. The Sears catalogue from 1897 shows eight different brands of commercial infant foods.
Even though formula is now widely available, sales remain modest. Proprietary formulas are more expensive compared to cow’s milk and many moms opt for exclusive breastfeeding.
1890 to 1915
The “percentage method” takes off in the medical community. The method, created by Thomas Morgan Rotch of Harvard Medical School, focuses on dilution and deficiencies.
Cow's milk contains more casein than human milk, so it must be diluted. However, when casein is diluted, it decreases the sugar and fat content to less than human milk contains. So, to correct this, cream and sugar are added in precise amounts.
By the 1920s though, doctors grow frustrated by the complexity of putting Rotch's percentage method (pretty difficult for moms at home, too) into practice. They go back to recommending commercial formulas or simple homemade formulas containing evaporated milk.
A new infant formula becomes available, and this one replaces milk fat with a fat blend made from animal and vegetal fats. The goal is to make the formula as close to human milk (rather than cow’s milk, as previously preferred) as possible.
Simulated milk adapted (SMA) is the first formula to include cod liver oil. Nestle’s Infant Food as well as many other competitors follow suit by adding cod liver to their formulas.
The Mead Johnson company introduce Sobee—the first soy-based formula—to consumers. A few years later, they also market Pablum, which is the first precooked fortified infant cereal made with ingredients like wheat, oats, corn, bone meal, alfalfa, and dried brewer's yeast.
1960s and 1970s
Commercial formulas become the standard for infant nutrition. It’s also important to note that during this time, the percentage of women breastfeeding their infants is at an all-time low, a mere 25%.
There are a couple reasons for this:
- formula was easy to use, readily available and cheap (free in some cases)
- formula was “medically approved” and also encouraged by many doctors
- In many ways, the fact that women could rely on formula is what helped so many women now entering and staying in the workforce.
The Infant Formula Act of 1980 is passed after multiple cases of hypochloremic metabolic alkalosis in infants (from consuming select soy formulas) are reported.
Let’s break this down:
Hypochloremia is caused by prolonged vomiting involving a loss of chloride in excess of sodium, accompanied by a compensatory increase in plasma bicarbonate. Metabolic alkalosis is an acid-base disorder in which the pH of the blood is elevated beyond the normal range of 7.35-7.45.
Hypochloremia + Metabolic alkalosis = Metabolic and electrolyte imbalance caused by prolonged vomiting. This was a serious condition that caused a metabolic imbalance in the babies from prolonged vomiting.
Following the Infant Formula Act of 1980 and backed by nutritional research, formula options continue to more closely try to resemble breast milk. A few examples, courtesy of Contemporary Pediatrics:
- Ross's Similac is reformulated to change the whey:casein ratio to 52%:48%, which more closely resembles that of human milk (70%:30%).
- Both Mead Johnson's ratio is 60%:40% and Ross's formulas contain added nucleotides in amounts similar to those in breast milk
- Both companies also introduce formulas that contain long-chain polyunsaturated fatty acids
What exactly are nucleotides?
Nucleotides are the building blocks of DNA (and its partner, RNA). DNA is in our cells, and it contains our genes, or the codes that make us unique.
The same way that protein is made of chains of amino acids, DNA and RNA are both made from long chains of nucleotides (nucleotides do not contain protein, nor are they the same as amino acids).
Nucleotides are in breastmilk and can be added to formulas.
Why add nucleotides to formula?
Nucleotides are found in human milk, along with a lot of other helpful components.
Scientists realized that nucleotides might provide some benefits to breast-fed infants, including to the immune system.
Nucleotides were first added to cow milk-based formulas as early as the 1960s, and have been used in formulas in the US since the 1980’s.
What are the benefits?
One of the possible benefits of adding nucleotides to formula is that they may help to support growth in some formula-fed infants.
You can read more about the evidence of how nucleotides may support growth in this publication.
Nucleotides may also help to reduce how often formula-fed infants get diarrhea and how long the diarrhea lasts. There is evidence that adding nucleotides to infant formula may minimize diarrhea.
Where does the controversy around formula stem from?
Regardless of what your views on formula are, it’s important to understand where the controversy is rooted. There are a few key points:
- Accessibility: Adding water to formula isn’t something most people in the United States have to think about, but can pose a challenge for people in developing nations.
- Replication: There are some things that are hard to replicate and therefore, not found in formula. For example, antibodies.
- Research: There are still a lot of unknowns when it comes to breast milk. Most recently, scientists have found that breast milk is teeming with bacteria that colonize the infant’s gut, and could help set the course for the baby’s growing immune system and metabolism.