by Marion Nestle
Jun 9 2010

Functional ingredients in infant formula: Are these about health or marketing?

If you don’t have a small baby, or your baby is breastfed(and see note at end) you no doubt are missing the furor over “functional” ingredients that companies have been adding to infant formulas.

DHA (an omega-3 fatty acid) came first.  As I discuss in my book, What to Eat, infant formula companies could not wait to add it.  They knew they could market it on the basis of preliminary evidence associating DHA with visual and cognitive benefits in young infants.    Although evidence for long term benefits is scanty, the companies also knew that they could charge higher prices formulas containing DHA.

The FDA approved the use of DHA in infant formulas on the grounds that it is safe, but did not require the companies to establish that DHA makes any difference to infant health after the first year.  Because of its marketing advantage, virtually all infant formulas now contain DHA.  Surprise!  They also cost more.

Companies now want to add other ingredients, such as prebiotics, probiotics, lutein, lycopene, and betacarotene, which also can be marketed as healthier and at higher prices.

In response, the Center for Budget and Policy Priorities (CBPP), has issued a report on the lack of evidence for the benefits of functional ingredients and the substantial harm they will cause to the economic viability of the WIC program, the USDA’s assistance program for low-income mothers and children.

WIC buys about half the infant formula sold in the United States each year.  WIC is not an entitlement program, meaning that the number of participants is limited by available funding (a GAO report explains how this works).

The CBPP report says:

As pressure mounts to limit federal discretionary spending, it is critical to ensure that WIC not spend funds on foods with functional ingredients that do not deliver clinically significant benefits. WIC spent approximately $850 million on infant formula last year, and a recent USDA study found that more than ten percent of that spending ($91 million annually) is attributable to higher-priced formulas with functional ingredients.  Under current law, the additional cost to WIC of providing foods with these ingredients is likely to grow substantially as such foods proliferate.

As the report explains, formula companies do not have to demonstrate that the added–and more expensive–ingredients do any good:

There is no mechanism within the national WIC program that requires USDA to review the research evidence on the claimed benefits of these functional ingredients or to base decisions about whether to offer foods containing such ingredients on their benefits and the specific needs of WIC participants. Currently, instead, infant formula manufacturers themselves decide whether WIC offers infant formulas with new functional ingredients, while state WIC programs decide whether WIC should offer other foods with such ingredients.

As I keep saying, functional foods (and ingredients) are about marketing, not health.  If companies are going to add functional ingredients–and charge higher prices–they need to have some convincing scientific evidence to back up their claims.

Postscript: Laurie True of the California WIC program writes:

Congressman George Miller, Chair of the House Education and Labor Committee, is writing the bill that reauthorizes the WIC Program this week. He should include a provision requiring independent scientific review of the efficacy of these “functional ingredients” before USDA allows them in WIC foods and infant formula.

Note:  Lori Dorfman sends a Berkeley Media Studies Group issue paper on how to advocate for hospitals and workplaces to make it easier for moms to breastfeed.

  • Genie

    WIC is corporate welfare. Companies pay for favorable placement and acceptance and then are beneficiaries of WIC’s “edorsement.”

    Also, WIC (Different requirements in each state) requires that grocers carry non-organic varieties of all food types accepted to participate. So, a small local & organic food cooperative can no longer participate in offering WIC to its members because it is required to always offer non-organic carrots for sale.

  • Subvert

    Breast is Best!

  • @Subvert- as a mother who breastfed her first child for almost two years, and is 8 months into breastfeeding her second… I obviously agree with you. But it is not that simple, and I suspect it is particularly complicated for women who work in low wage jobs, i.e., the group of women WIC aims to help. Let’s assume that these women start breastfeeding and manage to get it to work well in the early weeks. We do provide support to help get that relationship started, but then we stack the deck against having it continue successfully.

    If you can’t afford to take time off without pay (or with substantially reduced pay), you will probably go back to work when your baby is 6 weeks old. This coincides almost exactly with a major growth spurt. Both of my babies nursed almost non stop for several days at that time. If I had gone back to work right then, and was trying to pump to keep up with my baby’s milk intake, I would almost certainly have failed. It is hard enough to establish a pumping routine that keeps up with the baby’s milk intake without trying to do it in the midst of a growth spurt.

    Speaking of pumping…. I have a desk job, and can easily go and pump 3x a day. I had a computer put in the lactation room and can work while I pump. I am a salaried professional, and have never had anyone express any concern about the fact that I pump during the day. But when I used to go to a breastfeeding support group, there were many women with a very different reality. They had jobs that paid hourly wages. California (the state I live in) requires employers to provide a room and two unpaid 15 minute breaks for a nursing woman to pump. In my experience, two 15 minute breaks is probably not sufficient, and that combined with the loss of wages would be a powerful incentive to give up. Add in the not so subtle resentment of coworkers and bosses, and honestly, I think it is a miracle that any women working in those sorts of job manage to keep breastfeeding.

    So yes, breast is best. We should fix our policies and our attitudes to make it more likely that women will breastfeed. But I think we also need to recognize that for some women, formula is necessary, and I hate to see a bunch of unsubstantiated claims made by formula makers used to increase the cost of what is already a major expense for some families.

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  • I think serious effort needs to be put towards simplifying infant formula. I breast fed my son, but he also needed supplementation (life stresses immediately post partum limited my milk supply and I was never able to recover it). However, we found that he was allergic to infant formula. I found ONE version that he could tolerate, but he never felt full after drinking it. In the end, I made my own, resorting to an old family recipe from the Ozarks.

    I told the pediatrician about the problem and he didn’t believe me, insisting that formula is chemically identical to breast milk (sorry, I don’t lactate HFCS, but it sure is in the formula!) and that the allergic reaction (one that only ever occurred after a consuming a formula supplement) must have been to my milk–not the formula. I changed doctors, but I didn’t dare tell anyone I was making my own formula, because of the stigma against it.

    I remain convinced that if I could pronounce and identify every single ingredient in commercial infant formula that my son could have tolerated it.

  • Anthro

    Thank you, Cloud, for your perspective and your compassion. I breastfed as well, but I didn’t have to go back to work at all so it was easy. I did without a lot of “things” in order to stay home, but I know it just isn’t feasible for the very poor or those (like my young mother/doctor) who have so many years of education to put to use. I am sorry poor people often have so many children, but I would not want to deny them being parents because they don’t, literally, have enough time to breastfeed.

    It is such a sad state of affairs when our culture is so influenced by marketing campaigns, that people will actually buy the formula with the “functional” ingredients. It’s also sad that a company would stoop so low to boost profits. Finally, it’s sad that people buy stock in such companies which just feeds the greed. I’m so happy I could breastfeed all my babies as long as I wanted to and never had to pump and never owned formula or bottles.

  • Emily

    I absolutely agree, Cloud. Furthermore, I think we need a lot more more education out there, specifically for folks less likely to breastfeed to begin with. I’m sad to say that I know lots of women who didn’t breastfeed because it wasn’t culturally acceptable. Some even said it was weird or disgusting.

  • Jennifer

    I wonder, though, how many of these “functional ingredients” are being added to formula because they are present in breastmilk and some study, somewhere, has suggested that they might be correlated with something that is beneficial about breastfeeding. With the push for increased breastfeeding rates and the vilification of formula as substandard nutrition, is it any wonder that they are adding anything they can think of, no matter how little nutritional benefit it actually provides, to make their product “more like breastmilk” or more palatable (pun intended) to health-conscious moms?

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