Breastfeeding versus Bottled Formula

Human breast milk is the ideal food source for babies for at least the first 6 months after birth, but it has been estimated that only 30–40% of babies worldwide are exclusively breastfed during this critical postpartum period. Why is this the case and what are the pros and cons of exclusive breastfeeding? Why is infant formula so popular and are there any benefits to bottle feeding?

If the mother is healthy and able to obtain a highly balanced nutritional intake then breastfeeding is by far the best option for babies' health. Breast milk has the perfect ratio of bioavailable proteins, fats, and carbohydrates for optimal infant growth and development. Furthermore, breast milk is packed with immune cells, stem cells, pre-enzymes, some bacteria, thousands of bioactive molecules, and hundreds of indigestible oligosaccharides (short-chain carbohydrates) often referred to as human milk oligosaccharides (HMOs). Moreover, HMOs act as prebiotics to foster commensal gut bacteria such as Bifidobacteria that are essential for a healthy microbiome. More specifically, Bifidobacterium longum biovar infantis is the perfect symbiotic companion for a healthy gut because its bacterial genome contains a full complement of genes required for the production of enzymes that digest HMOs. By efficiently utilising human milk nutrients, healthy bacteria essentially act as "guardians of the gut" by limiting resources available to bad bacteria (pathogens). Compared to formula-fed babies, breastfed babies have significant microbiome differences and stronger immunity. Notably, scientific research has shown that breastfeeding reduces the frequency and severity of infections, decreases the incidence of childhood cancers, decreases childhood or adult obesity, and increases the effectiveness of infant vaccinations. Breast milk has also been associated with better brain development and higher intelligence.

Compelling stuff. So why don't all women breastfeed their babies? Well, similar to the old adage "You are what you eat!", breast milk is also based on what the mother eats. Medications, drugs, toxins, alcohol (depending on the quantity and timing of consumption), infections, and some diseases can be transferred to babies via breast milk. Furthermore, the composition of milks fats can be affected by the mother's dietary intake. Moreover, human milk is deficient in vitamin K and often low in vitamin D. Supplementation is usually required when breastfeeding. Breast milk is a generally a wonder food for babies, but it may not always be ideal.

There are numerous reasons why most women throughout the world do not exclusively breastfeed, including physiological problems affecting milk production, diseases or infections, medication use, addictions (drugs or alcohol), malnutrition, or social stigma. There may also be regional differences due to education or social status, for example, rural areas of the United States of America have lower breastfeeding rates than California or New York. Unfortunately, some clinics or hospitals may occasionally misinform or exaggerate the benefits of infant formula if they receive financial rewards for promoting certain brands of infant formula. The infant formula industry is a multi-billion dollar market. There may also be misinformation on social media regarding infant formulae that is not based on scientific research, or some people may think that science has all the answers and can trump nature, for example, individuals who think that supplements can fix all their health issues. Although the identification of many beneficial breast-milk compounds and the ability to synthesise some of them has increased in recent years, the scientific reality is that infant formulae are nowhere near as complete or balanced as breast milk. Moreover, blended formula nutrients such as proteins, fats, carbohydrates, vitamins, and minerals are not as bioavailable or as biologically active as in breast milk, and formulae also lack important immune factors. It should also be noted that infant formulae can become contaminated with bacteria during the manufacturing or packaging process. It is therefore essential to properly prepare powdered formula with boiled water to kill any pathogens. However, just because pathogens have been killed by pasteurisation or other methods during manufacture, or killed by preparation with boiling water, does not mean that immunogenic bacterial toxins have been destroyed or removed.

In summary, breastfeeding is the optimal choice for all healthy mothers with no medical contraindications. Any contraindications to breastfeeding must be identified by highly qualified professionals at reputable hospitals or clinics. Breastfeeding should be performed exclusively for the first 6 months, and continue until at least 12 months of age. Even after the introduction of solid foods at around 6 months of age, breastfeeding should be continued for at least another 6 months. This will help to protect your baby from infections and diseases, and provide highly bioavailable nutrients for optimal growth and development.

Notes and recommendations:

When exclusively breastfeeding, oral vitamin K supplementation given directly to the baby is required for the first 3 months. Vitamin K oral supplements must only be obtained from a hospital or licensed birth clinic.

Breast milk is low in vitamin D, the level of which is affected by the mother's diet. Lactating women should ensure adequate vitamin D intake by consuming several portions of salmon a week (salmon is generally very low in heavy metal contamination and is safe to eat multiple times a week). Certain varieties of mushrooms are rich sources of vitamin D, but it depends on their level of UV exposure. Mothers with poor diets should take a daily vitamin D supplement (600 IU or 15 microgrammes a day). Sometimes, a higher dose may be necessary. However, do not take very high-dose vitamin D supplements. Make sure to obtain any supplements from a licensed clinic or reputable high street pharmacy (do not buy online). Do not give vitamin D supplements directly to your baby.

Some mothers may perform a combination of breastfeeding and formula bottle feeding. This may provide a balance and help to top up shortfalls of vitamins in breast milk if the mother's diet or health is suboptimal. The ratio of breast milk to infant formula will vary according to the mother's nutritional and health status as well as the baby's needs. 70–90% breast milk with a corresponding 10–30% infant formula may help to provide a nutritional balance, depending on the mother's health and nutritional status.

For the ultimate nutritional guide to pregnancy and breastfeeding nutrition, please refer to the OneLife Diet Meal Plan (eBook).

Further reading:

OneLife Diet Meal Plan: Total Nutritional Guide. Link.

Infant microbiome cultivation and metagenomic analysis reveal Bifidobacterium 2’-fucosyllactose utilization can be facilitated by coexisting species. Link.

Essential and non-essential element concentrations in human milk samples and the assessment of infants’ exposure. Link.

Review of Infant Feeding: Key Features of Breast Milk and Infant Formula. Link.

The Centers for Disease Control and Prevention. Link.