Introduction of Solid Food: Separating Myth from Reality

The topic of introducing solids is a controversial topic. Many pediatricians recommend rice cereals beginning at 4 months, with the gradual replacement of breast milk with solids foods. In recent years, this use of rice cereal and other infant grains has been heavily questioned, as has the duration of exclusive breastfeeding, and whether or not spoon-feeding is the proper way to introduce foods. But what does the evidence say?

Duration of Exclusive Breastfeeding

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for "about" the first 6 months of an infant's life, followed by the introduction of complementary solid foods with continued breastfeeding. [1] The World Health Organization (WHO), as well as the United Nations Children's Fund (UNICEF) have set a global recommendation for "exclusive breastfeeding for 6 months (180 days)" followed by "nutritionally adequate and safe complementary feeding starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond." [2][3]

Neither organization supports prolonged exclusive breastfeeding beyond 6 months of age, with the WHO considering the too-late introduction of complementary solids to be of equal concern as the too-early introduction of solids.

In 2006, The Journal of Nutrition published a Mexican Cohort study on the implications of exclusive breastfeeding beyond 6 months. They found that infants in developing countries who were breastfed for longer than 6 months had an increased risk of developing Iron-Deficiency Anemia, particularly those whose mothers were also anemic. [4] These findings are supported by an AAP report published in 2010, where exclusive breastfeeding beyond 6 months was associated with an increased risk of Iron-Deficiency Anemia at 9 months of age. [5]

During the 3rd trimester, infants begin to store iron in their liver. These stores will satisfy the infant's iron needs for the first few months of life. Breast milk contains very low amounts of iron, but the iron that is in breast milk is bound to lactoferrin glycoprotein, making it incredibly bio-available to the infant. But by around 6 months, not only do infants begin requiring more iron, but their iron stores begin to deplete. Infants who are preterm, were born small for their gestational age, or who had immediate cord clamping are at an even higher risk of developing Iron-Deficiency Anemia in the second 6 months of life.

Food Before One: Is It Just For Fun?

With the growing increase in "Baby-led Weaning", a mantra has developed: "Food before 1 is just for fun." This is not entirely accurate. While BLW is considered to be a compatible method of infant feeding [6], care does need to be taken by parents to make sure that they are not unnecessarily delaying the introduction of solids, believing that food is of no nutritional value. Some infants, particularly those who are born premature or who have motor delays, may have nutritional requirements for solid foods before they possess the manual dexterity to self-feed. [7]

"This means it is also important that parents understand that a different approach may need to be taken for preterm infants or those with developmental delay, at least until they are able to effectively convey food to their mouth, and safely chew and swallow it, and also for those at increased risk of allergy; and perhaps during and following illness."*Nutrients. 2012. "How Feasible is Baby-led Weaning as an Approach to Infant Feeding? A Review of the Evidence."

Infant Rice Cereal

Many claims have been made about infant rice cereal, from it resulting in an increased risk of obesity, to diabetes, food allergies, as well as claims that it is nutritionally deplete, un-digestible, and unnecessary. Rice cereal is used by many pediatricians as a formula thickener for infants with reflux, and is believed by many parents to help a child last longer between feeds and even to sleep through the night. Clearly, what an infant is fed as a first food is of great debate.

The WHO recommends that all infant first foods should have a greater energy density than breast milk. They define the average caloric content of breast milk to be 0.8 kcal per gram (or 22 kcal per ounce). By this respect, infant rice cereal fits the bill. The Gerber Single Grain cereal contains 60 calories in 15 grams (4 kcal per gram). But concerns have been raised over whether feeding such a calorie-dense food is beneficial to an infant.

There has been some loose correlation between the early introduction of infant rice cereal and later obesity. One such study from the Journal of the American Medical Association (JAMA) found that mothers who introduce rice cereal prematurely are more likely to value their infants being "chunky", and are also more likely to use food as a rewards system for good behavior. This makes it incredibly difficult to differentiate between whether the increase in obesity is a result of complex feeding practices and behaviors or the actual nutritional content of the food being fed. [8]

Almost all the mothers in that study believed infant cereal to "fill their baby up" longer and to help them sleep longer. One of the first studies on rice cereal and infant sleep was also published in JAMA in 1989, finding that feeding infants rice cereal in a bottle "does not appear to make much difference in their sleeping through the night." [9]

On the other hand, the timing of cereal exposure may affect the risk of an infant developing islet autoimmunity (a marker for Type 1 Diabetes). Children who were exposed to rice cereal before 4 months and after 7 months had an increased risk of islet autoimmunity than those who consumed rice cereal within the window of 4-6 months. For those parents who want to use rice cereal, timing of initial introduction should be considered. [10]

What about gluten? Is gluten bad for babies?

Rice cereal is a gluten-free food, but as more and more parents shun the processed, boxed infant foods, it has become increasingly more common to see recipes for homemade porridge made from oats or other grains. One of the tenants of Baby-led Weaning is that an infant can consume pretty much any food (including bread) once they begin eating solids.

A study undertaken in 2005 looked at the incidence of Celiac Disease among children and whether or not it corresponded to the introduction of gluten-containing foods. Children exposed to gluten-containing foods in the first 3 months of life and also beyond 7 months of life were at an increased risk of developing Celiac Disease. But this increased effect was only noticed in children who were already at a higher risk of developing the disease in the first place (such as those were certain genetic factors or Type 1 Diabetes). The children who developed Celiac Disease were also less likely to be breastfeeding at the time of gluten exposure. [11]

A link between the introduction of gluten cereals and Celiac Disease was also noted by comparing countries with different rates of Celiac Disease with their cultural infant feeding behaviors. Infants in Estonia consume less gluten-containing cereal and have lower rates of Celiac Disease then infants in Sweden and Finland who consume more gluten-containing cereal. However, this study did not control for formula or breastfeeding, making the results difficult to apply to larger populations. [12]

What these studies suggest is that the ideal time to introduce gluten to an at-risk infant is between 4 and 6 months, and that mothers should also be breastfeeding at the time of exposure. [13]

Can Infants Digest Grains?

Another consideration that has been brought up is whether infants even possess the ability to digest grains. I've heard it repeated several times that infants cannot digest grains until 12-24 months old.  

The enzyme primarily responsible for the digestion of grains is amylase. Amylase is produced both in the saliva and by the pancreas. Salivary amylase begins to digest starches while the food is chewed, and then pancreatic amylase is secreted after the food passes in to the duodenum (upper section of small intestine), further digesting starches. Salivary amylase is at 60% of adult levels by 3 months of life and 83% by 5 months. [14]

Despite its designation as "salivary" amylase, this enzyme also functions in the lower digestive tract. A majority of starch digestion occurs in the duodenum, but because the infant stomach has a higher ph than an adult stomach, the salivary amylase retains much of its digestive properties. It is thus proposed that the salivary amylase that mixes with the food will continue to digest the grains even after swallowed, compensating for lower levels of pancreatic amylase. Around 6 months the infant's pancreas begins producing more and more of its own amylase. [15]

Another feature in the digestion of grains in infants is the presence of mammary amylase. Mammary amylase is the amylase that is found in breast milk. It has been suggested that, like salivary amylase, much of the mammary amylase retains its digestive properties, aiding in the digestion of starches until the infant's own pancreatic juices can begin to mature around 6 months. [16]

The digestion of carbohydrates by infants is a complex process, involving more than just the presence of amylase. Colon micro flora, and other small intestine brush-border enzymes play a role, and there is no evidence suggesting that infants who are old enough to consume solid foods have any difficulty digesting starches. The full strength of pancreatic amylase is not reached until a child is between 5 and 12 years old. Given that most infants, and especially most children, are able to digest starches and complex carbohydrates without issue, we can deduce that the digestion of starches is much more complex than merely the presence or lack of pancreatic amylase. [17]

So then, what would be a reasonable plan of action for the introduction of solid foods?

1. Delay solids until at least 4 months, preferably 6 months. 

2. Use "responsive" weaning. Allow infants to self-feed soft foods, if they desire. Use a spoon or your own finger to feed mushed, pureed or soft foods to infants who have a desire to eat but do not have the motor skills to self-feed. Never force an infant to take food off a spoon or to finish a whole jar of baby food.

3. Preterm infants or those who were born small for gestational age require special feeding care to make sure iron intake is adequate, especially after 6 months. An iron blood test is a simple procedure that can be done at your pediatrician's office, and can help you assess your child's unique iron needs.

4. If iron levels are low, the WHO recommends increased intake of iron-rich solid foods before relying on supplementation through drops or vitamins.

5. Breastfed infants should only be given iron supplements if they have iron-deficiency anemia (iron below 10.5) and are not consuming adequate food sources of iron (disclaimer: infants with Perinatal Crohn's Disease may have impaired iron absorption despite consumption of iron-rich foods)

6. There are no contraindications to consuming grains if a child is old enough to consume solid foods.

7. Families with an increased risk of Celiac Disease should introduce gluten between 4-6 months, while continuing to breastfeed.

References:

 

1. American Academy of Pediatrics. 2012. "AAP Reaffirms Breastfeeding Guidelines"
 http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

2. World Health Organization. 2009. "Infant and Young Child Feeding"
http://whqlibdoc.who.int/publications/2009/9789241597494_eng.pdf

3. World Health Organization. 2001. "Guiding Principles of Complementary Feeding for the Breastfed Child"
 http://www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf

4. The Journal of Nutrition. 2006. "Risk of Infant Anemia is Associated with Exclusive Breastfeeding and Maternal Anemia in a Mexican Cohort."
http://jn.nutrition.org/content/136/2/452.long

5. American Academy of Pediatrics. 2010. "Diagnosis and Prevention of Iron-Deficiency and Iron-Deficiency Anemia in Infants and Young Children."
 http://pediatrics.aappublications.org/content/early/2010/10/05/peds.2010-2576.full.pdf+html

6. Journal of Maternal and Child Nutrition. 2010. "Is Baby-led Weaning Feasible? When do Babies First Reach Out and Eat Finger Foods?"
http://onlinelibrary.wiley.com/doi/10.1111/j.1740-8709.2010.00274.x/full

7. Nutrients. 2012. "How Feasible is Baby-led Weaning as an Approach to Infant Feeding? A Review of the Evidence."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509508/

8. Journal of the American Medical Association. 1998. "Maternal Feeding Practices and Childhood Obesity."
http://archpedi.jamanetwork.com/article.aspx?articleid=189952

9. Journal of the American Medical Association. 1989. "Infant Sleep and Bedtime Cereal"
http://archpedi.jamanetwork.com/article.aspx?articleid=514762

10. Journal of the American Medical Association. 2003. "Timing of Initial Cereal Exposure in Infancy and Risk of Islet Autoimmunity."
http://jama.jamanetwork.com/article.aspx?articleid=197392

11. Journal of the American Medical Association. 2005. "Risk of Celiac Disease Autoimmunity and Timing of Gluten Introduction in the Diet of Infants at Increased Risk of Disease"
http://jama.jamanetwork.com/article.aspx?articleid=200903

12. http://www.allattamentoalseno.it/lavori/L99.pdf

13. Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Chicago. 2007. "The influence of gluten: weaning recommendations for healthy children and children at risk for celiac disease"
http://www.ncbi.nlm.nih.gov/pubmed/17664902

14. American Journal of Maternal and Child Nursing. 2007. "The importance of exclusive breastfeeding in infants at risk for celiac disease"
http://ajcn.nutrition.org/content/39/4/584.full.pdf

15. Journal of Digestive Diseases and Sciences. 1987. "Role of salivary amylase in gastric and intestinal digestion of starch"
 http://link.springer.com/content/pdf/10.1007%2FBF01300204.pdf#page-1

16. Journal of Pediatric Research. 1983. "Mammary Amylase: a Possible Alternate Pathway of Carbohydrate Digestion in Infancy"
 http://www.nature.com/pr/journal/v17/n1/abs/pr19833a.html

17.Journal of Pediatric Gastroenterology & Nutrition. 1999. "Starch Digestion in Infancy"
http://journals.lww.com/jpgn/Fulltext/1999/08000/Starch_Digestion_in_Infancy.4.aspx

Soy Formula: Birth Control for Babies?

It's not a new claim. It's been around since at least the late 1990's. But here it is, gracing the headlines once again: Soy Formula contains the equivalent of 3 birth control pills. [5]

This first appeared in my facebook news feed and I really didn't think much of it at the time. As a breastfeeding advocate and a lactation educator, it's sometimes hard to filter the anti-formula rhetoric through the lens of critical thinking, and since I work predominantly with breastfeeding mothers and not formula feeding mothers, I usually don't need to do that. But then someone asked me, point blank, if soy formula contained the equivalent of 3 birth control pills. I got to thinking and I realized that on the surface, that claim sounded ludicrous. But is it?

Tracking down the origins of this claim was incredibly difficult, and there are a couple different versions, ranging from "3 pills per day" to "3 pills per serving". I still cannot find a single reputable source of that claim. In fact, the original post that showed up in my newsfeed seemed to attribute it to calculations by the Swiss Federal Health Service, but didn't provide a reference for those calculations.

Finally, I was able to isolate a similar statement to the Weston A Price Foundation (specifically one of their honorary board members, Mike Fitzpatrick). According to the 2004 article published by WAPF:

"The most serious problem with soy may be its use in infant formulas. "The amount of phytoestrogens that are in a day’s worth of soy infant formula equals 5 birth control pills," says Mike Fitzpatrick, a New Zealand toxicologist." [2]

In a previous 2002 piece titled "Soy Formula: Birth Control Pills for Babies", WAPF said:

"According to a Swiss report, 100 mg isoflavones taken by adult women provide the estrogenic equivalent of a contraceptive pill.¹⁰ This means that 10 mg provides the estrogenic equivalent of a contraceptive pill to a baby of 6 kg. Thus, the average amount taken in by a child on soy-based formula provides the estrogenic equivalent of at least 4 birth control pills." [1]

So let's take a look at both of those sources.

Mike Fitzpatrick, New Zealand Toxicologist

Mike Fitzpatrick is a New Zealand toxicologist and campaigns against soya foods. He is an honorary board member of the Weston A Price Foundation. The quote attributed to him did indeed come directly from him in 1995, but has been clarified by him in later years.

"When I first did my review, I did compare the estrogenic equivalents of the contraceptive pill with how much soy infants and adults would be consuming. It’s at least the equivalent of one or two estrogen pills a day, on an estrogenic basis. I’ve been criticised that it’s not the same form of estrogen, but in terms of estrogenicity, it’s a crude but valid and alarming statistic." [6]

So not exactly 5 pills, but he still maintains that it's the equivalent of 1 or 2.

The Swiss Report

This one is much harder to verify and I have not been able to completely verify it. It was originally published in the Swiss Government's Bulletin de L'Office Federal de la Santé Publique,  in 1992. [7] Unfortunately that was before the wide availability of online publications, and the government of Switzerland only has online access to their official bulletins from the last 13 years.

But on the note of this study, I disagree with the way the WAPF interpreted and applied the calculations. The bulletin referred specifically to the birth control equivalent of a soy isoflavone supplement taken by adult women. Without knowing which specific isoflavone or combination of isoflavones in the supplement, it's hard to apply that research to all soy-containing products. Different species of soy plants have different levels of Genistein and Daidzein isoflavones, and even crops harvested at different times of the year can have up to 50% variability in their isoflavone content.

According to the USDA Database for the Isoflavone Content of Selected foods (2008), the isoflavone content of Similac Isomil ready-to-feed soy formula is:

Those figures are represented in mg per 100 g of food consumed. [3] If we adjust them based on the daily intake of soy formula per day we end up with 936 grams (33 ounces) of infant formula, leading to daidzein intake of  6.83 mg, Genistein intake of 12.82 mg, a Glycitein intake of 1.12 mg, resulting in daily total isoflavone intake of 20.69 mg/day.

On the surface, that would look to line up correctly with (and be even higher than) the WAPF's assertion that 10 mg of isoflavones is the equivalent of 1 birth control pill in a 6 kg infant. But it's complicated by the realization that just having a certain isoflavone content does not mean it will have an exact effect on the body the way synthetic estradiol in birth control pills does.

A review of the literature was published in the Annual Review of Nutrition in 2004. Entitled "Isoflavones in Infant Formula: A Review of Evidence for Endocrine and Other Activity in Infants," [4] the study specifically calculated the amount of soy isoflavones consumed per day by infants in relation to actual birth control pills.

"Estrogen intake from modern oral contraceptive pills ranges from 20µg/day to 50µg/day. If we assume the average weight of women taking such pills is 50 kg, the daily estrogen intake is 0.4–1µg/kg/day. As for infants fed with soy formula exclusively, the total daily genistein intake is about 5 mg/kg/day (70% of total isoflavones). Because the estrogenicity of genistein relative to estradiol varies widely depending on the method used, the relative quantitative estimation of bioactive dose of genistein is also variable. A 10−3 or 10−5 relative estrogenicity of genistein to estradiol would yield a relative intake of 5µg/kg/day or 0.05µg/kg/day estradiol for these infants."

In other words, the actual estrogenicity of genistein and soy isoflavones is not equivalent to the estrogenicity of actual estradiol. These isoflavones exert a much lower estrongenic effect than actual estrogen, and on an actual molecular level in the human body that estrogenic effect can be quite variable.

Another important point mentioned by the authors was that most infants who consume soy formula do not do so from the start. The switch to soy formula is usually undertaken in older infants after colic, gas, or allergy has been suspected from cows milk formula.

From a purely symptomatic angle, it's reasonable to expect that if infants were consuming the equivalent of 3-5 birth control pills per day from soy formula, that we would see more clinically significant effects, with regards to these hormonal side-effects. In women, just consuming 1 birth control pill per day can regulate menses, prevent pregnancy, and cause other hormonal effects. Soy formula has seen about 50 years of use, with no major clinically significant effects in infants. It's well known that infants do respond to estrogens, and it's also generally accepted that infants fed soy formula consume the largest concentrations of soy isoflavones than all the other soy-eating groups. But what is not well known is what effect, if any, it's actually having.

What we can deduce, based on this information, is that the claim of soy formula being 3-5 birth control pills is likely overblown and does not represent the actual estrogenic effects of the amount of isoflavones consumed from soy formula. That does not mean that soy formula does not have it's own set of unique risks. There are additional concerns about the affect of the isoflavones on thyroid function, risk of allergy, and the fact that soy formula contains higher amounts of aluminum than cows milk formula. For some infants, consuming soy formula is unavoidable, such as in the case of galactosemia. But recognizing the risks and implications of a soy-based diet in infancy does not need to involve overblown claims of giving infants birth control pills.

References:

1. Weston A Price Foundation, 2002, "Soy Infant Formula: Birth Control Pills for Babies" http://www.westonaprice.org/soy-alert/soy-formula-birth-control-pills-for-babies

2. Weston A Price Foundation, 2004, "Soy and the Brain"
http://www.westonaprice.org/soy-alert/soy-and-the-brain

3. US Department of Agriculture, 2008, "USDA Database for the Isoflavone Content of Selected Foods" http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/isoflav/Isoflav_R2.pdf

4. Annual Review of Nutrition, 2004 24:33-54, "Isoflavones in Infant Formula: A Review of Evidence for Endocrine and Other Activity in Infants" http://courses.biology.utah.edu/carrier/3320/Endocrine%20disruptors/soy%20and%20infants.pdf

5. Food Renegade, 2013, "Soy Infant Formula: A Formula for Disaster"
http://www.foodrenegade.com/soy-infant-formula-formula-for-disaster/

6. "In Unusual Letter, FDA Experts Lay out Concerns", 2002, Daniel Sheehan, Danial Doerge

7. Bulletin de L'Office Fédéral de la Santé Publique, no. 28, July 20, 1992.

Cupric Sulfate in Infant Formula "worse than GMO's"

This image has been floating around Facebook for the last few weeks, usually accompanied by an article written by Green Med Info.

http://www.greenmedinfo.com/blog/usda-organic-formula-contains-ingredient-worse-gmos

In the article, Green Med Info asserts that the addition of copper sulfate to infant formula is not only dangerous, but that it is actually worse than GMO's. But how true is that statement?

I am by no means advocating for infant formula. Powdered infant formula is not required by law to be sterile, and the early introduction of infants to cow's milk proteins in formula changes their intestinal flora, making the gut more conducive to the growth of harmful pathogens. It can also sensitize the infant to allergens, the nutrient amounts are unchanging (posting a risk of over-dilution or over-concentration if not mixed properly), and it is lacking in many important appetite regulatory hormones, peptides, and other components. The healthfulness of infant formula is not up for debate here. Nevertheless, there is no need to make rather sweeping, unsupported claims about infant formula, such as that it contains a deadly poison.

What is Copper Sulfate?
Copper Sulfate is a salt of copper ( CuSO₄). Copper is a metal that exists both as metallic copper, but also chemically bonded with other compounds to form copper salts. Copper Sulfate occurs naturally in the environment, and it is also manufactured industrially. It's a common ingredient in many children's chemistry sets. It is used as an industrial fungicide, both on crops as well as in drinking water. It is even taken (in the form of Chalcanthite) as a "holistic" supplement. This photo (from Trip Advisor) shows the Rio Celeste in Costa Rica tinted blue because of a natural vein of Copper Sulfate.


This photo of Rio Celeste is courtesy of TripAdvisor

So it IS used as an industrial fungicide?

Yes, Copper Sulfate is used as a fungicide and herbicide. It is one of the approved fungicides for use in organic farming, and can be purchased commercially in small quantities for home use, though its use as a fungicide has been repeatedly admonished (and even banned in parts of Europe) because of the possibility of copper buildup in the soil.

So if copper builds up in soil and is bad, that must mean it builds up and is toxic to humans?

Not exactly. The lowest quantity of Copper Sulfate that has ever been found to be toxic to humans is 11 mg/kg. [1] An adult weighing 150 lbs would need to consume 748 mgs in order to reach that level. A newborn infant weight 8 lbs would need to consume nearly 40 mg. Overdose is further complicated by the fact that high doses tend to illicit immediate vomiting, expelling most of the ingested compound from the body. This effect of high doses of copper sulfate led to it being used as an emetic for several decades. [2], [3] As an additive to infant formula, it is found in quantities of MICROgrams. An infant would need to consume an obscenely large amount of formula in order to begin seeing the effects of copper toxicity...but by the time that happened, the child would probably be in renal failure because of a toxic overload of other micro-nutrients found in much higher quantities.

But WHY is it added to infant formula?

Copper is an essential trace mineral. It is stored in the liver, and at any given time the average adult has between 75 and 100 mg of copper stored in their body. [4] It is an essential component to many enzymes and plays a very important role in iron utilization and the development of bone and connective tissue. Your body uses its copper stores to create a compound called "Ceruloplasmin", which circulates the bloodstream and helps the body properly uptake iron. A copper deficiency by lead to an iron deficiency. [4], [5]

There is an "Adequate Intake" level of Copper set for infants, which is currently 200 micrograms (mcg) per day. [6] [7] [13] Infant Formula is a sub-optimal food because cow's milk does not contain proper concentrations of many essential micro-nutrients and trace minerals, copper being one of them. Cow's milk is deficient in copper (from a human standpoint. It's great for baby cows!). This means that any commercially prepared infant formula needs to contain some form of copper. [8] It IS a nutrient. Indeed, it is even used as a source of copper in vitamin supplements (as are other forms of copper, such as Copper Gluconate and Copper Iodide).

What else do we know about Copper Sulfate?

Copper and Copper Sulfate are found in many municipal drinking water sources because of naturally high levels at the water source, as well as deliberate addition of Copper Sulfate to water to control algae growth. The Environmental Protection Agency (EPA) has regulations and standards regarding the amount of Copper Sulfate that is allowed to be in drinking water. That limit is currently 1ppm.

The World Health Organization published a review of the literature regarding copper in drinking water in 2004. The WHO review references several studies which found no significant increase in liver disorders in infants with high copper intake. [9] They had previously established a recommended limit of 2 mg of copper per liter of water, although higher limits have been suggested by other agencies, noting that concentrations >3 mg/liter alters the taste of the water, but does not pose a risk to humans. [10]

In 1998, the Journal of Pediatric Gastroenterology and Nutrition published a study on the health affects of infants consuming water with 2 mg/l of copper. They found "No acute or chronic adverse consequences of consuming water with copper content of 2 mg/l." [11]

A study from Letters in Applied Microbiology (Journal), 2010 found that use of Copper Sulfate in infant formulas could help to prevent formula contamination by Chronobacter Sakazakii (a culprit in necrotizing entercolitis). [12]

The conclusions derived by Green Med Info are much less alarming than the title of their original article lets on. They recommend returning to truly organic farming, being weary of infant formula, placing importance on breastfeeding as a matter of infant health, and also holding formula manufacturers accountable. I cannot say I disagree with any of those, and I feel they are very noble and appropriate conclusions. But in the face of those conclusions, there is really no need to claim that toxic pesticides are being added to infant formula. That really is nothing more than indulging in fear-based marketing.

There is no backing to the claim that Copper Sulfate is worse than GMO's (which is a whole other ball park entirely, on the topic of GMO danger), and there is nothing to suggest that Copper Sulfate is added to infant formula in quantities even remotely near what has been found to be toxic, or what is used as a pesticide. Higher levels exist in tap water, with no documented health effects in infants or children. Ascorbic Acid (vitamin C) has industrial applications as a corrosive agent to prevent metal build up in swimming pools, so clearly a chemical compound's application *outside* of the realm of nutrition should not be used to prove toxicity when consumed in nutrient quantities.

What it comes down to is balance: use appropriate, pre-measured quantities of infant formula and do not over-dilute or add more scoops than recommended. Use a ready to feed or concentrate liquid form of formula before opting for non-sterile powdered versions. Know the copper content of your area's tap water and/or use an alternate source of water to mix your formula (this even goes for other trace compounds in drinking water, such as fluoride and lead). And of course, the primary infant feeding recommendation...BREASTFEED.

References

1. National Institute for Occupational Safety and Health (NIOSH). 1981- 1986. Registry of toxic effects of chemical substances (RTECS). Cincinati, OH: NIOSH.

2. Journal of Pediatrics. Vol 42 No 1. 1968. Elevation of Serum Copper Following Copper Sulfate as an Emetic. http://pediatrics.aappublications.org/content/42/1/189

3. Extoxonet. June 1996. Extension Toxicology Network, Pesticide Information Profiles http://extoxnet.orst.edu/pips/coppersu.htm

4. Calsol. 1999. http://www.calosol.com/copper.php

5. Oregon State University: Linus Pauling Institute. 2001-2013. Micronutrient Information Center: Copper http://lpi.oregonstate.edu/infocenter/minerals/copper/

6. Healthline. 2005-2013 http://www.healthline.com/natstandardcontent/copper

7. Australia Ministry of Health. Nutrient Reference Values http://www.nrv.gov.au/nutrients/copper.htm

8. American Journal of Clinical Nutrition. 1998. Essentiality of Copper in Humans http://ajcn.nutrition.org/content/67/5/952S.full.pdf

9. World Health Organization. 2004. Copper in Drinking Water http://www.who.int/water_sanitation_health/dwq/chemicals/copper.pdf

10. Journal of Chemical Senses. Vol 26 No 1. 2001. Determination of the Taste Threshold of Copper in Water http://chemse.oxfordjournals.org/content/26/1/85.full

11. Journal of Pediatric Gastroenterology and Nutrition. Vol 26 No 3. 1998. Copper in Infant Nutrition: Safety of the WHO Provisional Guideline Value for Copper Content of Drinking Water http://journals.lww.com/jpgn/Abstract/1998/03000/Copper_in_Infant_Nutrition__Safety_of_World_Health.3.aspx

12. Letters of Applied Microbiology. Vol 50 No 3. 2010. Inactivation of Chronobacter in Infant Formula Using Lactic Acid, Copper Sulfate, and Monolaurin
 http://www.ncbi.nlm.nih.gov/pubmed/20025649

13. Institute of Medicine, National Academies, Food and Nutrition Board. 1997-2011. Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, Vitamins.  http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/RDA%20and%20AIs_Vitamin%20and%20Elements.pdf