Best Baby Formula – Carbs

How to Choose the Best Baby Formula Series: Baby formula carbs – Not all created equal

The predominant carbohydrate source in human breast milk is lactose.  All infants are born with the ability to digest lactose.  This is often a source of confusion for parents when infants/children develop an allergy or intolerance to cow’s milk-based formula.

Many people naturally assume it is the lactose in the milk because lactose makes a lot of parents gassy, crampy, and cranky too.  However, when an infant develops a reaction to something in cow’s milk or baby formula it is almost always a component of the protein, not the lactose (see the article above that explains why hydrolyzed protein baby formulas can prevent allergy development).  In short, for most healthy babies, lactose is not a bad thing, it’s what infants are supposed to eat.

Only some formulas use lactose as the main source of carbohydrate. Other commonly used sources of carbohydrate that I am not as enthusiastic about include: Corn Syrup, Corn Syrup Solids, Corn Maltodextrin (another type of corn sugar), Glucose Syrup, Brown Rice Syrup, and Sucrose (table sugar).

These other sugar sources are commonly used for a few reasons:

1. because they are much cheaper
2. much sweeter and
3. easier to digest than lactose.

I do not recommend corn sugar as the primary source of carbohydrate if you are just starting out with formula for many reasons:

1) We Nutritionists have been spouting concerns about excessive corn syrup intake for years now…. Why would we recommend it for infants?

2) Lactose is fundamentally different from these other sugars.  Lactose is a glucose and a galactose molecule joined together.  (YES! I am going to teach a little biology. Take one deep breath – it’s not that bad).

All babies make an enzyme called lactase that breaks apart the lactose into glucose and galactose molecules that can be absorbed.  Corn maltodextrin and corn syrup are primarily all glucose molecules. Glucose is the sugar in our blood. Sucrose is a glucose and fructose molecule joined together. These alternative sugars will not utilize infants’ lactase enzyme that is ready-to-go. These other sugars will also have larger impact on infant insulin as it contains twice as much glucose per gram than lactose does.  Click here to read some more nerd details about the biological differences in carbohydrate options in formula.

3) Lactose helps aid in the absorption of calcium from baby formula (1).

4) Lactose helps feed the good bacteria that we want to grow in babies’ intestines (2-5).

5) Almost all of the corn in this country is now genetically modified.  While I do not take a firm stance either way on genetically modified foods, I don’t think our susceptible infants are the population on which to be testing them.  But LOTS of formulas now have non-GMO versions.  In my opinion, this is a great option if a corn-based sugar is one of the main ingredients.

Now, babies need carbohydrate to grow so if you take out lactose, you have to replace it with something!  And babies also have limited ability to digest.  So, you can’t feed them vegetable fiber for their carbohydrate.  If you don’t use lactose in formula you are limited to using one of these glucose or sucrose-based sugars.

With that said, it is important to consider this one food is ALL baby is eating! For some simple math, Enfamil® Gentlease and ProSobee each contain roughly 10g of Corn Syrup Solids per 5 oz.  For a 2-month old eating 28 oz per day, this is 56 g of corn syrup solids every day!  That is more than the amount of corn syrup in 16 oz. of Coco-Cola.  I’ll repeat my mantra here:

You must read the formula label list of ingredients!

If you don’t read the ingredients, you can’t tell the difference in where the carbohydrates are coming from.  Remember that ingredients are always listed in the order of amount.  But interpreting carbohydrates is complicated! This is because cow’s milk naturally contains lots of lactose.  So, if you see “cow’s milk” on the  ingredients – you are just supposed to know that this is a source of lactose.  For example, Gerber Soothe formulas has no lactose on the list of ingredients. BUT, the carbohydrate in this formula is 30% lactose and 70% maltodextrin – even though only maltodextrin is listed on the list of ingredients.

I recommend starting with a primarily lactose – based baby formula.

To help poor sleep-deprived parents – below is a summary table of the most common brand-name baby formulas for healthy term babies, and the sources of carbohydrate in these formulas.

Notice above that the soy formulas do not contain any lactose.  There is an incredibly rare genetic disorder that makes babies unable to digest lactose. When this does happen, a true lactose-free formula is necessary and it’s wonderful that we have these options.  However, soy formulas often try to market to parents who mistakenly believe their baby has a lactose intolerance… which I don’t like.

Lastly, baby formula provides roughly 40% calories from carbohydrate (just like breast milk).  This means that a baby who is consuming a formula that contains no lactose (and all corn-syrup) will be consuming 40% of their calories as pure glucose.  If they are consuming a formula that is made with half corn syrup solids and half sucrose (or table sugar) then 10% of their calories will be coming from fructose. We have no idea what the long-term consequences of consuming this much glucose or fructose early in infancy may be.

That much glucose is likely to result in higher insulin surges in these babies.  Baby pancreases (the organ that produces insulin) are very strong and are able to handle that much glucose.  But what are the long-term consequences of forcing formula-fed babies’ pancreases to work harder than breastfed babies’ pancreases? Especially if that little-one has a family history of type 2 diabetes?  The answer is: we have no idea.

We also have no idea what the long-term consequences are of consuming large amounts of fructose in infancy, while all those tiny organs are still developing.  Human breast milk doesn’t contain really any fructose.  There is lots of research in adults about the damage that large amounts of fructose can have in the body.   Without getting too nerdy on you, fructose is digested differently than either lactose or glucose.   When adults consume too much fructose, it can lead to liver damage, insulin resistance, unhealthy fat inside internal organs and an increase risk of obesity and diabetes… yikes!! (6-15).  While no one has studied if these effects may also occur in infants, if possible, I would suggest avoiding sucrose in formula if possible.

References:

1.Ross, A. C., Manson, J. E., Abrams, S. A., Aloia, J. F., Brannon, P. M., Clinton, S. K., Durazo-Arvizu, R. A., Gallagher, J. C., Gallo, R. L., Jones, G., Kovacs, C. S., Mayne, S. T., Rosen, C. J., and Shapses, S. A. (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J.Clin.Endocrinol.Metab 96, 53-58
2.Mackie, R. I., Sghir, A., and Gaskins, H. R. (1999) Developmental microbial ecology of the neonatal gastrointestinal tract. Am. J. Clin. Nutr. 69, 1035S-1045S
3.Newburg, D. S. (2013) Glycobiology of human milk. Biochemistry (Mosc.) 78, 771-785
4.Pacheco, A. R., Barile, D., Underwood, M. A., and Mills, D. A. (2015) The impact of the milk glycobiome on the neonate gut microbiota. Annu Rev Anim Biosci 3, 419-445
5.Zivkovic, A. M., German, J. B., Lebrilla, C. B., and Mills, D. A. (2011) Human milk glycobiome and its impact on the infant gastrointestinal microbiota. Proc. Natl. Acad. Sci. U. S. A. 108 Suppl 1, 4653-4658
6.Aeberli, I., Gerber, P. A., Hochuli, M., Kohler, S., Haile, S. R., Gouni-Berthold, I., Berthold, H. K., Spinas, G. A., and Berneis, K. (2011) Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. Am. J. Clin. Nutr. 94, 479-485
7.Chung, M., Ma, J., Patel, K., Berger, S., Lau, J., and Lichtenstein, A. H. (2014) Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis. Am. J. Clin. Nutr. 100, 833-849
8.Innis, S. M. N., E. (2014) Lactose: a milk-specific carbohydrate enabling homeostatic regulation of glucose and insulin (623.12). FASEB April
9.Johnson, R. J., Nakagawa, T., Sanchez-Lozada, L. G., Shafiu, M., Sundaram, S., Le, M., Ishimoto, T., Sautin, Y. Y., and Lanaspa, M. A. (2013) Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes 62, 3307-3315
10.Kawasaki, T., Igarashi, K., Koeda, T., Sugimoto, K., Nakagawa, K., Hayashi, S., Yamaji, R., Inui, H., Fukusato, T., and Yamanouchi, T. (2009) Rats fed fructose-enriched diets have characteristics of nonalcoholic hepatic steatosis. J. Nutr. 139, 2067-2071
11.Kelishadi, R., Mansourian, M., and Heidari-Beni, M. (2014) Association of fructose consumption and components of metabolic syndrome in human studies: a systematic review and meta-analysis. Nutrition 30, 503-510
12.Le, K. A., Ith, M., Kreis, R., Faeh, D., Bortolotti, M., Tran, C., Boesch, C., and Tappy, L. (2009) Fructose overconsumption causes dyslipidemia and ectopic lipid deposition in healthy subjects with and without a family history of type 2 diabetes. Am. J. Clin. Nutr. 89, 1760-1765
13.Lowndes, J., Sinnett, S., Yu, Z., and Rippe, J. (2014) The effects of fructose-containing sugars on weight, body composition and cardiometabolic risk factors when consumed at up to the 90th percentile population consumption level for fructose. Nutrients 6, 3153-3168
14.Perez-Pozo, S. E., Schold, J., Nakagawa, T., Sanchez-Lozada, L. G., Johnson, R. J., and Lillo, J. L. (2010) Excessive fructose intake induces the features of metabolic syndrome in healthy adult men: role of uric acid in the hypertensive response. Int. J. Obes. (Lond.) 34, 454-461
15.Sievenpiper, J. L., de Souza, R. J., Mirrahimi, A., Yu, M. E., Carleton, A. J., Beyene, J., Chiavaroli, L., Di Buono, M., Jenkins, A. L., Leiter, L. A., Wolever, T. M., Kendall, C. W., and Jenkins, D. J. (2012) Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis. Ann. Intern. Med. 156, 291-304

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