Why are so many American infant formulas containing corn syrup?

Infant formula Lactose All mammals, including humans, produce milk in the same unique fashion: a fusion of galactose and glucose sugar molecules known as lactose. Despite the fact that scientists are not certain why all mammary glands stockpiling galactose and glucose combine, many believe that this procedure is critical for babies.

Infant formula Lactose
Infant formula Lactose

There is growing proof that lactose substitutes in infant formula, such as corn syrup solids, could have health worries, but the investigation comes with warning and experts caution against switching formulas as a result of a long-term shortage.

Research suggests that corn syrup-based formulas metabolize differently from lactose-based formulas and human milk, resulting in altered infant microbiomes and eating habits in toddlers.

According to a new study, published in The American Journal of Clinical Nutrition this August, corn syrup may raise the risk of obesity at four years of age in infants who received corn syrup-based formula as opposed to lactose-based formula. In addition to tracking participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the study included 15,000 infants.

WIC formula choices are constrained in every US state, and most are lactose-restricted. Formula is fed to nearly half the infants in the United States, and most are formula fed.

WIC formula options are usually limited, and in most states, only one is lactose-free. Many states have allowed WIC participants to select more options as a temporary measure. At the end of the year, all choices will once again be restricted.

Formula is usually made using lactose, but as recent purchasing data shows, about half of all infant formula sales now contain lactose-reduced or lactose-free formula, compared to a few decades ago when only a small proportion did. Corn syrup solids are typically used, but maltodextrin and glucose are also used.

Infant formula Lactose
Infant formula Lactose

Companies that sell lactose-free or lactose-reduced formulas often claim that the products help fussy, gassy, crying babies. According to Undark, Robert Boyle, a children’s allergy specialist and researcher at Imperial College London, has not seen “good evidence” that lactose-free or low-lactose formulas “have any positive benefits in that sort of context.”

He said that lactose-free formula is not necessary for most healthy infants. “It’s all smoke and mirrors,” he said about health claims. “It’s all fashion and mum’s insecurities, not health issues.”

Despite the fact that the Food and Drug Administration’s standards cover 30 required nutrients in infant formulas, including protein, fats, and vitamins, carbohydrates are not covered.

Infant formula Lactose 2023

In addition, the European Union maintains standards that limit the quantity and type of sugars that may be included in standard formulas, and prohibits corn syrup. Michael Goran, a pediatrics professor at the Children’s Hospital of Los Angeles and the author of the recent WIC study, says that whether corn syrup is a suitable substitute for lactose in formula is contingent on whether someone is lactose intolerant. “If someone is lactose intolerant, they would not eat corn syrup on their cereal instead of milk,” he said.

Inhaled and injected drugs are often adulterated with lactose, said Dr. Anthony Porto, a pediatric gastroenterologist at Yale. Rather than being lactase intolerant, very few babies are lactose intolerant, he said. Only babies born with a rare hereditary disorder known as galactosemia are unable to digest lactose.

For example, Carolyn Slupsky, a nutrition professor at University of California, Davis, argues against lactose-free formula for all children, including those without galactosemia. “All formulas, whether they are specifically for infants with galactosemia or not, should be lactose-based,” she said.

Even if a baby’s parents don’t participate in WIC, there are many lactose-based formula options if the baby is otherwise healthy. Even many formula brands advertised as made from milk may not contain lactose.

These formulas — which are often referred to as sensitive, gentle, comfort, or soothe on the front of the box — use corn sugar as a carbohydrate, rather than lactose.

Lactose usually isn’t the problem when a baby has trouble digesting a formula, according to Porto, as the protein is usually the issue and research supports this.

Infant formula Lactose
Infant formula Lactose

Because only a few partially hydrolyzed formulas are available with lactose, Porto recommends hydrolyzed formulas or formula with broken-down proteins for babies with digestive issues.

However, there are no fully hydrolyzed formulas, and only a few partially hydrolyzed formulas, which are lactose-based. Because most babies with digestive issues are still capable of digesting lactose, Porto believes there should be lactose-based formulas with broken-down proteins available.

According to Boyle, if a baby is otherwise healthy and receives lactose-reduced formula, there is no evidence to suggest that it will aid in colic, gas, or fussiness. However, intestinal damage caused by a gastrointestinal illness, such as a bout of diarrhea, may make the baby temporarily lactose-intolerant, which can lead to lactose intolerance.

Usually, this intolerance lasts only a couple of weeks, he said. However, there is no evidence that lactose-reduced formulas help with colic, gas, or fussiness — the research that suggests this is based on small studies by formula manufacturers. (Studies have shown that formulas with hydrolyzed proteins that are lactose-free can help with cow’s milk protein allergy, but lactose along with broken-down proteins haven’t been investigated.)

In an email to Undark, the Infant Nutrition Council of America, which represents four of the largest infant formula manufacturers, claimed that infant formulas are rigorously regulated by the U.S. Food and Drug Administration (FDA) and that all ingredients used must be deemed safe and suitable by the FDA.

Because infant formulas are nutritionally complete and need a source of carbohydrate to provide energy, corn syrup solids and maltodextrin are both clinically proven to be well-tolerated carbohydrate sources for infants with food allergies or gastrointestinal problems who cannot consume breast milk or standard formula, the spokesperson said.

Whether or not formula contains lactose is up for debate, but possible health consequences are not. Formula has been linked to higher infant mortality, more infections in infancy, lower wages in adulthood, higher cancer rates in adulthood, and increased obesity risk, among other things. However, there are no studies to confirm that formula is a cause, and a great deal of the evidence connecting it to these issues may be related to economic disadvantage, which makes lower-income people more susceptible. It’s also unclear whether certain components of human milk are beneficial when added to formula, or whether substituting ingredients might put them at risk.

While the quantity of nutrients in different types of milk may vary, for many mammals, including humans and cows, lactose is the most abundant component. As glucose enters the body in bulk when corn sugars are consumed, insulin rises quickly. Moreover, glucose has a glycemic index that is more than double that of lactose.

It is not well-known, however, whether the long-term consequences of these higher insulin responses in babies. Goran et al’s new WIC study is the first to track babies who were fed corn sugar-based formula after infancy. At two and four years of age, there were 10% and 7% increases in obesity, respectively, compared to infants who consumed lactose-based formula.

At the absolute level, roughly two out of 100 additional children received this formula with corn syrup solids, one being obese at ages two, three, and four, compared to those who received the other formulas, according to Goran.

At ages two, three, and four, the proportion of WIC participants nationwide that was obese was about 15 out of 100, said Christopher Anderson, an epidemiologist at Public Health Foundation Enterprises (PHFE) WIC, a program of Heluna Health in Southern California, who was an author of the study.

“Shannon Whaley, a director of research at PHFE WIC, said that obesity is already a public health crisis. What else can we be doing to reduce that risk? From this research, it is evident that formulas with corn syrup solids are associated with greater risk,” she said.

In an email to Undark, Bridget Young, an infant nutrition researcher at the University of Rochester, wrote: “This research provides important public health data that can be used to shape regulations and future studies.” Young, who was not involved in the research, also stated: “These findings do not indicate that parents should change their formula based on them, as there are still limited choices due to the formula shortage.”

There may be multiple reasons corn syrup is so commonly used in infant formula, but Goran explained that “the economy might be one of those reasons” — it is cheaper and more profitable to produce, and most of the time it is used to manufacture this food.

Porto, though, believes that there is a less duplicitous reason for using broken-down proteins in these formula supplements — these proteins taste bitter, and corn syrup solids might make them more palatable. However, they may instead be produced with primarily lactose and a bit of a sugar to disguise the bitter flavour.

Slupsky said that all mammals have lactose as their primary carbohydrate source, so experts think that the U.S. should do more to ensure that all babies have access to lactose-containing formula. In addition, Porto said: “There’s a reason why all mammals have lactose as their primary carbohydrate source.”