The Deadly Influence of Formula in America, Part I

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December 24, 2003 | 32,126 views

[Part 1, Part 2]

ByDr. Linda Folden Palmer
First published on NaturalFamily Online

Thisgroundbreaking analysis from noted author, health educatorand advocate Dr. Linda Folden Palmer is the first time ahealth expert has published an examination of the availablescientific research comparing the death rates of formula-fedand breastfed babies.

While the results hold no surprisesfor breastfeeding educators and advocates, the study mayprove to be a rude awakening for the millions of Americanswho have bought into the myth that infant formula is a perfectlysafe breast milk substitute.

Infant formula was designed to be a medical nutritional toolfor babies who are unable to breastfeed. Formula does notfully meet the nutritional and immunity needs of infants,leaving their immune systems flailing. An infant's immunesystem has three aspects: her own immature, developing immunesystem; the small component of immunities that passes throughthe placenta during natural childbirth (and to a lesser degreewith premature births and cesarean sections); and the mostvaluable, living portion that is passed on through mother'smilk on an ongoing basis.

Remove any of these components andyou take away a vital support structure.

This brings us face to face with the safety and effectivenessof infant formula as a breast milk substitute. Is formulaactually as safe as we have been led to believe? In fact,the answer is a resounding "no." In fact, the useof infant formula doubles the risk of infant death for Americanbabies.

While the dangers of formula feeding aren't somethingyou're likely to hear in your doctor's office, theconclusions can be derived through an examination of the availablescientific research on infant mortality in the United Statesand across the world. There are studies showing artificialfeeding's impact on overall infant death rates in bothdeveloping and undeveloped countries.

While studies offeringcomparative death rates are not available for industrializedregions, there are numerous studies providing comparativeoccurrence rates for many illnesses and disorders in the UnitedStates and other industrialized nations. Many more reportsare available extolling superior survival rates and decreasedillness rates among breastfed infants, but only those withsolid numbers are useful here.

We can assemble the statisticsfrom these studies to build a firm picture of the ratio ofinfant deaths for U.S. formula-fed babies against those whoare breastfed.

The relative risks of formula

It is clear that feeding infants artificial formula insteadof breastfeeding increases their relative risk of death. Anumber of studies point to this fact. Table 1 shows figuresfrom two studies measuring infant mortality risks during certainage ranges. A risk number of 3 in the chart represents threetimes the risk of infant death for infants who are artificiallyfed.

While the numbers in the charts reflect any amount of breastfeedingduring the study period (and not necessarily exclusive breastfeeding),nearly all studies mention that during the first six months,exclusive breastfeeding produces much higher survival ratesthan partial breastfeeding. No studies refute this assertion.Figures for each age range listed here do not include childrenwho died prior to reaching that age group. Figures reflectinfants who received no breast milk or had weaned prior toreaching the reported age group versus those who receivedany breastfeeding through that age.

Table 1 clearly demonstrates that the disadvantages of formulaare most devastating in the earliest months. Significant disadvantagesfor formula continue throughout the year-long study period.

Suggested Relative Risks for Infant Deaths

No Breastfeeding or Any Breastfeeding Ending Before DesignatedAge Ranges vs. Breastfeeding Through Designated Age Ranges (1,2)

Country Author 0 to 2 Mo. 3 to 5 Mo. 6 to 11 Mo.
Mexico Palloni 13 6 3
Brazil, Pakistan and Philippines (pooled) World Health Organization 0 to 2 Mo. 2-3 Mo. 4-5 Mo. 6-8 Mo. 9-11 Mo.
6 4 2.5 2 1.5

Arelative risk of 13 here means that a child who was notbreastfed through the time period has thirteen times therisk of dying
during his first year as a child who had receivedany breast milk through that period.


The studies cited in the next table compare no breastfeedingwith 12 months of breastfeeding, each deriving a relativerisk of death over the full first year.

Suggested Relative Risks for Infant Deaths

No Breastfeeding vs. Any Breastfeeding for 12 Months (3-7)

Country Author Current Infant Mortality Rate IMR During Period Study was Performed Relative Risk To Formula-Fed Infants
United States
  7   Number we wish to find
> 2 *
Mexico (from Table 1)
Palloni 24 38 10 *
Guilkey 28 31 > 5.5
Tu 27 36 > 3.0
Palloni 38 100
Brazil, Pakistan, and Philippines, pooled (from Table 1)
WHO 48 average   4.5 *
India Srivastava 61 106 > 1.5

InfantMortality Rates (IMR) are the number of infant deaths per1,000 live births, from 0 to 12 months of age. A relativerisk of 5 here means that an infant who receives formulastatistically faces five times the risk of dying as an infantwho is partially or completely breastfed.

*These values are calculated from numbers provided in thestudies, with averages weighted by percentages of totaldeaths occurring in each age range. More than two-thirdsof deaths occur during the first month.


While the United States has a current infant mortality rateof 6.75 per thousand, many countries have rates approaching100, with 16 of 225 reporting nations suffering well over100 infant deaths for every 1,000 children born.(8)The nations in the above table with lower infant mortalityrates can thus be seen as somewhat comparable to the UnitedStates.

Factors influencing high infant death rates include malnourishedmothers, high numbers of births per mother with short spacingbetween births, poor weaning foods, the early use of cow'smilk, inadequate medical attention and supplies, poor sanitationleading to high infection rates and a rapid spread of infectiousdisease, and limited education about methods of limiting infectionand the spread of disease.

Why do U.S. babies die?

Below are the percentages and total numbers of U.S. infantswho die from various leading causes, according to the 1999National Vital Statistics Reports. (9,10)

Total U.S. births in 1999: 4,000,000
Total U.S. infant deaths in 1999: 28,000
Percent Cause Total
20% Congenital abnormalities (birth defects) 5,500
16% Low birth weight and premature birth 4,500
10% Sudden Infant Death Syndrome (SIDS) 2,700
8.5% Complications during pregnancy and birth 2,400
6% Respiratory distress: lung collapse, influenza, pneumonia 1,750
3% Accidents (unintentional injuries) 850
2.5% Bacterial sepsis (infections) 700
2.4% Circulatory system diseases 650
1.4% Necrotizing enterocolitis 400
1% Intestinal inflammations (diarrhea) 300
0.3% Meningitis 100
0.3% Cancer 100

Numbersaccount for 70 percent of total infant deaths


So how does formula play into these deaths? Let's lookat some of the common causes of infant death and see whatcurrent research has to say on the involvement of infant formula.

Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS) accounts for a full 10percent of U.S. infant deaths. Several studies performed inthe United States and other industrialized nations revealincreased risks of SIDS among babies who receive formula insteadof breast milk. In the table below, the 2002 Scandinavianstudy takes into account variables thought to have affectedthe 2000 U.S. study, finding even stronger risks associatedwith formula.

The most recent U.S. study (2003) takes advantage of thelessons from these earlier studies to raise confidence inits final results. Its finding of five times the risk of infantdeath from SIDS for formula-fed infants seems to be the mostpowerful statistic yet.

Studies Demonstrating Relative Risks of Infant Death fromSIDS
Formula-Fed vs. Breastfed (11-17)

Country Author Year of study publication Relative risk for SIDS, formula-fed infants
United States
Hauck 2003 5
Scandinavia Alm 2002 1.6 to 5.1
United States
McVea 2000 2
Germany Schellscheidt 1997 7.7
Gilbert 1995 3.1
United States
Klonoff-Cohen 1995 2.7
New Zealand
Ford 1993 2

Arelative risk of 5 here means that an infant who receivesformula statistically faces five times the risk of dyingfrom SIDS as an infant who is breastfed.


Heart, Circulatory and Respiratory Failure

Premature infants and those with circulatory abnormalitiesoften display one or more warning signs of potential death,including inadequate oxygenation of the blood, apnea (episodeswhere breathing stops) and high blood pressure. Studies illustratethe dangers of formula for these infants. One study observedbetter body temperature and superior oxygenation in pre-terminfants receiving breast milk. Formula-fed infants demonstratedmany episodes of inadequate oxygenation and some apnea, bothof which were not seen among the breastfed infants. A Scottishstudy found significantly better blood pressure among naturallyfed infants.

Three U.S. studies are available examining feeding methodsfor infants with early circulatory problems. One study reportedthat more than half of infants with congenital heart diseaselost oxygenation during bottle feedings, while none did sowhile breastfeeding. Another study also dealing with heartdisease found infants' growth to be significantly inferiorand their hospitalizations to be longer when they were fedformula. A third study of very low birth-weight infants foundtwice as many episodes of inadequate oxygenation among formula-fedinfants as in those who received breast milk.

Heart and Circulatory Disease in Formula-Fed vs. Breastfed (18-22)

Country Author Year Findings for formula-fed infants
Scotland Wilson 1998 Higher blood pressure
Taiwan Chen 2000 Apnea and many episodes of oxygen desaturation (none among breastfed infants)
Inferior body temperature regulation
USA Bier 1993 Double the episodes of oxygen desaturation
USA Combs 1993 Less growth; longer hospital stays
USA Marino 1995 Oxygen desaturation during more than half of bottle feedings (none during breastfeeding)


Necrotizing Enterocolitis

Necrotizing enterocolitis is a severe intestinal inflammatorydisorder that affects around 4 percent of low birth-weightbabies and 1 percent of full-term infants. About one-thirdof low birth-weight infants and 20 percent of full-term infantswho contract this disorder die. While necrotizing enterocolitisis reported to be responsible for 1.4 percent of infant deaths,many more unconfirmed cases are likely to be responsible forsome portion of infant deaths reported as caused by prematurity.

In the United Kingdom, it was discovered that confirmed casesof necrotizing enterocolitis occurred in three times as manyinfants who received no breast milk as in those who receivedboth breast milk and formula. For infants who exclusivelyreceived breast milk, necrotizing enterocolitis occurred sixto 10 times less often than among wholly formula-fed infants.

Necrotizing Enterocolitis (23)

Country Author Year Relative risk of necrotizing enterocolitis, formula-fed infants
United Kingdom Lucas 1990 6-10 times more often


A World Health Organization (WHO) study revealed a risk ofdiarrhea for formula-fed babies in developing nations averagingmore than six times that of breastfed babies. A summary articlefor industrialized nations demonstrated an average of triplethe risk of diarrhea for formula-fed babies. The risk in Chinaand Israel is reported as slightly less than triple (2.8);in Scotland, the risk is five-fold; and a doubled risk ismeasured in Canada.

While one study noted nearly twice the risk of developingdiarrhea for artificially fed infants in Brazil, other studieshave demonstrated that the risk of actually dying from diarrheawas an astounding 14 to 15 times greater. The latter studiesdemonstrated not only that the artificially fed infants sufferhigher rates of illness, but also that the severity and durationof their illnesses are even greater when they do occur andresult in proportionately more deaths. This same assertionis demonstrated in a study from India, where formula-fed infantssuffer six times the death rate, once diarrhea occurs, asbreastfed infants with diarrhea.

Four separate studies in the United States all deduce a doubledrisk of diarrhea for formula-fed babies. The U.S. studiesalso reiterate the well-established factor of greater severityand extent of illness once diarrhea does occur among formula-fedbabies. Death rates for formula-fed U.S. infants who get diarrheamay be three times higher or more than their breastfed contemporaries.

The table below collates the reported risks of diarrhea forformula-fed infants from many studies.

Diarrhea Risks for Formula-Fed vs. Breastfed (24-40)

Country Author Year Relative risk of diarrheal illness (or death), formula-fed infants
Israel Palti 1984 2.7 (during the first 5 months)
Brazil Victora 1989 14 times the death rate
Scotland Howie 1990 5 (compared with infants with 3 months of breastfeeding)
India Sachdev 1991 6 times the death rate with diarrhea during the first 6 months
Canada Beaudry 1995 1.9
Philippines Yoon 1996 9 times the death rate
Mexico Lopez-Alarcon 1997 4 to 6.3
Industrialized nations, pooled Golding 1997 3 (gastroenteritis and diarrhea)
China Fu 2000 2.8 (during the first 4 months)
6 developing nations WHO 2000 6 (during the first 6 months)
Italy Gianino 2002 3 (rotavirus, including increased severity)
Brazil Escuder 2003 15 times the death rate (during the first 6 months)2.2 times the death rate (from 4 to 11 months)
Brazil Vieira 2003 1.8
USA Dewey 1995 2
USA Scariati 1997 1.8
USA Wright 1998 2
USA Raisler 1999 2 (during the first 6 months)


Respiratory Illnesses

Numerous studies document higher numbers of respiratory infectionsamong formula-fed infants than among those who are breastfed.It is clear that respiratory infections are at least triplein the United States for formula-fed infants. The death rateis likely to be even higher, since some of these studies notethat both the severity and extent of respiratory illnessesare considerably higher once they occur.

Respiratory Illness Risks for Formula-Fed vs. Breastfed (41-50)

Country Author Year Relative risk of respiratory illness (or death), formula-fed infants
Israel Palti 1984 3.7 (during the first 5 months)
Brazil Victora 1987 3.6 times death
Italy Pisacane 1994 4.5
Mexico Lopez 1997 2 to 8.5 (during the first 4 months)1.5 to 3 times as many days for each occurrence
Scotland Wilson 1998 1.9 (during the first 4 months)
Brazil Cesar 1999 17 times hospitalization for pneumonia
USA Wright 1998 2 (bronchitis)4 (pneumonia)
USA Levine 1999 3.7 (pneumococcal disease, 2 to 11 months)
USA Blaymore-Bier 2002 6 times as many days of upper respiratory infection (during the first month)
USA Bachrach 2003 3.5 (severe respiratory tract illnesses)



A joint study between the United States and Canada on neuroblastoma,a common childhood cancer, revealed a doubled risk for childrenwho did not receive breast milk for more than one year. Thisstudy is consistent with several other childhood cancer studiesin other nations, with results ranging from 1.45 to 4 timesthe risk for developing various common childhood cancers forformula-fed babies.

Childhood Cancer Risks for Formula-fed vs. Breastfed (51-56)

Country Author Year Findings for formula feeding and cancer risks
China Shu 1995 1.5 (leukemia and lymphoma)
UAE Bener 2001 2.8 (leukemia and lymphomas for no or less than 6 months breastfed versus longer breastfeeding)
France Perrillat 2002 2 (leukemia for breastfeeding over 6 months)
U.S. & Canada Daniels 2002 2 (neuroblastoma)

Dr.Linda Folden Palmer consults and lectures on naturalinfant health, optimal child nutrition and attachment parenting.After running a successful chiropractic practice focusedon nutrition and women's health for more than a decade,Linda's life became transformed eight years ago by the birthof her son. Her research into his particular health challengesled her to write BabyMatters: What Your Doctor May Not Tell You About Caringfor Your Baby. Extensively documented, this healthyparenting book presents the scientific evidence behind attachmentparenting practices, supporting baby's immune system, preventingcolic and sparing drug usage. You can visit Linda's Website at

It is good to see that attention is being given to theimportance of breastfeeding. Breastfeeding your newborn isthe best way to give her all the nutrients she needs to developinto a strong, healthy child.

I encourage every mother who is able to breastfeed hernewborn. However, there are cases when a woman may be unableto breastfeed for physical reasons. In these cases, it’simportant to recognize that ALLsoy formula is worse than worthless for human infants andis nearly guaranteed to cause problems down the road.What are some of the problems associated with soy formula?Well, for starters it:

Soy formula is generally given to infants who aren't breastfeedingand have trouble taking regular cow-milk-based infant formulas.While I am no fan of these formulas either, they tend to besafer than soy formula. However, the cow-milk-based formulasare derived from pasteurized milk. If you haven't heard bynow pasteurizedmilk is not good for you or your baby.

Fortunately, you can use rawmilk to produce a terrificinfant formula, but, again, remember that breast milkis ALWAYS best.

[Part 1, Part 2]

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