This is a guest post by Catherine Shanahan, MD Author of Deep Nutrition: Why Your Genes Need Traditional Food and Food Rules: A Doctor’s Guide to Healthy Eating
If you are a young mom, there’s a good chance your pediatrician has recommend that you provide an iron-fortified formula or cereal to your baby. But are these iron-fortified products really the best thing for your growing child, or are they a formula for possible health consequences down the road?
To answer that question, let’s take a look at what formulas and cereals really are. One stroll through the baby formula aisle and you’ll discover that formulas are essentially a combination of water, vegetable oils and soy products, and sugar—often four, five, or six different types of sugar. Baby cereals: same idea, vegetable oils and sugar.
If you’ve read my book, Deep Nutrition you know why I think a diet of sugar and vegetable oil is far from ideal, particularly for a growing baby.
But there’s something else about these convenience foods I find concerning, namely the “fortified” part. Baby formulas and cereals are often “fortified” with a list of supplemental vitamins and minerals. And often one of those supplements is iron. Manufacturers have learned that, since many pediatricians concerned about adequate dietary iron for baby recommend iron-fortified baby foods, it pays to put “iron-fortified” in bold print right on the label.
The human body needs iron. These days, we hear all the time how iron deficiency is associated with a wide variety of health problems in children and adults. Perhaps the most worrisome is the association with lowered intelligence, which can occur in children who have low iron but, since iron levels are not routinely tested in newborns, may not be properly diagnosed. Because of this, the American Academy of Pediatricians advises doctors to make a blanket recommendation that parents buy iron-fortified formula and cereal, and for breastfed babies to be given iron after 4 months of age. The assumption has been that a little extra iron is harmless to your baby, so why not go ahead and get that extra iron in however you can.
A friend of mine recently prompted me to question that assumption. As a new father to a bouncing baby boy, Patrick Vlaskovits (who runs the popular Paleohacks.com & PaleolithicDiet.com websites), received the usual advice from his pediatrician to fortify his son’s diet with iron.
The logic of his pediatrician was that a baby’s iron stores run out somewhere between 4-6 months of age**, and that human breastmilk is low in iron, ergo iron supplementation is necessary. This didn’t jibe well with Patrick’s evolutionary approach: if babies are meant to be fed breastmilk and breastmilk is naturally low in iron and even contains chelators that bind to iron so to minimize free iron in the gut, perhaps babies sensitive GI tracts may be harmed by iron. This made him worry that that extra iron, even a little extra iron, might not be so healthy for his little guy, and so asked me if I would be willing to do a little investigating.
I’m glad he did. The results of my investigation has convinced me to withhold any recommendation to parents about feeding their children iron-fortified foods until first checking iron levels. Supplementing iron when iron levels are already normal can lead to serious health problems. Below are five that have the most supporting evidence behind them:
1.Lowered IQ. When researchers studied the delayed effects of just a little extra iron in early life (between ages 6-12 months), the results were unmistakable. Half of the babies in the study had been given iron-fortified cereal, while half got unfortified cereal. Most of the children had normal iron levels, and among this majority, at the time of the intervention, their intelligence tests were evenly matched. Ten years after the intervention, however, both groups were given intelligence tests again, and this time members of the iron-fortified group scored an average of 11 points below the children who received no supplementation.
2.Bacterial infection. Iron fortified foods have been shown in multiple studies to promote the growth of intestinal pathogens and alter intestinal and systemic immune function. In children with fragile health (i.e. HIV or malaria), iron appears to increase mortality rates.( What follows are the most pertinent quotes from the article: “ Iron treatment has been associated with acute exacerbations of infection, in particular, malaria.” “Oral iron supplementation in the tropics in children of all ages … has been associated with increased risk of clinical malaria and other infections including pneumonia.” “In studies of the [prevention] of Pneumocystis carinii in patients with HIV disease, 30 mg of elemental iron daily for 6 mo was shown to be associated with excess mortality” “Parenteral [intravenous] iron treatment is associated with life-threatening sepsis when given in the early neonatal period.” -Robb’s Note note: Iron is an important co-factor in the reproduction of a variety of pathogenic organisms. In the case of acute or chronic infection an individual may appear to be low in iron. This is because the body has sequestered the iron in an attempt to keep it unavailable to the pathogenic organisms, thus slowing reproduction of the pathogen. Many, many people have aparently died after being diagnosed as “anemic” and subsequently given iron supplementation. Oops.
3.Early atherosclerosis, or “fatty streaks.” A Finnish study found that excess iron stores was a stronger risk for heart attack than hypertension or cholesterol levels. We have no comparable data on children because nobody is looking for an association.
4.Cancer. One study found a correlation between maternal iron supplementation in pregnancy and the most common childhood cancers: leukemia and lymphoma. Several studies show that children with the iron storage disease hemochromatosis, who have only slightly higher-than normal iron levels, suffer significantly higher rates of these cancers. (Similar studies in adults have found increased rates of the most common adult cancers: breast and prostate.)
5.Stunted growth. According to an extensive review of the effects of iron on the crucial skeletal developments in early life “iron supplementation in young children without iron deficiency may jeopardize optimal height and weight gains.”
The evidence says that a seemingly modest excess of iron can be harmful, especially in children. But why would this be? As with so many nutrients, it’s all a matter of balance.
We need a steady supply of iron because only iron can complex [associate without binding] with heme proteins in our blood to absorb oxygen in our lungs and then release oxygen wherever its needed. Iron is also necessary for many metabolic functions because of its unique reactions with oxygen. But with too much iron, the oxygenation reactions can run out of control, releasing free radicals that effectively burn us from the inside out.
While doing the the research for Deep Nutrition, I learned that the underlying pathology behind so many illnesses is uncontrolled oxidation. Oxidation reactions can go out of control in any tissue. And depending on exactly what they damage (cell membranes, enzymes, DNA), a variety of diseases can result. With this understanding, I now appreciate how iron-induced oxidation in various parts of a growing baby’s body can lead to each of these five serious health problems.
Lowered intelligence: In the nervous system, iron and oxygen react with certain fatty acids in nerve cell membranes. This can not only damage the affected nerve cell but also trigger inflammation and repair mechanisms that can lead to headaches and cause blood clots and swelling that can extend to nearby tissues, disrupting brain function. If these reactions are going on every day that the baby gets that extra iron, untold millions of nerve cells may die, and those that remain may be forced to jerry-rig novel connections that may cause abnormal behavior.
Bacterial infection: Bad bacteria love iron. Iron in the gut can promote the growth of pathogenic bacteria. Only 5% of the iron is absorbed from the gut when the source is fortified cereals, compared to 50% of the iron being absorbed from breastmilk. This leaves an abnormally high amount of unabsorbed iron in the gut to promote the growth of pathogens that cause intestinal and even blood infection, and disrupt immune function for some time after the infection is gone.
Early Atherosclerosis: Iron and oxygen react with certain fatty acids in fat-carrying blood particles called lipoproteins (the L in HDL and LDL cholesterol). The reaction damages the particles so that they can’t be recognized by the body. The unfamiliar particles never bind to the docking sites on that allow lipoproteins to unload their nutrient cargo
(nutrients like phospholipids, vitamins A, D, E, and K, and more). Instead of nourishing you, the damaged particles float endlessly in your bloodstream like plastic bags in the Pacific ocean. Eventually, they glom up together and precipitate out of circulation to form the beginnings of atherosclerosis called fatty streaks.
Cancer: Iron and oxygen react with a wide variety of chemicals in the cell nucleus to generate dangerous free radicals. Free radicals are high energy particles that, like X-Rays, can damage DNA. DNA mutations place us at high risk of developing cells that behave selfishly, and will divide and grow in spite of signals that they need to stop. This is how DNA damage leads to cancer.
Stunted growth: I’m not sure there’s a single mechanism that explains how excess iron leads to body-wide skeletal growth delays, including the skull and long bones. It may be that all this disruption burns up valuable nutrients that may no longer be able to support normal skeletal growth.
Because of the growing evidence that iron-fortification in babies is not without risks, increasing numbers of pediatricians are choosing to forgo the American Academy of Pediatricians recommendation to supplement babies with additional iron beginning at age four months and, rather, test iron levels in babies before deciding whether or not any iron supplementation is indeed appropriate.
To me, these research findings confirm my feelings about baby formulas and cereals. The fact is, these processed products cannot begin to compete with mom’s breast milk to give baby a running start for a life of extraordinary health. And when baby’s old enough for solid foods, there are far better alternatives than a box of cereal.
If you’ve been feeding iron fortified cereals to your toddler, here’s a few steps you can take to benefit your toddler’s health starting today:
1) Print this article and show it to your pediatrician.
2) Download Nina Planck’s “real first food list” here: http://www.realbabyfood.info/Resources/Handout_Baby_Food.pdf
3) Read through the excellent free info at http://nourishingourchildren.org/Home.html
4) Consider joining the Holistic Mom’s Network: http://www.holisticmoms.org/
** Robb’s Note: Check out this article from the Economist talking about a simple way to reduce infant anemia: Don’t cut the placenta immediately after birth. It’s interesting, a “standard of care” practice, cutting the placenta immediately after birth, is performed due to anxiety that “something” may go wrong in the transfer of blood from the placenta to the baby. Despite a lack of evidence that there is any real danger of relying on the natural process evolution has created in our species. And now, evidence that the procedure may in fact be quite harmful by increasing anemia rates.
Jimmie Markham says
Dr. Shanahan, what is your recommendation for parents who have checked their baby’s iron levels and have found a deficiency?
Dr Cate says
First and foremost you must work with your pediatrician/FP get at the root cause of the deficiency, and especially make sure that your baby doesn’t have any kind of intestinal problem because those are the most common causes for iron loss and low iron. The best way to get iron into a baby is through food, for the reasons described above its even safer than supplementation (due to excess remaining in the gut). So the foods listed in the links are going to be your best bet. Good luck!
Cereal made my younger son severely constipated, so we stopped after one or two tries. I guess we were lucky that our doctor didn’t think it was a big deal. She also recommended a vitamin supplement, but when that upset his stomach, she just gave me a list of veggies to include in my diet since he was breastfed. I think sometimes docs go on autopilot with various recommendations and don’t see it as a huge deal if you do things differently.
One bone to pick, though. I think articles that slam formula also need to provide some useful information on nursing. It can be a tremendously difficult experience for many mothers and the “formula is posion” aspect of the argument does very little to help a mom who is struggling with latch or supply issues. I had a horrible time nursing my older son and it was formula or starvation. Not my ideal, but we didn’t have much choice. I had multiple people come up to me in public and say things like I was poisoning him, I should just give him a cigarette, and I was a horrible mother because I gave him a bottle. Please don’t ever be that person.
I breastfed both of my children. there is a change in our society away from breastfeeding. Mother’s don’t grow up seeing their mother breastfeed nor aunts, nor friends of the family. There is a lack of help for mothers who have latch issues. I wish more mother’s would not give up but find a hospital with a lactation consultant on staff. They freely give help to new mothers. About the lack of milk, ask a lactation consultant and she will tell you to spend a day with your child at home and let the child nurse. More nursing will increase supply. No you were not a horrible mother, Shannon! You did the best you could.
I think what it comes down to is giving our kids the most optimal food we can, with our specific resources and children’s specific health in mine. I had terrible supply issues with my first and milk based formula made her ill. Thus, she got soy formula. Ideal? Heck no! The best we could do at that time, in that situation? Absolutely.
Second daughter was nursed until she refused, then supplemented with formula until she weaned. Perfect? Nope. Best we could do, when she literally refused to latch anymore at seven months old? Yup.
First son was nursed until he was about thirteen months old. Ideal? Some would say so. Better than what was given his sisters? Eh, arguable. I’m a big proponent of breastfeeding as being the best for all but the rare babies who have allergies to substances in breastmilk (amen for the uber-expensive formulas for dealing with this). But was this so far superior I have noticed any difference among my children, from the way they were fed? Nope. Not a bit. Each child is so individual, the best I can guess is that if breastmilk is best, I did my best to nurse in every situation. If their IQ points are lower because of it, what could I have done?
I say all this to get to the point that I approach trivisol, fortified cereals, and the like much the same way. Are they better? Maybe, maybe not. Does each parent have to research and decide for themselves with their pediatricians, based on what their individual child needs? Absolutely. I err on the side of using the cereals sparingly as thickeners, focusing more on things like avocado and banana as first foods than a rice slurry. But there is just not enough evidence to unequivocally state either way, and doing so is both presumptive and disregards that ‘ideal nutrition’ is a concept entirely relative to the health of each child.
Basically, I liked the article and the information, as well as the conclusions, and go a bit crazy when people start making sweeping up or down statements on what is or isn’t best in an area where the evidence doesn’t clearly support either conclusion.
Crunchy Pickle says
What would be the recommended formula for an adopted child that could not be breastfed?
The WHO Infant Feeding Hierarchy can be found on page 10, bullet #18 here: http://whqlibdoc.who.int/publications/2003/9241562218.pdf
Simply, it is as follows:
Breastmilk from the mother’s breast.
Expressed breastmilk from the mother.
Breastmilk from a healthy wet-nurse or a human-milk bank.
Here’s a website for finding donors in your area. All these women are happy to share what their diet is like, medications, and their pre/post natal blood work. I’m a donor and a friend of mine who has used this service when I didn’t make enough for her had a good experience finding a mother. http://www.hm4hb.net/communities.html
And finally here is the Weston Price Foundation’s home made whole food formula recipe for cases when you cannot find donor milk or are in between donors. There’s a raw cow milk version, raw goat milk, and liver broth version for highly allergic babies. http://www.westonaprice.org/childrens-health/recipes-for-homemade-baby-formula
Just curious, we were taught this idea of ‘every kid should get iron’ at school. Too me, however, it makes perfect sense to check the levels first.
I just wanted to ask: Are premature kids more/less likely to be iron deficient? Is it the same? Does breastmilk suit the needs of premature kids as well?
Thanks for this excellent article.
You are correct TESTING is REQUIRED before supplementing with iron as well as many other potentially dangerous substances. In general premenopausal women tend to be too low in iron. Men on the other hand are OFTEN way too HIGH. Many think this is is a large factor in the elevated CVD risk men have over women until the women hit menopause.
I favor self testing for sufficient iron for both men and women. A nursing mother might want to add some medical testing.
If iron ‘fortified’ products/cereals etc. are not ideal then what are some foods that can be introduced to my baby who is now just over 6 months old (he’s exclusively had breast milk to this point)?
Babies at 6 months don’t have the enzyme activity to digest carbohydrates well, but they do have the enzymes to digest protein and fat. Egg yolks (soft boiled) are a great first food. Sometimes adding small amounts of grated raw organic liver to the yolk is great too. The fermented cod liver oil from Green Pastures (especially the emulsified kind) is another good food. Bananas have amylase in them (an enzyme that helps the starch digestion), so mashed banana can be okay too. At 7 months you could start doing more pureed meats and avocado as well.
Here’s a good post for a little later too:
Lashiya Divan says
So I’ve taken my baby to a naturopathic doctor and she actually has good amount of iron, and she didn’t need any supplementation. The problem is my baby has to be formula fed now, I can no longer breastfeed because I am pregnant again and I had contractions while breastfeeding and being pregnant. Every formula in the world has iron and my baby cannot handle iron AT ALL! Any suggestions on what I can do?
My exclusively breastfed 10 month old daughter was diagnosed after a blood test as being slightly anemic.(hemaglobin levels 10.1) she was perscribed ferrous sulfates drops of 2mg a day. We did this for a few days and then went down to one ml, then stopped after a week. Her poop turned dark green and thick and she developed several anal fissures and diaper rashes that she has never had before! It seemed to bother her stomach as she constantly had gas. (Her dr. Did not seem concerned by these symptoms)
I’ve stopped the sulfate for about 5 days now and she still is having these problems. Could it be intestinal bacteria?
I would have chosen to totally skip the sulfate if it were not for the problems we have had with solids. She refused all solids at 6-8 months and has only recently become slightly interested.
Gabby's mom says
Why blame the food for the child’s low IQ? Environment and parenting skills are contributing factors, as well.
My kids were breast and formula fed, oh no, they even had cereal! 🙊 Each one is super healthy, highly intelligent, and above average in height; plus athletically inclined and social – they aren’t, however, anxious or paranoid or have eating disorders due to their parents over-analysis of everything.
A seasoned nurse offered me some sage advice: everything in moderation.