Maureen Minchin

(written August 2008, for use by communities exploring their response to proposed or enforced water fluoridation)


There used to be fluoride in some infant formulas, and manufacturers were asked to take it out because formula

was being made up with fluoridated water and excess intakes resulted. It is widely stated that now there is no

fluoride in any formula in Australia, and this has become part of our standard for such products, so that making

up formula with fluoridated water is said to be OK.  Is it?

Formula products come from many different countries and contain ingredients that come from many more.

Who tests them to ascertain whether the water used in producing their many components is fluoride free, and

how long will it remain so if community water supplies are fluoridated in the areas of origin? I imagine that

like much else - this is left to industry to police. There are on record problems relating to the water used by the

manufacturers of infant formula, so that recalls have had to be done, wells closed off, etc. Before this,

companies have marketed in Australia formula products made overseas which did not meet Australian

standards: iron was a classic example, and there were no penalties for doing so. In fact it was only picked up

because another manufacturer dobbed a competitor in, not because our regulatory agencies regularly test infant

formula to see it meets regulatory standards for every ingredient. (They don't.) And look how long it took

industry to get rid of lead in infant formula, or reduce aluminium levels. (With lead, even after it was agreed to

be a serious problem, companies were given another 10 years to swap over to non-lead-soldered cans.)

Are we relying on having a rule and expecting industry to abide by it universally? Or has anyone actually

analysed all the products on the Australian market? If so, where are the results published?

I am shocked by the clear misuse of the independent and reputable York review, in the Victorian pamphlet

circulating to all households. Those researchers stated categorically on the York website that their work is

being misinterpreted, that their results are consistent with anything from mild dysbenefit to mild benefit where

teeth are concerned. And York did not address the broader issue of safety in infancy. I would like some

more references to follow this up. It seems reasonable to assume that if the breast permits very little fluoride

to reach an infant, there is a need to prove overall safety, not assume it after looking only at teeth. Interestingly,

while it is (mis)quoted in the Vic pamphlet, no website is given in the references, so that readers cannot look it

up for themselves. An oversight? I think not. Go to this page - http://www.york.ac.uk/inst/crd/fluoridnew.htm

- for what the review really said.

I note that the Victorian Government website shows that infants' desirable upper limit of intake is 0.7mg/day,

and they calculate that bottle-fed infants exceed this intake only slightly -  by using average intake data

(780ml) for breastfed infants. But the problem is, we know that bottle fed infants at 4 months consume an

average additional 200mls over the breastfed infant, and many exceed 1 litre per day even younger than that.  

In addition, there is huge variability of intakes at every age: some breastfed infants consume a litre, others

500ml. Formula labels - read them - can suggest up to 1250 ml per day of formula or follow on products.

This excess over the acceptable upper limit of intake may indeed result in moderate fluorosis, but why is no

other potential adverse outcome ever discussed? I am more interested in seeing results of research into what

an imbalance like this might mean for developing brains, nerves and bones, not whether unsightly mottling and

greater susceptibility to decay occurs (yes, I followed current dental advice in the 1970s, and my children pay

the price.) Why is there no research on bottle-fed infants despite the evidence that they are a higher risk group

than breastfed infants? Fluoride is a powerful enzyme inhibitor, while breastmilk contains hundreds of bioactive

factors that assist the growing body.

Why is it just assumed that what applies to one group applies to the other, even in intakes, and despite

bothering to look at what's on the cans? Because no one wants to know the answers? So on the Victorian

Government's own data, bottle-fed babies given formula made up with fluoridated water will be getting more

than the upper limit of fluoride, day in day out for at least 4 months, and perhaps much longer.
Until I read more impressive work, I will continue to advise, as the American Dental Association does,

that bottle fed infants be fed on non-fluoridated water. And the ADA is only concerned about teeth! This is

another expense for families, many of whom cannot afford it. Does our government have no responsibility to

provide safe water for our babies?


* Maureen Minchin is a medical historian who studied at Melbourne and Oxford Universities. She has worked

extensively in the area of infant health and nutrition, including being involved in founding the International 

Lactation Consultant Association (ILCA), and the Australian Lactation Consultants' Association (ALCA).

She has been employed as a temporary consultant for UNICEF New York and World Health Organisation, Geneva,

as well as contracted by USAID to write a review. She was influential in the creation of the International Board of

Lactation Consultant Examiners (IBLCE), whose examination is the Gold Standard for Lactation Consultant

accreditation globally. She has written three books: Revolutions and Rosewater - the evolution of nurse registration

in Victoria, Food for Thought: A Parent's Guide to Food Intolerance, and Breastfeeding Matters; what parents need

to know about infant feeding. Her writing has been described as a milestone in the history of breastfeeding

advocacy and clinical knowledge.

Maureen's interest in infant nutrition began with the 1976 birth of her first child, who developed colic as

a result of in-hospital exposure to cows' milk artificial formula, and later dental fluorosis as a result of following

then-standard recommendations for fluoride tablets. Her concern for optimal infant nutrition makes her an outspoken

advocate of breastfeeding and a critic of the many avoidable practices and pressures that make this impossible

for so many women. She has spoken on radio and television and to many parent and professional audiences, both

within Australia and overseas, on the subjects of human milk, breastfeeding, artificial feeding, weaning, and food

allergy and intolerance. Much of what she first described in the 1980s as the clinical experience of Australian

families has since been validated by medical research, although many health professionals resisted this information,

and others are obviously still unaware of it or the research. She opposed then, and still opposes, fluoridation of water

supplies, even while accepting that the topical application of fluoride may be of some dental benefit (probably minor

compared with the benefits of good dental hygiene and diet). It is a basic medical principle that new ideas should be

proven safe before widespread application, and Maureen considers that water fluoridation, like artificial feeding of

infants, is an experiment which has not been proven safe, and likely never will be.