Ep 256: Fed is Best with The Formula Mom, Mallory Whitmore

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Mallory Whitmore knows her stuff about formula! She’s a certified infant feeding tech, leader of education at Bobbie–the only mom-founded and mom-run U.S. formula brand–and she’s the face behind The Formula Mom, an online platform for infant feeding info and support.

To be clear, she’s not against breastfeeding, quite the opposite in fact! Her mission is to help parents make informed, confident, and supported infant feeding decisions–without guilt or shame. If that means all breastmilk, all formula, or someplace in between, all that matters is that your baby gets the nutrition they need!

In this Episode, You’ll Learn About:

  • How formula compares to breast milk
  • Which “bioactive components” are found in breast milk
  • What parents should look for in a formula - ignore the marketing hype!
  • What types of formula are available
  • How to figure out which formula is right for you
  • What signs can indicate a formula is not working for your baby
  • How long you should give it before you switch to a different formula
  • How to feed a combination of breastmilk and formula
  • What actually makes DIY formula risky
  • Why it’s so important to destigmatize formula feeding
  • What the difference is between absolute risk and relative risk

Links Mentioned in the Episode

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I want this podcast to be more than a one sided conversation. Join me on Instagram where we can connect outside of the show! Through my posts, videos, and stories, you'll get even more helpful tips to ensure you have a beautiful pregnancy and birth. You can find me on Instagram @drnicolerankins. I'll see you there!

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Dr. Nicole (00:00): This episode is about formula feeding, and I so wish we would've had this information when we had to choose formula for our daughters.

(00:14): Welcome to the All about pregnancy and birth podcast. If you're having a baby in the hospital, you are giving birth in a system that too often takes away power from women over what happens in their own bodies. I'm Dr. Nicole Calloway Rankins, a practicing board certified OBGYN, who's had the privilege of helping well over a thousand babies into this world. I've been a doctor for over 20 years, and I'm here to help you take back your power, advocate for yourself, and have the beautiful pregnancy and birth that you deserve. This podcast is for educational purposes only, and it's not a substitute for medical advice. Check out the full disclaimer drnicolerankins.com/disclaimer. Now, let's get to it. Hello there. Welcome to another episode of the podcast. This is episode number 256. Whether this is your first time listening or you have been here before, I am so glad you're spending some time with me today.

(01:08): Super excited to have on the podcast today, Mallory Whitmore. Mallory is a mom of two educator advocate and certified infant feeding tech. She leads education at Bobby, the only mom founded and mom run US Formula brand, and she's the face behind the formula mom and online platform that helps new parents make informed, confident and supported infant feeding decisions without guilt or shame. She has built quite the platform there indeed, with a following of over 200,000 on Instagram. Now, to be clear, Mallory is not at all against breastfeeding, quite the opposite. As a matter of fact, she's really about making sure people have the information they need to make the best decisions for themselves, their families, and their babies. And let me tell y'all what Mallory knows her stuff about formula. Okay? So we have an incredibly informative conversation about how formula compares to breast milk in terms of what formula includes and doesn't include.

(02:14): We talk about things that parents should know when they are looking for a formula. What are the differences between the types of formula routine, gentle hypoallergenic, what are signs that a formula is not working for your baby and how long you should give it before you switch to a different formula? How to approach formula if you're using it in addition to breast milk and then some misconceptions that people have about formula. Again, great, great information. You are going to learn so much in this episode. Now, if you're listening to this episode on the day the episode is released, that's Tuesday, April 30th. Then do come join me this evening at 7:00 PM Eastern standard time to learn how to make a birth plan the right way. I am doing this free live class in order to teach you how to make a birth plan the right way and the right way means that it actually works to help you have the birth that you want.

(03:12): And at the end of the class, I'm sticking around to do 30 minutes of office hours q and a. Well, I will answer all of your questions about pregnancy and birth, or at least as many as I can get to now. Don't worry. If you are hearing this and it is past Tuesday, April 30th, you can sign up for the class@drnicolerankins.com slash birth plan. But don't worry if you missed it and it has passed April 30th. When you are hearing this, I will be doing the class live again in the future, and you can join my email list@drnicolerankins.com slash email in order to get notified when that next live class will happen. Okay, let's get into the conversation with the formula. Mom, Mallory Whitmore, thank you so much, Mallory, for agreeing to come onto the podcast. I'm super excited to have you on to talk about this topic. As I said before we started, I've followed you for a long time and admired your work.

Mallory Whitmore (04:13): Thank you so much for having me. I'm so excited for the opportunity to talk to your fans and followers about Formula.

Dr. Nicole (04:19): Yeah, so why don't you start off by telling us a bit about yourself and your work and your family, if you'd like.

Mallory Whitmore (04:24): Absolutely. So I'm Mallory Whitmore, known on the internet as the Formula mom. I started the Formula Mom platform when my youngest was a baby after thinking about it for several years. We formula fed with our first, she's almost eight, which is hard to believe. And I just remember feeling like I had taken the breastfeeding class, I had read the books, I knew where to go for support with lactation. There were so many resources on the internet and forums and Instagram. And then when we started Formula Feeding, I couldn't find anything out there that felt like it was research-based and supportive and educational. And so for a few years I just sat on it and then when my son was born, I was like, I bet there's something out there. Maybe I just didn't look hard enough and there still wasn't okay. And I was like, I know I am not the only person that has these questions or feels guilty or bad or doesn't know what formula to pick. And so I spent a long time doing my research and launched the Formula bomb platform. Okay.

Dr. Nicole (05:28): All right. And then if you don't mind sharing, did you know from the beginning that you wanted to do formula or you said you looked at breastfeeding resources. What was your thought process around

Mallory Whitmore (05:41): That? Yeah, it was different with our two kids. So with my first, I thought that we would breastfeed and looking back, I don't know that I necessarily wanted to breastfeed. It felt like that's what I should do. That's what everyone suggested. That's what good moms do. That's sometimes the narrative that we hear. And then for a variety of reasons, she was preterm and I had undiagnosed gestational diabetes and my milk supply was really delayed, and there was just a lot of factors that made our breastfeeding journey really difficult. And so then we switched to exclusive pumping, which for me personally was the worst of all the options. Even the sound of a pump today, my cortisol goes through the roof. I'm like, I can't listen to it. And then when she was about six weeks, it just was not working. She was not gaining weight. Well, I started developing postpartum depression and finally we were like, this is not working. So we switched to formula, and then with our son, we decided to formula feed from day one, which was absolutely the best decision that we could have made for us for him, and I've never regretted it.

Dr. Nicole (06:49): Gotcha, gotcha. Now, I think before we get into formula, because this topic can be so contentious to share your thoughts on breastfeeding because I think we should clear up that you're not anti

Mallory Whitmore (07:02): Breastfeeding. Oh my gosh,

Dr. Nicole (07:04): No. What are your thoughts on breastfeeding?

Mallory Whitmore (07:05): Yes. What I am pro is that everyone should be able to feed their baby the way they want to with as much support and education as possible. Oh, I hate so much that it does get contentious, and sometimes it feels like there are sides that you have to

Dr. Nicole (07:20): Take.

Mallory Whitmore (07:21): I think breast milk is truly one of the coolest things that our bodies do. It's amazing. I also believe that it's really the gold standard for infant nutrition, and sometimes it's hard for people to sort of piece apart the nuance that I can believe that, and I can still believe that breast milk wasn't the right choice for me. Breast milk still might not be the right choice for families, even if it is ideal nutrition, and that's why I'm glad we have formula for those folks.

Dr. Nicole (07:46): Okay, good. Thank you for clearing that up. So let's start off with the differences between formula and breast milk. How do they compare in terms of what they include and what they don't

Mallory Whitmore (07:58): Include? Yeah, absolutely. So nutrition wise, thinking through macronutrients, protein, carbs, and fat, and micronutrients, vitamins and minerals, formula is built to mirror breast milk as closely as possible. So you're going to get generally the same calories, the same amount of fat, the same amount of protein, the same proportion, like 50% of those calories will come from fat. Things like that that you'll find in breast milk. So from a nutrition standpoint, you're getting those same macronutrients and micronutrients. The big difference comes in what are called bioactive components. So breast milk includes things like stem cells and growth factors and prebiotics and probiotics. All of those things you're generally not going to find in a formula. And then there are other certain things like the type of protein is different in breast milk, the ratio or profile of fatty acids is slightly different. So on a macro level, you're getting the same nutrition on a micro level. Those individual components, some of them exist in formula, some of them are solely found in breast milk at this point.

Dr. Nicole (09:02): Okay. Okay. Alright. Alright. So when a parent is deciding to look for formula, what are some things that you would like them to know?

Mallory Whitmore (09:12): Oh my gosh, it's so overwhelming.

Dr. Nicole (09:13): Yes. Overwhelming. It's just a lot. It

Mallory Whitmore (09:19): Is. And you go in the aisle and it's the marketing, right? It's like best for brain development and supports immunity, and you're like, of course, I want all of that. And so the first thing I tell parents is to ignore the marketing. Ignore the marketing, because at the end of the day, the FDA requires that all formulas provide the same general nutrition in terms of nutrient levels. In that sense, all formulas are the same. You're going to get appropriate nutrition that is clinically shown to support healthy development and growth no matter what formula you choose.

Dr. Nicole (09:48): Gotcha. Because formula is highly regulated,

Mallory Whitmore (09:51): Correct? Oh my gosh, yes. It's the single most highly regulated food item that you can buy. Okay. So very highly regulated. So first thing, ignore the marketing. Second thing, you can basically ignore the nutrition facts because the FDA regulates that all of them include the same general nutrition. Where parents really want to pay attention is the ingredients that are used to source that nutrition. So just like as adults, we can get protein from tofu or we can get protein from nuts, we can get protein from chicken. The same is true for infant formula. There are different sources that are used to pull those various nutrients. So in some cases you might have cow milk protein, you might have goat milk protein, you might have soy protein, even pea protein. The same goes for the carb sources, lactose or corn syrup, salts or maltodextrin. That's really where the difference occurs between different formulas is what ingredients are used.

(10:44): So for a parent that's looking for a closest to breast milk formula, which is generally the number one thing that parents say they want, ideally you're looking for a formula that uses lactose as the carbohydrate source. It should be the first or second ingredient, some sort of milk protein, either cow or goat milk. Ideally, you want something that has added whey protein. It's typically listed as whey protein concentrate on the ingredient list. That brings the protein ratio more similar to breast milk, which tends to have like 60% whey protein, 40% casein in a mature breast milk. And then you can look for things like DHA or prebiotics, things that are extra from the sense of the FDA, but can be beneficial. We know they're in breast milk, so it's nice to have them in formula as well. Okay.

Dr. Nicole (11:32): I wish I would've known this information. I didn't know any of this. I was just like, I mean, my children are older now. They're 14 and 16, but we had to supplement. I didn't know any of this. This is great information.

Mallory Whitmore (11:41): No one does. And that's what's crazy is that it's not hard. It's just how do you get this information out to people to help cut through some of the noise.

Dr. Nicole (11:51): Gotcha. Gotcha. And I'll also say that it's obvious that you approach this from a very, it seems like scientific and evidence-based. You're serious about what you're talking about. This isn't just like you're reading an article here, article there, you're staying up to date on these things.

Mallory Whitmore (12:09): Oh my gosh, absolutely. And especially in the last couple of years, we've had the formula shortage and there was a big recall for one of the primary brands there has started to become a lot more interest in it. And it has been exciting to be able to be a resource for people and to have that knowledge to share.

Dr. Nicole (12:25): And I say that to say I'm, I've been on a little bit of a kick lately. Everybody with a camera is getting on social media. That's true. That's true. And the sources aren't always reliable or based on anything. And I just want folks to know that you should get information from sources, from people who are serious about it, presenting unbiased information, not trying to sway you one way or another, just giving you the best information to make choices for yourself.

Mallory Whitmore (12:53): Yeah, absolutely. I sign off on that 100% because there's some wild stuff

Dr. Nicole (12:58): On the

Mallory Whitmore (12:58): Internet. Yes,

Dr. Nicole (13:00): Absolutely. Yes. All right. So if you're looking for a formula, what are the different types? There's routine, there's gentle, there's hypoallergenic, there's this, there's that. So what are the different types? How do you choose it?

Mallory Whitmore (13:12): Yeah, absolutely. So the great majority of healthy term infants can use what's called a routine formula. So these are formulas that have intact milk proteins. They're typically labeled as like dairy or premium. These are not gentle or sensitive formulas, just general milk-based. For term infants that don't have any specific digestive concerns, we always recommend folks start there because the likelihood that their baby will tolerate it is high. They tend to be the cheapest and they tend to be most available. If a baby does not do well on a routine formula, then we suggest going to a gentle formula. And these are formulas that have partially hydrolyzed or broken down proteins. So the protein peptide has been split broken into smaller pieces so that it's easier to digest. Some of these formulas also will reduce the lactose content and include another carb source like sucrose or maltodextrin and corn syrup, something that's also a little bit easier to digest.

(14:11): If that doesn't work, then typically babies get moved to a hypoallergenic formula, which is great for babies that have diagnosed cow milk, protein, allergy milk, soy protein intolerance, sometimes babies that have malabsorption or conditions that affect absorption. And then beyond that, we have amino acid formulas. These are sometimes called elemental formulas, and these have no intact proteins at all. It's just single amino acids. And those tend to be for babies that have more significant medical or digestive needs. So always start with routine, and then it kind of becomes a ladder of further and further broken down, further and further easy to digest based on baby's tolerance level.

Dr. Nicole (14:50): Okay. And you may also have, there are some formulas made specifically for preterm babies. Is that

Mallory Whitmore (14:56): There are, yeah. So a lot of folks don't know, particularly for very low birth weight babies, very preterm babies, that human breast milk is not nutrition sufficient. It's intended for term babies. And a lot of what happens in the third trimester builds up, for example, iron stores in infants. And for babies that are born preterm who don't have that opportunity to develop those iron stores, they need more iron in a formula, then breast milk can provide. And so preterm formulas tend to have increased calories, increased fat, fat from a more absorbable source like MTC oil versus coconut oil, vegetable oils, as well as increased mineral content. Okay,

Dr. Nicole (15:42): Okay. Yeah, our first daughter was a preemie. She was eight weeks premature, and we had to supplement with a special formula until she got to be a certain size.

Mallory Whitmore (15:50): Yes. And the other thing, a lot of parents don't know, there are very few options for preemie formulas. There's basically, Similac has one, Enfamil has one. In some cases, parents can talk to their doctor, the clinicians at the hospital and ask whether it's possible to fortify another formula or fortify their own breast milk to increase the calorie count and the mineral count per ounce. And that basically just means changing the ratio of powder to water. And they can instruct you on what that looks like. But that's a possibility too, if the premature formulas aren't a good fit.

Dr. Nicole (16:23): So you get a formula, you start with one. How do you know if that formula is working well for your baby? It's

Mallory Whitmore (16:31): So tricky. It can be really tricky because we know all babies have immature digestive systems. All babies will be gassy sometimes and reflexes sometimes and struggle to poop. And so it can be really tricky to know, is this just a symptom of my baby being a new baby, or is this a symptom of them not tolerating the formula well? So I always encourage parents, try all of your non-formal switching things first. So try your gas drops, ask about a probiotic supplement, do your bicycle legs, make sure you're keeping baby upright after feeding all of those things first. Because often what happens is parents will say, it's probably the formula. I'll switch the formula, and then it doesn't get better because it actually wasn't a formula issue, it was something else. Gotcha. So always encourage them to try those things first. If you've been on a formula for 10 to 14 days and your baby's not getting better with all of these other non-nutritive strategies, then talk to your pediatrician about potentially switching. And then if there's obvious signs of allergy, if your baby's developed eczema, hives, projectile vomiting, blood in the stool, absolutely switch sooner than that, but give it some good time. Try some other things first, and then just listen to your gut. If your gut's saying, I think my baby is not doing well, then go ahead and switch.

Dr. Nicole (17:52): Okay. Got it. Got it. Does the bottle, the type of bottle impact that at

Mallory Whitmore (17:56): All? It absolutely can. I always recommend vented bottles. They're typically called antiga or anti colic bottles. They tend to help. The nipple shape can impact too. If you have a nipple that has a narrow base or doesn't have much of a slope to it, your baby can have a really shallow latch and then they take in too much air. The position of your baby can impact it too. If your baby is laying too flat and gets overwhelmed with the flow of the nipple, they can be gulping and taking in more air that way. So yeah, there's a variety of factors. It's not always the formula, which is sometimes sad because it feels easy to be like, well, I'll switch the formula and it'll get better. But sometimes that doesn't help as much as we wish it would.

Dr. Nicole (18:41): Gotcha. Gotcha. Yeah, and it can be challenging. I feel like for my second daughter, we had to go through two or three different formulas. So do you recommend, I'm guessing don't buy the case first to start. No,

Mallory Whitmore (18:57): No, no. You can't return it. It's a safety issue, so they won't let you return it. So yeah, get a week's worth, maybe two weeks, no more than that until you feel confident that the formula is working for your baby.

Dr. Nicole (19:08): Yeah. Yeah. Okay. Alright. Do you approach formula differently if you're using it in addition to breast milk? And if so, how does that change or how do you make that

Mallory Whitmore (19:22): Work? Yeah, that's a great question. So we call this combination feeding or supplementing, basically just offering both breast milk and formula for your baby's nutrition. A few things to note here. The first is that the food safety rules, how you prep and store formula is different from breast

Dr. Nicole (19:37): Milk. Oh, will you go through that, please? Yes,

Mallory Whitmore (19:39): Yes, absolutely. So breast milk, you can freeze formula, you can't, breast milk can stay out at room temperature. Gosh, I think for four hours, maybe longer. Formula can only stay out at room temperature for two hours after your baby has started drinking a bottle of formula, you need to use it within one hour. For breast milk, it's two hours. Generally breast milk, because it has some of those immune factors, you can keep it out longer. It's less at risk for bacterial growth than formula is. So I always tell parents, number one, pay attention to the two different sets of rules. And because of those two different sets of rules, parents tend to prefer to offer a formula bottle separate from either a nursing session or a breast milk bottle. If you combine the formula in breast milk, you have to follow the formula safety rules. Got it. So you are at higher likelihood of having to throw away or dump excess breast milk, which of course, nobody wants to do

(20:35): Liquid gold. Yeah. But outside of that, I always tell parents it can look like whatever you want it to look like. You can do formula bottles at night and nurse during the day. You can send formula to daycare and nurse at night. You can alternate expressed milk and formula. You can offer one breast milk bottle a day. If you have a stash in your freezer and you've dried up and you just want to keep offering a little bit throughout the year, there's no real right or wrong way to do it as long as you're still expressing enough to maintain a supply if you want to continue to use both. Gotcha. Yeah. So just pay attention to those food safety rules and then do whatever feels right for you. Okay.

Dr. Nicole (21:16): I like it. I like it. And I just thought of another question. Do formulas come in different preparations, or are they all powder or something? What are the preparations for formula?

Mallory Whitmore (21:27): Yeah, so there's three formats. There's powder, which is what folks are most familiar with. It tends to be most available, least expensive. There's liquid ready to feed, which you just open it up and pour it and it's good to go. You don't mix it with anything. And then there's liquid concentrate, which you tend to mix at a 50 50 ratio with water that we aren't seeing much of anymore. It's harder to find. So generally folks use either the powder or the liquid ready to feed. The ready to feed is convenient, but it's more expensive.

Dr. Nicole (21:58): Gotcha. Gotcha. Okay. Okay. All right. And then are there any things about mixing up or making formula that you need to be aware of? In terms of the water or,

Mallory Whitmore (22:09): Yes. Oh my gosh, yes. Biggest one, wash your hands before you touch anything, before you touch the powder, the scoop, the nipple, the bottle, wash your hands. There's been a lot of conversation in the last couple of years about bacteria and formula, and I always encourage parents, the likelihood that you're going to get a can of formula that has bacteria, and it is very, very low. The likelihood that you can introduce bacteria from your kitchen is significantly higher. So always wash your hands, always wash your hands first. And then after that, you always want to add the water to the bottle first. If you add the powder first, it displaces some of the water. You tend to get a powder to water ratio that's not accurate. So always add the water first. And then the question becomes, as you mentioned, what sort of water to use?

(22:54): And this is a contentious topic on the internet, and you'll hear different things from different governing bodies too. So the a p will say one thing they typically say, for most term, non immunocompromised babies, room temperature, tap water is fine to use as long as your tap water is safe to drink. The World Health Organization in the CDC who advise globally where safe water supply is not as common will say, you use bottled water, always boil your water. So I encourage parents talk to their pediatrician, their baby. There might be context around their baby's health that will inform what their pediatrician recommends. If parents want to go the safe, easy route, I recommend just gallons of distilled or purified water from the grocery store. It doesn't need to be nursery water or baby water, just like your Walmart or Target brand distilled and

Dr. Nicole (23:45): Jug. Okay. Okay. This is all great information. And do you mind sharing a little bit about what happened with that big formula recall and what that was kind of a disaster?

Mallory Whitmore (23:59): It very much was.

Dr. Nicole (24:01): Yes.

Mallory Whitmore (24:01): It really was. So a lot of parents don't know that two companies control 80 to 90% of the US formula market. Abbott, which is the parent company of Similac, and then Mead Johnson Rect, which is the parent company for Enfamil. The challenge with this is that if there's an issue with one of the manufacturing facilities for one of these two companies, it takes out a huge portion of the market. And that's why we saw empty shelves. The other players that make up maybe 3% of the market or 1% of the market, cannot compensate for 40% of the market going offline. And it was a tough situation because on the one hand, it left parents in a really, really rough state trying to find formula. On the other hand, it was evidence that the safety protocols that exist work in terms of identifying a problem, shutting down the facility, making sure it was sanitized, making sure the FDA put a plan in place that the facility and the manufacturer had to follow in order to reopen. So it means that the systems are working, but it did dramatically highlight the need for more resiliency in the formula market. We can't have a duopoly essentially when it's for a product this crucial. This is not like deli ham.

Dr. Nicole (25:25): This

Mallory Whitmore (25:25): Is how babies are fed largely. Absolutely. And so yeah, I think there's still a lot of folks in this world that are reeling and trying to figure out how do we make sure that never happens again?

Dr. Nicole (25:39): Gotcha. Gotcha. Okay. And I don't know why all these questions are popping into my head. No, go for it. Do you ever see people things, thinking about things on the internet, trying to do homemade formulas? Oh,

Mallory Whitmore (25:53): Yes. Oh my gosh, it terrifies me so much. And yes, we saw it more so during the shortage, but we also tend to see it in, I call them more crunchy circles, folks that tend to be more skeptical of

Dr. Nicole (26:11): Anything, medicine,

Mallory Whitmore (26:14): All of that. And there are a lot of risks of homemade formula. The first is bacterial contamination. A lot of these homemade recipes will use raw milk. So milk that hasn't been pasteurized, homogenized. And that in and of itself, I'm like, why? Where do you even get that? I don't know. I don't know. And of course, babies have really new immune systems. And so of anybody that would be at higher risk for a raw milk product having a bad outcome, that would be a baby or anybody else immunocompromised. So you have that risk. And then the other risk is that we know that babies have really, really specific nutrient needs. We know that breast milk is incredibly complex. We know that the formula industry has been trying for decades to come close to breast milk, and these are our nation's top scientists. It's really difficult for your average person in their home kitchen to get it right. And the risks of getting it wrong, of not having enough fat, of not having enough vitamin D, your child can end up malnourished with rickets, with stunted cognitive development, the risks are too high to get it wrong. So I always encourage folks, please, please, please, I can help you. There are people that can help you find a formula that you can feel good about the ingredients and the processing and the quality. Please do not make your own formula. It's just not worth the risk.

Dr. Nicole (27:38): Okay, great. Thank you. I'm glad we touched upon that because that's important. So what are any two or three misconceptions that you'd like to clear up about formula?

Mallory Whitmore (27:48): Oh, I could spend the whole hour talking about this. There are so many. So I think one of them, there's a lot of fear mongering about formula. And the biggest thing I like to talk to parents about is the difference between relative risk and absolute risk. So when you're pregnant and you have a new baby, you'll hear things like, oh, if you use formula, your baby is 50% more likely to get ear infections. And that sounds terrible, right? I would never want to do that to my baby. But that's the relative risk. The absolute risk is that your risk of your baby getting an ear infection during the first year goes from 2% to 4%. Yes, it has doubled. Your risk has doubled, but your absolute risk is still incredibly low. There's a 96% chance your baby's not going to get an ear infection no matter how they're fed.

(28:40): And so I think that's a big misconception that you are leaving your baby at risk at incredible risk for eczema or gastrointestinal stuff, or even, I mean, sometimes you'll see wild claims about leukemia or a DH, ADHD or autism or obesity. I mean, just wild stuff. And I always encourage parents to really look at what your absolute risk is, because it's generally teeny, teeny tiny. And also a lot of that research, it's really hard to do good quality research on this topic because it's unethical To compel a control group, you have to breastfeed and an intervention group, you have to formula feed. So all of the research around this tends to come from folks who opt in one way or another. And we know that people opt in for different reasons. Generally, folks who breastfeed have higher incomes, they have jobs that let them take a leave so they can establish a milk supply. They tend to have higher education levels. There's a variety of factors, and it's really hard to discount how those factors then play into their child's outcomes. And then can we actually attribute it to the breast milk, not those other factors. So that's a big misconception. I think another misconception is that these are highly processed industrial products.

Dr. Nicole (30:06): Okay, yes. Talk on that.

Mallory Whitmore (30:08): Yes, you look at the back of the can and it has the scientific name for a lot of these nutrients. It won't say vitamin D, it will say the scientific name of vitamin D. And a lot of folks grow up with the belief that you shouldn't eat things that you can't pronounce. We hear that occasionally. And so you look at the back of the formula can, and it looks like a bunch of chemicals, when in reality it's the vitamins and minerals your baby needs. There's also, especially in recent years, become a lot, there's been a lot of chatter around seed oils. I don't know if you've seen this in your work, but lots of folks that are like, oh, inflammatory industrial, toxic seed oils. And there are always plant-based oils in formula to provide calories and specific fatty acids. So that's a myth I find myself debunking a lot that babies shouldn't have plant-based oils because they're inflammatory. And there's really no real research to show that. And there's a ton of research to show why they're important for your baby's brain to grow. Gotcha.

Dr. Nicole (31:16): Gotcha. Okay. Alright. And then what are suggestions for dealing with that guilt surrounding the feeding journey? And if it doesn't go as you anticipated?

Mallory Whitmore (31:29): Yeah, it can be really hard, and I always encourage parents that it's okay to acknowledge the grief there. It's okay to acknowledge that you might feel sad or disappointed or frustrated because it's a loss. You had the expectation it didn't work out. There's a loss there, and so it's okay to grieve it. We don't want to live in that place for the entire first year. It's not helpful, but it's okay to feel that way. What helped me was really digging into what does the research say? What am I really feeding my baby? What do the outcomes look like? You mentioned I am a science based person. That's how my brain operates. That's really helpful. The other thing that was really helpful for me was being vocal about my decision to use formula, and not just obviously on my platform, but in my personal life. It's wild.

(32:22): I mean, the CDC says that by six months, 75% of US families have introduced formula. So the great majority of parents that are using formula, but no one tends to talk about it. Everybody feels ashamed about it, and then it perpetuates this idea that it's something shameful. And so when I started talking about it, even among people in my real life eight years ago almost, it was like, oh, you use formula. I use formula too. I use formula too. And then you start to realize that these people that you love and respect, who also want to do the best thing for their baby, are also using formula. And that takes some of the pressure off. So those are my two suggestions. Dig into the research, talk to people, and then also give it time. Once you start to see that your baby is developing appropriately, they are gaining weight, they are meeting milestones, they are happy and healthy, then you realize that this was a perfectly valid and fine choice, and it's allowing them to thrive. And then that helps to reduce some of that guilt as

Dr. Nicole (33:22): Well. Yeah, definitely. And you also may feel some element of failure, like your body failed you in some kind of way. I know I definitely sort of felt that way. I had just wasn't making enough milk. And even though my children are now 14 and 16, and both straight A students who are a year ahead in school and incredibly smart, kind, wonderful human beings, I still feel like, oh, I wish I could have breastfed. So I say all that to say you still may feel like some feelings, but don't, as Mallory mentioned, don't let it fester. Don't stay in that space. Yeah. Yeah. And it's totally normal to feel that

Mallory Whitmore (34:00): Way. And to that, I always encourage parents to think about the other ways that our bodies don't work as they should. So I'm wearing glasses right now if you're listening to this online.

Dr. Nicole (34:11): I have context. There

Mallory Whitmore (34:12): We go. Yes. I do not feel any sense of moral failure that my eyes don't work the way they should. That does not say anything about me. Yes, same thing. I had gestational diabetes. My pancreas not working, does not say anything about my ability to be a good mother. Our bodies just sometimes don't do what we think they're supposed to do, and that's okay. It doesn't have to mean anything about

Dr. Nicole (34:41): Us. Right. I love that. That's an excellent point. Excellent point. Okay, so then as we wrap up, I ask all of my guests these questions. What's the most frustrating part of your work?

Mallory Whitmore (34:49): Oh gosh. The most frustrating part. Two things. The first is the misinformation that you mentioned, and that's internet wide. It's just hard to be out there and really trying to help people and having to combat the wildest

Dr. Nicole (35:06): Stuff. I mean, just like why are we even talking that people belief

Mallory Whitmore (35:10): And that harms parents and families? That's hard. And then the other thing, I think for me specifically, it's frustrating that this has become such a contentious topic and that we can't all just support each other. Why can't I formula feed and that be right for me, and you breastfeed and that be right for you. Why does the fact that you want to breastfeed have to impact me? Why does the fact that I'm formula feeding have to impact you? We all just live and be

Dr. Nicole (35:38): Supported. Exactly.

Mallory Whitmore (35:39): Yeah. That's really hard. I don't want it to feel like as much of a, sometimes it feels like the feeding wars as much of a contentious topic as it does.

Dr. Nicole (35:48): Gotcha. Gotcha. And then on the flip side, what's the most rewarding part of your work

Mallory Whitmore (35:52): Hearing from parents, they'll come into my dms or they'll send me an email and hearing their stories, hearing the ways that formula has allowed them to feel like they're themselves again or connect with their baby better or get on the medication that they need to take or go back to work and finish their residency

Dr. Nicole (36:12): Or whatever,

Mallory Whitmore (36:14): Whatever it is. Yeah, that's definitely the most rewarding hearing from parents who had been in a place where they were frustrated or confused or overwhelmed or upset, and now feeling confident and happy and empowered with their baby's feeding journey.

Dr. Nicole (36:29): Absolutely. So then, what's your favorite piece of advice that you like to give to expectant moms or expectant families?

Mallory Whitmore (36:35): Don't wait until you are sleep deprived and hormonal and recovering from a major medical event to think about what you might do with formula. That was my experience standing in the grocery aisle at 9:00 PM with a crying baby, barely able to walk, trying to figure out what formula to use. Nobody makes the best decisions in that state. No. Spend some time thinking about formula. You don't even need to buy it. There are some people that I'll talk to and they'll say, I know if I have it on the shelf, then I might use it. And I really don't want to use it. You don't even have to buy it. But just think through what's important to you in a formula. What sort of ingredients might you want to use or avoid? Would you like something organic? Are there certain cultural or religious preferences that may impact what you would or would not use? Sure. Just spend a little bit of time thinking about it. That will at least narrow down your list. And then if you do need formula, you're not overwhelmed with the 50 products on the market. Gotcha. So just spend some time researching, have an idea of if that ends up being your journey, where you might want to start. Gotcha.

Dr. Nicole (37:42): And I know you have tons of resources to help people with things like that. So where can people find you?

Mallory Whitmore (37:47): Yes, so I'm on Instagram and TikTok, Facebook and Twitter at the formula mom. And then also@milkdrunk.com. Milk slash no milk-drunk.com is where my blog lives. Okay.

Dr. Nicole (38:02): Alright. And we will link that in the show notes. Thank you so much for agreeing to come onto the podcast. This is very, very helpful information.

Mallory Whitmore (38:09): I'm so glad. I love to talk about it and I love the opportunity to share with more people, so I really appreciate the opportunity.

Dr. Nicole (38:23): Wasn't that a great episode? Again, Mallory just really knows her stuff about infant feeding, and I'm so glad that she was able to share that information with us today. Now, after every episode when I have a guest on, I do something called Dr. Nicole's notes where I talk about my top takeaways from the conversation. Here are my top takeaways from my conversation with Mallory. Number one, I loved how she said ignore marketing. I think this is a really important point to make in the sense of making sure that you're paying attention to the things that really matter. A lot of marketing can be to try to get you roped into something or flashy things, trendy things, or little snippets that actually don't mean anything. An example of this is in my area, there are a few hospital options where you can give birth and one of the hospitals will tout a lot that they have brand new rooms and that they have tubs in every room.

(39:24): And yes, some of those things are important, but what's really important is how you are treated during your birth and the type of care you receive during your birth. And a brand new fancy room isn't going to make up for being treated poorly during your birth experience. So just pay attention to the messages that people send and the marketing things that people do. And don't get distracted or taken in by shiny objects. Make sure you're actually looking for the information that matters most to what you need to what you want. Second thing is, please, I've said this before, please, please get information from reliable sources on social media. Anyone with a camera can pop up and say things. And people say things in ways that make it sound like they really know what they're talking about when they may not necessarily know what they're talking about or the information that they're saying is not based on anything other than opinion. And not that opinion is wrong, but you should know what people are basing their recommendations and the things that they're saying on. So you should get information from reliable sources where people's credentials, people's background, you know what they are bringing to the table with the information that they share. In this case, Mallory is very knowledgeable about the things that she shares, and that's the type of person who you want giving you information. So be sure you get your information from reliable sources.

(40:56): Next step is, I really appreciate how she talked about the difference between relative risk, absolute risk, how data can sometimes be manipulated. You can have a three to four times risk of something, and the risk for something can be one in a hundred thousand. And then if it's four in a hundred thousand, that's going to be four times the risk. But the absolute risk of four in a hundred thousand is very, very low. I use that as an example. Sometimes data and statistics can be manipulated in order to support the message that people want to get forth. And I don't think that people do this maliciously or anything like that. Sometimes people have a stance or an opinion on something and the data can sometimes be interpreted to support that. So just be careful when you're looking at statistics that say something is three times as likely, twice as likely, five times as likely, look at the absolute numbers and see what the actual risk is.

(41:54): And that way you have a more complete picture of exactly what's going on. And then the final thing I'll say is that I absolutely love the comment that she made, that we do not think it's a moral failure when other parts of our body don't function as we'd like. Do not think that way about your breast. That is so huge to me. We definitely, if your elbow is creaky or your knee acts up a little bit, we don't think of it as a moral failure. So please, please don't think about your body being a failure or some sort of moral failure because you weren't able to breastfeed. You want a similar way as if you weren't able to have a vaginal birth. Same thing. It is not a moral failure about you or who you are or anything like that. It just means you had some difficulties and challenges in breastfeeding.

(42:50): I certainly had you take that message in for myself. All right. So there you have it. Please share this podcast with a friend. Also subscribe to the podcast where you're listening to me right now, and leave me a review in Apple Podcast. I do do shout outs from those reviews from time to time, and I read those reviews and love to hear what you think about the show. Do come join me for my class, make a birth plan the right way. That's happening tonight, Tuesday, April 30th at 7:00 PM Eastern Standard Time. You can sign up drnicolerankins.com/birth plan. If it is not April 30th. When you're listening to this, head over to my email list, drnicolerankins.com/email to be notified when the next live class will happen. So that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.