Formula Series 7 – Extra Additives

Non-Nutrient Additions

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With or without DHA?   Are pre or probiotics better?  What the heck is a nucleotide, and why is it in my baby’s food?  How are parents possibly supposed to answer these questions if they do not understand what these things are, or how to decode the matching ingredients on a nutrition label?  I am here to help you de-code!

Most of these nontraditional and “non-nutrient” ingredients in formula may not appear on the nutrition facts chart (where you find calories, fat, etc.).  Here’s another reason for the mantra … You must read the list of ingredients!  All of these “designer” ingredients will be included with the vitamins and minerals after the “contains less than 2% of:”.  Below is a little summary of the most common designer ingredients and the information you need to make a decision about feeding them to your infant.


  • DHA stands for docosahexanoic acid – This is a fatty acid that is involved in many processes in the body and is especially used in high amounts for infant eye and brain development.  DHA is one of those “long chain omega 3” fatty acids we are always hearing so much about.
  • ARA stands for arachidonic acid – This is also a fatty acid that is involved in the production of many different signals in the body and plays a role in regulating inflammation.  ARA is one of those “long chain omega 6 fatty acids” you are always hearing about.

Both DHA and ARA are technically not “essential” fatty acids (which are all required ingredients in formula).  This is because our bodies are capable of synthesizing these fatty acids from shorter precursor fatty acids.  The argument for adding them to formula is two-fold: 1) The amount that infants need may be greater than their ability to generate these long fatty acids, and 2) Both these fatty acids are found in breast milk, although at extremely variable concentrations (4).  A large review of many research studies on the topic found that addition of these fatty acids to infant formula did not result in significant improvements in either vision, brain development, or overall growth in healthy term babies (12).  However, adding these fatty acids did not result in any adverse effects either.  Despite the unenthusiastic research, it has become popular to add these fatty acids to formula.  Since they do not cause harm, and are found in breast milk, I support choosing a formula that has DHA and ARA added.  Just know – this will not improve your baby’s IQ.

Decoding the Ingredients Label:
Ingredient What is it? Look for it on the label as:
DHA Docosahexanoic acid(DHA) – a fatty acid that helps brain and eye development Mortierella Alpina Oil (on Enfamil® formulas) or M. Alpina Oil (on Similac® and Gerber® Formulas)
ARA Arachidonic acid (ARA) – a fatty acid that plays lots  of roles in baby’s body Crypthecodinium Cohni Oil (on Enfamil® formulas) or C. Cohni Oil (on Similac® and Gerber® formulas)

To help you decode the label, manufacturers will often add an asterisk (*) after these oils with a note on the bottom of the ingredients explaining that these odd looking oils are a source of DHA or ARA.

Prebiotics and Probiotics

Pre- and probiotics are all the rage these days!  Both of these are considered avenues of optimizing the intestinal microbiome.  This is a fancy word for all of the bugs that live in our gut.  The healthy human gut is full of millions upon millions of bacteria that help us digest our food and keep our immune system functioning well.

  • Probiotics are actually live bacteria!  These are “good” bugs that are added to formula with the hope that they will move into the infant intestine.  The most common type of infant probiotic that you’ve probably heard of is called bifidobacteria.
  • Prebiotics are indigestible fibers that improve good bacteria’s growth in the intestine.  In other words, prebiotics are food for the probiotics.

Both live good bacteria and food for these bacteria (prebiotics) are found in breast milk.  In fact, breast milk contains a really huge amount of prebiotics (called galactoligosaccharides) and many researchers study these fibers so we can try to replicate their benefits in formula.  Pre-and probiotics in formula are added to help infants develop a healthy microbiome.

Breast and formula fed babies develop very different intestinal microbiomes. Adding pre- and/or probiotics to formulas is safe since they are found in breast milk.  Feeding prebiotics to healthy term formula-fed babies helps shift the bacteria in their intestines to more resemble that of breastfed babies … a very good thing (14)!  Research has shown that both pre-and probiotics may be helpful in preventing and treating atopic dermatitis or eczema in healthy term infants who are at risk (15), and probiotics may help improve immune responses in healthy term babies (16).  All of this work is pretty promising, but we desperately need more studies, especially long-term studies that follow infants for several years. However, in general, I am fairly supportive of both pre-and probiotics in formula.  If I had to choose one, I recommend prebiotics as there are much more of these in human milk.  Furthermore, it is much easier to add a probiotic (than a prebiotic) supplement to your baby’s feeding regimen if you think he/she needs one.  Lastly, probiotic formulas only come in powdered form, so you have more flexibility when choosing a prebiotic formula.

Decoding the Ingredients Label:
Ingredient What is it? Look for it on the label as:
Prebiotics Food for the good bacteria that help them grow in baby’s intestines. Galactooligosaccharides (GOS) or Fructooligosaccharides (FOS)
Probiotics Live good bacteria that help the infant intestines function Reuteri cultures or B. lactis (Gerber® Good Start Soothe and Good Start Protect)


Nucleotides are actually the building blocks of your DNA and RNA: adenine, Guanine, cytosine, uracil, and thymine, with a sugar attached.  They serve many other functions in the body as well. Knowing how useful these molecules are, it isn’t much of a surprise that they are also found in relatively high concentrations in breast milk.  Some research in very small infants has suggested that feeding nucleotides helped these infants mount a proper immune response.  They are considered very safe for infants to consume.  However, we still don’t really understand why nucleotides may be helpful in formula, or what their long-term impact is for healthy term babies.  Since nucleotides are found in human milk formula companies have been adding them to formula since the 1990’s.

  • Look for them on the list of ingredients as: “Nucleotides (long list of formal chemical names)”.
  • Here’s a word-for-word example: “…Nucleotides (Adenosine 5’-Monophosphate, Cytidine 5’-Monophosphate, Disodium Guanosine 5’-Monophosphate, Disodium Uridine 5’-Monophosphate)…”


Since our goal is to make infant formula the best substitute for human milk as possible, I do recommend choosing a brand that does add nucleotides.   Most do, but don’t assume.  Here’s an example: Similac® Advance formula does contain nucleotides, but Similac® Soy Isomil does not.  You must read the list of ingredients!

Below is a brief summary of which mainstream formulas for healthy term babies contain which of the above “designer” ingredients.





Gerber® Good Start

Gentle Yes Yes No Yes
Protect Yes No Yes(Bifidus Lactis) Yes
Soothe Yes No Yes(Reuteri) Yes
Soy Yes No No No


Premium Yes Yes No Yes
Gentlease Yes No No No
A.R. Yes Yes No No
ProSobee (Soy based) Yes Yes No No


Advance Yes Yes No Yes
Advance Organic Yes Yes No Yes
Total Comfort Yes Yes No Yes
Sensitive Early Shield Yes Yes No Yes
Soy Isomil Yes Yes No No
For Spit Up Yes No No Yes


Take-Home Messages

  • DHA and ARA are not essential fatty acids but are found in breast milk.  They are added to almost all formulas these days, which is great!
  • Probiotics are live, good bacteria that colonize the intestine.  Prebiotics are food for good bacteria.  Both are found in breast milk.  Prebiotics are found in breast milk in very large quantities.  You can choose a formula that contains either pre-or probioitcs.  I like both, but would choose prebiotics over probiotics if I had to pick one
  • Nucleotides have been added to formula for decades.  These are safe and found in large quantities in breast milk.  I recommend them. Not every formula contains nucleotides.

4.         Stam, J., Sauer, P. J., and Boehm, G. (2013) Can we define an infant’s need from the composition of human milk? Am. J. Clin. Nutr. 98, 521S-528S

12.       Simmer, K., Patole, S. K., and Rao, S. C. (2011) Long-chain polyunsaturated fatty acid supplementation in infants born at term. The Cochrane database of systematic reviews, CD000376.

14.       Thomas, D. W., Greer, F. R., American Academy of Pediatrics Committee on, N., American Academy of Pediatrics Section on Gastroenterology, H., and Nutrition. (2010) Probiotics and prebiotics in pediatrics. Pediatrics 126, 1217-1231

15.       Foolad, N., Brezinski, E. A., Chase, E. P., and Armstrong, A. W. (2013) Effect of nutrient supplementation on atopic dermatitis in children: a systematic review of probiotics, prebiotics, formula, and fatty acids. JAMA dermatology 149, 350-355

16.       Holscher, H. D., Czerkies, L. A., Cekola, P., Litov, R., Benbow, M., Santema, S., Alexander, D. D., Perez, V., Sun, S., Saavedra, J. M., and Tappenden, K. A. (2012) Bifidobacterium lactis Bb12 enhances intestinal antibody response in formula-fed infants: a randomized, double-blind, controlled trial. JPEN J. Parenter. Enteral Nutr. 36, 106S-117S