A Hearty Southern Vegetarian Dinner

We have been having our regular vegetable delivery from Shino who 

delivers to Pasay every week (Friday).  What I like about him is his flexibility with the basket contents.  I just get the 4.5 kg basket which lasts us 1.5 weeks. I also get a 500ml bottle of fresh cow's milk.  You can tweak the amount of vegetables included to suit your family's weekly menu. During my first few orders, I over-ordered the okra so I had to look for some recipes so the okras won't go to waste. Stan was not exactly a fan of okra so the dish had to be tempered with something palatable to him. A quick google search for okra led me to several recipes. But it was this Okra and Tomato Soup recipe by Diana Rattray that caught my eye:

Review: Veggies and Meat Delivery

*Update 6/26/2012 - I've change the title to just Veggies and Meat delivery since not all of the vendors in the list offer organic items.

I've become more conscious of what food to cook/eat ever since Naima lessened her milk intake and started eating more and more solids. Unfortunately, the area where we live at has no accessible wet market and I usually end up shopping in SM Hypermart or Shopwise or S&R. S&R's produce is fresh - for Hypermart/Shopwise, I'm able to get fresh items if I go on delivery day. However, I don't think their produce are organic.

Sometimes, I'm able to go to Salcedo or Legazpi markets to buy vegetables (which I hope are organic because they're quite expensive!). I am constantly on the look-out for companies that deliver fresh organic veggies and was happy to have found a couple that do!

1. Shusaesh Farms, Inc. [Update: February 2013 - Shino has stopped deliveries :( Scroll below for other options]

In early 2009, I was quite happy to find a company that delivers fresh organic veggies. An officemate shared their number. The company is called "Shusaesh Farms, Inc." formerly "Francisco-Shinozaki Farm Inc." and is based in San Jose Patag, Santa Maria, Bulacan. I emailed Yasutaka Shinozaki for details on ordering and he sent me the following information about his farm:

"We develop farm from soil, no pesticides, no weed-killers, or no chemical fertilizers at all, take out insects, caterpillars and worms by hands every day, use smoke of natural leaves, branches and grasses, sometime spray vinegar or calamansi with garlic, even deploy fine nets to protect our vegetables, and use compost and other natural materials only. Our fowls are grown up in open area or rice field, never been kept in small cages all long, eat all natural stuff, like rice-bran/dusts, beans, corns, potatoes, greens, fish, seaweed, and our organic vegetables and fruits, and drink deep well or natural water only, running around or swimming around about 2,000 square meter area, we don't use anti-biotic in principle, unlike broilers, which are usually over-dozed with special hormones to grow"

You can read more details about the farm here. I started with vegetable delivery from them in May 2009. Shortly thereafter, delivery stopped because Shino's farm was affected with Ondoy - and this meant no deliveries for the whole of 2010!!

Early this year, Shino texted me and said that they were ready to receive orders again and I was happy to note that they did not increase their prices from 2009.

I put in my first order for the veggies (invoice on left) and requested Shino to adjust the amount of certain items e.g. squash (which I wanted less of) and lettuce (which I asked to be increased). I chose the small basket for P450 plus P50 delivery chip-in. The big basket is P650 and you get 1.5 more veggies compared to the small basket. Aside from veggies, you can also order eggs, chicken, duck (wild or white), goose and turkey. They also have fruits and other vegetables available which can be added on top of your basket order.

Shino admits that their vegetable prices are more expensive than ordinary but he justifies this as they put in more care towards the production and their harvest ratios are less. We used to correspond via email and he emails the harvested items for the week. However, since Ondoy, their internet connection has been spotty and he recommends contacting him via SMS - 0917838-8081 instead.

Check out my veggie delivery from Shusaesh Farms:

2. My Personal Farmer

This company was referred by a friend when Shino stopped delivery. However, I found the prices quite expensive maybe because the produce was packed and flown in from Bukidnon. From what I gather, this company is quite popular with the expat community in the Philippines, though. My Personal Farmer is based on Village Supported Agriculture and designates a "village mother" in Metro Manila where you can pick-up your weekly delivery. You can read about their farming methods here.

Technically, there is no delivery straight to your home but you can choose a pick-up place near your home. You can choose from full box (P1600), half-box (P850) or couple's box (P800). Multiply those prices x 4 and that's the amount you need to pay to sign-up, because you need to commit to 4 deliveries - this was why I was quite hesitant to try their delivery.

In early January 2011, I was excited to stumble upon a Beeconomic Deal offering a half-box of produce at P425. I purchased 2 coupons and tried the January 26-27, 2011 delivery. For that week, my half box contained 1kg of carrots, 300g each of broccoli, green cabbage, celery and pak choi, 600g of squash, 200g each of cherry tomato, baguio beans and spinach, 400g of pechay, 200g of lettuce mix (butterhead and red wave), 175g of organic herbs (parsley, oregano, chives and lemon grass) and a 1.5kg pineapple!

Check out My Personal Farmer delivery:

The veggies were fresh and very-well packed. However, I do have an issue with the pick-up. The village mothers are clients who have been designated as pick-up points. They are not employees of My Personal Farmer and coordination plus patience is necessary for a successful pick-up. In my case, the village mother nearest to me lived in a restricted area so I had to deal with arrogant security guards before I could pick up - I don't think I want to deal with this every week.

Verdict:

Check out the vegetables delivery I had from Shinozaki (with radish) and My Personal Farmer (with broccoli and pineapple):

Except for the tomatoes, squash and lettuce, the box contents were quite different. So if you have the budget, you can opt to have weekly deliveries of half-box from Shino and another half-box from My Personal Farmer (with pineapples straight from Bukidnon!). However, given the huge variance in price, I will probably continue with Shusaesh Farm, especially since they deliver straight to my home.

Other vegetable delivery options:

I came across Emporium Antipolo (FB Page), a store in Antipolo that also delivers fresh produce. However, I was not able to try them yet as I'm still waiting for the response to the 2 emails I sent last week. Not too reliable, huh?

Another option to consider is Herbana Farms. According to their website, their produce is available at Mercato Centrale and Salcedo Market. I was able to get a flier for the Community Supported Agriculture Program but find the prices quite steep. You need to pay an annual membership fee of P1000 plus at least P1,200 for a box of veggies. Contact Gian Carandang at 09228180215 for details. A tip from a friend - text Gian on Thursday to order veggies then just pick them up at Mercato/Salcedo Market on Saturday. See flier for CSA below:

*I love Picasa's slideshow! I like using it rather than pasting my photos on the post. As you can see, I can't figure out how to arrange the inserted photos properly. :(

*Disclosure: All vegetables were purchased and paid for. :D

*Update - 02/01/11: Thanks to Rowie, I was able to add another veggie delivery option to my list - GoodFoodCo. I emailed them this morning and got a response this afternoon! Charlene gave me the following details:

What we're basically doing is a community-supported agriculture program where stakeholders in the city, like yourself, commit to purchasing a season's worth of vegetables to support the livelihood of small organic farmers in Tarlac and Zambales. What we offer in return is a basket of 3.5 kgs of fresh, seasonal organic vegetables every Saturday from Feb 12- April 30 which you can pick up at one of our designated pickup points (Loyola Heights, Valle Verde 5, New Manila and San Juan) between 9.30 am- 1pm.

Each basket is P400 and you need to commit to 12 weeks delivery. Check their blog for details.

*Update - 02/02/11: Found another CSA program - OrganicManila through the PinoyOrganics blog. The farm is located in Benguet and you need to pay a one-time, assignable and refundable fee of P1000 to purchase a share and participate in the program. Boxes range from P600-P1,950 and there are pick-up points in Makati, Quezon City and Pasig - none near my residence though! Visit their site for more details.

*Update - 04/13/11: Dainty Mom also wrote an article for smartparenting.com listing 10 Organic Food Sources.  Also found another organic vegetable delivery through Facebook - The Green Grocer.  Check them out!

*Update 07/28/2011:  Found another weekly vegetable delivery from Down to Earth.   Prices are quite reasonable!  Plus they have grassfed beef, pasture raised pork and chicken! Check them out:

Regular	Box of 3-4 kilos	P2,000/mo.; 1 box/wk for 4 wks.
Medium	Box of  5-6 kilos	P3,400/mo.; 1 box/wk for 4 wks.
Large	Box  of 9-10 kilos	P6,400/mo.; 1 box/wk for 4 wks.

*Update 08/15/2011:  Check out Down To Earth's blog post - "Eat What you Sow".  They also list down several sources of real food in Metro Manila.  Several are from the South, though.

*Update 09/29/2011: Here's another CSA Program - Organic Manila based in Pasay City.  Their veggies are sourced from Majayjay, Laguna - the Costales Nature Farms which you can book for farm tours.

*Update 10/10/2011: Another organic produce delivery based in Bulacan with a Makati office, as shared by Pat Grace - Green Earth Heritage Foundation.  I saw from the website that each bag of organic produce is P45 only!! That's cheap!  Let me know if you've tried them.

*Update 10/18/2011: Free range meats available via phone orders! As shared by Michelle.

*Update 6/26/2012:  Available from The Farm Organics - fresh organic grass fed beefs.  Call 0927-741-2660, 0947-939-6598, 4039130

*Update 7/30/2012: Found a Cebu-based organic vegetable farm who delivers - Tanny's Organic Farm.   Visit their Facebook page for details.

*Update 2/13/2013: Green Earth Heritage Foundation is a member of the Organic Farmers and Processors Association of the Philippines.  They deliver medicinal and local greens.  You can also visit their farm in San Miguel, Bulacan.  

Do leave a comment/feedback if you've tried any of the listed vendors. Thanks!

*Update 4/21/2013:

Photo from Balik Bukid Davao Facebook page

You can order organic produce in Davao City!  Visit Balik Bukid in Calinan.  Details in their Facebook page.  To order Balik bukid organic produce call louella at +639173021208

The Magic of Breastmilk

Last week, an almost-toddler nursing mom raised formula/pediatrician concern with me. Her son who is turning 1 at the end of January came from his last pediatrician's check-up. According to the pediatrician, her son did not gain weight since September but had above-average weight for his age group. Her son also increased in height. Her pediatrician told her that her milk was no longer nutritious and that she had to supplement with formula. I was appalled by the doctor's comment. I had thought that they at least studied the composition of breastmilk during medical school but apparently, I was mistaken! And even worse - I guess they didn't take up breastfeeding or breastmilk either during their specialization in pediatrics!

Kellymom has a comprehensive compilation on the composition of breastmilk. Tanya over at Motherwear blog recently posted the composition of donor's milk. The Attachment Parenting Blog also has a detailed post on the composition of mature milk. I wish I could print out all these notes and articles and give it to the doubting pediatrician.

Further, not only does breastmilk change while the baby grows but even during the feeding session itself, breastmilk changes in contents from skim (foremilk) to fatty (hindmilk) and likewise, throughout the day as it was found that the milk has day-specific ingredients that stimulate activity in the infant, and other night-time components that help baby to rest.

But for me, a top benefit is that my breastmilk is composed of a variety of tastes, depending on the food I ate just before nursing. In November 2010, I came across this article about how exposure to flavors takes place both in utero and through breastfeeding. While pregnant and breastfeeding, I tried to keep a healthy diet by refusing softdrinks and sweets (must not have worked as Naima is such as sweet tooth like her dad!!). I'd like to think that my continuous eating of vegetables contributed to Naima's easy acceptance of new foods in her diet. We started her on solids shortly after she turned 6 months beginning with avocado. Her yaya kept track of her intake for the first year which I'm sharing as a slideshow below. Looking back, I'm quite happy that her yayas were dedicated in trying new recipes and checking out the baby food cookbooks I had for Naima.

From simple, single dishes, Naima's palate has expanded to a variety of cuisines - Japanese, Chinese, Western and even raw food! Check out her meals below:

All thanks for breastmilk (oh and an inspired cook!)! :)

Challenges to the 6-month breastfeeding recommendation

Early this morning, I was tagged in FB by my good friend and fellow breastfeeding mom, Nikki to an article from the Guardian, entitled "Six Months of Breastfeeding Alone Could Harm Babies, Scientists Say" Needless to say, I was alarmed and really bothered by the article! However, reading through the article raised several red flags. First, "the paper acknowledges that three of the four authors 'have performed consultancy work and/or received research funding from companies manufacturing infant formulas and baby foods within the past three years.'" Second, I'm no nutritionist but I was amazed that the authors suggested that the moms give babies fresh food, including MEAT for iron. Okay, so some moms wean early (e.g. as early as 3 months) - but I know none of them gave MEAT as the solid food. According to the authors, they advised babyfood manufacturers because they were specialists in child nutrition - but doesn't this conflict with their own disclosure that they received funds from baby food/infant formula companies? How do you deal with this conflict of interest?

I posted this article to the LATCH yahoogroups this morning and just now, Velvet shared this reply from Francesco Branca, Head of Nutrition at the World Health Organization.

WHO's global public health recommendation is for infants to be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health. Thereafter, infants should be given nutritious complementary foods and continue breastfeeding up to the age of 2 years or beyond.

WHO closely follows new research findings in this area and has a process for periodically re-examining recommendations. Systematic reviews accompanied by an assessment of the quality of evidence are used to review guidelines in a process that is designed to ensure that the recommendations are based on the best available evidence and free from conflicts of interest.

The paper in this week's BMJ is not the result of a systematic review. The latest systematic review on this issue available in the Cochrane Library was published in 2009 ("Optimal duration of exclusive breastfeeding (Review)", Kramer MS, Kakuma R. The Cochrane Library 2009, Issue 4). It included studies in developed and developing countries and its findings are supportive of the current WHO recommendations. It found that the results of two controlled trials and 18 other studies suggest that exclusive breastfeeding (which means that the infant should have only breast milk, and no other foods or liquids) for 6 months has several advantages over exclusive breastfeeding for 3-4 months followed by mixed breastfeeding. These advantages include a lower risk of gastrointestinal infection for the baby, more rapid maternal weight loss after birth, and delayed return of menstrual periods. No reduced risks of other infections or of allergic diseases have been demonstrated. No adverse effects on growth have been documented with exclusive breastfeeding for 6 months, but a reduced level of iron has been observed in developing-country settings.

The authors of the paper criticized BabyMilk Action who challenged the findings of their paper and said that BabyMilk Action only chooses to quote their papers when it supports breastfeeding. See below and click this link to read BabyMilk Action's press statement on this matter. Really, is there anything else better than what Mother Nature gives?

WHO breastfeeding recommendations under attack from industry-funded scientists.

Press release 14 January 2011

The BBC, the Guardian and other media are carrying stories about a new review which published in the British Medical Journal today. Three of the four authors of this study, Mary Fewtrell, Alan Lucas and David Wilson, receive funding from the baby food industry. Prof Lucas in particular plays a key role in advising the UK baby food industry, and has opposed the WHO recommendation for many years. In 2003 he went so far as to appear for the defence when one of the largest baby food companies, SMA Wyeth was successfully prosecuted for illegal advertising by Trading Standards.

www.babymilkaction.org/press/press31july03.html

http://www.babymilkaction.org/update/update33.html#2

http://www.babymilkaction.org/www.babymilkaction.org/update/update29.html#2

http://www.babymilkaction.org/www.babymilkaction.org/update/update23.html#11

Baby Milk Action expects this new study and the media coverage it is generating to be used by companies in their attempt to weaken national policies and legislation requiring complementary foods to be labelled for use from 6 months. In the UK, baby food companies are already labelling complementary foods for use from 4 months of age despite Government policy recommending 6 months exclusive breastfeeding or formula feeding.

When looking at this data the following points should be borne in mind:

• the four authors are not attacking the recommendation that breastfeeding continue alongside complementary foods or the WHO recommendation of breastfeeding into the second year of life and beyond.
• this is not a report on new data - it is observational only.
• WHO’s policy arose from a review of 3,000 studies on infant feeding.
• Keeping recommendations under review is good practice and randomised controlled trials in progress; this paper is pre-empting the results of these.
• The study implies that delayed introduction of solid foods may be linked to increased obesity - this is total conflict with the studies which show that early introduction - particularly of sugary foods is an important factor behind the obesity epidemic. Breastfeeding may actually help in the development of taste receptors.
• The argument to introduce solids at 4 months to prevent coeliac disease and allergies was summarised by ESPGHAN in late 2009 and was considered by many to be flawed. see our press release: http://www.babymilkaction.org/press/press23dec09.html
• the UK Scientific Committee on Nutrition (SACN) and the Committee on Toxicity (COT) are reviewing the evidence on solid foods and coeliac disease. The draft opinion is NOT FINAL BUT Is on the SACN website with the Agenda papers for next week's SACN meeting. See paper SMCN/11/01 downloadable fromhttp://www.sacn.gov.uk/meetings/sub_groups/maternal_child_nutrition/1901...
• SACN use international growth charts to describe the optimal pattern of infant growth in the UK (UK-WHO charts). These are based on studies of babies in 7 countries around the world and no significant difference was found between their growth profiles. The proposal from the four scientists that babies are treated differently depending on where they live conflicts with this research evidence. The mean age at introduction of solids to this cohort of breastfed infants in the WHO studies was 5.4 months (or "..about 6-months").
• The UK policy is to introduce complementary foods at around 6-months and progress responsively, in line with individual babies' progress and acceptance. Not all babies need solids at the same time: in every aspect of infant development there is a wide range of normal. Very importantly the introduction of the new policy in 2003 has been associated with a marked reduction in the numbers of mothers giving solids very early (i.e. before 4-months). Since it is widely accepted that very early introduction carries greater risk (particularly of coeliac disease), the UK policy could be considered from this perspective a success.
• The practice of ‘baby-led weaning’ is becoming more widespread, where babies are allowed to play with appropriately prepared solid foods and decide for themselves when to eat. Experience in this area suggests that babies naturally start to ingest complementary foods at around 6 months of age, when various developmental factors (hand-eye coordination, mastication ability etc) come together. This may be an evolved natural behaviour that has been lost through the practice of spoon feeding prepared paps. Further research is required in this area.
• Marianne Monie, Chair of the nationwide Breastfeeding Network, made an important point about the risk of swine flu: “The evidence supports introducing food when a baby is developmentally ready at around 6 months. Introducing food or infant formula before that time increases the risk of infections. Questioning the wisdom of the six-month guideline at a time when babies are at risk of catching swine flu is unfortunate, because exclusive breastfeeding reduces the risk of secondary infections that can be serious enough to need hospital admission. Parents should not feel pressured into rushing their baby onto solid food. Waiting until around six months gives another two valuable months of additional protection against chest and stomach infection."

Thank you, Velvet, for sharing these articles!

Update: 1/15/2011

Click HERE for UNICEF UK's response.

Gifts of Breastfeeding

The theme for last month's Carnival of Breastfeeding was aptly, "the gift of breastfeeding". However, I wasn't able to submit my entry in time to participate. I still want to write something about it because Naima was a Christmas baby and after 3 years, I've come to realize how breastfeeding is a gift she has given to me and not only something that I gave to her.

I shared my early breastfeeding experiences during a May 2009 Carnival and as I'm reading through it again, I can't help but be grateful that despite the challenges and hurdles, I was still able to continue breastfeeding Naima to date.

The best gift of breastfeeding would be the gift of good health. As a baby, Naima was generally healthy and quickly recovered from coughs and colds and had no major illness. As a toddler, she has gotten more susceptible to various germs, especially when she started going to school. But I believe that the breastmilk she received has helped her recover faster from these illnesses.

Breastfeeding has also given me the gift of time, patience and the chance to bond with my daughter. I have to admit that I love keeping busy and can easily do a million things at once. My husband and I are a perfect match since he takes things slowly and easily why I rush to complete everything if possible. If Naima was formula-fed, I would probably have endorsed her to yaya while I do some other things. Nursing Naima has allowed me to stop, relax and spend time with my baby. Breastfeeding is our quiet bonding moment time - allowing me to explore and enjoy the miracle that is Naima.

Finally, as Melodie over at Breastfeeding Moms Unite puts it, breastfeeding is the gift that keeps on giving. Moms who have had a great breastfeeding relationship end up passing on advice, tips and support to other moms who are encountering early difficulties. I received great support and advice from friends who had successfully breastfed their children. Through this blog, I hope to pay it forward and pass on the good vibes that breastfeeding has brought to me, Stan and Naima. I am always happy to read comments and emails from readers saying how this post is helpful and how they have likewise shared advice to other friends who are about to start their breastfeeding journey. Breastfeeding gives moms confidence and the ability to make a huge difference in another mom's life.

Year 2011 is all about changes and challenges for us. At past 3 years old, I really want to wean Naima. Our first goal was to wean at Christmas but then she got sick. Now, she promises to wean when she enters "big school" in June. I'm all for child-led weaning but I do want to have some breastfeeding-free time before we have our second baby. Crossing my fingers that 2011 is the year! What is the best gift of breastfeeding that you have received?

More on the Recall and Press Advisories from Arugaan and IBFAN

I was quite disappointed to receive an email from Nanay Ines yesterday that FDA Acting Director Nazarita Tacandong recanted and said that it is safe to use the recalled Mead Johnson products. Meanwhile, in L.A.T.C.H.'s Facebook page, one of the fans posted that their doctor told them that the low fat content in Sustagen and Alactagrow is nothing to worry about since kids get fat from their meals.

Mead Johnson was also quick in damage control and their Philippine website now shows a message from their President:

All of our products currently sold in the Philippines, including Alactagrow and Sustagen Junior, have passed stringent Philippine FDA health and safety requirements and are considered to be safe for consumption and of high quality. While the fat level requirement does not relate to the safety or quality of the product, Mead Johnson is taking steps to meet that requirement also.

Mead Johnson is launching today a reformulated version of Alactagrow that meets the new regulatory requirements. Work is underway to develop an updated version of Sustagen to meet the revised standards.

I think the real issue here is deceptive marketing to consumers. Isn't it strange for Mead Johnson to say that there is nothing wrong with their products YET released a new formulation for both Sustagen and Alactagrow Bibo? They might argue that hey, the new formulation is a response to the new regulatory requirements. Continuously, new ingredients in breastmilk are being discovered resulting in constant changes in minimum formula requirements. This just supports the position that despite what the formula companies say, formula can never equate breastmilk.

I'd like to share the Press Advisories of Arugaan and International Baby Food Action Network below.

Press Advisory

Save the Babies Statement

Contact Person: Ines A. Fernandez cp 09088888153

Protest on Recalled and Recant of Mead Johnson Products

Save the Babies Coalition registers our rage over the recant of the Acting Director Nazarita Tacandong of Food and Drug Administration in last night TV newscast September 22, 2010 saying "It is safe to use these products".

The Recall on the dangerous products of Mead Johnson's Alactagrow Bibo trio and Sustagen Jr. bespeak of its nutrient defieciency of fat contents. It showed that Mead Johnson wrongly disseminated its nutritional and halth claims of "resistensiya builders" and "all around health".

It is a case of misbranding.

Mead Johnson cheated the Filipino consumers.

Based on scientific evidences upheld by Codex Alimentarius that fatty acids deficiency affects the nervous system and brain developmemt of the infants and young children.

Furthermore, Sustagen Jr. product certification registry at FDA - Food and Drug Administration already expired last May,2010 due to non-compliance of Codex Alimentarius and Philippine laws.

Our Constitional law protects us in its aim that " Anything that endangers the life of an individual is a criminal act".

Both Mead Johnson President Paul Richards and FDA Acting Secretary is responsible and accountable for gross deception to the Filipino people.

PRESS ADVISORY

INTERNATIONAL BABY FOOD ACTION NETWORK (IBFAN) STATEMENT

CONTACT PERSON: Velvet Roxas 0915-7741614

RE: DOH and FDA ADVISORY 2010-010:

Product Recall Order For Alactagrow Bibo Trio Milk Supplement Covered by Registration No. FR-71538

The International Baby Food Action Network urges the FDA to fully implement the Product Recall Order for Alactagrow Bibo Trio Milk Supplement, manufactured by Mead Johnson covered by Registration No. FR-71538.

Infants and young children are our most vulnerable consumers and deserve the utmost protection from harmful products. Such protection is vital for milk products marketed for older infants and young children and intended to support growth and development.

The failure of Alactagrow Bibo Trio Milk Supplement to provide the fat content of 3 to 6g. per 100 kcal. as set by FDA regulations and the Codex STAN 156-1987 for milk supplements, potentially puts older infants and young children at serious risk for undernutrition related to insufficient fat intake.

Fats in the diet of older infants and young children are critical because they are essential for brain and neurological development. Brain and neural growth remains rapid during the second year of life. As well, fats have 2.5 times the energy density of carbohydrates and proteins and therefore are critical to providing adequate energy for growth.

Alactagrow has no added fats; hence the only fats present are those from the whole milk powder, which as the 4th listed ingredient, after skim milk powder (no fat) and corn syrup solids and sucrose, is likely to be minimal. Indeed the total fat content as determined by the FDA is a mere 1.34g. per 100 kcal.

The deception and misrepresentation of the label is confounded by the confusing and contradictory messages regarding the recommended age for the use of this product – which on the one hand states 1-3 years old and on the other hand states that a milk supplement should not be introduced before the sixth month. This conveys the clear message that the product is suitable for infants after 6 months. The need for essential fats for infants between the ages of six to 12 months is even greater, so this increases the risk to health.

The product is primarily a fat reduced milk powder, with sugar, fortified with minerals and vitamins. An expensive product that is deficient in the essential level of fat required by older infants and young children.

Since milk (unmodified with added sugars and reduced fats) remains the most important component of a young child’s diet providing:

· 55% of energy - 9-11 months

· 40% of energy - 12-23 months

The marketing of Alactagrow by MJ is fraudulent, misleads parents and risks less than optimal growth and development, especially brain and neurological development for older infants and young children.

Thus we urge FDA to enforce a full recall of Alactagrow Bibo Trio Milk Supplement Covered by Registration No. FR-71538 and any other milk products that violate the nutritional and labeling standards of the Codex-STAN 156-1987, the International Code of Marketing of Breastmilk Substitutes and relevant WHA resolutions.

===========================

Contact Persons:

Velvet Roxas, IBFAN and Arugaan (0915-7741614)

Ma. Ines Av. Fernandez, Save Babies Coalition (0908-8889153)

Atty. Ipat Luna, Health Justice (0928-5048265)

2 Mead Johnson Products in the Philippines are Recalled

Two Sundays ago, Mead Johnson paid for a cover story in the Sunday Inquirer Magazine to feature their "Feeding Hope" program.A couple of days after that feature, our Food and Drug Administration issued 2 advisories recalling Mead Johnson products - Sustagen Junior Milk Drink Powder Vanilla Flavor (for toddlers 1-3 years old) and Alactagrow Bibo Trio Milk Supplement under Advisory Nos. 2010-009 and 2010-010, both issued on on 16 September 2010.

Under Advisory No. 2010-009, Sustagen Junior is being recalled because of its non-compliance with the standard fat content level (3-6 grams per 100 calories) for milk supplements. Testing showed that Sustagen Junior's fat content is at 1.5g per 100 calories - clearly at a substandard level.

Meanwhile, under Advisory No. 2010-010, FDA declared that tests also showed that Alactagrow

Bibo merely had 1.34g per 100 calories of fat content - also at substandard level.

Interestingly though, labels of both products didn't clearly state the fat contents of their products or that they were within the required levels. Sustagen's label stated that fat content was at 5.9 g per 100g (392 calories per gram), while that of Alactagrow Bibo was at 5.1g per 100 g (380 calories per gram).

The average consumer wouldn't really understand if this is within the required level as stated by the FDA.

However, the 2 advisories clearly stated that upon testing, fat levels of the 2 products are non-compliant with the standard level of quality. This morning, the Mead Johnson representative, who was being interviewed in the morning news, kept harping on (1) how this was a 3rd class recall; (2) the recall shouldn't have been made public and that they were caught by surprise; and (3) their products passed all the minimum standards. I wouldn't be surprised on how Mead Johnson will deal with this recall given their underhanded marketing tactics to undermine breastfeeding efforts and implicitly (sometimes not even!) influencing mothers to think formula milk is as equal to breastmilk and to choose that instead!

If you have purchased these 2 recalled products, better contact Mead Johnson to return then. Consumers of these products are children from 1-3 years old and can actually just choose to drink fresh milk instead. Read THIS POST on why formula milk is not necessary for toddlers.

Medical Reasons for Breast Milk Substitutes

During the breastfeeding classes I've attended and conducted, it is always emphasized that from birth to six months, exclusive breastfeeding is best for babies, unless there medical reasons prescribing otherwise.

These “medical reasons” vary though from doctor to doctor, with some doctors even saying that moms who underwent caesarian births cannot breastfeed for x number of days!

In 2009, the World Health Organization and UNICEF released a 12-page publication entitled “Acceptable medical reasons for use of breast-milk substitutes”. According to WHO and the UNICEF, they first developed a list of medical reasons for supplementation in 1992, as an annex to the Baby-friendly Hospital Initiative tool package.

With new and emerging scientific evidence, WHO and UNICEF agreed to update the list with the participation of the departments of Child and Adolescent Health and Development and Nutrition for Health and Development. Other additional evidence sources used were (1) The Drugs and Lactation Database, a peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed, hosted by the United States National Library of Medicine; and (2) The National Clinical Guidelines for the management of drug use during pregnancy, birth and early development years of the newborn, review of which was done by the New South Wales Department of Health, Australia in 2006.

The WHO and UNICEF posit that only a small number of health conditions of the infant or the mother may justify temporary or permanent cessation of breastfeeding. Further, these conditions concern very few mothers and infants. In recommending the cessation of breastfeeding, the WHO and UNICEF mandates that the benefits of breastfeeding should be weighed against the risks posed by the presence of the listed conditions.

The following are the conditions for infants not to receive breast milk or any other milk except specialized formula:
1. infants with classic galactosemia (a special galactose-free formula is needed) – a rare genetic metabolic disorder that affects an individual’s ability to metabolize the sugar galactose (one of the components of lactose) properly
2. infants with maple syrup urine disease (an inherited disorder in which the body is unable to process certain amino acids or protein building blocks properly. If untreated, this leads to severe brain damage and death) – special formula free of leucine, isoleucine and valine is needed
3. infants with phenylketonuria (a genetic disorder that is characterized by an inability of the body to utilize the essential amino acid, phenylalanine) - a special phenylalanine-free formula is needed – some breastfeeding is possible, under careful monitoring

For all other infants, breastfeeding is best although the following infants may need other food aside from breast milk for a limited period:

1. a. infants with very low birth weight – weighing less than 1500g
2. b. infants born too early – at less than 32 weeks of gestational age
3. c. newborn infants who are at risk of hypoglycaemia by virtue of impaired metabolic adaptation or increased glucose demand, if their blood sugar fails to respond to optimal breastfeeding or breast-milk feeding

• preterm
• small for gestational age
• have experienced significant intrapartum hypoxic/ischaemic stress
• those who are ill
• infants with diabetic mothers

Just because a baby is premature, it does not mean that s/he should be given formula or any other fortifier (like Cell Life a.k.a. spirulina). WHO/UNICEF listed above specific instances when fortifiers are necessary.

As for maternal conditions that may justify permanent avoidance of breastfeeding, only one is listed – HIV infection, only if replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS). WHO/UNICEF however recognizes that the most appropriate infant feeding option for an HIV-infected mother depends on individual circumstances – mother’s health status, health services available and most importantly whether there is replacement feeding AFASS.

Certain conditions justify the temporary avoidance of breastfeeding, such as severe illness that prevents a mother from caring of her infant (e.g. sepsis), herpes simplex virus-1, certain maternal medication (sedating psychotherapeutic drugs, anti-epileptic drugs, opioids, radioactive iodine-131, excessive use of topical iodine or iodophors (povodine-iodine), cytotoxic chemotherapy.

Meanwhile, the publication lists down certain conditions wherein breastfeeding can still continue, although health problems may be of a concern, namely: breast abscess, hepatitis B, hepatitis C, mastitis, tuberculosis, substance abuse. I highly recommend that you peruse the short publication to read the details on these conditions.

Clearly, there is a limited number of conditions for both infants and mothers to recommend the cessation of breastfeeding. I would definitely recommend that pregnant moms to read this WHO/UNICEF publication so they will be informed and know what questions to ask their pediatricians and ob-gynes. And if your doctor gets irritated when you ask questions, then I believe that it is time to look for a new medical provider.

Toddler Moms and Relactation

Since I joined L.A.T.C.H., I have received several inquiries connected with relactation. The ages of their babies vary from 1 month to 16 months. For a mom to successfully relactate, a lot of dedication, special strategies and medication is usually necessary. Thus, I always refer cases like these to the International Board Certified Lactation Consultants (IBCLC) in the Philippines. There are currently just 5 with a couple more applicants trying to complete their certification.

However, I also give the moms some reading materials on relactation so they know what to expect before they contact the IBCLCs. Here are some of the materials I share:

1. Kellymom

2. La Leche League International

3. Idaho Public Health (PDF)

4. Dr. Jay Gordon

For moms with toddlers, however, I also advice them not to stress out about relactation anymore. As a toddler, it is more important for him/her to learn how to eat healthy foods and have a balanced diet. In fact, milk is gradually replaced by solids beyond the first year. In fact, some kids completely stop drinking milk by age 2 and get their calcium and other requirements from foods such as malunggay, orange juice, cheese and yogurt. In my previous post, I shared the thoughts of Dr. Francesca Tatad-To, on the importance of having a balanced and healthy diet instead of filling up toddlers with milk. Thus, the best advice I can share to moms with toddlers is to focus on their children's diet and making sure that they are fed with healthy nutritious food, rather than worrying and stressing themselves out with relactation.

Learnings from the Milk Code Forum

Two LATCHers presented during the Forum. Velvet discussed the superiority of breast milk over formula and how a baby learns rhythm through breastfeeding. She also mentioned that in the Muslim culture, when a mother has given 3 full feedings to another baby, that baby will be considered as her own child's milk-sibling. Judy also had a short presentation on the "superstars" of the formula milk industry - BPA, rocket chemicals, growth hormones, melamine - you will be amazed and scared to learn about the multitude of contaminants that go into formula milk. She also showed a powerpoint show on "The Story of Milk". A more detailed summary of Judy's presentation is available here.

It was enlightening to hear about the experiences of Carmen Solinap, who was a representative of the Women Trade Union. She worked with a textile company in Laguna and was able to establish a lactation room in the factory. Ms. Solinap shared that they did not seek the milk-expression times as a favor or additional benefit from management but rather, they were able to schedule the employees' breaks around their milk-expression time. The Laguna lactation program was quite successful such that it had become the "norm" among the female employees to breastfeed their babies even if their maternity leaves already ended. She is now working on the establishment of a similar program in factories in Bulacan.

The heart of the Forum - the Milk Code and Rooming-In Act - were discussed by Atty. Ipat Luna of Tanggol Kalikasan. Atty. Ipat emphasized the coverage of the Milk Code and the violations being committed by the milk companies. She had a collection of photographs evidencing these violations. She also emphasized the need to be vigilant in watching or policing these milk companies. Atty. Ipat recognized the difficulty in implementing the penal provision of the milk code on individuals but stressed that if the different breastfeeding groups worked together, it would be possible to penalize milk companies (through suspension/revocation of the licenses/permits) in view of their rampant violations. The main problem is the lack of violation reports to set-up the stage for penalizing the milk companies. If no formal report of the violation is filed and submitted with the Inter-Agency Committee set up by the Milk Code, then there will be no basis to hold these companies liable.

It was very timely that the UP law students formed a new campus organization - UP Volunteers for Children. They had their first activity in May 2009 which was directed towards understaning the Milk Code and its Revised Implementing Rules and Regulations. They also had exercises on identifying the coverage of the Milk Code, activities being regulated and reviewing advertising materials/packaging of milk companies. They were a very enthusiastic group of students - they reminded me of myself when I was a young "hungry" law student :D. I was very happy to see a group step up to handle the monitoring of the Milk Code. They have set-up a website and you can email them if to report violations of the Milk Code. This is also a great project for Ateneo Human Rights Center to look into, particularly since AHRC has a Children's Desk.

Finally, the last speaker was Alessandro Iellamo of Unicef. Alex again emphasized the importance of vigilance in making sure that the milk companies act with the bounds of the Milk Code and its RIRR. Unicef in the Philippines is very active in promoting breastfeeding and policing these milk companies.

I was really happy to have attend the Milk Code Forum. In my previous post, I thought that familiarity with Code was sufficient. But after attending the Forum, I realized breastfeeding educators/counselors/consultants must read, know and live the Milk Code and RIRR. Otherwise, they become unwitting accomplices or even principal violators themselves - which makes them even worse than milk companies as these educators/counselors can be major influences in how a new mother will choose to feed her baby.

Part 1

Trying to Read the Labels

Following my posts on formula milk, my officemates and I started talking about how effective milk companies' marketing efforts are in influencing consumers' buying choices. We remembered how the commercial for Nido was emphasizing how it had less sugar than other milks. My officemate then whipped out his own Nido powdered milk (which he used in his oatmeal). I was really appalled when I read the label!

Now, Nido has another endorser - Dyan Castillejo whose "tagline" is "It pays to check the label". So let us examine the label of Nido. Read the ingredients list -- do you see sugar? So where did Suzy Entrata's 70g of sugar go? Now I undestand why it is only Nestle which has a "boycott Nestle" group especially targetting that company. Honestly, when I see "recombined whole milk", I wouldn't think that sugar was part of it. But even if Suzy's commercial already blatantly states that Nido has sugar, this ingredient is still not listed in the label! So, it will never pay to check the label as long as manufacturers are not transparent or honest enough to actually list each ingredient of the products they are selling.

Formula Milk for Toddlers

For older babies, even if extended breastfeeding is considered to be beneficial, the milk companies attempt to manipulate consumers that by giving their children formula milk, they are getting something better. If you notice, all of the formula milk ads are targeted towards toddlers and preschoolers. In the US, the American Academy of Pediatricians recommends whole cow's milk for children beyond one and not formula. However, in the Philippines, we have formula milk for almost everyone!
Dr. Francesca Tatad-To,* respected pediatrician-neonatologist AND breastfeeding advocate shares her thoughts on this matter. Please note that this post is for informational purposes only and this is no substitute for medical advice given after an actual examination by a board certified doctor of your particular case.

Formula is unnecessary in children who are older than 1. At this age, children are expected to have a full/complete diet which may or may not include full cream fresh milk.
Fresh milk is the standard dairy recommendation for children older than 1 who are no longer breastfed, and the American Academy of Pediatrics actually recommends low-fat milk for ALL children (Except malnourished ones) older than 2.

As infant formula was originally designed to be a breastmilk replacement/alternative, children who have weaned naturally and no longer require breastmilk should not require formula either.

In most countries, formula sold is really only for babies 1 and below. It is only in countries like ours where the commercial demand is strong that formula manufacturers take advantage and try to create an even bigger demand through marketing, etc.

The average toddler formula is higher in calories than full cream fresh milk and this is not a good thing. These extra calories are usually from sugar and fat, not from any added 'special nutrients'. In fact, toddler and preschool formula is often the culprit in young children who are obese and who have poor diets. The typical caloric requirement for a toddler is 1000-1200 kcal/day and the majority of this should be coming from solid food. The recommended limit for dairy/milk intake for children older than 1 is 16-24 oz or 2-3 cups a day only. This means that a toddler taking 3 cups of milk a day will already consume 40-50% of his calories in milk, leaving 50% for food. Giving your child toddler formula almost always ensures that he/she will get more fat, sugar and calories than he/she needs.

Also, it is common for children who exceed the recommended milk intake to develop iron-deficiency anemia. This is because cow milk protein causes a little bit of bleeding in the gut and larger amounts of milk translates to bigger blood loss. Many parents don't know this but this is a common concern of well-trained pediatricians and is found in all our medical textbooks.

There is a lot more information available in books and online. If you look at the recommended Food Pyramid for children, you will see that there is no recommendation for formula here either.

Indeed, a lot of research has shown that formula (actually milk for that matter) is unnecessary in children who are older than 1. In fact, even Dr. Sears believes that milk is not necessary and experts generally believe that milk is just an easy and convenient source of calcium, protein, fats, vitamin D (if fortified).
Hopefully, Filipino moms will realize that we do not really need to purchase those formula milk to make our children healthy or smart. To be honest, being "panatag" (secure) is just an excuse to be lazy and not attempt to teach or encourage your child to have a healthy diet. As Dr. Zeka pointed out, there is no recommendation for formula in the Food Pyramid.


Furthermore, just because Nido claims to have less sugar (70g) doesn't mean it is better than the other brands or than regular milk for that matter. The 70g sugar is still extra sugar that your child will do without if you choose to give him regular milk or other foods to provide whatever "nutrients" s/he is supposed to get from Nido.
Whether or not you decide to include milk in your family's diet is your choice. But again, really, FORMULA MILK IS NOT NECESSARY. It is really high time for Filipino consumers to be educated and bust those formula milk myths.

*Dr. A.M. Francesca Tatad-To specializes in pediatrics and newborn medicine. She also serves as medical consultant to L.A.T.C.H.
*The opinion that toddler formulas are unnecessary is also shared by this American doctor.

Part I of this Post is here.

So called nutrition for Toddlers

Do toddlers still need to be given formula milk?! (a.k.a Breastmilk v. Formula)

Recently, the issue of the hazards of cow's milk (including formula) cropped up in my peer counselor group and another local mother's group I'm part of. One of the moms was worried about the effects of formula milk (or hormonized cow's milk, as she calls it) that her daughter was taking. Her pediatrician had patients who were menstruating at 4 and 7 years old - and the pediatrician thought it was because of the milk they were taking (the mom required the child to take 8 glasses to make up for the low food intake). Meanwhile, another mom (who continued to breastfeeding her 18 month old baby - yay! :D) was worried that her toddler was not getting all the required vitamins and minerals - she had been bombarded with the commercials for formula milk (and we have plenty!! DHA? ARA? +7 IQ points?).

During the Milk Code Forum I attended last Saturday, one of the presenters, Judy, had a terrific presentation on the story of milk. She emphasized that because of the great demand for milk, dairy farmers are doing everything to boost their cows' milk production - by adding hormones which for sure eventually ends up in the milk that we drink. Judy also shared that even if companies say that they've tested the milk for contaminants and did not find any, there are other contaminants not being tested or detected! There are about 60 or more chemicals/medicines injected into cows but only the presence of 6 (in the end-milk product) is being tested. And this is only for the regular milk! Formula milk undergoes more processing for it to be converted into milk "suitable" for babies. To mimic breast milk, milk companies then add synthetic DHA and ARA (from cultured algae, etc.) to the powdered milk. The formula milk is exposed to more contamination risks (BPA, melamine, salmonella, etc.) during the processing, canning and preparation process. No wonder our generation's hormones are totally whacked out - with menstruation even starting at age 4!!!
In my response to the breastfeeding toddler's mom, I shared how milk companies earn P42B from Filipino consumers which is why they spend P1B in marketing their products. I got those figures during the Milk Code Forum from Nanay Ines of Arugaan. Obviously, each milk company wants to get the biggest chunk of that P42B pie - which is why they are aggressively (and unethically) marketing their products.
With the passage of the Milk Code's revised rules and regulations, milk companies recognized that they can no longer actively market products targeted for babies below 1 year old, to preserve their "good image". The superiority of breast milk of formula has been settled and established. Detailed comparisons are available here and here. There is even a downloadable brochure of stacked blocks which show how far away formula milk is from breast milk, particularly in terms of nutritional content. So, they directed their attention to older babies.

To be continued... Part 2.