What is lactose?

Lactose is a carbohydrate. It is often called milk sugar because it is the primary carbohydrate found in breast milk and other mammalian milk such as cow’s milk. It is a disaccharide, meaning that it is made of two monosaccharides, glucose and galactose.

What is lactose intolerance?

When an infant, child or adult is unable to digest lactose, this is referred to as lactose intolerance. This occurs because the enzyme used by the body to digest lactose, which is called lactase, is either absent or has declined. Without lactase, lactose cannot be broken down into glucose and galactose. The lactose cannot be absorbed by the intestinal wall into the bloodstream like glucose and galactose and, thus, the lactose remains in the intestinal tract. The bacteria in the intestinal tract then use the undigested lactose which produces a large amount of gas. The symptoms of lactose intolerance include stomach cramps, nausea, bloating, gassiness and diarrhea.

Are there different types of lactose intolerance?

There are three types of lactose intolerance:

Congenital Lactase Deficiency which is a genetic disorder where the body does not produce the enzyme lactase. This type of intolerance will occur at birth.

Primary Lactose Intolerance which occurs when infants, children and adults live in non-dairy consuming environments and are not exposed to the lactose in dairy products. The body has reduced its ability to make the enzyme lactase.

Secondary Lactose Intolerance occurs after certain gastrointestinal diseases where the production of lactase is disrupted. Common causes of temporary secondary lactose intolerance are gastroenteritis, particularly the gastroenteritis caused by rotavirus and acute diarrhea.

How is lactose intolerance diagnosed?

Usually when an infant is lactose intolerant, symptoms (cramping, nausea, gassiness, fussiness, bloating) will occur soon after feeding the lactose containing product. If there are questions as to whether the infant has lactose intolerance or intolerance to cow’s milk protein, a physician can perform a hydrogen breath test to determine if the infant has lactose intolerance. Stools can also be tested for malabsorbed carbohydrate. If questions still remain, an intestinal biopsy can be performed.

What is the treatment for lactose intolerance?

For a baby with lactose intolerance, a lactose-free formula, such as Baby’s Only Organic® Lactose Free or Soy Formulas, will be recommended.

If lactose intolerance is temporary due to a gastrointestinal upset or diarrhea and the infant is being breastfed, breastfeeding is usually still recommended. However, a lactose-free formula may be needed to supplement the baby occasionally until the baby’s digestive system is again producing enough lactase to digest the lactose in breast milk. Consultation with baby’s healthcare professional and/or a lactation consultant should be sought to ensure that breastfeeding is not negatively affected. If an infant is being solely formula fed, a lactose-free formula, such as Baby’s Only Organic® Lactose Free or Soy Formulas, will usually be recommended in these situations.

If an infant has been diagnosed with a congenital lactase deficiency, a lactose-free formula, such as Baby’s Only Organic® Lactose Free or Soy Formulas, will be recommended throughout the infant and toddler years and a lactose free diet will usually be needed.

Can a Soy Formula be used for lactose intolerance?

Soy formulas, such as Baby’s Only Organic® Soy Formula, are lactose free and can be used for lactose intolerance. Because there are some infants who are allergic to soy protein or for families who prefer not to use soy products, Baby’s Only Organic® Lactose Free is available. Baby’s Only Organic® Lactose Free and Soy Formulas offer all the nutritional benefits of a standard dairy-based formula, such as Baby’s Only Organic® Dairy Formula or leading brand infant formulas, but without the lactose.

What if my child suffers from galactosemia or a cow's milk protein allergy?

Baby’s Only Organic® Lactose Free Formula should not be used when galactosemia has been diagnosed or when an infant has a cow’s milk protein intolerance. Baby’s Only Organic® Soy Formula is suggested for a child with galactosemia or a cow's milk protein intolerance as recommended by a healthcare provider.

The philosophy at Nature’s One® is to promote breast milk for infants the first year of life when possible. Our philosophy is in accordance with the World Health Organization's Code of Marketing Breast Milk Substitutes. Baby’s Only Organic® is suggested for a baby 12-months and older. For infants less than 12-months, use as directed by a healthcare professional. Baby's Only Organic® has complete nutrition - nothing is missing, nor is it concentrated. For any age baby, mix the formula according to label instructions. Nature’s One® recommends that you print the nutritional comparison chart below and present it to your doctor before changing your baby's diet.
Lactose Free Formula Nutritional Comparison Chart

For all ages: To ensure appropriate nutrition, do NOT increase or reduce the recommended water to powder ratio. Mix according to label directions unless otherwise specified by a healthcare provider:

1. Using a chart below, pour desired amount of water into bottle then add an unpacked, level measuring spoon of powder. Warning: Do not use a microwave oven to warm formula.
2. Cap bottle; shake well until powder is completely dissolved.
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3. Feed immediately. Discard leftover formula after feeding or formula that is unrefrigerated for 1 hour or longer.

Storage:

1. Cover prepared formula and refrigerate; use within 48-hours to preserve vitamins.
2. Cover opened can with lid and store in cool, dry place; use within one month of opening.
3. Store unopened cans at room temperature; avoid extreme temperatures.

"DRY" MEASURING SPOON
To Make:	Formula Powder:	Add Water:
1 fl oz bottle	1 ¾ teaspoons	1 fl oz
2 fl oz bottle	3 ½ teaspoons	2 fl oz
4 fl oz bottle	2 Tablespoons,  plus 1 teaspoon	4 fl oz
6 fl oz bottle	3 Tablespoons,  plus 1½ teaspoons	6 fl oz
8 fl oz bottle	5 Tablespoons	8 fl oz
16 fl oz container	½ Cup,  plus 2 Tablespoons  (Equal to 10 Tablespoons)	16 fl oz
24 fl oz container	¾ Cup,  plus 3 Tablespoons (Equal to 15 Tablespoons)	24 fl oz
32 fl oz container	1½ Cups (Equal to 20 Tablespoons)	32 fl oz

METRIC MEASUREMENTS
To Make:	Formula Powder:	Add Water:
240 ml container	34 gms	240 ml
120 ml container	17 gms	120 ml
30 ml container	4.25 gms	30 ml

BABY’S ONLY SCOOP
To Make:	Powder:	Add Water:
2 fl oz bottle	1 unpacked level scoop	2 fl oz
4 fl oz bottle	2 unpacked level scoops	4 fl oz
6 fl oz bottle	3 unpacked level scoops	6 fl oz
8 fl oz bottle	4 unpacked level scoops	8 fl oz
16 fl oz bottle	8 unpacked level scoops	16 fl oz

Click here to order a scoop from Nature’s One. Please include your name, address and phone number when requesting a scoop.

The current recommendation is that infants can be switched from breast milk or formula to whole cow’s milk or a lactose free beverage at their first birthday. The assumption is that by the time an infant reaches this important toddler milestone, the baby is consuming a well-rounded diet consisting of the appropriate amounts of protein foods, breads and cereal products, fruits and vegetables and thus receiving all the correct nutrients in the correct balance.

Parents and healthcare professionals may choose to continue the use of formula as an “insurance policy” whenever there are concerns about a child’s consumption of all the nutrients he or she needs for growth and development during the important toddler years. Use of a cup rather than a bottle is usually recommended to promote development of eating skills.

Baby’s Only Organic® Toddler Formulas provides the correct balance of proteins, carbohydrates, essential fatty acids, vitamins, and minerals needed to support normal growth and development.

There are two basic groupings of fatty acids called (1) essential fatty acids or “precursor fats” (as found in Baby’s Only Organic^® pediatric formulas) and (2) non-essential fatty acids which can also be “preformed fats” (as found in Baby’s Only Essentials^® DHA and ARA Fatty Acid Supplement*).

Baby’s Only Organic^® pediatric formulas contain two essential (precursor) fats: Alpha-Linolenic Acid (ALA) and Linoleic Acid (LA). Alpha-Linolenic and Linoleic fatty acids are called “essential” because the human body cannot make these fats and therefore it is essential to derive them from food sources. Alpha-Linolenic Acid is an omega-3 used by the body to make Docosahexaenoic Acid (DHA). Linoleic Acid is an omega-6 used by the body to make Arachidonic Acid (ARA). DHA and ARA are called “non-essential” fatty acids because full-term, healthy infants, children, and adults can manufacture these from Alpha-Linolenic and Linoleic fatty acids.

Baby’s Only Essentials^® DHA and ARA Fatty Acid Supplement is made with preformed DHA and ARA long-chain fatty acids. This means the fats are already available in their final forms and the body does not need to manufacture from precursor fats, Alpha-Linolenic and Linoleic fatty acids.

*These statements have not been evaluated by the Food and Dug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Yes, Baby’s Only Organic^® Dairy and SOY formula are Certified Organic by OneCert. OneCert is a USDA approved government agency, similar to Quality Assurance International (QAI). For more information about OneCert refer to their website at www.onecert.net. OneCert also complies with the new USDA National Organic Standards Program.

The concern with bisphenol-A coatings used in some packaging is the potential migration of bisphenol-A into canned foods. Health concerns related to bisphenol-A have recently been reported because of bisphenol-A’s endocrine-disrupting properties, particularly the estrogen pathway.¹ Bisphenol-A is used in the epoxy resin that coats the inside of some metal cans. This coating helps to prevent corrosion of the can, contamination of the canned food from dissolved metals, and bacterial contamination causing spoilage of the food. Thus, the coating helps to maintain the food product’s quality and taste and aids in extending shelf life.

Baby’s Only Organic® formula canisters and re-closeable plastic lids are uncoated and do not contain bisphenol-A. However, the can’s “easy-open” metal top contains an epoxy-based interior coating that may contain trace amounts of unreacted bisphenol-A. It is highly unlikely that any detectable amount of bisphenol-A would migrate from the easy-open top into Baby’s Only Organic® formulas. This is especially true considering there is minimal contact between the powder and the easy-open top during processing and distribution. Once the formula is opened, the easy-open metal top is discarded.

The greater risk of BPA migration has been found to be related to heat exposure during processing.² BPA migration appears to be most often associated with liquid ready-to-feed and concentrated formulas sold in cans where high processing temperatures are used once the liquid formula is sealed in the can. High temperatures are needed during canning of liquid formulas to achieve product sterility and prevent botulism or the growth of other microorganisms that would lead to spoilage. The presence of high processing temperatures is thought to provoke a migration of the bisphenol-A into liquid formula. The canisters used for Baby’s Only Organic® are NOT hot-filled. Baby’s Only Organic® powder formula cans are filled at room temperature and then vacuum sealed.

As always, Nature’s One® will continue to work with its suppliers to identify the safest packaging and most nutritious ingredients available.

From our investigation on this matter, we have found there are varying conclusions based on the results of many studies. To help you in your research efforts, we are providing a link to the Environmental Working Group website, http://www.ewg.org, as well as a Fact Sheet provided by The Inter-Industry Group for Light Metal Packaging.

1. Kuehn, B. “Expert panels weigh bisphenol-A risks,” JAMA. 2007; 298: 1499-1503. 2. Goodson, A. et al. “Survey of bisphenol A and bisphenol F in canned foods.” Food Addit Contam. 2002; 19: 796-802.

Carbohydrates

Brand	Carbohydrate Source
Baby’s Only Organic®	100% Organic Brown Rice Syrup
Similac® Sensitive™	Corn Syrup Solids, Sugar (Sucrose)
Enfamil® LactoFree® Lipil®	Corn Syrup Solids

Carbohydrates are one of the crucial dietary sources of energy that supports the brain, enables muscular contractions, and provides the fuel necessary for a baby’s rapid growth through 24-months of age. So it is important for a child to get plenty of carbohydrates from good sources.

In some cases, the carbohydrate lactose can overwhelm a baby’s ability to digest the milk-sugar and cause gassiness, bloating and a very unhappy baby. If your baby is experiencing these symptoms, consult with your healthcare professional to determine whether a lactose-free or soy formula may be recommended. If the parents are milk sensitive, it is not unusual for a baby to inherit this same intolerance.

Baby’s Only Organic® Lactose Free Formula uses organic brown rice syrup as its carbohydrate source. Rice is known to be a relatively non-allergenic food and well tolerated by infants. This is the reason rice cereal is most often the first food introduced to older infants. Baby’s Only Organic® Lactose Free is a milk based formula, but the lactose or milk sugar has been removed using a special enzyme process.

Similac® Sensitive™ and Enfamil® LactoFree® Lipil® formulas contain corn syrup solids and Similac® also adds sugar (sucrose) for carbohydrate. Sugar or sucrose used in Similac® Sensitive™ is a simple sugar. Simple carbohydrates are quickly digested and absorbed into the bloodstream, increasing insulin levels. A more complex carbohydrate, such as organic brown rice syrup used in Baby’s Only Organic® formulas, requires more time for digestion resulting in slower and steadier absorption of the carbohydrates into the blood stream and a more constant production of insulin.

Essential Fatty Acids

Brand	Linoleic Acid (per 100 kcal)	Alpha-Linolenic (per 100 kcal)
Baby’s Only Organic®	1000mg	128mg
Similac® Sensitive™	1000mg	100mg
Enfamil® LactoFree® Lipil®	860mg	Not Stated

Many formulas, such as Enfamil® LactoFree® Lipil®, are lower in the essential fatty acid, Linoleic Acid and Alpha-Linolenic fatty acid. These precursor fats are important for the body to convert to DHA & ARA and are critical to brain and eye retina development. In fact, the makers of Similac® supported a study¹ comparing breast fed infants to three formulas described below:

• A formula containing no added DHA & ARA, but contained higher levels of linoleic acid and alpha-linolenic acid similar to Baby’s Only Organic^® Toddler Formula.
• Two formulas supplemented with synthetic DHA and ARA that contained lower levels of linoleic and alpha-linolenic acid.

The results of this study did NOT support adding synthetic DHA & ARA to formula that contained the higher levels of linoleic acid and alpha-linolenic acid. However, Nature's One® recognizes that some babies may not be as efficient at converting linoleic and alpha-linolenic acid and recommends supplementation with Baby's Only Essentials® DHA & ARA. The synthetic DHA & ARA used to supplement Enfamil® LactoFree® Lipil® and Similac® Sensitive™ infant formulas are treated with hexane solvents, acid and bleach during the manufacturing process.

It is best to compare pediatric formulas using a 100-calorie serving, which is approximately 5-ounces of formula. So over the course of a day of feedings totaling 28oz, a baby consuming Baby’s Only Organic^® would receive 784mg MORE linoleic acid and 185mg MORE alpha-linolenic fatty acid when compared to Enfamil® LactoFree® Lipil®.

1. Austed, N. et al, “Growth and development in term infants fed long-chain polyunsaturated fatty acids: A double-masked, randomized, parallel, prospective, multivariate study,” Pediatrics (108); 2:372-381.

Similac is a registered trademark of Abbott Laboratories. Enfamil is a registered trademark of Mead Johnson & Company.

DHA & ARA Fatty Acids

Brand	DHA Fatty Acid
Baby’s Only Organic®	Sold separately as Baby’s Only Essentials® DHA & ARA Supplement
Similac® Sensitive™	Martek's DHASCO/ARASCO C. cohnii oil (algae) & M. alpina oil (fungus)
Enfamil® LactoFree® Lipil®	Martek's DHASCO/ARASCO C. cohnii oil (algae) & M. alpina oil (fungus)

Baby’s Only Essentials^® DHA & ARA Fatty Acid Supplement is available for parents who would like to take precautionary measures to help ensure their baby has sufficient levels of DHA and ARA. The DHA and ARA in Baby’s Only Essentials^® fatty acid supplement are naturally derived from egg phospholipids (egg yolk) using a gentle aqueous (water) process. Egg phospholipids, like those found in Baby’s Only Essentials^® DHA & ARA have been used in clinical studies with infants over the past decade. One recent study showed that egg phospholipids are more efficiently absorbed than other sources (fish oil and fungal oil).¹ Egg phospholipids contain Choline, an important nutrient needed for the production of neurotransmitters and development of the memory center in the brain. Egg phospholipids also contain cholesterol, used by the body to manufacture Vitamin D, various needed hormones and bile acid. Cholesterol is also an important component in cell membranes. Baby’s Only Essentials^® DHA and ARA Fatty Acid Supplement is a well understood and a safe source of DHA and ARA that can be added to Baby’s Only Organic^® Toddler Formulas or to foods as a child grows older.

Enfamil® LactoFree® Lipil® and Similac® Sensitive™ use a novel synthetic source of DHA and ARA for their infant formulas. Our company does not like the source or the extraction process for vegetarian fatty acids. The C. cohnii oil (algae) and M. alpina oil (fungus) used in the organic and conventional infant formulas are treated with hexane solvents, acid and bleach.² We also know that vegetarian sources are a relatively new/novel source of fatty acids and there may be much to learn on the efficacy of these fatty acids. We share some of the same concerns addressed by the FDA when these oils were first submitted for review (FDA report is available upon request). For that reason, Nature's One^® developed its DHA & ARA product using egg phospholipid, which has been naturally derived and consumed by humans long before the first "chicken or the egg" riddle was posed.

1. Gil, A., et al, "Role of long-chain polyunsaturated fatty acids in infant nutrition," European Journal of Clinical Nutrition (2003)57, Suppl 1, S31-34.

2. Sam Zeller, Ph.D. - Martek Biosciences Corporation, Food & Drug Administration Agency Response Letter, GRAS Notice No. GRN 000137

Similac is a registered trademark of Abbott Laboratories. Enfamil is a registered trademark of Mead Johnson Company.

Kosher

Brand	Kosher Status
Baby’s Only Organic® Dairy and Lactose Free	Kosher
Baby’s Only Organic® SOY	Kosher Pareve
Similac® Sensitive™	Kosher
Enfamil® LactoFree® Lipil®	Kosher

Baby’s Only Organic^® Toddler Formula is certified Kosher by Orthodox Union (O-U). The kosher symbol, O-U, is located on the front portion of the label. A current Kosher Certificate is available upon request.

*Similac is a registered trademark of Abbott Laboratories. Enfamil is a registered trademark of Mead Johnson Company.

Vegetable Oils

Brand	Vegetable Oils
Baby’s Only Organic®	Organic High Oleic Sunflower Oil, Organic Soybean Oil & Organic Coconut Oil
Similac® Sensitive™	High Oleic Sunflower Oil, Coconut Oil & Soybean Oil
Enfamil® LactoFree® Lipil®	Organic High Oleic Sunflower Oil, Organic Soy Oil, Organic Coconut Oil

Some formulas, such as Enfamil® LactoFree® Lipil®, use palm olein oil as part of the fat blend in their formulas. Palm olein oil is made from palm oil. Unfortunately clinical studies have proven the use of palm olein oil as a predominant fat source in infant formulas causes some babies to poorly absorb calcium resulting in lower bone mineralization.^{1, 2} When palm olein oil is provided in the formula, calcium soaps (calcium in fat) are formed in the gut. These calcium soaps prevent the absorption of fat and calcium in the gut and can also result in harder stool formation³ or constipation.

Almost 90% of all palm oil is produced in Indonesia and Malaysia at oil-palm plantations. This has resulted in widespread deforestation, destruction of rain forests, and putting the survival of some animals at risk. The razing by burning of tropical rain forests to make way for oil-palm plantations also results in the release of large amounts of greenhouse gas into the atmosphere.⁴

Baby’s Only Organic^® Toddler Formulas contain no palm olein oil and no palm oil. Instead, Baby’s Only Organic^® formulas contain a blend of organic oils: Organic High Oleic Sunflower Oil, Organic Soybean Oil and Organic Coconut Oil. Baby’s Only Organic^® vegetable oils are expeller-pressed, which is a squeezing process to extract the oil from the organic plants. No harsh chemicals are used to produce the vegetable oils.

1. Koo, W.W.K., et al, “Reduced bone mineralization in infants fed palm olein-containing formula: A randomized, double-blinded, prospective trial.” Pediatrics 2003; 111:1007-1023.

2. Kennedy, K. et al, “Double-blinded, randomized trial of a synthetic triacylglycerol in formula-fed term infants: Effects on stool biochemistry, stool characteristics, and bone mineralization.” Am J Clin Nutr 1999; 70:920-927.

3. Nelson, S.E. et al, “Absorption of fat and calcium by infants fed a milk-based formula containing palm olein.” J Am Coll Nutr 17: 327-332.

4. Brown, Ellie and Jacobson, Michael F. Cruel Oil. Washington, D.C.: Center for Science in the Public Interest, May, 2005.

Similac is a registered trademark of Abbott Laboratories. Enfamil is a registered trademark of Mead Johnson Company.

Nucleotides

Baby’s Only Organic^® Dairy Formula contains naturally occurring nucleotides found in organic dairy protein. Nature’s One^® believes this is adequate to meet the growth and development needs of children. These organic nucleotides are not declared on Baby’s Only Organic’s label because it is not an ingredient addition - instead they occur naturally as mentioned.

Nutritional science and the medical community have not determined if there are any added benefits for added nucleotides - especially since all are synthetically derived. The American Academy of Pediatrics Committee on Nutrition weighs-in on this subject as well commenting that “...additional studies are needed to understand the mechanism of action, confirm clinical endpoints, and monitor the long-term effects of adding nucleotides to infant formula.” ¹

Most importantly, nucleotides added to conventional and organic infant formulas are derived by synthetic, non-organic methods. There are presently no organic or natural sources for nucleotides. We are therefore concerned about the harmful effects of the chemicals used to process nucleotides and the synthetic source of nucleotides; especially since the benefits of their addition have not been clearly demonstrated.

1. Reference: Committee on Nutrition, Pediatric Nutrition Handbook, 5th edition, American Academy of Pediatrics, pg 618.

Taurine, Selenium & Iron

Baby's Only Organic^® formulas do contain taurine, selenium and iron, similar to conventional formulas.

Taurine, an amino acid normally present in breast milk, has been shown to play a role in retinal development, among others. Cow and soy milks do not contain adequate amounts of the amino acid.

Selenium is a mineral important for proper formation of red blood cells, development of skeletal muscle and proper growth. Selenium, too, is normally present in breast milk, but lacking in cow and soy milks. Baby's Only Organic^® contains added taurine and selenium.

Iron is added at the level recommended by the Academy of Pediatrics Committee on Nutrition. Inappropriate dietary iron could result in anemia, weakness, muscle fatigue, abnormal gastrointestinal motility, and a reduction of cognitive ability. This reduction in cognition has been shown to be irreversible, even once a normal iron level is retained.