Lactoferrin Milk Powder with HMO 2gx30stick sachets/Tin

With lactoferrin, the answer depends more on your situation than on the ingredient, so these are the questions our naturopaths ask in store before you buy it.

A good fit if

• Iron tablets have left you constipated or queasy and you want to see what else has been trialled
• You're comparing lactoferrin with colostrum and want the single protein rather than the whole mix
• You're fine with dairy and you're looking for general immune or gut support
• You'd rather have the evidence and its limits than a marketing line

Check with us first if

• You already take prescribed iron, because lactoferrin binds iron and the share of iron absorbed went down, not up.
• You're pregnant or planning a pregnancy. It's been given in pregnancy trials to women at high risk of premature birth, but that isn't the same as being established as safe for general use.
• You're breastfeeding. We found no trials in breastfeeding women at all.
• It's for a child. The children's trials were medically supervised, in specific conditions, at 100 mg a day.
• You're being treated for H. pylori. Lactoferrin has only been studied as an addition to prescribed antibiotics.
• You've been diagnosed with anaemia. That needs managing with blood tests by whoever diagnosed it.
• You're thinking about doses in grams. At 3.4 g a day, antibodies to the cow protein rose about threefold, and what that means for your health isn't known.

• Bovine lactoferrin (Schedule 1 item 941). Best known for: The only lactoferrin allowed as an active ingredient in an Australian listed medicine, and the one the trials used. Absorption: It's broken down by digestion, and lactoferricin can't be detected in gut contents. Typical use: Allowed in listed medicines with no specific requirements, no warning statement, no dose limit and no restriction on how it's taken.
• Enteric-coated bovine lactoferrin. Best known for: The same protein with a coating designed to carry it past stomach acid intact. Absorption: Reviews describe coatings and other protective technologies as an answer to that breakdown, but none has been shown to work better in people. Typical use: The only adult tolerability trial we hold used an enteric-coated 200 mg dose. There's no direct comparison with uncoated, so no claim that it's better can be made.
• Apolactoferrin versus holo-lactoferrin. Best known for: How much iron it carries, which is the difference product pages lean on hardest. Absorption: Nothing we hold compares one with the other. Typical use: Neither name appears in Schedule 1 and no clinical comparison exists, so we don't make one.
• Lactoferricin. Best known for: The fragment released from lactoferrin by the digestive enzyme pepsin, described as its active part, and used in infant formula. Absorption: It can't be detected in gut contents. Typical use: It isn't in Schedule 1, so it can't be the active ingredient in an Australian listed medicine.
• Recombinant human lactoferrin. Best known for: A protein with the human sequence, made in yeast rather than purified from milk, tested at 0.34 and 3.4 g a day. Absorption: Not compared with the bovine protein for absorption in anything we hold. Typical use: So far there's only data on safety and immune response, and it isn't in Schedule 1, so it can't be a listed medicine active here. Don't treat it as the same substance.
• Bovine colostrum (Schedule 1 item 940). Best known for: Whole colostrum, which contains lactoferrin along with many other components. Absorption: It's a mixture rather than an isolate, so it can't be compared like for like. Typical use: Listed separately, and it carries a required under-12-months warning that lactoferrin on its own doesn't.

Reference values. There aren't any. Lactoferrin isn't an essential nutrient, so the NHMRC sets no RDI, Adequate Intake or Upper Level for it, at any age.

Typical supplemental range. We won't quote a standard Australian capsule strength, because we haven't checked one against a current pack, so read the label on yours. For scale, the adult trials we reviewed used 200 mg a day: 200 mg for the inflammation marker research, and 200 mg enteric-coated in the only adult trial on how well it was tolerated. The children's iron trials used 100 mg a day for three to four months, all under medical supervision.

Upper level. Australia's permitted ingredients list (Schedule 1) sets no daily dose cap for bovine lactoferrin, and there's no NRV Upper Level either. The highest dose with published safety data in healthy adults that we've seen is 3.4 g a day for 28 days, which is far above anything sold on a shelf.

Worth knowing. No one has tested taking it with food compared with on an empty stomach, so there's no evidence-based advice on timing, and anyone who gives you one is guessing. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Cow's milk and skim milk: naturally present, and the industrial starting material. No verified milligrams per glass exists, so we won't print one
• Cheese whey: the other industrial source, and where supplement-grade lactoferrin is purified from
• Human breast milk: described as a major iron-binding protein in human milk; an amount per feed isn't established in our register
• Bovine colostrum: contains lactoferrin among many other components, and is sold as an ingredient in its own right
• Infant formula products: fortified with bovine lactoferrin under an express food-law permission in Standard 2.9.1

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• Cow's milk allergy. Bovine lactoferrin is purified from cheese whey or skim milk and is a dairy allergen. No lactoferrin product may be described as dairy free or suitable for a milk allergy.
• Vegans and vegetarians. It's a milk protein from animals. This is about suitability, not safety.
• Pregnancy. It was given in trials to women at high risk of premature birth, and the authors call for larger trials. That doesn't make it established as safe for general use. Talk to a health professional.
• Breastfeeding. We hold no trial in breastfeeding women. It's unknown, so check with a health professional.
• Prescribed iron tablets. Lactoferrin binds iron, and measured absorption was lower, not higher, in pooled trials and in an isotope study. Don't assume the two add up; raise it with a pharmacist.
• Antibiotic treatment for H. pylori. It was only studied alongside prescribed treatment, in open-label, single-centre trials. Never use it instead of treatment.
• Children. Trials at 100 mg a day reported no side effects, but they were medically supervised studies in specific conditions.
• Premature and very low birthweight babies. This is for hospitals, not the shop shelf. In one trial of 2,203 babies there were 16 serious side effects on lactoferrin against 10 on control, and two of them were assessed as possibly related.
• High doses. Schedule 1 sets no daily limit. The highest published adult safety data is 3.4 g a day for 28 days, where antibodies against lactoferrin rose about threefold, with no side effects found.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.