Children who eat 'proper food' from infancy do not develop enlarged tonsils, adenoids or appendicitis; formula milk and infant cereals are the reason children need these operations.
Original statement
موضوع بقى الالبان الصناعي والسريلاك وكل ده زباله عشان كده العيال كلها في سن خمس سنين يجيله لحميه ولوز وزايده وشيل يا معلم
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Children who eat 'proper food' from infancy do not develop enlarged tonsils, adenoids or appendicitis; formula milk and infant cereals are the reason children need these operations.
Origin
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! انتاج الطاقة مرتبط بانتاج الجذور الحرة (Open source)
- Published
- 14 September 2025
- Timestamp
- 0:26:00 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
- Claimed mechanism
Wrong food causes lymphoid tissue disease.
- Claimed health effect
Tonsil/adenoid hypertrophy, appendicitis.
- Population concerned
Children
- Geographic restriction by Elawady
none found
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! الدراسات اللي ينشرها لمعرفة مدي تخبط الطب حتي ٢٠٢٥ (Open source)
- Published
- 26 July 2025
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
Scientific assessment
Unclear / insufficient evidence – The data do not allow an assessment either way.
Certainty of evidence: very low – Any assessment is very uncertain.
1. What was claimed?
Diet from infancy prevents these diseases; formula causes them.
2. What is demonstrably correct?
Breastfeeding is recommended and protects against childhood infections (I-INTC-14). A small study found that children breastfed for longer had appendicitis less often than their siblings (I-INTC-12).
3. What is wrong or exaggerated?
The claim that 'all children' develop enlarged tonsils, adenoids or appendicitis because of formula and infant cereals is not supported. In one large clinical study of referred snoring children, breastfeeding was associated with sleep apnoea, a main reason for adenotonsillectomy (I-INTC-13); that study compared breastfeeding with no breastfeeding (not formula or infant cereals specifically), measured sleep apnoea rather than tonsil or adenoid size or surgery, and used a highly selected sample, so it limits the claim but does not show that formula does not cause adenotonsillar hypertrophy.
4. What remains unclear?
Whether infant feeding has a causal effect on appendicitis or adenotonsillar hypertrophy is unknown; the available studies are small or confounded, and no study of infant cereals was found.
5. Which studies support it?
I-INTC-12 (weak association between breastfeeding and less appendicitis); I-INTC-14 (fewer infections with breastfeeding; surgery not addressed).
6. Which studies contradict it?
I-INTC-13 (breastfeeding associated with OSAS in a clinical sample, likely confounded); I-ORG-06 (tonsillectomy indications based on infection frequency and documented sleep apnoea).
7. What applies to Germany and Europe?
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
8. What is known about Egypt?
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
9. What practical conclusion is appropriate?
No conclusion possible; the claim is unproven.
Assessment details
- Rationale for certainty of evidence
A targeted search found only indirect or weak evidence. One small sibling case-control study associated longer breastfeeding with less appendicitis (I-INTC-12). Breastfeeding protects against childhood infections, but surgical outcomes are not addressed (I-INTC-14). In a large clinical sample, breastfeeding (not formula) was associated with childhood sleep apnoea, a main indication for adenotonsillectomy, probably due to confounding (I-INTC-13). Indications for tonsillectomy are defined by infection frequency and documented sleep apnoea (I-ORG-06). No study supports the claim that formula or infant cereals are 'the reason' children need these operations.
- Source quality
Assertion without data.
- Regional transferability
n/a
- Individual exceptions
n/a
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Not supported by high-quality evidence – There is no good evidence for the claim; this alone does not prove it wrong.
Research question: In infants and children, does formula feeding or infant cereals (versus 'proper food' such as breastfeeding) cause adenotonsillar hypertrophy or appendicitis requiring surgery?
Research question in detail (PECO)
- Population
- Infants and children
- Intervention or exposure
- Formula milk and infant cereals
- Comparison
- Breastfeeding / 'proper food'
- Geographic scope
- universal biology; infant feeding practices vary by country
- Outcomes
- Adenotonsillar hypertrophy
- Snoring/OSA
- Appendicitis
- Adenotonsillectomy or appendectomy
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Breastfeeding and appendicitis
Alves JG et al.. Trop Doct 2008 · PMID 18820196 · DOI 10.1258/td.2008.070404 Case-control studyabstract checkedSmall sibling case-control study: longer breastfeeding associated with less appendicitis.
- Actual result
- Effect sizes not given in abstract.
- Methodological quality
- low (small case-control)
- Relevance
- indirect: breastfeeding vs not, not formula per se
- Limitations
- Recall bias; small.
Breastfeeding and snoring in children
Storari M et al.. Eur J Paediatr Dent 2021 · PMID 35034467 · DOI 10.23804/ejpd.2021.22.04.10 Systematic reviewabstract checkednewly addedSystematic review: breastfeeding associated with less habitual snoring.
- Actual result
- No pooled estimate in abstract.
- Methodological quality
- low (narrative SR of observational studies)
- Relevance
- indirect: snoring, not surgery
- Limitations
- Confounding; no meta-analysis.
What speaks against the claim?
Breastfeeding and adenoid size in preschool children
Zwierz A et al.. J Clin Med 2023 · PMID 38137751 · DOI 10.3390/jcm12247683 Case-control studyabstract checkednewly addedBreastfeeding duration was not associated with adenoid size in 145 preschool children.
- Actual result
- No effect on adenoid size; less snoring with >= 3 months.
- Methodological quality
- low (small case-control)
- Relevance
- direct for adenoid size
- Limitations
- Small clinic sample.
What is linked to sleep apnoea in children
Xu Z et al.. J Otolaryngol Head Neck Surg 2020 · PMID 32131901 · DOI 10.1186/s40463-020-0404-1 Cross-sectional studyfull text, structured risk-of-bias assessmentIn a large referred sample, breastfeeding was associated with more OSAS.
- Actual result
- OR 1.72 (1.26-2.36).
- Methodological quality
- low (cross-sectional, confounded)
- Relevance
- indirect
- Limitations
- Selected sample, likely confounded.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Breastfeeding has established benefits (fewer infections) and may be associated with less snoring, but no study shows that formula or infant cereals cause enlarged tonsils/adenoids or appendicitis, and the absolute statement that well-fed children 'do not develop' these conditions is unsupported.
Why some studies weigh more
Only small or confounded observational studies exist; none tested formula or infant cereals directly; no study measured surgery rates.
Is a causal relationship established? Not established No direct data; observational findings conflict.
Remaining uncertainty
Whether infant feeding influences adenotonsillar growth or appendicitis at all.
Justified conclusion
Unproven; breastfeeding is recommended for other reasons, and children with sleep apnoea, recurrent severe throat infection or suspected appendicitis need medical assessment regardless of diet.
Why do studies seem to disagree?
Storari 2021 (less snoring) and Xu 2020 (more OSAS with breastfeeding) answer different questions in different samples (general children vs referred clinic patients); snoring is not the same as adenoid size, which Zwierz 2023 found unrelated to breastfeeding. Pitesa 2025 concerns adult/population diet and fibre, not infant feeding.
Does this depend on the country?
- General biological effects
- Adenotonsillar growth in early childhood is physiological; appendicitis occurs in all feeding groups.
- Eating habits
- Infant feeding practices differ between Egypt and Europe, but no data link them to these operations.
- Origin of the food
- Not applicable.
- Contaminants
- Not applicable.
- National production conditions
- Not applicable.
- Legal rules
- Not applicable.
- Actual monitoring data
- No Egypt-specific monitoring data identified.
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- Pooled fibre difference significance and heterogeneity – MD -4.53 g (95% CI -10.98 to 1.94) crosses zero; I2 98.3% - no reliable pooled effect not recalculable from the published data
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Adenotonsillectomy/appendectomy by infant feeding type
- Starting level
- low (observational studies)
- Reasons for downgrading
- risk of bias
- indirectness (no study of formula/infant cereals or of surgery)
- inconsistency
- Result
- very low
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- AAO-HNS Foundation: Clinical Practice Guideline: Tonsillectomy in Children (Update) (2019) · Original publication
Strong recommendation for watchful waiting for recurrent throat infection below 7/5/3 episodes per year in the past 1/2/3 years; modifying factors may favour surgery; polysomnography before tonsillectomy for obstructive sleep-disordered breathing in high-risk children; tonsillectomy is a treatment option for obstructive sleep-disordered breathing with tonsillar hypertrophy (abstract key action statements; registered as I-ORG-06).
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | (breastfeeding OR "breast feeding" OR "breast-feeding" OR "formula feeding") AND (TITLE:appendicitis) | supporting evidence | 40 | |
| Europe PMC | 26 October 2026 | (breastfeeding OR "breast feeding" OR "breast-feeding" OR "formula feeding" OR "infant feeding") AND (TITLE:tonsillectomy OR TITLE:adenotonsillectomy OR TITLE:adenoidectomy OR TITLE:"adenoid hypertrophy" OR TITLE:"adenotonsillar hypertrophy") | supporting evidence | 36 | |
| Europe PMC | 26 October 2026 | (breastfeeding OR "breast feeding") AND (TITLE:"sleep-disordered breathing" OR TITLE:snoring OR TITLE:"sleep apnea") AND children AND (TITLE:"meta-analysis" OR TITLE:"systematic review" OR cohort) | both directions | 47 | |
| PubMed | 26 October 2026 | (breast feeding[tiab] OR breastfeeding[tiab]) AND appendicitis[tiab] AND (meta-analysis OR cohort) | supporting evidence | 1 | |
| Europe PMC | 26 October 2026 | (TITLE:appendicitis) AND (diet OR "dietary fibre" OR "dietary fiber" OR "infant formula") AND (cohort OR "case-control") | both directions | 149 | |
| Europe PMC | 26 October 2026 | (TITLE:"infant formula" OR TITLE:"formula feeding" OR TITLE:"formula-fed") AND (TITLE:tonsil OR TITLE:adenoid OR TITLE:appendicitis OR TITLE:"sleep apnea" OR TITLE:snoring) | supporting evidence | 0 | |
| PubMed | 26 October 2026 | (adenotonsillar hypertrophy[tiab] OR adenoid hypertrophy[tiab]) AND risk factors[tiab] AND children[tiab] AND (breast* OR feeding OR diet*) | contradicting evidence | 14 | |
| PubMed | 26 October 2026 | (appendicitis[ti]) AND (breastfed OR breastfeeding OR breast-feeding) AND (risk[tiab]) | supporting evidence | 1 |
Open questions
Prospective birth cohorts with surgery outcomes by feeding type.
How deeply was this checked?
7 linked studies: 1 checked in full text (1 of them with a structured risk-of-bias assessment), 6 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Unclear / insufficient evidence (very low)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Unclear / insufficient evidence (very low)
Unchanged (“Unclear / insufficient evidence”, very low). New studies are small and indirect and point in different directions; no direct evidence on formula, infant cereals or surgery rates was found.
New sources: I-ORG-120 I-ORG-119 I-ORG-121
In plain language
Elawady said that formula milk and infant cereals are why children develop enlarged adenoids, tonsils and appendicitis. Breastfeeding has real benefits, such as fewer infections, and one small study linked longer breastfeeding to less appendicitis. But no study shows that formula is the reason children need these operations, and one large study even found sleep apnoea more often in breastfed children, probably for other reasons. The idea remains unproven.
Studies on this claim
Studies supporting the claim (0)
No studies in this group.
Studies contradicting or limiting the claim (3)
-
What is linked to sleep apnoea in children
Xu Z et al.. J Otolaryngol Head Neck Surg 2020 · PMID 32131901 · DOI 10.1186/s40463-020-0404-1Cross-sectional studyindependent cross-checkfull text, structured risk-of-bias assessmentEnlarged tonsils and adenoids, obesity and male sex were linked to sleep apnoea; breastfeeding was too, probably due to other factors.
Breastfeeding, not formula, was associated with OSAS in this sample (likely confounded).
Does the study support the specific claim? No · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Identify OSAS risk factors in children
- How was the study done?
Cross-sectional with sleep studies
- How many people, animals or samples were studied?
1578 children
- What was actually found?
Adenotonsillar hypertrophy, obesity, male sex, breastfeeding
- How large was the observed effect?
not reported
- What do the results mean in everyday life?
Formula feeding was not identified as the cause of enlarged tonsils.
- What are the study's limitations?
Confounding; clinic sample
- What does it say about Elawady's specific claim?
Does not support the formula claim
- Do the results apply to Germany and Europe?
Low
- What can explicitly not be concluded from this study?
Causation
-
US guideline on tonsil surgery in children
Mitchell RB et al.. Otolaryngol Head Neck Surg 2019 · PMID 30798778 · DOI 10.1177/0194599818801757Guideline / position statementindependent cross-checkabstract checkedWatchful waiting is recommended unless infections are very frequent; surgery is recommended for documented sleep apnea.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Indications
- How was the study done?
Guideline
- How many people, animals or samples were studied?
n/a
- What was actually found?
Clear thresholds
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Not every child needs surgery; some clearly do
- What are the study's limitations?
US
- What does it say about Elawady's specific claim?
Partly aligns
- Do the results apply to Germany and Europe?
Similar principles
- What can explicitly not be concluded from this study?
Individual decisions
-
Breastfeeding and adenoid size in preschool children
Zwierz A et al.. J Clin Med 2023 · PMID 38137751 · DOI 10.3390/jcm12247683Case-control studyindependent cross-checkabstract checkedLonger breastfeeding was linked to less snoring and fewer ear infections, but not to smaller adenoids.
Breastfeeding duration was not associated with adenoid size.
Does the study support the specific claim? No · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Relate breastfeeding duration to adenoid size and snoring
- How was the study done?
Case-control study
- How many people, animals or samples were studied?
145 Polish children aged 3-5
- What was actually found?
No effect on adenoid size; less snoring and AOM
- How large was the observed effect?
Snoring risk >4-fold with <3 months
- What do the results mean in everyday life?
Breastfeeding has benefits but does not seem to prevent adenoid enlargement
- What are the study's limitations?
Small, recall bias
- What does it say about Elawady's specific claim?
Contradicts the claim
- Do the results apply to Germany and Europe?
European
- What can explicitly not be concluded from this study?
Cannot prove causation
No study in this group is marked as key.
Studies with mixed or unclear results (4)
-
Breastfeeding and appendicitis
Alves JG et al.. Trop Doct 2008 · PMID 18820196 · DOI 10.1258/td.2008.070404Case-control studyindependent cross-checkabstract checkedChildren breastfed for longer had appendicitis less often than their siblings in one small study.
Weak association between less breastfeeding and appendicitis; not causation.
Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Test breastfeeding vs appendicitis
- How was the study done?
Sibling case-control
- How many people, animals or samples were studied?
200 cases, 200 siblings
- What was actually found?
Breastfeeding associated with protection
- How large was the observed effect?
not reported in abstract
- What do the results mean in everyday life?
A possible link, not proof.
- What are the study's limitations?
Small; recall; no numbers
- What does it say about Elawady's specific claim?
Weak partial support
- Do the results apply to Germany and Europe?
Low
- What can explicitly not be concluded from this study?
Causation; tonsil/adenoid outcomes
-
Benefits of breastfeeding
Victora CG et al.. Lancet 2016 · PMID 26869575 · DOI 10.1016/S0140-6736(15)01024-7Meta-analysisindependent cross-checkabstract checkedBreastfeeding protects children against infections and has other benefits; it is not shown here to prevent tonsil or appendix surgery.
Breastfeeding protects against infections, but surgical outcomes are not addressed.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Summarise effects of breastfeeding
- How was the study done?
Systematic reviews and meta-analyses
- How many people, animals or samples were studied?
Global
- What was actually found?
Fewer infections, other benefits
- How large was the observed effect?
823,000 deaths preventable per year (modelled)
- What do the results mean in everyday life?
Breastfeeding is beneficial; formula is not shown to cause surgery.
- What are the study's limitations?
Observational evidence; surgery outcomes not covered
- What does it say about Elawady's specific claim?
Supports only the general importance of infant feeding
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Tonsil/adenoid/appendix outcomes
-
Breastfeeding and snoring in children
Storari M et al.. Eur J Paediatr Dent 2021 · PMID 35034467 · DOI 10.23804/ejpd.2021.22.04.10Systematic reviewindependent cross-checkabstract checkedA review suggests breastfed children snore less, but the studies are observational and no numbers were pooled.
Breastfeeding linked to less snoring (weak); no data on surgery or on formula/infant cereals as a cause.
Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Review breastfeeding and childhood sleep-disordered breathing
- How was the study done?
Systematic review
- How many people, animals or samples were studied?
Not stated
- What was actually found?
Breastfeeding linked to less habitual snoring
- How large was the observed effect?
Not reported
- What do the results mean in everyday life?
Breastfeeding has benefits; it is not proven to prevent tonsil surgery
- What are the study's limitations?
Observational, no meta-analysis
- What does it say about Elawady's specific claim?
Weak partial support; does not show formula causes surgery
- Do the results apply to Germany and Europe?
Moderate
- What can explicitly not be concluded from this study?
Cannot show causation
-
Diet and appendicitis
Pitesa R et al.. World J Surg 2025 · PMID 41265933 · DOI 10.1002/wjs.70166Meta-analysisindependent cross-checkabstract checkedLow-fibre western diets may be linked to appendicitis, but the evidence is weak and inconsistent.
Weak signal that low-fibre western diets are linked to appendicitis; nothing on formula or infant cereals.
Does the study support the specific claim? Partly · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Review diet and appendicitis risk
- How was the study done?
Systematic review and meta-analysis
- How many people, animals or samples were studied?
21 studies
- What was actually found?
Possible link with low fibre; not statistically clear
- How large was the observed effect?
MD -4.53 g fibre (not significant)
- What do the results mean in everyday life?
Diet might matter but is not proven
- What are the study's limitations?
High risk of bias, heterogeneity
- What does it say about Elawady's specific claim?
Weak indirect support; not about infant formula
- Do the results apply to Germany and Europe?
Moderate
- What can explicitly not be concluded from this study?
Cannot show that diet prevents appendicitis
No study in this group is marked as key.
Regional context
Germany / EU
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
Egypt
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
- Antimicrobial use in food animals and antibiotic growth promoters
- Hormones in poultry, meat, milk and farmed fish
- Dioxins, PCBs and PFAS in eggs and other animal foods
- Aflatoxin M1 in milk and dairy products
- Drinking water quality
- Import controls and the meaning of RASFF notifications for Egyptian products
What applies in my country?
General scientific assessment
Unclear / insufficient evidence Unproven: breastfeeding is beneficial, but formula has not been shown to cause the need for tonsil, adenoid or appendix surgery.
The following areas of food safety are relevant to this statement:
- Veterinary medicines and antibiotics
- Hormonal growth promoters
- Contaminants (heavy metals, PFAS, PCBs, dioxins, nitrate)
- Mycotoxins (mould toxins)
- Controls, imports, recalls, labelling
Dairy
Choose a country to see the checked information for it.
Limits: legal rules describe what is allowed, not what every single food contains. Measurement data come from samples and are meaningful only together with their method details.
Country of residence or purchase Compare with another country
References
- Risk factors of obstructive sleep apnea syndrome in children.. Xu Z et al.. J Otolaryngol Head Neck Surg 2020 · PMID 32131901 · DOI 10.1186/s40463-020-0404-1
- Clinical Practice Guideline: Tonsillectomy in Children (Update).. Mitchell RB et al.. Otolaryngol Head Neck Surg 2019 · PMID 30798778 · DOI 10.1177/0194599818801757
- Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children.. Zwierz A et al.. J Clin Med 2023 · PMID 38137751 · DOI 10.3390/jcm12247683
- Does breast feeding provide protection against acute appendicitis? A case-control study.. Alves JG et al.. Trop Doct 2008 · PMID 18820196 · DOI 10.1258/td.2008.070404
- Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.. Victora CG et al.. Lancet 2016 · PMID 26869575 · DOI 10.1016/S0140-6736(15)01024-7
- Breastfeeding and sleep-disordered breathing in children: systematic review and proposal of underlying interaction models.. Storari M et al.. Eur J Paediatr Dent 2021 · PMID 35034467 · DOI 10.23804/ejpd.2021.22.04.10
- Revisiting Diet and Appendicitis: A Systematic Review and Meta-Analysis.. Pitesa R et al.. World J Surg 2025 · PMID 41265933 · DOI 10.1002/wjs.70166