How what is good about breastfeeding is made bad (Part 1)

Many physicians as well as anti-breastfeeding activists manage to turn logic on its head and push the notion that what is good about breastfeeding is, in fact, bad for the mother or baby. Two examples follow.

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1. Breastmilk contains antibodies that protect the baby against infection

Unlike what many people, including many physicians, think, breastmilk has many, diverse immune factors, not only antibodies, that help to protect the baby against infection. The fact that even exclusively breastfed babies sometimes get infections often is taken as “proof” that breastmilk does not really offer much protection in “first world societies”. That, of course, proves nothing at all, since no measure of protection is perfect.  And, it should not be forgotten that while breastfed babies are actively protected, formula fed babies in affluent societies are protected because the are “cloistered”.

However, the formula “pushers” forget that we have our own “third world” even within some of the wealthiest countries of the world; in the slums of the cities, in some areas of the countryside, and in the first nations reserves, in Canada, the USA, Australia and South America.

Breastmilk contains many immune factors, dozens in fact, working together, helping to protect the baby against infection. As mentioned above, antibodies represent just one of these factors.

One important way, but not the only way, breastmilk actively protects the baby is by forming a barrier of immune factors on the linings of the digestive tract and respiratory tract that blocks bacteria, viruses and fungi from entering the baby’s body (anything inside the digestive tract or respiratory tract is considered outside the body). The vast majority of antibodies in the milk are called sIgA (“secretory” IgA, made up of two molecules of the antibody IgA, with an added secretory chain which allows the molecule to get into the milk and a J chain which protects the molecule from digestion by gastric and intestinal enzymes). The sIgA molecules make up one component of this protective barrier, but the barrier is made up also of lactoferrin, lysozyme, mucins and others; however, the sIgA antibodies do not get absorbed into the baby’s bloodstream. Some people who do not know what they are talking about have said (and even written in books) that breastmilk antibodies can protect the baby only against infections of the intestinal tract (gastroenteritis which causes vomiting and diarrhea) because the antibodies don’t get into the baby’s bloodstream. But obviously they don’t know how this barrier works. Clearly, it is better to prevent the bacteria, viruses and fungi from getting into the baby’s body in the first place rather than fight them off once they have invaded into the baby.

Mothers with autoimmune diseases are often told they cannot breastfeed

Many mothers who have conditions caused by antibodies against their own tissues (Graves’ disease, Hashimoto thyroiditis, lupus erythematosus, idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, rheumatoid arthritis and others) are told that they should not breastfeed because the antibodies causing their disease will get into the milk and cause the same disease in the baby.

This is simply not true. First of all, the sIgA, which is the main antibody in breastmilk, making up at least 95% of all the antibodies in the milk, does not get absorbed from the baby’s intestinal tract, therefore, cannot get into the baby’s body and cause disease. Secondly, the antibodies that cause diseases such as rheumatoid arthritis are not of the IgA type and, in any case, they would not get into the milk in any but insignificant amounts. Even if they did, they would be destroyed in the baby’s stomach (sIgA does not get destroyed because it has that J chain which protects it from digestive enzymes). And even if the antibodies causing autoimmune diseases somehow did get past the digestive enzymes, they also would not be absorbed into the baby’s body.

So, if the mother has a condition in which antibodies in her body attack her own tissues, the mother can and should breastfeed her baby with confidence that she is doing the best for her baby and not worry about the antibodies getting into the milk and causing a problem for the baby.

But the baby could be born with the same problem!

True, in conditions such as those mentioned above, the baby is often born with the same problem as the mother. For example, a baby whose mother has idiopathic thrombocytopenia purpura (where the mother has low platelets caused by antibodies against platelets, thus causing them to be destroyed) will often be born with low platelets as well, since the mother’s antibodies passed through the placenta to the baby during the pregnancy, but the antibodies do not come from breastmilk. This is obvious because the platelet count is easy to measure, a routine part of the blood count along with hemoglobin, hematocrit and white blood cell counts. The baby’s low platelet count can be present for a few weeks after birth, but only rarely is the platelet count so low as to cause a real risk of bleeding. With time, usually by six or eight weeks after the baby’s birth, the platelet count of the baby will be rising since the antibodies will be disappearing from his blood.

Another situation in which the problem is easy to measure occurs when the mother has autoimmune hemolytic anemia, a condition due to antibodies against her red blood cells, resulting in anemia. The baby can be born with his red blood cell count low because of the antibodies that passed into his body during the pregnancy through the placenta. Both idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia almost always improve without specific treatment unless the baby’s platelets, in the one case, or the red blood cells, in the other, are very low and require transfusion, which is only rarely necessary.

Yet another situation occurs when the mother has Graves’ disease which causes hyperthyroidism (overactive thyroid). The antibodies in the mother’s blood cross the placenta, as with the other conditions discussed above and the baby is born with signs of hyperthyroidism; rapid heart rate (over 160/minute), jitteriness, high blood pressure and even congestive heart failure if severe.  Poor weight gain may also occur. Treatment of the baby’s symptoms is possible with drugs that block the effect of the overactive thyroid. But again, there is no reason to restrict breastfeeding.

In some rare cases, however, the baby continues to have the above problems much longer than the usual 6 to 8 weeks. It seems very unlikely that this is due to the continued presence of antibodies from the pregnancy which disappear from the baby’s blood within the first few weeks at most, and as mentioned above, impossible to explain to be due to antibodies in the milk. More likely, there are cytokines, small proteins that can affect immune responsiveness in the baby.

A prolonged effect on the blood cells or platelets as well as other such syndromes, longer, say, than two to three months is unusual, even rare, and no reason to tell the mother not to breastfeed from birth as is often done. Should prolonged low platelets or low hemoglobin or other syndrome occur, more than 3 or 4 months, despite treatment such as transfusion or oral corticosteroids in the baby, stopping breastfeeding may be considered. It should be pointed out that low platelets, unless very low, are not usually associated with a high risk of bleeding.

2. Breastmilk varies from woman to woman, from the beginning of the feeding to the end of the feeding, from morning until night, according to what the mother might have eaten, from early in lactation (colostrum), to later in lactation. In other words, the milk changes according to the needs of the child. Because of this, some people begin to have some strange ideas.

This variation in the composition of breastmilk is good, not bad. It means that breastmilk changes in response to the needs of the growing baby and his individual needs. But how have we turned this into something bad?

Breastmilk from a mother breastfeeding a baby of a certain age is not appropriate for a baby of another agea

How absurd is that?

We receive emails, not rarely, asking, for example, if a mother can use breastmilk from her sister who is breastfeeding a ten month old. Her own baby is only 3 months old and is not getting enough milk from her breast. “Would her sister’s milk be okay for her 3 month old baby or should she supplement with formula instead?” Such questions come not only from mothers but also from lactation consultants. Many doctors, with rare exceptions, do not bother to ask. They just tell the mother it’s not okay, without thinking about it. There are ways, incidentally, of increasing the breastmilk production of mother of the three month old.

The question speaks volumes about the pernicious effectiveness of formula company marketing. However, let’s think about this for just a minute. A given brand of formula doesn’t change at all, assuming it was prepared according to directions. How is this better? If a baby requires different breastmilk for a different age, formula, which doesn’t change at all, how is it somehow appropriate for babies of all ages? The formula “recommended” for a 2 day old, 2 week old, 2 month old is the same, identical. Formula, if we look at it biochemically, is nothing like any breastmilk, whether the breastmilk is from a mother breastfeeding a 2 day old, a 2 week old, a 2 month old, or a 2 year old. “Followup formulas” also called “toddler formulas” which are almost completely unnecessary products except for the bottom line of the formula companies, do not get around this problem, as they are the same whether for a baby of 6 months or 12 months or 36 months.

Breastmilk sharing

Even pediatricians are ready to make absurd statements about the need for breastmilk to be “appropriate for the age of the baby” (not surprising as most have had nothing useful about breastfeeding in their training). Here is part of a statement from the Professional Association of Pediatricians with regard to breastmilk sharing (as reported in the Daily Mail October 17, 2012): “It (the Professional Association of Pediatricians in Germany) also warned that a newborn’s nutritional needs differed from those of a baby even of several weeks or months old. The milk of a woman who already has an older child does not contain the right nutrient composition for a newborn, it added, and said women who were unable to breastfeed should use…” One is left perplexed and unable to comment at the absurdity of this statement.  So, formula which does not change with time, is better for the baby than breastmilk which does change with time.  The mind boggles.

Breastmilk banking

Many breastmilk banks will not accept milk from mothers breastfeeding a child older than 6 months, apparently for the same reasons as above. This is a terrible waste of potential donations. It is often the mother who is breastfeeding a toddler who can most easily express milk for donation.

If there is no breastmilk available in the breastmilk bank, then a baby requiring supplementation would receive formula, and this is true whether the baby is a week old or 6 months old or 8 months old. The same formula, presumably chemically the same for all ages. How does this make sense?

It doesn’t make sense. What does this tell us about how we view breastmilk and how we view formula? It says a lot. We believe that breastmilk is intrinsically hazardous while, at the same time, that formula is intrinsically safe. No matter how different formula is from breastmilk, we, as a society, as medical professional organizations, accept, somehow, that formula is superior to the breastmilk of a mother whose baby is of a different age than the possible recipient baby.

Of course, this can only be due to our love of and blind acceptance of “science”, even though the “science” is to often formula company marketing and not based on science at all. See the formula company ad below, with all the meaningless lines to make the ad look scientific. It’s an old ad, from the 1990s, when formula did not yet contain so many of the important ingredients the formula companies now tell us, indeed, warn us, are necessary for the baby’s proper development, but apparently didn’t need in the 1990s. And which now make formula almost exactly like breastmilk (even if formula does not change).

"Scientific" ad for formula

This ad for a formula published in the 1990s is trying to convince us that their formula is based on science. The lines on the ad have this intention, but in fact are nothing but tangents to various circles. Meaningless.














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Copyright: Jack Newman, MD, FRCPC, Andrea Polokova, 2017, 2018