Successful Breastfeeding
...And Successful Alternatives
By Sally Fallon and Mary G. Enig, PhD
Breastfeeding is best. Breast milk is nature's perfect food for babies. Breast milk contains special substances that give the growing baby immunity to infection and disease. Breastfeeding bonds a mother to her baby, stimulates important hormonal activities in her body, helps her lose weight after pregnancy and protects her against future breast cancer and osteoporosis.
Breastfeeding is best. . . in a perfect world. But the world is not perfect and self-evident statements are not always true. Breastfeeding advocates argue that breast-fed children have lower mortality rates and better levels of health than formulafed children. In third world countries, where the cleanliness needed for safe bottle-feeding is lacking, this is undoubtedly true. But a perusal of recent studies comparing breastfed and formula-fed infants presents a real dilemma for breastfeeding advocates because the research does not provide a clear case of benefit.
DISTURBING STUDIES
A study published in July, 2001, for example, found that breastfed children in Japan had more asthma than bottle-fed infants.1 A European study found that breastfeeding was not related to iron status in one-year-old children. Those with the best iron status were those who received iron-fortified formula.2 A Swedish study found that breast fed infants were just as likely to develop childhood cancer compared to formula-fed babies.3 In fact, babies breastfed for one month or more had a higher risk of non-Hodgkins' lymphoma, although this finding was based on low numbers of cases. A study from Norway found that breastfeeding did not provide protection against frequent ear infections.4 A report in Pediatric Clinics of North America noted that many breastfed babies suffer from failure-to-thrive and dehydration.5 The author warned: "Those who enthusiastically promoted breastfeeding for its many health benefits must confront the reality of breastfeeding failure and implement necessary changes in medical education and support services to foster successful outcomes in breastfed infants."
Only one study carried out during the past two years found a clear-cut benefit for breastfeeding. Researchers at the Harvard Medical School found that children who were breastfed we much less likely to be overweight as adults.6
Studies on the relationship between breastfeeding and cognitive skills are mixed.7 Some studies have shown that breastfed infants are more intelligent while others show no difference. Critics contend that better cognitive scores in breastfed infants are due to the fact that mothers with higher levels of educational attainment are more likely to breastfeed.
Formula manufacturers are quick to use the lackluster performance of breastfed children as proof that formula is "just as good" as breast milk. Breastfeeding advocates retort that the studies were designed to give results that benefit the formula makers. Our interpretation is the following: the diet of modern American women is so appalling, and their preparation for successful breastfeeding so lacking, that their breast milk provides no better nourishment for their infants than factory-made formula.
DOES DIET MATTER?
"Breastfeeding mothers do not need to worry about their diets. As long as they are getting enough calories, their milk will be fine." This is the dogma of most of the groups promoting breastfeeding throughout the world. "The message that diet has an influence on milk quality will discourage mothers from breastfeeding," they say.
Typical advice to pregnant women is as follows: "Include fruits, vegetables, grains, meat or meat alternative and lowfat milk products in your diet every day. Avoid caffeinated beverages and alcohol." Lactating women are advised to eat "vitamin-A rich foods" such as "carrots, spinach, sweet potatoes and cantaloupe." Above all, say the "experts," don't worry too much about what you eat. "Your diet does not have to be 'perfect' to nourish your baby well."8
Lactation consultants cite one study that found no difference in levels of several factors between "well-nourished" and "undernourished" mothers. These factors were the immune-protecting compounds sIgA, lysozyme and lactoferrin.9 We are tempted to ask how researchers with such an abysmal knowledge of nutrition—promoting lowfat milk as nutritious, meat alternatives as the equivalent of meat, and vegetables as a source of vitamin A (which they are not)—how such researchers could be trusted to know the difference between "well-nourished" and "undernourished" mothers?
But even if there is little variation in certain immune factors as claimed, there can be huge variations in other nutrients depending on what the mother eats.
LONG-CHAIN FATTY ACIDS
Mother's milk contains long-chain polyunsaturated fatty acids (LCP) that the baby needs for the development of its nervous system. These special fats accumulate in the brain and retina. If they are absent in the infant diet, the child is likely to suffer from learning disabilities and reduced visual acuity.10 The most important LCP's are arachidonic acid (AA) of the omega-6 family, docosahexaenoic acid (DHA) of the omega-3 family and eicosapentaenoic acid (EPA), also of the omega-3 family. (For more information on long-chain fatty acids, see "Tripping Lightly down the Prostaglandin Pathways.")
The LCP composition in the tissues of growing infants is largely determined by the LCP content of the milk that the baby consumes. The recognition that these LCPs are vital for the optimal development of the infant has led to efforts to mandate their inclusion in commercial formula—as is done in other countries, notably Japan. Formula manufacturers have resisted because the fatty acids add considerably to the cost of making the formula and also require special handling to prevent oxidation. However, so compelling is the research that on July 16, 2001, the US Food and Drug Administration approved the addition of two fatty acids derived from blue-green algae to infant formulas.
What is less well known is that the levels of LCPs in human breast milk greatly depend on the mother's diet. An important 1997 study compared the fatty acid composition of breast milk of mothers in two Chinese provinces with that of Canadian mothers.11 Mothers in the traditional province of Chongqing had higher levels of milk fat than those from westernized Hong Kong, and higher levels of AA, due to a special period of feeding for the first four weeks after the birth of the baby during which Chongqing mothers consume up to ten eggs per day and large amounts of chicken and pork. The diet of Hong Kong mothers was much lower in fat and calories, but because of high fish consumption, their levels of DHA were as high as those of Chongqing mothers. But breast milk levels of AA and DHA in both provinces were much higher than those of Canadian mothers.
The Chinese breast milk study proves that the levels of important fatty acids in mother's milk are strongly influenced by the mother's diet. For example, the content of erucic acid (a long-chain monounsaturated fatty acid) increased in the milk of Chongqing mothers during the later weeks of lactation, reflecting a dietary switch from animal fats to rape seed oil. Levels of omega-6 linoleic acid were high in the milk of Hong Kong mothers, reflecting their use of high-omega-6 vegetable oils derived from corn and soy.
Ideal breast milk contains high levels of both saturated fats and LCPs. This can be accomplished by consuming high levels of animal fats plus eggs, cod liver oil and oily fish throughout the lactation period. Saturated fats in mother's milk stimulate the immune system and work synergistically with LCPs to maintain them in the tissues where they belong.12 Levels of fat in a mother's milk will decrease with each baby unless she takes special care to consume high levels of nutrient-dense fats between pregnancies and during each lactation.13
VITAMINS AND MINERALS
A recent study found that breast milk did not meet the minimum requirements for many nutrients.14 Vitamin D was especially low. A study in Nigeria found that calcium and potassium levels in human milk varied by a factor of 2, magnesium and copper by a factor of 3, chloride levels by a factor of 4, iron and selenium by almost 5, iodine and sodium by almost 7, and zinc, which is vital to the nervous system, by over 7.15 In other words, some mothers had seven times more zinc in their milk than others.
Another survey found large variations in the levels of B vitamins.16 Vitamin B6 concentrates in breast milk and B6 requirements are increased in lactating women.17 More B6 is required if the woman is exercising—an important reason for adequate rest during the nursing period. The same study found that vitamin C ranged from 0 to 11.2 mg per 100 grams and vitamin A from 15 to 226 IU.
Vitamin A is vital for the development of the infant. Vitamin A is found only in animal fats. Mothers can convert some of the precursors in fruits and vegetables into true vitamin A and these will then show up in her milk, but adequate supplies can only be met with consumption of animal foods rich in the true form of this nutrient.18 A 1992 study carried out in Indonesia found that mothers who received vitamin-A supplementation had higher levels in their blood and milk than those who received a placebo and the infants of the supplemented group were less likely to be vitamin-A deficient.19 Deficiency was measured by the presence of conjunctivitis in the eyes. Incidence of conjunctivitis fell in infants nursing from mothers taking a vitamin-A supplement. The authors noted that vitamin-A status was lowest in women who were thin and who had had many babies—a warning not to lose weight too quickly after birth of a baby and to put sufficient space between children so that vitamin-A stores can be rebuilt.
Adequate B12 is essential for the development of the infant. One study found a B12 deficiency in a breastfed infant of a strict vegetarian.20 Another found lower levels of long-chain polyunsaturated fatty acids in the blood of babies born to vegetarian women.21
While protein levels in human milk remain constant at about 11 percent under various conditions, levels of fat and lactose—both essential for the development of the nervous system—vary widely.22 Even the various anti-inflammatory and antibacterial compounds in a mother's milk vary markedly according to her diet.23
TRANS FATS. . . AND OTHER BAD THINGS
Trans fats from partially hydrogenated vegetable oils are present in margarine, shortening and many processed foods. The accumulated evidence is that trans fats are bad news indeed. They interfere with many enzymatic processes, cause reduced learning ability, disrupt the endocrine system, and contribute to allergies, asthma and many other diseases.24 (However, small amounts of one form of trans fats naturally occurring in butterfat are not harmful.)
If exposure to trans fats is bad for adults, it is even worse for babies and children during their growing years. Formula makers know better than to put trans fats into baby formula—yet human milk will contain high levels of trans fats if the mother consumes margarine, fried foods and commercial baked goods. The Chinese study found that Canadians had 33 times more trans fats in their milk than the traditional Chongqing mothers who did not consume processed foods! Hong Kong mothers had four times more trans fats in their milk than the Chongqing mothers, reflecting the inroads that processed foods have made in westernized Hong Kong.
Many other bad things can end up in mother's milk, including pesticides, mercury (from amalgam fillings), and high levels of phytoestrogens, if the mother eats a lot of soy. (However, phytoestrogens in the milk of mothers who eat a lot of soy is still about 3000 times less than levels in soy-based formula.25)
One study discovered peanut proteins in mother's milk and warned that lactating women who eat peanuts may cause peanut allergies in their infants!26 Even mother's milk can cause allergies.
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