Dexin infant formula manufactured by Burroughs Wellcome & Company, screenshot from Etsy website
“… but if your lives were embittered as mine is by seeing day after day this massacre of the innocents by unsuitable feeding, then I believe you would feel as I do that misguided propaganda on infant feeding should be punished as the most criminal form of sedition, and that these deaths should be regarded as murder.” ---Dr. Cicely Williams, was speaking at the Rotary Club in Singapore in 1939 in front of the local president of Nestle. https://everything.explained.today/Cicely_Williams/
Many books on breastfeeding have the Cicely Williams’ quote from her 1939 speech at the Rotary Club in Singapore, yet all her papers now reside in the UK Wellcome Collection archive. Dr. Cicely Williams is an example of speaking truth to power. She was born in Jamaica, and lived from 1893-1992. During WWII she was held in a Singapore Japanese internment camp along with a number of mothers and babies. Through her influence all the babies at that camp were breastfed, and survived despite the starvation conditions the mothers and Dr. Williams faced in the camp. Dr. Williams was also tortured, and nearly died from the malnutrition she experienced. After her death her family gave the Wellcome Collection 56 boxes of her papers as well as 2 outsized folders of documents. The Wellcome Collection is an archive of documents derived from Burroughs Wellcome & Company and the Wellcome Trust. https://wellcomecollection.org/works/fy2n52en
Burroughs Wellcome & Company manufactured an infant formula called Dexin from 1932-1992. How ironic that a company that manufactured infant formula during Cicely Williams’ lifetime has ownership of all her papers. https://wellcomecollection.org/works/ndxuvvxy
It appears to me that while membership is free to the Wellcome Collection, access to documents in the collection would be difficult for those who live outside of the UK. The Wellcome Collection states the following, “Our collections were first assembled in the early 20th century, following a racist, sexist, ableist system of cultural hierarchies. We have begun to change the ways we manage and use our collections.”
Besides her stance on infant formula, Dr. Cicely Williams named and described a severe form of malnutrition that young children suffered in what is now called Ghana. The young children had sufficient calories but not enough protein. She named the protein deficiency of young children, Kwashiorkor. Among the people who lived in Ghana it was described as the “disease of the deposed child.” A new baby is breastfed, while the weaned, older child may suffer from not having enough protein foods because of famine conditions within a society. https://hekint.org/2017/01/28/cicely-williams-and-kwashiorkor/
The understanding of breastfeeding and its importance to babies and young children’s health and survival is still so little understood. Corporations continue to globally influence infant feeding decisions that ultimately influence morbidity and mortality of babies and children. Advertising is one of the ways in which parents are influenced. With the internet, advertising has become world-wide.
New research on human milk appears to be overturning long held evidence in the science of breastfeeding. A lot of the new research is funded by the infant formula industry and the breast pump company, Medela. New knowledge or evidence that overturns old knowledge or evidence may very well be correct. But corporate funding of the new knowledge calls into question whether the new knowledge on breastfeeding/human milk is slanted towards making profits from products rather than increased understanding of breastfeeding.
For example, it seems little understood by environmental researchers on toxic chemicals in human milk that US infants not only breastfeed and/or receive human milk in a bottle; but are often given infant formula, water, other drinks, and even solids before 6 months. According to the US CDC National Immunization Survey for the year 2018, 46.3% of US moms were exclusively breastfeeding at 3 months postpartum; and at 6 months postpartum only 25.8% were exclusively breastfeeding. Exclusively breastfeeding was defined as “only breast milk—no solids, water or other liquids.” Breastfeeding mothers who supplemented with infant formula (with or without other supplemental liquids or solids) before 3 months were 31.3% and before 6 months were 35.8%. Breastfeeding at birth was 83.9%. Thus according to these statistics some 31%-36% of breastfed infants are also getting infant formula. So why are there so few studies on PFAS chemicals in baby formula? https://www.cdc.gov/breastfeeding/data/nis_data/results.html
Just measuring toxic chemicals in human milk tells us very little about the health risks of these chemicals to infants. Why? Because most infants under 1 year get a variety of drinks (infant formula, water, juice, soda) and foods besides human milk. Revelations in the media regarding toxic chemicals in breastmilk cause parental fear of breastfeeding and human milk, based on research that is a partial understanding of the risks.
I am not sure how accurate the CDC statistics are because a mom’s recall of information regarding infant feeding is often inaccurate. In my IBCLC practice I had moms who told me they were exclusively breastfeeding their babies. But when I did a home visit, they had infant formula on the counter. Some moms say what they think you, the interviewer, want to hear. I did a home visit with a mom whose husband was a doctor, and he wanted her to breastfeed. She didn’t want to, and they compromised with her pumping and bottlefeeding her milk. Bottlefeeding human milk exposes babies to ingestion and inhalation of various plastic chemicals. On the other hand in comparison to plastic bottles and nipples, the breast is an eco-friendly container! Researchers doing environmental studies on human milk need to consider the variety of ways mothers feed their babies. Human milk is only part of the picture of infant feeding exposure to toxic chemicals.
A Questionable Research Paper
Let’s look at a recent (2020) paper that is used as a reference to a research paper on a infant’s exposure to PFAS chemicals in breast milk. The paper’s title is “Nutritional and Non-nutritional Composition of Human Milk Is Modulated by Maternal, Infant, and Methodological Factors.” There are six authors. Four of the authors are or were employed by Nestle Nutrition. One author, Valerie Verhasselt received funding from Nestle Nutrition, but also is the 1st Chair in human lactology in biochemistry at the University of Western Australia through an endowment of AUD 8.6 million from the Family Larsson-Rosencrist Foundation. Two of the authors received speaking fees from Medela. Funding for the research was provided by the Nestle Foundation. https://www.frontiersin.org/articles/10.3389/fnut.2020.576133/full#T3
The authors of this paper did a literature review of maternal, infant, and methodological factors that varies human milk composition and volume. They state, “Maternal diet is an important factor that influences the volume and composition in human milk.” The statement has no footnote and I assume this is the authors’ conclusion. Another research paper entitled "Exposure to per- and polyfluroalkyl substances associated with an altered lipid composition of breast milk" uses their paper as evidence that maternal diet in a breastfeeding mother is influential to milk production and composition. While I would not dispute that a mother’s diet somewhat impacts the composition of human milk (DHA/ARA fatty acids, some vitamins), I would say that there is evidence that the volume of milk is only impacted by maternal malnutrition/starvation. There is plenty of evidence that mothers in concentration camps during WWII who were able to have babies despite the starvation conditions in those camps; were able to breastfeed and keep their babies alive.
Dr. Ruth Lawrence in the “9th Edition Breastfeeding: A Guide for the Medical Profession” (2020) discusses the factors that influence the volume of milk. She states, “Any factor that influences the frequency, intensity, or duration of suckling by an infant influences the volume.”(pg.248) In the Darling Study by KG Dewey et al in 1991, It states, “The results suggest that infant demand is the main determinant of lactation performance in populations such as this.”
Why is this a important issue? If diet is an important factor on the volume and composition of human milk, then maternal diet becomes the focus of fixing the problem of PFAS chemicals. We know from past history of breastfeeding promotion that some mothers who believe that they have to be on special diets to breastfeed do not breastfeed. I think we need to be very sure of the evidence that it is maternal diet that impacts PFAS chemicals in human milk.
The infant formula industry is also involved in the manufacture and sale of supplements for infants and breastfeeding mothers. Research that shows that maternal diet is deficient or influences the amount of PFAS chemicals in breast milk is financially lucrative to the supplement industry, and ultimately to the sale of infant formula. The following infant formula companies also own vitamin/supplement companies: Abbott, Bayer, Nestle Health Sciences (had the most vitamin/supplement companies), Reckitt Benckiser (Mead Johnson). https://drnealsmoller.com/rant/the-14-mega-corporations-that-own-your-supplement-brand/
This study on maternal diet’s influence on milk volume and compositions was a literature review. There are 274 references/footnotes. Yet the paper left out the following references in their literature review or having read the research decided not to use the following information.
The fat content of human milk is the most variable component, “varying in concentration over a feeding, from breast to breast, over a day’s time, over time itself, and among individuals.” (Lawrence, Ninth Edition Breastfeeding: A Guide for the Medical Profession, 2020, page105)
According to the 1997 Breastfeeding Answer Book edition, “Research from developing countries and other parts of the world indicates that even mothers who are mildly malnourished produce plenty of good quality milk for their babies and that only under famine or near famine condition will a mother’s nutrition affect her milk supply or the composition of her milk. (Perez-Escamilla 1995; Prentice 1994)” pg.372
Breastfeeding and Human Lactation, 2nd edition by Riordan & Auerbach (1999) states, “Worldwide studies, considered together, support the idea that maternal nutrition has only a modest effect on milk production and milk composition.” pg. 515
Ninth Edition Breastfeeding: A Guide for the Medical Profession (2020) states, “The quantity of breast milk produced can be affected by maternal dehydration (when severe, >10% weight loss) or severe maternal malnutrition, but the quality of breast milk as adequate nutrition for the infant is maintained.” Pg.247
Should we accept that the newer research is the more accurate research? How influential are these two corporations, Nestle and Medela, in this research paper? The paper never mentioned an infant’s suck as critical to milk volume and composition. Either they dismissed the past research as irrelevant, or they never looked at this particular research. If the infant is the driver of volume and composition, then we cannot always believe that mothers are responsible for a low milk supply. Rather health care providers must take into account the health of the infant, an infant’s suck, and the frequency and length of feeds. Who makes money when mothers’ believe that their diet is one of the most important aspects of breastfeeding success? Who makes money when the focus of a low milk supply is to change the mother’s diet and purchase a pump; rather than evaluating the health of the infant, and encouraging the mom to increase the frequency and length of breastfeeding?
Copyright 2021 Valerie W. McClain
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