"Young mother breastfeeding her son" by French artist Jules Breton
Living in a small town in Northern New York, near the Canadian border, there was not much to do on a Saturday afternoon. My girlfriend told me that there was going to be a party in a house outside of town. It was a small party with young men drinking beer, and watching football on TV. It was not the kind of party one would remember, just the usual small town party of men glued to the TV set, and women in the kitchen fixing food and talking. The party became memorable, when the hostess of the party asked those of us in the kitchen, if we wanted to watch her nurse her baby. We followed her into her bedroom. She closed the door for privacy, sat down on the bed, and opened her shirt to nurse her baby. It was a magical moment. Sunlight slowly danced across the shadows of the room, creating a vision of a baby and mother that seemed like a painting from 150 years ago. I had never seen a baby breastfeed. I had seen plenty of babies being bottle-fed. Bottle-feeding a baby seemed pretty boring compared to watching this baby breastfeed. After all, it was the 1970’s, breast and breastfeeding were not words often used in public. I remember feeling this sense of awe watching our hostess nurse her baby. I decided that if I ever had a baby, I would breastfeed.
Many years later, when I had my own babies, I realized I owed this mom and baby a debt of gratitude. I have never forgotten that first experience of watching a mother and her baby breastfeeding. Now I have many memories of breastfeeding my own children and watching my grandchildren nurse. As a retired La Leche League leader and IBCLC, I have seen a lot of breastfeeding moms and babies. Yet, I still believe that breastfeeding is magical, a dance between a mother and her baby. It can also be a tug of war between a mother and her baby. A battle between the strong will of the mother and the strong will of her baby. It can also be a mundane moment of duty in the ho-hum of life. It also has its comedic moments. But I will always believe that there are those magical moments that are never, ever forgotten.
Recently I read an article in the News Medical Life Sciences reviewed by Emily Henderson entitled, “PFAS Exposure Associated with Decreasing Nutritional Value of Breast Milk.” One of the authors of that particular study was Tuulia Hyotylainen, Professor of Chemistry at Orebro University, Sweden who stated in the article, “Breast milk is becoming less nutritious because chemical exposure causes changes in lipid composition—the fat in breast milk.” She goes on to state, “Of course mothers should continue breastfeeding their babies if they are able to.” If PFAS chemicals are ubiquitous in the environment, I suppose not too many women will be “able” to breastfeed. Is it possible that the research scientists do not understand the science of breastfeeding? I realized that I now had to read the research paper that Hyotylainen co-authored this year, “Exposure to per-and polyfluoroalkyl substances associates with an altered lipid composition of breast milk.” https://www.sciencedirect.com/science/article/pii/S0160412021004803?via%3Dihub
In 2018 Hyotylainen co-authored a research paper published in Pediatric Research entitled, “Serum, plasma and erythrocyte membrane lipodomes in infants fed formula supplements with bovine milk fat globule membranes.” Two of her co-authors (Ollie Hernell, and Bo Lonnerdal) to this study were funded by Hero Group, Switzerland (infant formula manufacturer) and Semper AB, Sweden (infant formula and gluten-free baby food manufacturer. The conclusion of this research paper is that bovine milk fat globule membranes used in infant formula has beneficial benefits of positive cognitive and immunological properties to infants. “The study was funded by grants from Sweden Innovation Agency (Vinova), Semper/Hero [2 formula companies] and Vasterbotten County Council.” https://www.nature.com/articles/s41390-018-0130-9
Wondering about bovine milk fat globule membranes I found another research paper entitled, “Clinical Benefits of Milk Fat Globule Membranes for Infants and Children,” states, “The benefits of breastfeeding are greater for preterm than term infants…” I find that an odd statement to make. Somehow breastfeeding loses its benefits in term infants? Of course it makes sense, when a person reads the section on funding. All 4 authors (Ollie Hernell, Niklas Timby, Magnus Donnelly, Bo Lonnerdal) have been funded by various infant formula companies. Milk fat globule membranes added to infant formula will supposedly be beneficial to preterm infants. https://www.jpeds.com/article/S0022-3476(16)00300-0/fulltext#relatedArticles
Let’s go back to the research paper, “Exposure to per- and polyfluoroalkyl substances associated with an altered lipid composition of breast milk.” We find out as we read this paper that this paper is listed under clinicaltrial.com NCT01735123. https://clinicaltrials.gov/ct2/show/results/NCT01735123
The clinical trial of NCT01735123 results were published in 2021 by Journal of Pediatrics and entitled, “Effect of early feeding on intestinal permeability and inflammation markers in infants with genetic susceptibility to type 1 diabetes: a randomized clinical trial.” The clinical trial recruited Finnish mothers during their pregnancy. According to the Finnish Diabetic Association, “Finland has a population of 5.5 million. There are about 50,000 people with type 1 diabetes and about 400,000 people with type 2 diabetes in Finland. About 4,000 children under the age of 15 have diabetes.” DOI: 10.1016/j.jpeds.2021.07.042
https://www.diabetes.fi/en/finnish_diabetes_association/diabetes_in_finland
Both papers (“Exposure to per-and polyfluoroalkyl substances associated with an altered lipid composition of breast milk” and “Effect of early feeding on intestinal permeability and inflammation markers in infants with genetic susceptibility to type 1 diabetes: a randomized clinical trial”) are tied together. In order to understand and get some of the background information on the study on altered lipid composition (I will call it the Lipid Study) of breast milk associated with PFAS chemicals one must also read the research paper on early feeding effect on type 1 diabetes (I will call it the Diabetes Study).
The Diabetes Study states, “Randomization for the study formula was performed during the 35th gestational week and families received their first batch of the study formula before the delivery.” The Diabetes Study also states, “breastfeeding was encouraged,” while they randomly handed out the experimental extensively hydrolyzed formula (Mead Johnson) or the control cow’s milk formula (Mead Johnson). Mead Johnson guarded the randomization codes. Seventy-three infants were in the experimental goup and forty infants were in the control group.
Thus the Lipid Study is examining a majority of mothers who are doing both breastfeeding and formula feeding. According to the Diabetes Study there were 7 mothers in the study who exclusively breastfed (no definition of exclusive breastfeeding disclosed) to 9 months. They obtained cord blood at 2-4 days and serum from moms at 3 months, 6 months, and 9 months. They also obtained stool samples of all the babies to determine intestinal permeability and inflammation.
The Lipid Study was on a subgroup of mothers from the Diabetes Study, 44 mothers. I assume all of the mothers in the Lipid Study must have been breastfeeding; since they obtained breast milk samples at 2-4 days postpartum and at 3 months postpartum. It is questionable how many of the babies were exclusively breastfed because all the moms received infant formula in their 3rd trimester of pregnancy. The Lipid Study had serum samples from the 3rd month postpartum but I found no statements made about serum samples at 2-4 days postpartum. The Diabetes Study got cord blood for HLA genotyping in the 2-4 day postpartum. But the Lipid Study states under “Results”, “Maternal PFAS levels were measured in serum samples collected 3 months after the delivery.” But I could not find any discussion about collected serum samples on days 2-4 postpartum.
The Lipid Study states the following, “As another limitation of the study, the data on the daily volume of BM [Breast Milk] were not available, which restricted us to study infant growth only in relation to lipid composition of BM. Nonwithstanding this, maternal diet is a major factor that influences the breast milk volume. (Samuel et al., 2020)” Bold is my emphasis because this reference is to the Samuel et al. research paper that I discussed in Questionable Research Papers-PART 1 of my blog. Maternal Diet is not a major factor that influences breast milk volume. If you haven’t read PART 1, https://vwmcclain.blogspot.com/2021/11/questionable-research-papers-part-1.html
I have a real problem with the ethics of infant feeding studies in which infant formula is given out to all pregnant moms. Exclusive breastfeeding is important to the health and well-being of the mother and baby. It appears to me to be a breach of ethics to give out formula to pregnant moms. Some moms may believe that they have to use the infant formula, because medical professionals are giving it to them. Just stating that recruited moms were encouraged to breastfeed (which they state), while handing out infant formula undermines breastfeeding. What about the WHO Code? No free samples? No promotion of products in health care facilities? Do research scientists in infant feeding feel they are exempt from the WHO Code? I guess so.
How can a researcher determine a cause for a health issue, when there are more than one variable? If breastfeeding infants are getting breast milk plus infant formula, is the health issue the breast milk, infant formula, or both? What about other foods and drinks in the first year of life? How can research state categorically that breast milk is the problem, when mothers are also formula feeding?
The fat of breast milk is the most variable component. It changes from moment to moment, from day to night, day to day, month to month. Thus, depending on when a researcher gets a breast milk sample, it may vary in fat content. It seems to me that at least 2 or 3 samples of breast milk at varied times are necessary to get an average of the fat content. Concerns were expressed in the Lipid Study about the milk fat globules being too large. Yet human milk fat “globules vary from 1 to 10mm in diameter, with 1 mm- globules predominating.” (Lawrence et al. Ninth Edition Breastfeeding: A guide for the Medical Profession, 2020, pg. 105) The Lawrence text book references that to a paper published in 1992. The Lipid Study did not measure the globules, and a number of presumptions are made regarding the supposedly large size as being an indicator of PFAS chemical contamination.
One of the funders for the Lipid Study was the Novo Nordisk Foundation (Novo Nordisk sells insulin). Novo Nordisk Foundation also owns the company Novo Holding which has invested in the company, BIOMILQ (US $21 million). BIOMILQ will be the first company to manufacture novel infant feeding from human mammary cell culture. https://www.prnewswire.com/news-releases/novo-holdings-leads-us21m-series-a-financing-in-biomilq-301404490.html
The Diabetes Study received funding from Mead Johnson and other US government health institutions.
What is most curious and sad is that there is research that shows that introduction of cow’s milk or cow’s milk-based infant formula in diabetes susceptible infants increases their risk of diabetes. Here is sample of the research from 1988, and recently 2021.
“Genetically susceptible children weaned too early onto cow’s milk-based formula had a risk of Type 1 diabetes that was 13.1 times greater than children who did not have these genes and who were breast-fed for at least three months (thus minimizing their exposure to cow’s milk).” 1996 research paper in the Journal of Molecular Medicine by Perez-Bravo et al. From The China Study by T. Colin Campbell, PhD and Thomas M. Campbell II,
“Formula feeding accounts for 2-26% of insulin dependent diabetes mellitus in children.” 1988 research paper in Diabetes by EJ Mayer et al. From International Lactation Consultant Association (ILCA), Summary of the Hazards of Infant Formula. 1992, compiled by Marsha Walker, RN, IBCLC
“In conclusion, this study supports that infant and childhood diet may influence the risk of T1D [Type 1 Diabetes]. The most convincing evidence was seen for beneficial effects of breastfeeding, later introduction to gluten, cow’s milk, and fruit, and lower consumption of cow’s milk during childhood.” 2021, research paper in EBioMedicine by Ana-Maria Lampousi et al.
The introduction of cow’s milk-based formula in infants who are considered genetically susceptible to type 1 diabetes seems almost insane to me. I wonder about the world we live in, when researchers turn a blind eye to the risks created to Finnish mothers and babies involved in this kind of research. I read a recent document in which they stated that in Finland exclusive breastfeeding was 66% at birth in the hospital and only 9% at 6 months. The article was lamenting about the low rates of breastfeeding. Certainly these kind of clinical studies only add to the abysmal rates of breastfeeding in Finland.
Copyright 2021 Valerie W. McClain
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