Fact-Checking the Breastfeeding Media: The Other Dangers of Infant Formula

Someday I might be able to stop talking about breastfeeding.  Possibly not until my grand kids roll their eyes and start lactating. But until then I feel like someone's gotta make sense of the claims*.  Like the rest in the Tossing the Formula article last week that I didn't get to in my original post.  Meant to get back to you all last week because I'd heard from some of you via email who were wondering about those other claims about formula-feeding:
Health experts warn that even small amounts of formula dilute breast-feeding’s benefits by altering intestinal micro-organisms and decreasing breast milk supply, since women produce less when babies nurse less. They say that while some women face serious breast-feeding challenges, more could nurse longer with greater support, and that formula samples can weaken that support system.  Tossing the Formula/Hospitals Ditch Formula Samples to Promote Breast-feeding, New York Times
Now some people read "health experts warn" and accept it. Some just ignore it and keep reading.  Some click over to their Amazon carts.  But not those of us here today.  I know you thought about those remarks. I'm sorry to say that much of it is without solid empirical evidence except the intestinal benefits. There's been much ado about the good gut bacteria associated with breastfeeding. Studies have identified a beneficial bacteria agent in breast milk that might account for the reduced risk of  ear infections and colds in breastfed babies but alas this research is mostly limited to petri dishes and in one case, colon bacteria from farm animals, yes, that's right, piggie poop.

In a typical study Duke researchers grew bacteria in formula, cow's milk and breast milk then threw in a dash of E.coli to witness any protective powers of the latter:
 Within minutes, the bacteria began multiplying in all of the specimens, but there was an immediate difference in the way the bacteria grew. In the breast milk, bacteria stuck together to form biofilms -- thin, adherent layers of bacteria that serve as a shield against pathogens and infections. Bacteria in the infant formula and cow's milk proliferated wildly, but it grew as individual organisms that did not aggregate to form a protective barrier.  Breast Milk Promotes a Different Gut Flora Growth Than Infant Formulas, Science Daily
Pity the independent study student assigned to buy the infant formula. Hey you, what's your name? When you stop at the Seven Eleven for the condoms and beer, pick up a six-pack of Similac**.  To think I was hanging out in the psych department coding transcripts of sexual assaults when I could have been squeezing toxins into breast milk. If only. Anyhow, I digress but my point here is yes, it looks like breast milk increases the beneficial flora and such but it is unclear to what extent supplementing with formula significantly impedes this phenomenon.  Of course it's also unclear whether there's any evidence the fab flora actually reduces respiratory illnesses et al. 

It's also unclear whether supplementing significantly reduces milk supply.  If you can dig up this evidence let me know. I've been rooting around all week without much success. 

As for claims about more "support" having the effect of women breastfeeding longer, some surveys out there suggest this might be true.  It's also true the Journal of Human Lactation (and often Pediatrics) twists every other study into suggesting this may be the case but as for actual data, paltry. Perhaps in a perfect world where all women can and want to breastfeed for years on end then yes, giving them spa-like breastfeeding lounges, uber nipples and nothing else to do for months and months might make them take out the boob more.  But I wonder how much more. 

Not surprising there is limited research out there tying the whole Baby Friendly/Ban the Bags/Toss the Formula from hospitals to increased breastfeeding but given what we know about some breast-feeding researchers moonlighting as anti-formula activists or is it it the reverse? (see previous post), I am not without skepticism.

The 2008 study cited as evidence that the bag banning increases boob time? Exclusive breastfeeding time and not breastfeeding with a supplemental bottle. Even the author admits it:
We found that there was no association between nonexclusive breastfeeding for at least 10 weeks and the receipt of a CHDP (i.e. free formula). Other studies also have found no statistical association between nonexclusive breastfeeding and CHDPs.35 The reason for the lack of an association is not clear.
Not clear?

I for one believe a supplemental bottle saved me many nights and helped me to breastfeed longer. It's not hard to imagine.  Especially if you don't think formula is the devil and once tempted (i.e. take the first step, the first bottle) you don't believe your child is already doomed and don't feel defeated and that you might as well just give up breastfeeding altogether.  I'm here to say this should I or shouldn't I supplement (or even go halfsies) does not have to be a slippery slope. This should not be an either-or choice. Today's lop-sided, tone deaf public health lecture (not a debate or even a discussion) is what happens when we think only of the physical or health aspects of breastfeeding.  It's what happens when we obsess about physical health and forget the woman attached to the breast, the mom, her mind, her beliefs, opinions, emotions and her destructive, defeatist thinking. Yes there is a psychological component most definitely but you wouldn't know it from today's health authorities who undervalue the psychology of breastfeeding and motherhood with psychologists nearly silent on this one. Not to be heard from until toddler starts throwing down in the toy aisle in a full-blown melt down.  Then we'll ask their opinion.

For the final claim I'm going to have to re-write it because I don't understand it and I need your help:
They say that while some women face serious breast-feeding challenges, more could nurse longer with greater support, and that formula samples can weaken that support system. 
Can weaken that support system? What does this even mean? That the very existence of formula endangers the creation of pro-breastfeeding policies and practices?  Good luck with this one because I can't even understand it.  Maybe I have over thought it and somehow infant formula in the hospital or home threatens to undermine the breast-feeding of women who are finding it difficult?  But this says "weaken that support system" so not quite.  Someone jump in here.  I just don't get it.  But then again I find so much of the breastfeeding rhetoric irrational.  Like the message it's natural, anyone can do.  Except for those who find it necessary to call upon the throngs of lactation specialists and breast pump manufacturers and everyone else who's made feeding babies "naturally" into a lucrative industry. 

*Sometimes it feel like I'm on my own except for The Fearless Formula Feeder and a few other skeptical women including The Skeptical Ob and Breastfeeding Without BS.

**Sam's was the place in Durham to get beer, condoms, gummy worms and to the best of my recollection Swamp Girls and other viewing material incompatible with the politically-correct/Take Back the Night campus atmosphere of the late 1980s and early 1990s.

UPDATE: Thanks to Clare who alerted me and now you to the new UNICEF report saying the NHS in the UK could save millions if women would breastfeed more.  Yes it's the UK version of The Burden of Suboptimal Breastfeeding.  I said that study would haunt me. 

Anyhow, in some ways the UK report appears more nuanced, like talking baby deaths for only a few illnesses but unforunately, one of them is SIDS and the link is very tentative. Also the report specifies "cognitive ability" - meaning intelligence.  I cannot even begin to critique that ridiculous evidence here.  I refuse.  Not worth my time or yours.  Consider this report Reason #527 that empirical evidence of benefits must be addressed here and abroad in a more critical manner. 


Awesome Mom said...

Maybe they are saying some LCs can't even stand to be in the presence of formula and therefore would not assist a mom who has tainted her child with poison which would naturally hinder the support the mom could have received.

Polly Palumbo, Ph.D. said...

Hey Awesome, it certainly seems some lactation-minded professionals have an aversion to formula. Unfortunately I'm not sure your hypothesis is completely absurd.

Rusty Shackleford said...

I think it means (that the fear is) the formula sample will be there for you at 2 am when your support system (LCs and whatnot) will not, and can't tell you STOP IN THE NAME OF SUPPLY AND INTESTINAL MICROORGANISMS! (BTW I'm not trying to make fun of LCs, they are great, just making fun of the NYT article). That is the only scenario I could think up that would make sense at all because you are right, how can a freebie weaken laws that mandate employers give workers adequate break time to pump, etc.

Or, if breastfeeding is a super power, as I've seen touted on posters and bumper stickers, then perhaps formula in free sample form works like kryptonite...

Polly Palumbo, Ph.D. said...

Hi Rusty! Yes, I like that explanation, formula as kryptonite. Thanks for helping untangle that puzzle.

The Fearless Formula Feeder said...

"Today's lop-sided, tone deaf public health lecture (not a debate or even a discussion) is what happens when we think only of the physical or health aspects of breastfeeding. It's what happens when we obsess about physical health and forget the woman attached to the breast, the mom, her mind, her beliefs, opinions, emotions and her destructive, defeatist thinking."

I cannot begin to tell you how much I love this. I have to go post it everywhere. ;)

I talked a bit about that UNICEF study in my post today. From what I can see (and I read all 104 pages, sadly, while I could have been throwing a ball with our neglected puppy or working out on the abandoned elliptical machine), it is far more palatable in tone than our beloved BOSB piece. But I'm not sure it tells us much of anything. They used the same economic equation to calculate their costs, and often the studies used were limited to one or two. I'd love to hear your thoughts on it....

Polly Palumbo, Ph.D. said...

Puppy? Okay now my kids are the only ones without a dog....me allergic, hubby allergic, son allergic...maybe not enough breast milk?

Honestly, why can't we ever talk about the empirical evidence?? Or the mom? Am heading over to your blog. I skimmed through the report quickly and my impression meshes with yours. Cannot wait to take a closer look, but am I reading right that for some outcomes they used a single study? Ridiculous.