Toxic Breastmilk?

"'Cocktail of chemicals' found in UK mothers' breast milk due to home furnishings" 

The Telegraph

Household chemicals blamed as UK mothers have highest levels of toxins in breast milk

Daily Express

And yet again I wondered who really funds these clickbait headlines.

The paper that provoked such a media response is an environmental audit called "Toxic Chemicals in Everyday Life".  It explores the toxic contamination of our environment, the impact to wildlife, the food chain and society as a whole - with a particular focus on the aftermath of the Grenfell Tower fire. It discusses the levels of toxin exposure we face and how these can affect our health.

They note that toxins from fire-retardant sprays for home furnishing are at significant and worrying levels in everything they tested - from newborn cord blood to the urine of adults.

What's truly bizarre is that the media ran with the breastmilk angle - which is only noted briefly in one of the subsections, and frankly is a drop in the ocean in terms of the level of the problem.

The relevant section reads:

"44. Flame retardants have been detected in air, soil, water, food, wildlife and humans. They are present in homes and offices via dust and on surfaces including windows, floors and carpets.151 Exposure occurs when additive flame retardants leach from goods into the air, dust and surfaces.

So in short, flame retardants (PBDEs) have contaminated everything from the air in your home, to the soil your food is grown in. Oh and the formula you have to use if you don't breastfeed.

"152 Breast Cancer UK suggests the US and UK have the highest levels of flame retardants in human body fluids."

I dug out the Breast Cancer UK briefing which states:

"In general, the USA and the UK have the highest recorded levels of flame retardants in human body fluids (36). The highest concentrations of legacy PBDEs in mothers’ milk have been detected in American women, and the second highest levels in those from the UK (37). Elevated levels of PBDEs have also been found in human blood serum in Californian children at 5 times the US average, and 10-100 times the European and Mexican average"

Oh, so hang on Daily Express - UK mothers don't have the highest levels, Americans do. 

Reference 36 is a 2008 study exploring the US population - it highlights that there are significant differences recorded depending on area and age.

Reference 37 is a 2009 review with particular focus on external exposure routes (e.g. dust, diet, and air) and the resulting internal exposure to PBDEs (e.g. breast milk and blood).

So let's pause a moment to consider that yesterday's headlines were in fact based on a TEN YEAR OLD study...

They note that fats contain higher levels of contaminants presenting an important exposure pathway for humans. This includes foods like fish, dairy products and breastmilk,

They state blood serum levels are 10 times higher in the US in their study than in Europe.  Yet they  couldn't find ten times the difference in the food chain.

But do you know where they did?

Dust

"The ingestion of dust conveys the highest intake of BDE-209 of all sources, possibly also of other PBDE congeners. The PBDE exposure through dust is significant for toddlers who ingest more dust than adults.
Indoor air and dust concentrations have been found to be approximately one order of magnitude higher in North America than in Europe, possibly a result of different fire safety standards."

To compare breastmilk, researchers searched for recorded data from different countries. We're not really comparing like for like, since not all data compared is from the same time period, nor using the same techniques or sample sizes. In the context of contaminants this is a significant flaw, because even within the same area, research highlights massive variations from sample to sample based on their immediate surroundings; some data pooled was samples from 10 people, some from 100, we have no idea what the ages of the sampled were (as the previous study highlights, the older we are - the higher our toxin level).

Everything tested recorded higher in the UK than other parts of Europe, in the one data sample we provided - blood serum, dust etc.

Peeing your pants about breastmilk, is like realising the entire second floor house is on fire, about to burn to the ground - and you make a public announcement your ashtray downstairs in the basement has just caught alight, distracting everyone from the actual imminent disaster.

What the media also fail to recognise - is that by scaremongering against breastmilk, not only will infants continue to be exposed (via the placenta, maternal blood flow, infant formula, the air they breathe and so on), but parents may wrongly believe it to be beneficial to their infant to not receive breastmilk.

In fact - this is like swapping the water you were pouring on the fire to cooking oil.

Exposure to environmental chemicals has been linked to dysregulation of the immune and reproductive system, diseases like cancer - and are known to alter the gut bacteria (microbiome).

Numerous studies have demonstrated that breastmilk is significant in terms of the developing microbiome, contains factors that assist regulation of the immune system and in short, assist the body in dealing with the effects of exposure (1-8).

It's time some media sources started sorting fact from fiction, before they write their headlines.

1. Pannaraj PS, Li F, Cerini C, et al. Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome. JAMA Pediatr. 2017;171(7):647–654. doi:10.1001/jamapediatrics.2017.0378
2. Van den Elsen LWJ, Garssen J, Burcelin R, Verhasselt V. Shaping the Gut Microbiota by Breastfeeding: The Gateway to Allergy Prevention?. Front Pediatr. 2019;7:47. Published 2019 Feb 27. doi:10.3389/fped.2019.00047
3. Alba Boix-Amorós, Fernando Puente-Sánchez, Elloise du Toit, Kaisa M. Linderborg, Yumei Zhang, Baoru Yang, Seppo Salminen, Erika Isolauri, Javier Tamames, Alex Mira, Maria Carmen Collado. Mycobiome profiles in breast milk from healthy women depend on mode of delivery, geographic location and interaction with bacteria. Applied and Environmental Microbiology, 2019; DOI: 10.1128/AE
4. Cacho NT, Lawrence RM. Innate Immunity and Breast Milk. Front Immunol. 2017;8:584. Published 2017 May 29. doi:10.3389/fimmu.2017.00584
5. Hsu PS, Nanan R. Does Breast Milk Nurture T Lymphocytes in Their Cradle?. Front Pediatr. 2018;6:268. Published 2018 Sep 27. doi:10.3389/fped.2018.00268
6. Laura M'Rabet, Arjen Paul Vos, Günther Boehm, Johan Garssen, Breast-Feeding and Its Role in Early Development of the Immune System in Infants: Consequences for Health Later in Life, The Journal of Nutrition, Volume 138, Issue 9, September 2008, Pages 1782S–1790S, https://doi.org/10.1093/jn/138.9.1782S
7. Molès, J‐P, Tuaillon, E, Kankasa, C, et al. Breastmilk cell trafficking induces microchimerism‐mediated immune system maturation in the infant. Pediatr Allergy Immunol. 2018; 29: 133– 143. https://doi.org/10.1111/pai.12841
8. Babak Baban, Aneeq Malik, Jatinder Bhatia, Jack C. Yu. Presence and Profile of Innate Lymphoid Cells in Human Breast Milk. JAMA Pediatrics, 2018; DOI: 10.1001/jamapediatrics.2018.0148

Breastfed Children at Risk of RICKETS

Or so the Daily Express told me today.  And if the Daily Express says it in capitals, it must be true right?

Yawn.

Even before opening the study I'm wondering how such dodgy reporting makes it past any editor with a modicum of self respect.

Breastfed children aren't at risk of rickets because they're breastfed; breastmilk doesn't magically sap their vitamin D stores leaving them depleted and deficient.

The Express article goes on to say:

"According to the UK Department of Health, all infants and young children aged six months to five years should take a daily supplement containing vitamin D in the form of vitamin drops, to help them meet the requirement set for this age group of 7-8.5 micrograms of vitamin D per day. 

However, those infants who are fed infant formula will not need vitamin drops until they are receiving less than 500ml of infant formula a day, as these products are fortified with vitamin D."

This means when formula fed infants are taking less than 500ml of vitamin D fortified formula, they too are at risk of rickets without supplementation.

UNICEF state to give formula to a year - meaning this is really valid for all mums who have infants older than 12 months not drinking formula.

According to the royal college of paediatrics and child health:

Rickets was common in Victorian times and was eradicated by the use of cod-liver oil and fortifying food with Vitamin D. It is the commonest childhood complication of vitamin D deficiency (VDD) and is caused by a lack of dietary calcium or problems with the supply, metabolism or utilisation of vitamin D. There are many possible reasons for this - lack of good quality sunlight in the UK, not exposing ourselves to sunlight (covering up with clothing, sun creams, staying indoors, and immobility).

So rickets can actually be caused by either lack of dietary calcium or vitamin D deficiency.  Most people take it as given we get enough calcium, others aren't so convinced.

Anyway the study in question was exploring infants 1-5 years, with the mean age being 24.5 months.

It's a group of "urban Canadian children" that were studied; so I of course wondered what the diet of a
typical urban Canadian kid was like. Not great as it goes. Some key points I found:

"A notable proportion of the diets of 1-3 year-old children contain total fat in quantities below the recommended range. (http://www.hc-sc.gc.ca)"

Since vitamin D is fat soluble, this may not accurately represent those with a different diet.

The final analysis included 2508 children, the average age of which was 24.5 months.   They read the levels of serum 25-OHD (generally considered the most reliable method) as a marker of vitamin D levels and the average was 32 nanograms per milliliter.  130 or 5% of the children had levels less than 20 nanograms per milliliter (considered deficient).

This next bit is key:

The median total duration of breastfeeding was 10.5 months (IQR = 6–14 months)

Anyway let's plough on. 

53% of children in the study received vitamin D supplements whilst the rest didn't.

What they discovered was infants who were breastfed and given a vitamin D supplement remained within totally normal levels, regardless of how long they were breastfed.  Those over 12 months who didn't receive a supplement were more at risk of experiencing a drop.

The researchers add:

"Age, total daily milk (cow’s milk and formula) consumption, skin type, and season of blood sampling were statistically significant covariate"

Meaning their diet, skin type and what time of year they were tested in, all impacted on the outcome.

For those that don't know, vitamin D recommendations are tricky and vary widely.  It depends on your skin pigmentation (the paler the less sunshine is needed, the darker the more), how strong the sun is i.e. how close to the equator you are and how much you get via other sources like diet.

This means probably quite obviously that those at the biggest risk of vitamin D deficiency are those who:
a: Have a darker skin type and live in location where sunlight levels are low
b: Are born to mothers who are vitamin deficient.
c. Are frequently covered heavily (particularly head) when outdoors or who spend little time outdoors.
d. Don't either eat foods containing d or fortified with

The connection in this study is really quite simple.  An infant who continues to breastfeed is less likely to consume cow's milk (or drink smaller quantities), something showed to be an influential factor in the study. And what you might not know, is due to the dark winters, all Canadian milk sold according to food law is fortified with vitamin D - thus breastfeeding toddlers aren't getting or are getting less of this supplement.

In the end they concluded absolutely nothing that we didn't already know:

"Vitamin D supplementation during breastfeeding beyond age 1 year may minimize the risk of serum 25-OHD levels less than 20 nanograms per milliliter".

Let's remember that by 1 year of age, breastmilk isn't supposed to be the only source of vitamin D for an infant, far from it.   Indeed breastmilk is usually considered insufficient to prevent vitamin D deficiency in exclusively breast-fed infants if sunlight exposure is limited.  And of course, along with sunshine, there is also diet.

I did start out including diet in this entry, but it became too long - therefore I've split in and will post all about food and D shortly.

Give the breastfed baby via their mother?
We know the amount of vitamin D in breastmilk depends upon mom's vitamin D status, yet an option that rarely mentioned is to supplement the breastfeeding mums to increase amounts available via breastmilk.  Studies have repeatedly shown supplementing mum to be a satisfactory option which is as effective as supplementing baby direct.

Supplement anyway, UK levels are set too low?

There has been lots of speculation recently over whether UK levels are too low, with some countries recommending much higher amounts.  It's not really that simple though (what is?). 

First going beyond deficiency and normal levels, into therapeutic use of vitamin D to prevent or treat other diseases - the evidence is actually not as cut and dried as some would have you believe.

This 2014 review looked promising when researchers concluded:

 "Despite a few hundred systematic reviews and meta-analyses, highly convincing evidence of a clear role of vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable."

But as you can see from the rapid responses here, it has been criticised for containing too many flawed studies that warped the overall findings.  Other studies have some now asking if we've been wrong about the benefits of vitamin D, and whether low levels associated with disease might be correlation rather than causal.

It also isn't (according to many) easy as just isolating one vitamin and throwing huge amounts into the human body.  The way that vitamins and minerals work together is interconnected. How well vitamin D works depends on the amount of other vitamins and minerals that are present in your body. The other vitamins and minerals needed to help vitamin D work well are called cofactors.

"To get the most benefit from vitamin D, you must have other cofactors in your body. Vitamin D has a number of cofactors; the ones listed below are the most important.

• Magnesium

• Vitamin K

• Zinc

• Boron

• Vitamin A "

from here

In short not getting enough vitamin D increases an infants risk of getting rickets, not breastfeeding.

Why Bottle Wasn't Best For Me

This is a parody based upon a recent article in the Daily Express (click here to read)

I DID a double-take when I saw this picture in 2010 of a four year old Suri Cruise having her bottle. The little girl was old enough to make herself a sandwich so for me it was shocking to see she was still using a bottle!

Of course the photo is deliberately provocative, designed to add to the heated debate among mums who bottlefed from a few weeks or months, those who believe in bottle feeding from birth (so-called "detachment" parents) and people like me who breastfed all my children.

Many mums feel under enormous pressure to bottle feed after the first few months but now I’m concerned they’ll feel that four years is the new standard.

Meanwhile the pro- bottlefeeding lobby is now so vociferous that mothers can sometimes forget there is a choice.

I’d like to tell any panicked new mother feeling the pressure from doctors, nurses, parenting groups and other mums that, as a bottlefeeding refusenik, my tall, smart, healthy children are my evidence that the sky doesn’t fall in if you never use a bottle.

I delivered my babies in the noughties but I wasn’t keen on the idea of bottlefeeding, even though health professionals I met were.

Breast milk substitutes were discussed as though they had magical properties (too small, too big, too awake - formula can apparently solve everything!). My GP told me there was no value to breastfeeding after a few months, and they bonded better with their dads when they could feed them too.

Twenty-odd years later I know that the bonding part is rubbish.  Their dad could not love our four more or be closer to them than he is. Not feeding them as infants has nothing to do with that. I got off lightly for choosing breast over bottle compared with today’s women who are emotionally clobbered for making others feel bad or grossed out if they opt to breastfeed whenever, wherever.

A neighbour with a newborn baby who didn't want to bottle feed recently said she felt she’d lost the Baby Olympics because other mums in her post-natal group were so competitive about how much weight their babies were gaining, how many people could feed them and how long they slept.

Some implied, with raised eyebrows and hard stares, that she was being selfish by exclusively breastfeeding and that perhaps she should think again and at least express to introduce a bottle "just in case" or so dad could at least do one feed per day. The prevailing view is that good and selfless mums introduce a bottle and bad, selfish (hardcore, militant) ones don’t.

When I gave birth to my first baby I wondered if after delivery a wave of hormones would flood through me, make me doubt giving my baby milk of his own species and make me choose to bottlefeed after all. It didn’t.

To be blunt, formula feeding uddermilk from hairy cows wasn't my style.

The night my son arrived I was instantly besotted and declared he was going straight on the breast - after all other body parts are most definitely multi functional, why are breasts any different? I wanted him to have the real thing not a replica, which is why I also ruled out mix feeding.

As a first-time mum I loved the closeness of feeding my new baby. My husband and I both planned to work full-time after the birth and so we maximised sleep for everyone by having baby in a side car cot, he made meals to feed me whilst I fed the baby!

My theory at the time was that the burgeoning “bottle is a must” lobby was created by formula manufacturers who wanted to exploit parents to make billions.

Dad did the bathing, soothing and cared for us both and I liked that. What a joy to see granny and grandad happily snuggling their grandchild. I confess that when they were busy with baby I took the time to enjoy long baths and daytime naps. After the very early days the following months were a breastfeeding breeze.

Just 18 months after the arrival of baby number one I was pregnant again and this time with twins.

Midwives and health visitors were eager to explain to me that I would never make enough milk to feed two babies! I was having none of it. The prospect of the amount of work involved with bottle feeding twins rather than just popping them on the breast made me feel quite ill.

When my milk came in after the twins were born I suffered breast engorgement (which is normal whether you use it or lose it). The swelling started just beneath my collar bone and my breasts looked like miniature barrage balloons - I quickly put my babies to my breast and the relief was instantaneous.

Our house was happy and peaceful when my children were small and I believe breast feeding played a part in that. I was never stuck having to make up feeds with crying babies at 3am (have you seen the guidelines from the DOH?!) or trying to hold a plastic bottle to feed while the other vied for my attention, I always had one hand free. The toddler would snuggle up on my lap with the new arrival, stroking them tenderly.

I know all the hard facts about breastfeeding being the normal food for humans. However when breastfeeding is established it is about so much more than calories, the oxytocin hit is the ultimate relaxant. Far from being selfless I love the convenience, and the knowledge he is receiving immunological factors that will impact on his body and lifelong health  The alternatives simply lack thousands of constituents that can be found in same species milk, and new mums should be free to make their bottle or breast choice without judging or being judged (or compared to farmyard animals).