Mature Breast Milk -- Ever Changing, Ever Perfect for Human Babies.

While formula companies like to promote that their product is superior to breast milk with regard to Vitamin D, this is a mis-representaion.  Human milk contains adequate amounts of Vitamin D if the mother has normal amounts in her body.  Rickets is a rare bone caused by Vitamin D deficiency.  It tends to be found in dark skinned children, people on vegetarian diets with limited exposure to the sun, and babies who were born to mothers who were deficient in this vitamin, also.  To prevent rickets in at risk babies, the AAP recommends Vitamin D supplementation for all babies when, in reality, only a very low percentage actually need the supplement.  Yet, formula companies make this a major marketing ploy.  (See "A Lesson in Slick Advertising").  They subtly communicate that breast milk is deficient and their formula is better because it supplies Vit. D.

"The unique feature of human milk is that virtually every component examined plays some extra-nutritional role.  The elegance of the system (emphasis mine) is remarkable--the more so the more we learn about it"  (J. Hopkinson, PhD, Associate Professor of Pediatrics, Baylor College of Medicine, quoted in Core Curriculum for the Lactation Consultant Practice).  

What Hopkinson is saying is that human milk does not just provide nutrients and energy.  It is bioactive.  Components work together and with factors in the baby's gut to provide proper development of the central nervous, the G.I., respiratory, and other body systems.  It actively defends against bad bacteria and viruses until the baby's own immune system is mature  Even then continues protective support.  Human milk is alive.  It changes almost constantly to meet the ongoing, changing needs of the infant.

"Formula is adequate, not optimal, and is not perfectly acceptable.  It does not resemble breast milk except for the fact that it contains proteins, fat, and carbohydrates from bovine (or plant -- added by blog author) sources.  It has none of the enzymes, ligands ("an antibody, hormone or drug that binds to a receptor" -Wikipedia), immune properties, or infection protection properties.  It will stave off starvation and predispose to obesity."  (R.A. Lawrence, MD, 2006.  Quoted in Core Curriculum for the Lactation Consultant Practice, Third Ed., 2011) 

Source:  AlphaParent.com.  Permission to use has been requested.  Awaiting response.  Will remove if permission is denied.

 
The components of colostrum have been examined in an earlier post.  As promised, we'll look at some of the special features of mature human milk.  At least 200 components have been identified, but the function of some of them is not yet understood.  Let's look at a few of them.  These should be enough to agree that the Creator designed a great "formula".

Just to remind us there is a difference, take another look at the photos of human milk and of formula, taken at the same magnification, by Dr. Stephen Buescher.

Human Milk:  It is bioactive and full of living cells to nourish and protect the developing human.

 

A Typical Newborn Formula:  There are no living cells.  It is not bioactive. It provides basic nourishment, but does not actively protect the infant from disease.

Human milk is made mostly of water (87.5%).  It provides all the water a baby needs, even when mother and infant live is a hot climate.

In the not too distant past, it was standard for hospitals to give newborns water, sometimes sugar water, to make certain they had enough fluid intake.  Research now clearly shows that ANYTHING other than human milk is a lesser form of nutrition.  In some cases, water feedings have led to water intoxication in the baby.  Water intoxication can lead to neurological damage and even death.  More commonly it led to problems with establishing breastfeeding.

At one time, it was thought that water feedings would prevent or treat hyperbilirubinemia (jaundice).  Now we know that bilirubin -- a substance formed when a newborn's red blood cells break down after birth -- is eliminated via the G.I. track and not the kidneys. (This breakdown of RBCs is a natural process because pre-borns have a higher level and different type of red blood cells, designed to "hang on" to oxygen during the stress of labor contractions and birth.) Water feedings do not promote excretion of bilirubin.

While we are on the topic of bilirubin, breastfed babies do have higher levels of bilirubin than formula fed babies.  At some point, the light bulb went off in the medical community that IF breastfeeding was normal, and IF breastfed babies had higher levels of bilirubin in the first days of life, then perhaps this was NORMAL?  Bilirubin, when present in a normal range in the baby's blood, provides some benefits to the central nervous system.  Health, term babies can handle fairly high levels. However, the medical community begins intervention well before those levels become too high.

Jaundice can be caused by reasons other than the normal breakdown of fetal hemoglobin. Some require medical intervention (in some cases, a bood transfusion), but these are relatively rare.  Most of the significant jaundice experienced by babies in the first week is due to inadequate breastfeeding.  Babies need milk -- ideally breast milk -- to eliminate bilirubin from the gut.  Formula is often prescribed for a day or so to get enough milk into the baby for the baby to eliminate the extra bilirubin.  The problem with this is, formula can set up issues of its own within the baby, including interfering with the normal flora in the baby's G.I. tract.  We discussed this problem in an earlier blog.

The best prevention is frequent skin to skin contact and frequent breastfeeds.  If bili levels reach the point of concern because of "starvation jaundice" (a much too strong term, I think), human milk is the preferred supplement.  Women should continue to breastfeed, and probably pump and hand express to build milk supply during the baby's treatment.  If possible, continue skin to skin as much as possible if the UV light producing device will allow this.

When babies were given supplemental water bottle feeds the number of breastfeeds during the first days naturally decreased.  The less colostrum the baby received, the greater the bili levels in it's blood. 

Treatment via bili-lights (UV lights) often required separation from the mother, as the baby had to stay in the nursery under the lights (this has changed, thankfully.  Treatment can now occur at the mother's bedside or even at home.  Breastfeeds were often restricted, thinking the milk itself was the problem.  In many cases, babies ended up being formula fed because the mother was not able to establish an adequate milk supply and/or the baby learned to prefer the bottle nipple and refused to breastfeed.  

Since we better understand the various reasons for hyperbilrubinemia (jaundice), treatment should occur in a way which protects breastfeeding.

Back to fluids.  God designed it so healthy newborns come with a cushion of 10% to 15% extra fluid on board.  As this normal cushion decreases during the first days, mother's milk supply changes and increases. By the end of the third day or so, baby's nursings include some that may be thirst driven.  This is great for mom because she has a rapidly building milk supply.  A "thirsty" and hungry baby, whose stomach is daily increasing in size, helps mom to avoid becoming engorged. While engorgement is common, it is not a normal part of the process of establishing lactation.  Some fullness, yes -- engorgement, no.

Birth in the hospital setting has become so medically managed, many babies are now born with a larger degree of fluid overload.  This is due to IV fluids and medications the mother received in labor.  This skews the birth weight so when the baby "looses too much weight" by day 3 or 4, it is assumed that the baby's birth weight was normal. Formula is often given.  In reality, once the extra fluid has been taken into account, the baby's weight loss would be within normal limits.

One study found that babies will diurese (pee) the extra amount during the first 24 hours to get its body back to normal.  The study also suggested that it might be a good idea to take a weight 24 hours after birth and use that weight as a baseline for weight loss to determine how breastfeeding is going. 

So, how was the birth weight selected as the best "baseline" for determining how babies are doing?  Arbitrarily.  According to the study mention in the previous paragraph, there have been no studies confirming this is a valid approach in all cases.

Bottom line, for the healthy newborn and infant, mother's milk provides all the fluids the baby needs.

The fats found in human milk are specifically designed for growth of the babies brain and the further development of its central nervous system.  They provide energy, also.  Formula does not contain the exact types of fatty acids found in human milk, and thus can not build the baby's brain and CNS (central nervous system) correctly. It does not mean the babies will be the village idiots, just less smart than they would have been.

Formula companies have added one such type of fatty acid, known as DHA to their artificial baby milks.  While they claim their formulas supports brain growth like breast milk, there is no evidence from studies to support this.

The source of DHA in U.S. infant formulas is actually from fermented microalgae.  AA, another fatty acid added to formula, comes from soil fungus.  There is no established standard on what amount to add to formula, and no  methods are in place to determine if there are any ill effects of these foreign sources of fatty acids on the young human.  There are indications that these supplements disrupts the antioxidant system and allows damage from oxygen free radicals.  This can result in diseases like necrotizing enterocolitis (an intestine destroying disease) in pre-term babies, among other serious diseases. Also, cases of severe diarrhea have been reported when these types of formulas are used.

Yet, addition of DHA and AA increases the cost of formula by approximately 15% -25%, with little if any return on investment to the families who buy it.  In fact, there seems to be potential for extra monetary loss from treatment for suspected side effects of these additives.

Numerous studies indicate that babies receiving the fatty acid (and other ingredients) from human milk have higher IQs.  The longer the baby is breastfed, the more likely the IQ scores increase.  The average is 8 IQ points.  This moves the grown breastfed person approximately 24 percentage points on a scale of 100 percentage points.  The scale represents mental, or cognitive, capabilities when compared with the range of scores in the general population.

The mental capabilities of the breastfed person, where human milk was the primary food source for several months, are evident even before entering grade school. The results are clear in grade school and into adulthood.  If a baby is born with a neurological issue which tends to result in lower cognitive abilities, breastfeeding can help optimize brain growth in that child, improving the quality of life for that baby and its family.  In some cases, it can overcome milk insults to the brain which can occur from lack of oxygen at birth or during seizures common for very premature babies.

Bill and Melinda Gates support a breastfeeding initiative in many third world countries.  A year ago I saw a poster produced by their foundation.  It listed 4 benefits of breastfeeding.  One of the benefits was stated simply, "Smarter kids". 


There are many types of proteins in breast milk, and they are present in different amounts in pre-term milk, term milk, and mature milks.  Their ratios change over the weeks and months of breastfeeding.  Formula does not do this.

One of the whey proteins, Alpha-lactalbumin, acts as an "anti-tumor" agent.  It undergoes a change in the baby's stomach, and this substance, called HAMLET (human alpha-lactalbumin), is lethal to tumor cells.  It has been shown to kill "transformed cells as well as 40 different carcinoma and lymphoma cell lines".  (Svensson et. al, 2000 in Walkers Breastfeeding Management for the Clinician: Using the Evidence).  Formula fed babies are more likely to develop certain cancers in childhood, like lymphoma and leukemia, than breastfed babies.

Immunoglobulins attack pathogens and help defend the baby against infection and illness.  A variety of enzymes found in breastmilk have certain functions.  One of these, lysozyme, attacks HIV and gram positive bacteria. 

The primary carbohydrate in breast milk is lactose.  This type of sugar is the sweetest God ever made, and He saved it for our babies and His own little ones!   Oligosaccharides and other types of carbohydrates occur in smaller amounts.  Lactose provides the proper environment for colonization of the infant's gut with helpful organisms.  These organisms promote optimal nutrient absorption and also protects against illness.  Galactose in breastmilk provides the building blocks for myelination for nerves (growth of a coating, wrap, or "skin" like substance surrounding a nerve cell).  This protects nerve function, and has life long benefits.

Lactose is digested by lactase, an enzyme found in breast milk.  This is the reason breastfed babies are NOT lactose intolerant -- lactase digests the lactose!  Fussy babies with excessive gas, explosive diarrhea, and so on have something else going on.  The baby can not be intolerant of the lactose if it is being digested by the accompanying lactase.

Oligosaccharides promote the growth of "good" bacteria in the baby's gut and suppress growth of "bad" bacteria.  It also promotes growth of healthy cells lining the wall of the intestine.  to Dr. Steve Buescher, who has researched human milk attributes, there are around 200 forms of oligosaccharides.  Each has it's own function.  Soon, if not already, formula companies will advertise the addition of oligosaccharides to their manufactured milks.  These oligosaccharides for infant formula tend to be plant based, and there are concerns of negative side effects of their use.



I could go on and on about the myriad of components in human milk and how they work to nourish, grow, and protect the human baby.  By now you get the idea of the specificity of God's formula and how it meets all the babies needs.  It constantly changes according to baby's changing needs.  Manufactured formula can not do that (I repeat this, I know).





Much of the specific facts regarding the components of human milk are found in Breastfeeding Management for the Clinician:  Using the Evidence by Marsha Walker. Published by Jones and Bartlett Publishers. 2011.