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When Breastfeeding Is Not Contraindicated

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When Breastfeeding Is Not Contraindicated 5/25/2011 When breastfeeding is not Formula=Breastmilk? contraindicated Jack Newman, MD, FRCPC Jack Newman, MD, FRCPC A crucial question Is formula almost like breastmilk? Is infantformula really verynear to, or almost like How canit possibly be? breastmilk? We don’t really know whatisinbreastmilk If itis,itisdifficult to explainanyhealth risksto There is no such thing as a standard breastmilk artificial feeding Even the formula companies admitthat not all But isitreally very nearto or almost the same as babies need exactly the same stuff breastmilk? And, ofcourse, willuse this notion to market their No! formulas (special formulas for special babies) Even now, formula is only superficially similar to While, at the sametime convincing usthat formula breastmilk is virtually the same as breastmilk There is no question about this !! But different andbetter thanthe formulas oftheir competitors, which arealso virtually the sameas breastmilk Quote from: Travels in Hyperreality Breastmilk varies byUmbertoEco ...the American imaginationdemands the real From womanto woman thing and,to attainit, must fabricate the absolute Depending on the baby’sgestational age fake; With the mother’s diet With the time ofday With the length oftime after birth During asingle feeding With whichbreast isoffered first With the time ofthe mother’s menstrual cycle With the number of previous pregnancies Depending on howthe milkisobtained 1 5/25/2011 Variation in fat content during a Diurnal variation of breastmilk single feeding Variation in lysozyme over 18 months But… Number of consecutive sampling daysrequired for One sample is not enough each woman to obtainastable estimate DhonuksheDhonukshe--RuttenRutten RAM, Vossenaar M, West CE et al .Day.Day--toto--DayDay variationinIron, Zincand Copper in breastmilk ofGuatemalan Mothers. J Pediatr Gastro Nutr 2005;40:1282005;40:128--3434 2 5/25/2011 Theformula fedbaby needs moreand What is an adequate sample? more withincreasing age and weight We don’t knowthis either We nowknow thatthe breastfed babyisgetting Many old studies (upon which we still rely) used less than we previously thought, much less than “dripped milk” the formula fed baby Is pumped milkthe sameasthat whichthe baby The exclusively breastfed, well gaining 5month gets when he’son the breast? old isgetting only, atmost , 10, 10--15%15% more milk than the exclusively breastfed, well gaining1month old, even though the 5 month old istwice asheavy Really? Is that possible? Colostrum is a wonderful fluid See: Kent, J.C., Mitoulas, L.R., Cox, D.B., Owens, More Na,K, Cl, protein, fatfat--solublesoluble vitamins R.A. andHartmann, P.E. Breast volume andmilk More minerals production during extended lactation in women Rich inimmunoglobulins, especially SIgA Experimental Physiology 1999;84:4351999;84:435--447447 Rich incells (100,000(100,000--5,000,0005,000,000 leukocytes per ml) During this period of exclusive breastbreast--feeding,feeding, 24 h Higher percentage of fatisdocosahexaenoic, milk production from eachbreast remained arachidonic andlinolenic acids relativelyconstant(453.6 ±± 20.1g,nb=48),and storage capacity was209.9 ±± 110 ml(nb=46) They compared milk production by the mother between 1and6months of age In addition, colostrum… Facilitates establishment of L.bifidus flora inGI tract Facilitates expulsion of meconium Is the best “treatment” for preventing hypoglycæmia andhyperbilirubinæmia 3 5/25/2011 Ad for formula So why leave out all the other important ingredients? A double standard? What’s missing in breastmilk? There is alot of blahblah blahabout what’s 1.1. Iron? missing inbreastmilk No, there isjust the right amount ofiron in But wedon’t talk much about what’smissingin breastmilk formula Together withthe stores the babygets atbirth, probably there isenough to keep the babyiron Maybe becauseit would takeallday sufficient for up to 6to 9months 2.2. Vitamin D? The breastmilk does not need to supply vitamin DD Getting free vitamin D What’s missing from formula? (Toronto in February) What about colostrum? Where do Ibuy Similostrum? Enfalostrum? Good Startostrum? 4 5/25/2011 Which formula is closest to which Breastmilk varies with the length of colostrum? time after birth; consider this email I hadacall today from a woman whose sister who is adruguser delivered a baby today. The baby remains inhospital andisbeingtreated for drug withdrawal. The mother hasabandoned the infant andthe baby willbe caredfor by an aunt. My question isthis: the caregiver wantsto breastfeed thisnewborn assheisstill nursing her own 11month old. Is her milkappropriate for this infant or should the babybesupplemented at breast as well? So, should this baby be supplemented with formula? Why? In what waydoes formula become more appropriate for supplementing colostrum thanthe milk of a mother who isbreastfeeding an11 month old? There wegoagain,believing formula isagood copy of breastmilk What age wasthe calf whose mother provided the milk to makethe formula? White cells? 5 5/25/2011 Immune Factors in Breastmilk Breastmilk made to measure And these are not even all of the immune factors which are present in breastmilk, but absent from formulas 6 5/25/2011 If the mother has autoimmune disease, can she pass on illness to the baby in through Oligosaccharides antibodies in her milk? 1.1. The predominant immunoglobulin inhuman milk issecretory IgA, butthere isno evidence that secretory IgAisa pathogenic antibody in autoimmune disease 2.2. In anycase,secretory IgAisnot absorbed via the gastrointestinal tract 3.3. There is no evidence that IgGinhuman milkis absorbed into the circulation ofthe infant 4.4. IgM alsoexcluded from the infant’s circulatory system Formula contains the same amount of protein as breastmilk Breastmilk contains 8 to 15g/L of protein This issomewhat less thanmost formulas (most contain 15 g/Lor more )) But: Up to 6060--65%65% (about5g/L) ofthe protein in breastmilk islactoferrin, whichisnot absorbed from the gut! About 0.5 g/L ofthe protein isimmunoglobulin, which isalso not absorbed from the gut! formula contains wayto much protein 7 5/25/2011 What about S100B protein? Stem cells in breastmilk S100B is anacidiccalciumanacidiccalcium--bindingbinding protein ofthe See: EFEF--handhand family, characterized by the most Cregan MD,Fan Y, Applebee, A, et al. common calcium bindingmotif of ahelixahelix--looploop-- Identification of nestinnestin--positivepositive putative mammary helixstructure stem cells inhumanbreastmilk Cell Tissue Res Whatever thatmeans (2007) 329:129329:129––136136 It maybe important to braindevelopment Present inmuch higher concentrations in breastmilk than informula (andhigherinmature breastmilk than incolostrumin colostrum)) Yogurt closest to breastmilk? So what’s this all about? Is it good or bad? If thisisformula, it’sneither good nor bad If it’sbreastmilk, it’s probably good, but why? Breastmilk isfull of immune factors (andnot just immunoglobulins) The immune factors line the babiesupper respiratory tract andupper gut, likely protecting the babyagainstinfection So ifthe babyaspirates breastmilk? formula=breastmilk? 8 5/25/2011 That’s nice, but does it make a A Perfect Example difference to the baby? You bet it does! Many did not believe that the long chained polyunsaturated fatty acids in breastmilk could make babies “smarter” The studies areall there, it’sjust that so many people prefer not to believe them because they Maybe they don’t don’t like tobelieve them But when the formula came out with their new formula, I have heard pædiatricians have said “Now formula is just as As soon as one study comes out doubting the good as breastmilk” results of many studies, we hear“Yousee? Long chained PUFA’s make babies smarter only when they Formula isjust asgood!” are in formula? Studies showing risksof formula arenever as well Check out Mead Johnson’s website for the “breastmilk formulaformula----Enfamil”:Enfamil”: Grossly unethical marketing! done asstudies showing norisk… http://www.enfamil.com/app/iwp/enfamil/productDetail .do?dm=enf&id=.do?dm=enf&id=-- 10733&iwpst=B2C&ls=0&csred=1&r=3422101508 Oh, and one more thing formula is In fact… missing… No evidence that simply addingDHA and ARAto Breastfeeding! formula gives the benefit it’ssupposed to How could I forget that? These PUFA’sneed to beadded incorrect Because inthe mindof the average person in an proportions, andthey are not absorbed from industrialized society… formula inthe same way asthey arefrom breastmilk Bottle feeding=Breastfeeding Studies do not support anybenefit when added to formula See http://cornucopia.org/DHA/DHA_FullReport.pdf 9 5/25/2011 How breastfeeding helps prevent adult heart disease Toscke AM et al . Overweight andobesity in6in6--toto 1414--yearyear--oldold Czech children in1991: Protective effect of breastbreast--feedingfeeding J Pediatr 2001;141:7642001;141:764--99 von KriesR et al .(1999) Breastfeeding andobesity: cross sectional study Br Med J 1999;319:1471999;319:147--150150 Ravelli AC et al .Infant feedingandadult glucose tolerance, lipid profile, blood pressure, andobesity Arch Dis Child 2000;82:2482000;82:248--5252 How breastfeeding helps to prevent Formula: a heavy metal cocktail adult cardiac disease Armstrong J et al . Breastfeeding and lowering the risk of childhood obesity Lancet 2002;359:20032002;359:2003--0404 Owen CG et al . Infant Feeding and Blood Cholesterol: A Study in Adolescents and a Systematic Review Pediatrics 2002;110:5972002;110:597--608608 Singhal
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