Feeding a Baby for Best Long-Term Health
Some New Information about Long-term Considerations regarding Breastfeeding vs. Bottle Feeding
The most important decision a mother needs to make regarding feeding her infant is whether or not to breastfeed, and if she decides to breastfeed, for how long and how exclusively. This website will not attempt to add to what is already widely available that presents the presumed benefits to babies of breastfeeding. There is considerable information on the other side of that question that has not been adequately presented to the general public, which will be the main topic here.
According to the American Academy of Family Physicians, "Throughout the middle part of the 20th century, most physicians did not advocate breastfeeding...." And beyond that period, "in the late 20th century in the United States, breastfeeding and formula feeding continued to be considered virtually equivalent, representing merely a lifestyle choice...." (1) It was only relatively recently that it became typical for doctors to promote breastfeeding as a preferred alternative to formula for feeding babies. After such a major change in opinions on an important matter (knowing that people are very much subject to bandwagon effects), it is worth slowing down and trying to determine just how good the evidence is to support reversing a position that had prevailed for several decades. There are substantial reasons not to follow along with this latest turn. That is especially true since U.S. Surgeon General Regina Benjamin points out that all of the studies that have found benefits of breastfeeding are of the "observational" type, which she says provide information that can lead only to inferences;(2) according to the American Heritage dictionary (Fourth Edition, 2009), a synonym of ”infer" is "surmise," and "surmising" is defined as something done "without sufficiently conclusive evidence."
So, by the highest U.S. authority, the case in favor of breastfeeding is built merely on studies of the kind that are inconclusive and that can only find associations, such as the association between high death rates in Florida and sunshine. From such studies, one can arrive at inferences, such as
(a) that sunshine causes deaths, while overlooking the factor of the old average age of Florida residents, or
(b) that breastfeeding prevents certain illnesses in babies, while overlooking the underlying factors of low income and smoking that are known to be disproportionately prevalent in bottle-feeding households, and which are known to result in those same illnesses in babies and infants.
The U.S. Agency for Healthcare Research and Quality (AHRQ) points out that observational studies are subject to false conclusion,(3) because of the difficult-to-determine effects of confounding factors. But lactation promoters nevertheless refer to such studies as conclusive evidence of benefits to babies of breastfeeding. They especially point to a review of such studies that was contracted by the AHRQ, which told about some associations of breastfeeding with certain reduced illnesses in infants (from among many hundreds of different possible diseases and conditions); this review also emphasized that there was no evidence showing that breastfeeding was a cause of any reduced illnesses. Proponents of breastfeeding look at the very limited statements about possible benefits of breastfeeding and try to use them to justify believing that bottle-feeding of babies has proven drawbacks; they also improperly try to attribute credibility to this report by referring to it as "the AHRQ review," even though the AHRQ clearly distanced itself from this contracted report by stating conspicuously at its front, “No statement in this report should be construed as an official position of AHRQ.”(4)
Regarding the studies that were considered in the report, all the AHRQ-contracted reviewers asked was, “Did authors consider appropriate confounders and justification for adjusting or not adjusting for those confounders?” “Yes” was the highest possible rating; there was no attempt to assess whether the difficult, complex process of properly dealing with such confounders was done competently. In addition, the authors routinely gave A ratings to studies that apparently didn't even consider known confounders.(5) And even after they had assigned grades to the studies, these reviewers sometimes essentially ignored the significance of their grades: Most of the A-graded studies of the association between breastfeeding and SIDS found no beneficial effects of breastfeeding with regard to SIDS; but the reviewers nevertheless "pooled" results of studies that included ones they recognized to be of poor quality, and used the pooled figures to conclude with a finding of an association between breastfeeding and reduced incidence of SIDS. Their conclusion stated only the result of this dubious pooling process, and nothing was mentioned in the conclusion about the findings (not favorable to breastfeeding) reached by the majority of the A-graded studies.
So the U.S. Surgeon General points out that the studies finding benefits of breastfeeding to babies are essentially all merely observational studies, the kind that the AHRQ says are subject to false conclusion. The relevant Policy Statement of the American Academy of Pediatrics (AAP), "Breastfeeding and the Use of Human Milk," makes several unjustifiable statements indicating certainty, such as, "Any breastfeeding compared with exclusive commercial infant formula feeding will reduce the incidence of otitis media (OM) by 23%."(6) When several high AAP officials were challenged on these unjustifiable claims of certainty in letters from the author of this website, as of seven months later those officials had failed to respond. The AAP attempts to support its position by improperly referring to the "AHRQ metaanalyses," meaning the very same contracted review that the AHRQ had conspicuously said in the opening page should not "be construed as an official position of AHRQ.” That isn't even to mention the obvious deficiencies of that review (touched on in the previous paragraph) and the extremely restricted nature of the favorable findings regarding breastfeeding.
Aside from the weaknesses of the evidence that is used in the attempt to indicate benefits of breastfeeding, there is considerable relevant historical evidence covering the period of transition from low-breastfeeding to high breastfeeding. This evidence shows that health outcomes among the highly-breastfed generations of infants have become substantially worse with respect to all but one of the conditions alleged to be reduced by breastfeeding. In three or more of those areas, new "epidemics" have been declared among children and young people whose infancies took place during the period of higher breastfeeding. Much more on this topic will come later.
Moreover, there are many studies that have found breastfeeding to be associated with adverse health outcomes, including 26 studies just in the categories of asthma, allergies, and diabetes alone, as well as three regarding autism (including a study of all 50 U.S. states and 51 U.S. counties finding amounts of breastfeeding to be directly correlated with autism prevalence), and one major study showing a direct, dose-response relationship between specific toxins in breast milk received from mothers and ADHD-like behavior in the children. For itemization of the above, see www.breastfeeding-studies.info.
Q: If the case in favor of breastfeeding is not based on good evidence, what difference should that make, since it's such a natural way of feeding a baby, and since it's been done since the beginning?
A: Well, it's natural in the same way that drinking water out of a local stream is natural. It was the best thing available (or the only usable infant food) in the early days of the human species; and it worked well enough that the human race multiplied, as long as almost every woman bore many children. But there are many toxic chemicals prevalent in today's environments of industrialized countries, most of which tend to become concentrated in breast milk. The pro-breastfeeding organization, MOMS (Making Our Milk Safe), in addition to other toxic chemicals contained in breast milk, also lists Bisphenol A (endocrine disruptors), perchlorate (used in rocket fuel), perfluorinated chemicals (PFCs, used in floor cleaners and non-stick pans), polyvinyl chloride (PVC, commonly known as vinyl) and the heavy metals cadmium, lead and mercury.(7) “One property of breast milk is that its high-fat and -protein content attracts heavy metals and other contaminants,” according to a New York Times article and also as stated by the NIH.(8) Well-researched suggestions as to ten specific environmental chemicals that are said to justify further research as possible causes of autism have recently been presented by very authoritative authors: Philip Landrigan, MD, MSc, Director of the Children's Environmental Health Center at Mount Sinai School of Medicine, and others, including the Director of the National Institute of Environmental Health Sciences. Those chemicals include lead, mercury, PCBs, certain classes of pesticides, endocrine disruptors (which include dioxins), PAHs, perfluorinated compounds, and PBDEs (brominated flame retardants). (9) Most or all of those chemicals have been found to be present in breast milk, some of them in high concentrations. Just two of those chemicals will be mentioned briefly here, with a link for much more information about these and the other toxins to follow:
a) An EPA study estimated the average daily exposure of a breastfed infant to dioxin toxicity to be 86 times higher than the reasonably-safe upper threshold of dioxin exposure estimated by the EPA in 2012. (60 pg of TEQ/kg bw/day vs. 0.7 pg of TEQ/kg bw/day) (9a)
The accumulated dioxin toxic equivalency exposure in infants that had been breastfed for one year was estimated to be about 6 times higher than in infants that had not been breastfed, in an EPA study. (10)
Note that dioxin has been determined by the EPA to be both a known carcinogen and a neuro-developmental toxin/ endocrine disruptor.
b) Typical breast milk appears to be over 50 times as high as infant formula in PBDEs. (10a) A major study found that children who had consumed breast milk with top-quartile levels of PBDEs were 3.3 times as likely (compared with those below median) to have high scores in activity/impulsivity behavior, of a kind that indicated likelihood of developing into Attention Deficit/Hyperactivity Disorder. Those whose breast milk levels were merely above average in PBDEs had over twice the assessed likelihood of developing into ADHD, compared with children whose equivalent levels were below average. (For more about effects of PBDEs on children, see Section 2.a of www.breastfeeding-toxins.info.)
Much more is presented about these and other chemicals and their concentrated presence in breast milk at www.breastfeeding-toxins.info .
Breastfeeding rates in the U.S. increased greatly after 1972, so we now have several decades of historical health data that enable us to make an educated "before and after" comparison to see whether the inferences about breastfeeding's presumed benefits turned out to have been correct. Assuming some validity to the claims about benefits to an infant resulting from breastfeeding, it would be reasonable to expect improvements in the health data of the generations of children who came to be highly breastfed.
As it turns out, not a single one of the favorable health outcomes that would have been predicted on the basis of the claims for benefits of breastfeeding has materialized, as shown by actual historical health data for those generations. And in fact, the actual outcomes have turned out to be substantially worse in all but one of the conditions and diseases that would have been expected to improve based on those claims. A point-by-point examination has been carried out regarding each of the principal claims made for benefits of breastfeeding in relation to the actual health outcomes of the generations who started to be highly breastfed beginning in the 1970's; the health outcomes of the highly-breastfed generations are also compared with the health outcomes of the low-breastfed generation that preceded them; to see these comparisons, go to www.breastfeedingprosandcons.info .
There is also considerable government health data regarding the rise and major growth of ADHD and serious psychological problems following the transition to high breastfeeding, which can be read about in Section 2 of http://www.breastfeeding-health-effects.info.
In addition, substantial increases have also taken place in other important adverse conditions following the transition to much higher rates of breastfeeding, including childhood cancer (see www.breastfeeding-and-cancer.info) and autism. To read about increases in both autism and childhood cancer in relation to breastfeeding, go to http://www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm.
There is considerable information about the dramatic increases in childhood diabetes that apparently took place following the great increases in breastfeeding, which can be read at www.breastfeeding-and-diabetes.info. To read about increases in childhood obesity that have taken place in extremely close correlation with increases in breastfeeding, see www.breastfeeding-and-obesity.info. There is also a great deal of information about increases in asthma and allergies that took place following the increases in breastfeeding, which can be read about at www.breastfeeding-and-asthma.info.
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It will seem surprising how far off the inferences about "risks" of not breastfeeding turned out to have been in relation to what actually happened. There are various reasons for this:
(a) The selectivity that has been exercised by breastfeeding's promoters, in finding and quoting certain studies that support their position while ignoring the many studies that disagree with their position. In the areas of asthmas and allergies, for instance, allegations are made based on some studies that these diseases are increased by breastfeeding; but nothing is mentioned about the 20 studies just in the areas of asthma and allergies alone that found that those diseases actually increased among children who were more breastfed. (see the last link above)
(b) "Confounders" can cause the inferences from observational studies to be in error; and there were major confounders present in those studies that were done about breastfeeding, which were either not recognized or properly adjusted or controlled for: low income conditions and household smoking, both of which are known to be disproportionately present in bottle-feeding households. Section D of www.breastfeeding-benefits.net goes into detail about those confounders and about how each of them is known to cause the same adverse health outcomes that have been attributed to lack of breastfeeding.
(c) The fact that lactation effectively takes in known developmental toxins (of kinds that have come to be increasingly present in environments of developed countries) and concentrates them in breast milk; most of the toxins are attracted to fat and hence to the fat content of the milk; (for more about this, go to www.breastfeeding-toxins.info) and
(d) the increasingly well-accepted theory that proper development of an infant's immune system depends on the immune system's being challenged by everyday microbes, such as those that are attacked by immune cells in breast milk. That "hygiene hypothesis" is generally discussed in reference to improved conditions in contemporary developed countries as compared with those of earlier times. But modern sanitation and hygiene had already been achieved early in the 20th Century; and it was apparently not until the 1970's that a great many children's immune systems started failing to develop well; this came directly following the great increase in breastfeeding, with its injection of immune cells from outside an infant's body. It was only following the 1970's that "epidemics" were declared in obesity, childhood diabetes, and asthma and allergies in general, and later in autism. For more about the hygiene hypothesis, see Section 1 of www.breastfeeding-and-asthma.info .
Additional details and sources for the above will follow in this paper.
A question that should be addressed to those who are recommending breastfeeding, but which they probably won't want to answer:
Given (a) the inconclusiveness of the studies that support breastfeeding and the selectivity exercised when choosing to cite only the studies favorable to breastfeeding,** (b) the known concentrations of environmental toxins in recent human milk,** and (c) the many close correlations between variations in breastfeeding levels and similar variations in levels of several epidemics of childhood diseases (seen in national health data**): How do we know that breastfeeding is more beneficial than harmful?
** Supporting information and references to authoritative sources regarding matters raised in this question are included in a one-page printable version of this question, to be found at www.pollutionaction.org/Q.pdf .
We have good reason to say that those who recommend breastfeeding probably will not have an answer to the above question. Slightly different versions of essentially this same question were mailed twice to four different high officials at the U.S. Department of Health and Human Services, who are heads of divisions that are involved in promoting breastfeeding. As of 3 months and more after mailing those letters, no reply has been received. Several months earlier, each of those officials had sent one response to an earlier letter that brought up the matters above, and none of their responses said anything in criticism of any of those points. Those points are all well substantiated. Three or more letters each to the American Academy of Pediatrics, the American Academy of Family Physicians and the American Congress of Obstetricians and Gynecologists have all brought similarly poor responses: no replies have been received to any of those letters, as of over a year later. The question that comes at the end, above, is a logical question to ask, especially when addressed to people who actively promote feeding infants a substance known (with no disagreement) to contain very high levels of developmental toxins. But the promoters of breastfeeding appear to be unwilling or unable to respond to this question. If they can't or won't answer that question as part of an informed debate on this matter (therefore to email@example.com, as well as to you), should anybody pay attention to their advice?
In contrast with the blind eye turned by the doctors’ associations, we have received responses to our various publications from seven individual doctors as well as from members of the general public. Some of the doctors have responded negatively, but three have been very favorable and two highly recommended our publications to readers of their doctor’s blogs. Their comments, and those of other readers, put into more readable, conversational form some of the points raised in more detailed form in some of our publications. We invite you to read those comments at www.pollutionaction.org/comments.htm.
It is very well established that the way to develop long-lasting immunity is to subject the body to weak microbial challenges, so that the person's own immune system develops capabilities. By contrast, immune cells from an external source (such as human milk) provide short-term immunity; they shield an infant from infections that, in developed countries, (a) would generally be non-serious, and (b) would actually be stimulative to the development of the infant's immune system. It should not be surprising that the benefits of reducing infections in the near term turn out to be outweighed by the long-term effects of having done so.
The table above is a small part of the evidence presented at www.breastfeedingprosandcons.info pointing out that, in almost every case of "excess risks" that are alleged to apply to not breastfeeding, the actual health outcomes for the generations who were born following the increases in breastfeeding were actually much worse than was the case for the low-breastfed generation that preceded them.
ADHD and psychological problems among children and young people first becoming widespread following increases in breastfeeding - - the testosterone connection
The American Psychiatric Association first coined the term "Attention Deficit Hyperactivity Disorder" (ADHD) in 1980, (41) eight years into the period of rapidly-rising breastfeeding rates. And, as shown in this CDC chart, "serious emotional or behavioral difficulties" in children were apparently not considered significant enough by the CDC to justify reporting about them until well into the period of increasing breastfeeding. Before reaching the 5% level in the first data provided, those emotional or behavioral difficulties rates must have been building for many years before the 2003 year of the first data shown. Extrapolating backward from the roughly 14% per 5 years growth rate shown in the above table would arrive at an extremely low level as of the 1970's; this would be fully compatible with origin of this condition's rapid growth in an infant exposure that greatly increased beginning in the early 1970's.
As explained in www.breastfeeding-toxins.info, citing several authoritative sources, chemicals that are concentrated in breast milk (and which are many times lower in bottle feedings) are known, on the basis of high-quality scientific studies, to have de-masculinizing, anti-androgenic, testosterone-reducing effects. According to Web MD, the leading effects of low testosterone are not only low sex drive but also "diminishing ability to concentrate, as well as irritability and depression." Also, quoting a urology department chairman, "diminished mental clarity, motivation, drive -- all of these things can be related to low testosterone." (42) Scientific literature points out that testosterone has important effects not only on ability to concentrate but also on mood, memory, and "the overall sense of vigor and well being." (43)
The above is only an introduction to the subject of probable effects of breastfeeding on increases in ADHD and serious psychological problems among the young. For the complete section on this subject, go to Section 2 of http://www.breastfeeding-health-effects.info
Message to health professionals and scientists reading this paper: This author cordially invites you to indicate your reactions to the contents presented here. As of now, new parents almost never hear anything but completely one-sided promotion of breastfeeding, with no mention of possible drawbacks except in cases of serious problems on the part of the mother. If you feel that parents should be informed about both sides of this question and thereby enabled to make an educated decision in this important matter, please write to the author of this paper. Also, if you find anything here that you feel isn't accurately drawn from trustworthy sources or based on sound reasoning, please by all means send your comments, to firstname.lastname@example.org.
***Comments from readers:
From this paper's inception in early 2012 until present, the invitation has been extended to all readers to submit criticisms of contents of this paper, asking them to point out how anything written here is not well supported by authoritative sources (as cited) or is not logically based on the evidence presented. As of May 4, 2013, after more than a year, no criticisms of contents of this paper have yet been received in response to that invitation. (That is significant, considering the thousands of visits we receive from readers every month.) We have received some e-mails that have not criticized contents of this paper but which are of interest; several of those comments or inquiries and our responses to them are entered at www.pollutionaction.org/comments.htm . All comments are welcome, especially those that point out any deficiencies in our evidence in relation to conclusions drawn or any lack of quality in the reasoning as presented. Please send comments or questions to email@example.com .
* About Pollution Action: Please visit http://www.pollutionaction.org
(1) "Breastfeeding, Family Physicians Supporting (Position Paper)" -- AAFP Policies -- American Academy of Family Physicians
(2) "Surgeon General's Call to Action to Support Breastfeeding, 2011," p. 33 at http://www.surgeongeneral.gov/library/calls/breastfeeding/calltoactiontosupportbreastfeeding.pdf
(3) Agency for Healthcare Research and Quality, U.S. DHHS, Systems to Rate the Strength of Scientific Evidence, Evidence Report/Technology Assessment: Number 47 http://archive.ahrq.gov/clinic/epcsums/strengthsum.pdf
(4) Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries Prepared for: Agency for Healthcare Research and Quality, US HHS (Evidence Report/Technology Assessment Number 153, Part 1. Acknowledgement of lack of demonstrated causality in "Structured Abstract" in front.
(5) for details, see Appendix 1, Section D at www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm
(6) American Academy of Pediatrics, Policy Statement Breastfeeding and the Use of Human Milk
(7) Quotation to be found at http://www.scientificamerican.com/article.cfm?id=earth-talks-breast-feeding
(8) (New York Times.com>Magazine First Person Toxic Breast Milk? by Florence Williams, Jan. 9, 2005)
(9).(April 25, 2012 editorial "A Research Strategy to Discover the Environmental Causes of Autism and Neurodevelopmental Disabilities," in Journal Environmental Health Perspectives, reported in ScienceDaily (Apr. 25, 2012)
(9a) http://www.epa.gov/iris/supdocs/dioxinv1sup.pdf in section 4.3.5, at end of that section, "...the resulting RfD in standard units is 7 × 10−10 mg/kg-day." In the EPA’s “Glossary of Health Effects”, RfD is defined: “RfD (oral reference dose): An estimate (with uncertainty spanning perhaps an order of magnitude) of a daily oral exposure of a chemical to the human population (including sensitive subpopulations) that is likely to be without risk of deleterious noncancer effects during a lifetime.
(10) Infant Exposure to Dioxin-like Compounds in Breast Milk, Lorber and Phillips Volume 110 | Number 6 | June 2002 • Environmental Health Perspectives http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=54708#Download Also EPA Home/Research/Environmental Assessment: An Evaluation of Infant Exposure to Dioxin-Like Compounds in Breast Milk, Matthew Lorber (National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency) et al.
(10a) U.S. EPA (2010) An exposure assessment of polybrominated diphenyl ethers. National Center for Environmental Assessment, Washington, DC; EPA/600/R-08/086F. online at http://www.epa.gov/ncea Sections 4.7 and 5.6.2. In the only data regarding PBDE concentrations in infant formula that is provided in the EPA's PBDE Exposure Assessment (citing Schechter et al., 2006 a), two samples of infant formula were found to have PBDE concentrations of 32 and 25 pg/g wwt (wet weight), respectively. (81f) Going by EPA data, total PBDE concentrations in mother's milk average about 1760 pg/g wwt or higher. (The EPA states the figure as "44.1 ng/g lwt" (44.1 ng = 44,100 pg). For comparison purposes, the lipid (fat) weight indicated here needs to be converted to whole weight, which can be done as follows: The EPA here assumes a fat content of 4%. Using that figure, 44,100 pg/g lwt becomes 1760 pg/g wwt. )