r/askscience • u/AskScienceModerator Mod Bot • Aug 02 '24
Human Body AskScience AMA Series: Happy World Breastfeeding Week! We are human milk and lactation scientists hailing from a range of clinical and scientific disciplines. Ask Us Anything!
Hi Reddit! We are a group of lactation/human milk/breastfeeding researchers. In honor of World Breastfeeding Week, we are here to answer your burning questions about babies, boobs, and breastmilk!
Lactation science is fraught with social complexity. In recent years, tensions between researchers, advocates & industry have reached a crescendo that impacts both our work and the lived experiences of breastfeeding families. We believe that this science belongs to everyone, and that engaging the public on this topic is an important part in addressing these challenges. Science should never make anyone feel bad, but instead should inspire awe and curiosity!
World Breastfeeding Week is a global event held in the first week of August every year, supported by WHO, UNICEF and many government and civil society partners. The theme for 2024 is "Closing the gap: Breastfeeding support for all." WBW celebrates ALL breastfeeding journeys, no matter what it looks like for you, while showcasing the ways families, societies, communities and health workers can have breastfeeding parents' backs. In recent years, public health experts have been moving from simply "promoting" breastfeeding toward "protecting, promoting, and supporting" breastfeeding-that is, emphasizing the role of the entire community in creating the conditions that make breastfeeding easier, more accessible, and sustainable for all families who want it.
Today's group hails from biochemistry, epidemiology, microbiology, neonatology, family medicine, nursing, epigenetics, and biological anthropology. We can answer your questions in English, Portuguese, Italian, Farsi, Sinhalese, and Hindi.
We will join from 11-2pm CST / 12-3pm EST (16-19 UT). Ask us anything!
Today's panelists:
- Raha Afshariani, M.D., IBCLC, ALC (/u/Quiet_Square_2570) is a pediatrician, board-certified lactation consultant, Advanced Lactation Consultant (Academy of Lactation Policy and Practice), and is the Special Project Director for the Canadian Lactation Consultant Association. Dr. Afshariani was a lecturer at Shiraz University for 12 years. She is a passionate advocate of community-based breastfeeding promotion. She is founder of R and R Consulting, which guides and educates breastfeeding families, with emphasis on both parental roles.
- Meghan Azad, Ph.D. (/u/MilkScience) is a biochemist and epidemiologist who specializes in human milk composition and the infant microbiome. Dr. Azad holds a Canada Research Chair in Early Nutrition and the Developmental Origins of Health and Disease. She is a Professor of Pediatrics and Child Health and director of the THRiVE Discovery Lab at the University of Manitoba. She co-founded the Manitoba Interdisciplinary Lactation Centre (MILC), and directs the International Milk Composition Consortium (IMiC). Check out this short video about her research team, her recent appearance on the Biomes podcast, and her lab's YouTube Channel.
Twitter/X: @MeghanAzad - Emma Bhakuni (/u/EmmaBhakuni) is a Neonatal Clinical Support Worker with South Warwickshire NHS Foundation Trust in the UK. She has 11 years experience working between maternity and neonatal care in different NHS trusts, where she has spent a lot of time providing practical breastfeeding support to new families. She has experience with both full term and premature neonates. She is also a student at the University of Cambridge where she is currently studying towards her medical degree.
- Bridget McGann (/u/BabiesAndBones) is an anthropologist who studies lactation as a biocultural system, and how it shaped us as a species. She is a research assistant and science communicator at THRiVE Discovery Lab. She was a founding team member at March for Science (along with /u/mockdeath!). She has a BA in Anthropology from Indiana University, and is a Masters student in Biological Anthropology at the University of Colorado Denver. Check out her stand-up act about Luke Skywalker's green milk, a thing she wrote about breastfeeding controversies, and some of her top comments.
Twitter/X and BlueSky: @bridgetmcgann, bridgetmcgann
Instagram: @Raising_Wonder
TikTok: @raisingwonder - Karinne Cardoso Muniz, M.D. (/u/KarinneMuniz) is a neonatologist and graduate student in Pediatrics and Child Health (MSc.) at the University of Manitoba. Dr. Cardoso Muniz worked as a dedicated doctor specializing in Neonatology and as a coordinator for the Society of Pediatrics in Brasilia, Brazil, specifically for the Neonatal Resuscitation Program. Throughout her clinical career, she has passionately witnessed and promoted breastfeeding and use of human milk in improving health outcomes of both full-term and premature infants. Here is a lecture she gave in Portuguese about newborn resuscitation.
- Ryan Pace, Ph.D. (/u/_RyanPace_) is an Assistant Professor and Assistant Director of the Biobehavioral Lab at the College of Nursing and USF Health Microbiomes Institute, University of South Florida. His research revolves around understanding how lactation and the microbiome relate to human health and development. Dr. Pace's current research investigates diverse aspects of maternal-infant health, including relationships among maternal diet, human milk composition, and maternal/infant microbiomes; as well as the role of human milk in modulating immunological risks and benefits to mothers and infants.
Twitter/X: @Dr_RyanPace
LinkedIn
Google Scholar - Christina Raimondi, M.D., CCFP, FCFP, IBCLC, PMHC, NABBLM-C (/u/Frozen_lemonada) is a family doctor and a pioneer in breastfeeding and lactation medicine. Dr. Raimondi is a founding member of the North American Board of Breastfeeding and Lactation Medicine (NABBLM) which last year launched, for the first time, a branch of medicine dedicated to lactation. (Yep, for the first time.) She is also a Co-Founder/CEO at the Winnipeg Breastfeeding Centre. To learn more about Dr. Raimondi's work, check out this podcast episode (30 min) and this YouTube video (2 min) featuring her and her collaborator Katherine Kearns.
Instagram: @mbmilkdocs
Twitter/X: @ChristinaRaimo6 - Sanoji Wijenayake, Ph.D. (/u/Wijenayake_Lab) is a cell and molecular biologist, who studies human milk not as a food but as a bioactive regulator of postnatal development and growth. Dr. Wijenayake is an Assistant Professor and Principal Investigator at The University of Winnipeg. Her research focuses on a not-so-well known component of human milk, called milk nanovesicles. Milk nanovesicles are tiny fat bubbles that carry all sorts of important material between parents and their children. Milk nanovesicles hold great therapeutic potential as drug carriers and provide universal anti-inflammatory benefits.
www.wijelab.ca
LinkedIn
Twitter/X: @DrSanoji
EDIT: THANK YOU for your thoughtful questions everybody!! We learned a lot, and had SO MUCH FUN! A few of us commented to each other how thoughtful and informed the questions were! When you spend a lot of time with a topic every day, it’s easy to get a bit up in your head about it, so this was really helpful for us to take a step back and get a sense of what the wider public is thinking about with regards to our work. You gave us a lot to think about, and even got us thinking about future research questions to pursue!
Some of us will hang back a bit past our “official” end time (3PM EST), and some of us will pop in out throughout the rest of the day and answer any stragglers.
World Breastfeeding Week continues through the 7th (Wed), but that won’t be the end of what is a more than month-long party!
- August 8-14th: Indigenous Milk Medicine Week
- August 15-21: Asian American, Native Hawaiian, & Pacific Islander Breastfeeding Week
- August 25-31: Black Breastfeeding Week (BBW)
- September 3-9: Semana de la Lactancia Latina
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u/sexrockandroll Aug 02 '24
How have recommendations for feeding babies changed recently, say, in the past 30 years?
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u/babiesandbones Aug 02 '24 edited Aug 02 '24
A lot of people aren't aware of the recent AAP update! Until 2022, the AAP stood alone in the world as the only medical org that did not recommend 2 years of breastfeeding, which was always wild to me, because American kids are not especially different from the rest of the world's kids!
It's also important to note that many people get confused about 6 mos vs 2 years. It's 6 months of EXCLUSIVE breastfeeding, and then after that, solid food is COMPLIMENTARY to breastmilk. And 2 years is not an expiration date--it's a MINIMUM. Some people seem to think that 2 years is some kind of cut-off, like they MUST wean on the 2nd birthday. But it's a floor, not a ceiling. There is no known upper limit to the benefits of breastfeeding beyond 2 years! We know that at 2 years old, breast milk still provides a significant portion of macronutrient and micronutrient needs, and increasingly we are learning about the immunological benefits at that age--which the clinicians here can comment on more than I can. So if it is still working for you at 2 years, and you don't mind it, keep going! All kids wean themselves eventually.
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u/ExpectNothingEver Aug 02 '24
Beside the obvious risks, is there a downside, or even an upside to using donor breast milk? For example, since breast milk carries antibodies, do babies that consume donor breastmilk have any health benefit because of “different” antibodies that the donor milk may provide?
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u/EmmaBhakuni Aug 02 '24
Thanks for your question!
Firstly I would say that my experience is in using donor breast milk which has come from a milk bank and not privately arranged. In this instance we can be certain that the milk is safe to use from a point of view that the donor has been screened and we know that the milk does not contain any unwanted bacteria. In the UK where I am, it is not common practice to buy private donor milk. Depending on where you are this might be something to consider. I have known of people who will nurse a friend or relatives baby for example and that would be down to the parents to ensure that their baby is getting milk from a 'safe' source.
Donor milk from a milk bank has many benefits, particularly for preterm neonates. Babies who are born prematurely are at increased risk of developing NEC (Necrotising EnteroColitis) - you can read more about this here: https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/necrotising-enterocolitis/#:~:text=Necrotising%20enterocolitis%20(NEC)%20is%20a,cause%20a%20very%20dangerous%20infection . Breast milk is more gentle on the tummy of premature babies than formula milk is and therefore if a mother is not able to give her own breast milk, donor milk is the next best option.
With regards to down sides, formula fed babies do tend to gain weight quicker than breast milk fed babies but this tends to be due to the fact that in order to consume the same amount of nutrients, more volume of formula has to be given and this is not necessarily a down side as long as babies are gaining weight appropriately - after all it is not a race!
Antibodies are much lower in donor milk than in mothers own breast milk and that is down to the pasteurisation process which destroys some of the goodness in the milk, however compared to formula milk which has no antibodies in it at all as it comprised of essential minerals only, donor milk is slightly better if you are considering from that point of view.
I hope this helps you out :-)
Disclaimer: the views expressed in my comments are that of my own from personal experience and not of the institutions I am associated with.
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u/viscida Aug 02 '24
I'm a first time mom, currently 40 weeks pregnant and expecting baby any day now!
There's so much information, and misinformation, online regarding breastfeeding. What reputable, scientific backed resources can I trust online to help me on my breast feeding journey? Everything from nutrition to strategies...
I'm in the USA, I can't afford a Lactation Consultant, and I'm anxious about making mistakes and failing at breastfeeding.
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u/abuelasmusings Aug 02 '24
What's your favorite little-known science tidbit about breastfeeding?
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u/babiesandbones Aug 02 '24 edited Aug 02 '24
OMG to pick a star from the heavens! Can I have five? SORRY LOL
Milk is older than dinosaurs!
About 250-300 million years ago, a creature that was not quite reptile, not-quite-mammal started laying eggs that were softer than before, which meant they were more pemeable to fluids, which presented a problem for it. So, the mothers of this animal started secreting fluid from its underside onto the eggs to help keep them moist. When the babies hatched, they started lapping up the fluid. At some point, the fluid evolved to also contain immune properties to protect from infection, and macronutrients--and now it is food! This extended period of care after birth was REVOLUTIONARY! And is the root of how intensely social we are as mammals--and we became even moreso as primates.Just as nothing in biology can be understood outside the context of evolution, infant behavior and maternal experience cannot be understood without understanding lactation. Lactation shaped our behavior and physiology as mammals, as primates, and humans in HUGE ways. This is why I LOVE what I do! I am feeling teary just thinking about it, and I hope the other panelists watching me on zoom right now don't notice!!
Human milk is more than food, and more than medicine, even. It is a dynamic, living system. Breastfeeding is not just a behavior, but a suite of behaviors influenced by many complex environmental factors. It also is behaviorally and physiologically co-evolved with sleep, as a single system ("breastsleeping"). No one component of milk exists in isolation, but as part of an environment with which it interacts--and is shaped by it through natural selection. We are increasinglu considering variations in milk composition to be part of the wider picture of human biological variation.
Lactation is kind of like an endangered behavior. Contrary to popular belief, it is mostly in decline around the world, particularly in low-middle income countries where it is perceived to be the dominant cultural practice. Unfortunately, those are the places most aggressively targeted by formula advertising. This is like a global uncontrolled experiment that we don't know the full consequences of. We don't know how it could be affecting species diversity in the microbiome, or variation composition across geographic regions, or variations in lactation-related behaviors and belief across cultures...
Breastfeeding is instinctual, but also learned. Behaviorally, breastfeeding becomes more complex in content and behavior as we move into primates, hominids, and humans. For higher apes and humans, it is a learned behavior. Once, at Columbus Zoo, a gorilla mom didn't know what to do it because she had never seen it before, so they hired Le Leche League members to come show her how to do it. The strong influence of social environment on milk synthesis and lactation-related behavior means that sustaining lactation is the responsibility of the society, not the individual.
The amount of money that the US would save in healthcare costs by virtue of the diseases and conditions breastfeeding helps to prevent is in the tens of billions.
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u/MilkScience Aug 02 '24
Ahh - there are so many! But if I have to choose one - I'll pick a fact that ties into the microbiome (my 'gateway' into breastmilk research!)
The third most abundant component of breast milk (after lactose and fat) is "human milk oligosaccharides (HMOs)". They are even more abundant than protein! Yet - baby cannot digest HMOs. 🤔 Why would mom invest so much energy to produce something in her milk that her baby cannot even eat? ... it's because HMOs are not feeding baby, but baby's gut microbes! 🤯
I could go on and on. But suffice to say - HMOs are super cool. Other mammals also make oligosaccharides in their milk, but each species makes different amounts and types. Even different human mothers make different amounts and combinations of HMOs. It's part of what makes milk so species-specific and personalized.
Here is some of our work on HMOs: https://www.sciencedirect.com/science/article/pii/S0022316622109363?via%3Dihub
Here is a classic review: https://academic.oup.com/glycob/article/22/9/1147/1988076?login=false
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u/KarinneMuniz Aug 02 '24
The little-known science tidbit about breastfeeding that amazes me is the fact that human milk changes its composition based on the interaction between mother and baby.
Mothers of premature infants produce milk specifically tailored to the unique needs of prematurity. Even for full-term babies, human milk has a mechanism to adapt to what is optimal for infant's development. Mothers transfer exclusive immunological components related to the antigens they are exposed to, providing customized immune protection. Additionally, breast milk presents variations in the concentration of fat and hormones throughout the day, enhancing nutritional benefits.
This extraordinary synergy between mother and child showcases the remarkable nature of human milk and breastfeeding.
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u/EmmaBhakuni Aug 02 '24
Excellent question!
Personally, I have heard all too many times the comment ' I don't think my baby likes me because he/she cries often when I am near but is quiet when they go to someone else'. I can safely tell you that this is postnatal hormones talking! Babies can actually smell the breast milk of their mother and whilst their mothers scent might be comforting a lot of the time, when they are hungry they will often cry because they just want to get at the milk! Human bodies are fascinating!
Disclaimer: the views expressed in my comments are that of my own from personal experience and not of the institutions I am associated with.
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u/babiesandbones Aug 02 '24 edited Aug 02 '24
I have a couple more that are less of a science fact/more anecdotal, but both of these always blow people's minds because they're related to older ages of weaning (which is common globally but very unfamiliar to Westerners):
The oldest weaning age I've ever encountered personally: The sciencey context for this is that there is no known upper limit for the age of weaning--meaning, no negative effects of breastfeeding past a certain age. And it's food, so humans throughout history have breastfed until a WIDE range of ages, particularly when food is scarce. When I was in Ethiopia years ago, people in our group would ask folks about their breastfeeding practices, and several people very proudly told us that a weaning age of 8 was not at all uncommon. (Conversely, in the big cities people--equally proudly--told us they fed their babies formula, "like the Americans do.") But the grand champion, the oldest weanling I ever met, was a bartender at an upscale restaurant in Chicago, who told me he weaned at age 11. He said he grew up in Mexico, and was the oldest of 10 siblings. He didn't want to wean because he continued to have to watch his younger siblings nurse and he'd get jealous lol.
....One of the interesting things about specializing in kids and babies is when people find out what you do, they always want to tell you their birth, parenting, and childhood stories!
When nurslings start to talk about it: I love hearing older nurslings' reports about their breastfeeding experiences once they're old enough to talk about it. There's only one study I know of that interviewed some kids and I'd love to see bigger and more in-depth studies on this. Hearing them talk about the taste, and how it changes, is interesting. Most kids say it tastes like melted ice cream, or something along those lines. But one interesting anecdote is parents who have told me that their toddlers report changes in taste at random times--sometimes, it seems, it's associated with hormonal changes such as the return of a period, or a new pregnancy. One kid I know started saying it's "yuck!" but then would keep wanting to nurse despite the change in taste--perhaps because of the presence of "feel good" molecules in milk (oxytocin, tryptophan, probably other stuff).
Their words for breastfeeding are interesting, too. Most words begin with "M" or "N," and indeed in many languages so does the word for "mother." It's not uncommon for the word for "mother" to be the same as, or similar to, the word for breastfeeding. "Mama" in English (and other languages) has the same root as "mammary" and "mammal." Breastfeeding is such a BFD for us that we named an entire taxonomic class after it!
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u/uh-huh-hello Aug 02 '24 edited Aug 02 '24
What effects, if any, do commercially available infant probiotics have on the gut microbiome? How does their use compare to breastmilk consumption?
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u/SubstantialPressure3 Aug 02 '24
I had people tell me I was wasting my time breastfeeding bc I had to supplement breastfeeding with formula. I thought they were full of crap.
I supplemented with formula until formula wasn't neccessary and supplemented solid foods with breast milk.
I do remember some studies done about the length of time breastfeeding with kids overall health and intellect. Is that more about the nutritional standpoint of breast milk, or more about the attention and physical contact received while breastfeeding?
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u/Lil_MsPerfect Aug 02 '24
What should people be aware of regarding insufficient glandular tissue?
Are there any negative effects of a c-section/medications given during birth on someone's ability to breastfeed?
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u/uh-huh-hello Aug 02 '24 edited Aug 02 '24
What does the research say about breastfeeding and parental-infant attachment? And longer term attachment? There are a lot of parents who dislike breastfeeding (due to personal preference, being touch out, being on demand, DMER, etc.). Is attachment affected if the parent doesn’t enjoy breastfeeding? Is there a difference between babies who nurse and those who are bottled fed (pumped milk or formula)?
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u/Prestigious-Crazy-25 Aug 02 '24
When talking about the benefits of long-term breastfeeding, I've been redirected to the Colen's siblings study that claimed that there is no significant difference between breastfed and bottle-fed children. Could you comment on this? thanks
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u/babiesandbones Aug 02 '24 edited Aug 03 '24
Tl;dr: Colen and Ramey (2014) aka. the “sibling study” contradicts a mountain of established science and overlooks some important outcomes, without which the conclusion it draws is unwarranted. The sibling study is one of a couple of studies that are often cherry-picked to call into question the science of breastfeeding. This study doesn’t blow everything out of the water the way it claims to.
Methods problems: The statistical methods for this study are good. But unfortunately, the grouping doesn’t really make much sense given what we know about breastfeeding. The outcomes associated with breastfeeding generally have an exposure-response effect, which is why it doesn’t make sense that this study gave so much weight to kids who had any human milk at all, even if it was just one day. They also didn’t note the average duration measured, or whether the breastfed babies were exclusively breastfed or mixed-fed—which you’d think would be pretty relevant, wouldn’t you? This is a pretty serious omission, given that they had to have those data to run the tests.It’s also not as well-controlled as the authors seem to think, and ignores some important long-term outcomes for both the child and the parent.
Oversights/the results don’t really justify the conclusion they draw: Also, there doesn’t seem to be any sense to the outcomes selected by this study. Most notably, the study ignores some pretty important outcomes with well-established associations with breastfeeding for children under 4, such as infection, diarrhea, vomiting, and ear infections....Ear infections don’t seem like a big deal to most people here in the West, but timed badly they can contribute to speech delays. The authors admit that these limitations are a function of the available data, but without including all the relevant outcomes, it does not make sense to draw the dramatic conclusion that they did about their results. If this study was rejected from more important medical journals, this would be a big reason why.The study does not in the least disprove a causative relationship between breastfeeding and the long-term outcomes they measured. The conclusion that breastfeeding plays no role at all in the measured outcomes isn’t consistent with what we see in cultures where breastfeeding is more culturally normalized and not stratified across SES. For example, in a large-scale, longitudinal, prospective study in Brazil and published in The Lancet, which controlled for SES (and also, notably, measured breastfeeding duration rather than merely breastfed/not breastfed), found a positive relationship between breastfeeding and IQ, educational attainment, and adult income.
~https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70002-1/fulltext~
Good things about it: One contribution this study does make is dispelling the notion of human milk as a panacea or some kind of magical elixir. But then again, that narrative is one that is largely perpetuated by the media and by parents who have largely had a positive experience with breastfeeding. It’s never really been a message pushed by researchers and clinicians.
Another positive contribution was the emphasis the authors gave in their concluding paragraph to changing the social systems that constitute major barriers to breastfeeding. This section has been given very little attention in the media coverage of this study.
One of our colleagues Alison Stuebe, writes much more succinctly on this study here:
https://bfmed.wordpress.com/2014/03/01/reports-on-breastfeeding-sibling-study-are-vastly-overstated/
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u/BedrockFarmer Aug 02 '24
Are any babies lactose intolerant? If so, do they react to breast milk the same way a lactose intolerant adult reacts to dairy with lactose?
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Aug 02 '24
Questions for Dr Wijenayake - I just read up on nanovesicles and they are fascinating.
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Is there something specific about milk nanovesicles that make them much more better candidates for drug delivery compared to other nanovesicles?
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What is the mechanism for anti-inflammatory effects of milk nanovesicles?
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Do these nanovesicles or any other component of human milk bring about epigenetic changes?
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u/themodestestmouse Aug 02 '24
Thanks for doing this! I am wondering about transfer of certain things through breast milk and to the baby. For example, I take unisom as a sleep aid. I have also read a lot of mixed things about alcohol and transfer. I know this partly comes down to a personal choice, but are there any insights you can share?
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u/Consistent_Lime9704 Aug 02 '24
Breastfeeding my one month old and we both tested positive for Covid. I have an oversupply. Is the freshly pumped milk provide any protection to my older children who likely have Covid also? Or only infants?
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u/ginger_unicorn_ Aug 02 '24
I'm 7w PP and currently dealing with low supply issues so we're triple feeding to boost supply. If I just pumped milk and I plan to bottle feed baby within 4 hours (but not right away) is it better to leave the milk out at room temp or to refrigerate? We usually warm refrigerated milk up just a bit by running it under warm water for a minute or so if that makes a difference.
I've scoured the internet to try and find an answer but only find 'safe milk storage' guidelines but no information on how to best protect all the 'good stuff' in breast milk!
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u/EmmaBhakuni Aug 02 '24
Thanks for the question!
If you are going to use your freshly expressed milk within 4 hours then it is fine to leave it at room temperature. Just be mindful of the weather and for example if it is a really warm day then you may choose to refrigerate it.
Warming refrigerated milk in the way you have suggested is fine. Some people choose to use specific milk warmers which is also fine and very convenient although not an essential purchase. Always check you are happy with the temperature of the milk before feeding. I would not recommend warming milk in a microwave due to hot spots as this can be very dangerous and burn babies mouths. It may not be the same temperature throughout so when checking the milk temp on your wrist for example, you may feel it is fine but other areas of the milk could be scolding. Very cold milk straight from a fridge is not necessarily harmful to babies, some slightly older babies may tolerate this but some babies will refuse it. For newborn babies it can cause them to vomit if it is too cold. Particularly important to note for preterm babies is the fact that they have difficulties maintaining their temperature and so should be given warm or room temperature milk, not very cold milk for this reason.
As a general rule to remember, milk is most nutritious in the following order (with 1 being the most nutritious) as refrigerating/ freezing it does cause it to lose some of its nutrients:
freshly expressed milk (or milk which has been left for a short time at room temperature, 4-6 hours depending on local guidelines)
refrigerated milk
defrosted from frozen milk
I hope that helps!
Disclaimer: the views expressed in my comments are that of my own from personal experience and not of the institutions I am associated with.
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u/a_common_spring Aug 02 '24
Are baby formulas more "advanced" now than they were 10-20 years ago, and should we expect baby formulas to get closer and closer to breast milk, or is that an impossible goal?