Large amounts of immune cells in breastmilk? We call that pus.

34910554_s

Breastmilk is amazing?

Possibly, but not in the ways that lactivists imagine.

Angela Garbes insists The More I Learn About Breast Milk, the More Amazed I Am. But Garbes doesn’t even get the basic facts about breastmilk right, let alone more dubious claims.

It contains all the vitamins and nutrients a baby needs in the first six months of life …

Wrong.

Breastmilk does not contain enough Vitamin K to prevent deadly hemorrhages of the newborn, and it doesn’t contain the iron that babies need.

 There was no difference in immune cells in breastmilk of mothers whose babies had infections.

According to Hinde, [Katie Hinde, a biologist and associate professor at the Center for Evolution and Medicine at the School of Human Evolution & Social Change at Arizona State University] … If the mammary gland receptors detect the presence of pathogens, they compel the mother’s body to produce antibodies to fight it, and those antibodies travel through breast milk back into the baby’s body, where they target the infection.

Not exactly.

According to Bode et al. in It’s Alive: Microbes and Cells in Human Milk and Their Potential Benefits to Mother and Infant:

Recently, Hassiotou et al. (5) showed that a low proportion of human milk immune cells (0–2% of total cells) exists in the milk of healthy mother/infant dyads during established lactation. Immune cell numbers increase rapidly in response to infection of the mammary gland and other maternal infections, as well as infant infections, returning to baseline amounts during recovery.

So in healthy mother/infant dyads, breast milk has few white cells. But if the mother gets mastitis, the proportion of white cells rises. That’s hardly surprising. White cells race to the site of any infection. We have a name for large collections of live and dead immune cells and the debris of the bacteria they have destroyed. It’s called pus.

Indeed, in severe cases of mastitis, abscesses (collections of pus) can develop in the breast and may require surgery to treat them.

Does the breast respond to infant infections? It does if both mother and baby have the same infection. For example, a baby can develop thrush (a yeast infection of the mouth) and the mother can get a yeast mastitis as a result, and vice versa.

But what about infections restricted to the infant? The claim that infant infections affect the immune cells in breastmilk comes from this paper, Maternal and infant infections stimulate a rapid leukocyte response in breastmilk. The authors note:

A small increase in breastmilk leukocyte content was also observed when only the infant had an infection, while the mother was asymptomatic (P=0.046).

The authors defined statistical significance as p<0.05.* Although that means that the result is significant, the paper itself shows that there were only 3 babies in that cohort and only 28 in the normal cohort. It’s unclear if the study is adequately powered and the authors never did a power calculation.

Therefore, there was NO DIFFERENCE in the level of immune cells in breastmilk of asymptomatic mothers whose babies had infections.

This is illustrated in a chart excerpted from the paper:

Immune cell response breastmilk

The red arrow shows the difference in immune cells in breastmilk from an infected breast. There’s clearly a large difference. But there’s no change when an infant has a cold (green question mark) and an insignificant difference when an infant has measles (blue arrow).

Hinde claims:

Everything scientists know about physiology indicates that baby spit backwash is one of the ways that breast milk adjusts its immunological composition. If the mammary gland receptors detect the presence of pathogens, they compel the mother’s body to produce antibodies to fight it, and those antibodies travel through breast milk back into the baby’s body, where they target the infection.

But what do the data really show?

Returning to the leukocyte response paper:

In addition to breastmilk leukocyte response to maternal/infant infection, a less consistent but often significant humoral immune response was observed…

The authors make no mention of what proportion of these infections were infant infections, so there’s no way to know if the observed response is solely due to maternal infection and whether infant infection elicits any humoral immune response at all.

So is there really spit backwash?

If there’s NO DIFFERENCE in levels of immune cells in breastmilk of mothers whose babies are sick and no evidence demonstrating a humoral response to infant infection, there NO EVIDENCE that breastmilk changes in response to a baby’s illness, and NO REASON to postulate fanciful mechanisms for events that don’t happen.

Is breastmilk amazing? Possibly.

Sure the number of immune cells changes dramatically in response to an infection in the breast. That’s pus. But breastmilk DOES NOT change in response to infant illness.

The only thing that’s amazing is how willing lactivists are to stretch the truth in a never ending effort to convince us that breastmilk is amazing.

 

*In my original analysis I failed to note that the authors used a p value of <0.05, which means that a result of p=0.046 is statistically significant.

  • Tasha Nicole Brown

    This is why breast milk “lacks” certain nutrients.http://www.mommypotamus.com/when-should-my-baby-start-solids/

    • Azuran

      So……dont give your baby food, Let him eat dirt?
      And now spoons are responsible for every health problem ever.

  • Maya Markova

    I like very much the top illustration of this post.

  • Cipher

    The tailored antibodies claim is especially silly since it takes about 2 weeks for mom to produce mature antibodies. Simultaneously, baby is making his or her own antibodies. A week after baby gets over the respiratory infection, antibodies are ready to target that pathogen–the next time it comes up. Antibody production is too slow to help you fight off an active infection. It’s part of the adaptive immune system to help protect against future threats, but it’s the innate immune system that gets you past the cold you have today. That has nothing to do with antibodies.

    Now mom’s antibodies might help protect her from being infected by contact with her baby if she’s run across enough similar viruses in the past, but since her antibodies are not absorbed into baby’s bloodstream, they’ll only do any good for the baby if it’s a GI infection. Nursing for 18 months hasn’t kept my baby from getting multiple upper respiratory infections and a round with norovirus, which she then gave to me and her dad.

  • Julia B

    The alarm bells went off in my head reading the original article and I was very interested to see Dr Tuteur’s analysis of the baby backwash story. The original article also did not mention that breast milk is also low in vitamin D and exclusively breast fed babies are at risk of rickets, so given the low iron, vitamin D and vitamin K content, it is not the perfect food.

    My thought with the backwash story was, even if it is true, it doesn’t seem biologically plausible that the breast increases production of antibodies during the same nursing session, which was what was implied in the article. And seeing the graphs, the total effect seems to be very small. If people start talking about increases or decreases, I always wonder “how much”? Quite often the differences are in the margins and don’t make a large difference to the end result.

    • Marisa McLin

      All babies are given vitamin k in the hospital after birth. As far as I know they are still doing this. The good bacteria in the gut is how we produce our vitamin k which plays a role in blood clotting. Babies are not born with this bacteria in the gut. This will be developed in time with feeding. We get most of our vitamin D from the sun. Rarely does anyone get enough from food alone. Most people these days need a supplement. This deficiency in breastfed babies is due to our current lifestyles. People are not farming, working outside, or hunting and gathering where contact from the sun would be more prominent. They are sitting on the couch watching Netflix or otherwise involved in indoor activities. The good news is that also due to our current lifestyles we can go to any pharmacy and pick up a liquid vitamin D supplement. As far as iron I do not have an answer for that other than to say that I do iron checks on infants and children both breastfed and formula fed and I personally have not seen a major difference in occurrence between the two groups. It is fairly common to see 1 year olds with low iron in both camps. Breastfed babies on average tend to delay starting solids on there own because they would rather breastfeed and some refuse baby foods for quite some time. Most infants in general do not seem to like baby food meats. This may contribute to that problem. I still truly believe that breast milk is so highly superior to formula that I am having a difficult time comprehending that people are trying to rationalize that it is not.

  • Amy Tuteur, MD

    I tweeted this piece to Katie Hinde, the professor quoted in the original article. Here’s what I got back:

    http://24.media.tumblr.com/d490caee42571f5619b6b0deb671eb4f/tumblr_mfumv8wr2a1r4iz5oo1_500.gif

    Very professional.

    • Amy Tuteur, MD
      • Rosalind Dalefield

        I guess she doesn’t do professionalism.

      • Who?

        Really a case of pictures painting a thousand words.

    • Rosalind Dalefield

      Doesn’t take kindly to criticism, does she?

  • Outi

    But… but… IT HAS TO BE AMAZING! How else can I feel so superior and smart and cute and perfect mother?!

    Honestly, stretching the truth is nothing new and doesn’t even surprise me anymore. It would be more surprising if someone from that group would admit the truth. But that would be admitting not everything is perfect and that just wouldn’t do.

  • Anne Catherine

    I’ve read a couple of things on antibodies and breastmilk that say that there are antibodies in breastmilk, but they cannot come out of the GI system, and can prevent some GI issues, but are of little help elsewhere.

    Thank you for this great article —

    I just saw that Dr. Tuteur said the same thing earlier in the blog-I guess this is old news but-here are a couple of articles that explain things pretty well, if anyone is interested

    Below is Slate article by a MD and Yale professor:
    http://www.slate.com/articles/health_and_science/medical_examiner/2006/03/tales_from_the_nursery.html
    Here is also a blog out of Cambridge University that says the same thing:
    http://www.slate.com/articles/health_and_science/medical_examiner/2006/03/tales_from_the_nursery.html

    Funny thing, I put these two articles on an academy of Breastfeeding Medicine blog after an article (written by a neonatologist) that said that the antibodies in breast milk helped prevent allergies and meningitis, and asked them what they thought. Guess what? No response!!

  • Ann E. Mick

    I was reading about iron supplements this week, because my doctor told me to start taking them. It’s amazing how casually articles on supplements and iron will state that breastfed babies are often iron deficient. Yet those same newspapers, when writing articles specifically on breastmilk, unquestioningly print the claims about it being the perfect, complete food for babies!

  • Sullivan ThePoop

    If you think about the findings with between measles and a cold you can clearly see that it has nothing to do with backwash. The mother was probably immune to measles and being exposed to it through general contact with the infected infant. In response she produced antibodies. Nothing magic there.

    • Rosalind Dalefield

      Exactly. Memory T cells recognizing the pathogen.

  • Allie P

    I find it baffling that they make all these claims about the breast instantly making the right nutrients or antibodies for the baby, and then simultaneously claim that you should use donor breastmilk or pump and freeze. Where are those benefits in those cases? How can a stranger make milk perfect for my baby? How can my breasts know three weeks in advance what nutrients or antibodies my baby will need?

    Look, I’m breastfeeding ( I’m actually exclusively breastfeeding these days after a few weeks of supplementation, because — shocker! — the boobs are producing plenty), but I don’t think it’s magic. She’s growing well and seems healthy…except for the diaper rash, the day of green poop, and the baby acne that looks like a proactive “before” pic. All minor, but don’t try to sell me on this “breastmilk is magic” my little pony BS.

    • Fallow

      Yes, you’ve put your finger on something that I always want to scream about when lactivists of my acquaintance, suggest donor milk is a good idea. If breastmilk is magically calibrated to each baby’s nutritional needs and immune needs, then donor milk will not be calibrated to the recipient baby.

      A related note about the lactivist belief in magic breastmilk:

      One of my friends didn’t like my antipathy toward donor milk, because I received blood due to a PPH. She was implying (not stating, mind you, but passive-aggressively implying) that the risk of breastfeeding post blood donation was at least equal to the risk of unscreened donor milk.

      Yes, she was implying that unscreened donor milk from a “local mama”, was the equivalent of breastfeeding after receiving screened blood donations handled by medical professionals. If anything, she thought unscreened milk was LESS risky, because breastmilk is magic and prevents all disease. So even if it was contaminated, it would be fine! She said I needed to be “more trusting”, because those local mamas would never put something in their own kid if it wasn’t safe. Uh huh.

      • demodocus

        ‘Cause no true Earth-Goddess Mama (and those are the only ones who’d have enough to donate) would *ever* have an unsuspected case of herpes.

        • demodocus

          Much less a known case

      • Sarah

        Said it before, say it again- the problem with unscreened donor milk is that you have to trust not only the woman, but her sexual partner/s. Adultery is a thing.

        • SporkParade

          Yes. This is what drives me batty about the women who insist that their babies’ Hep B vaccine can wait a couple months because they tested negative at the start of pregnancy.

          • Roadstergal

            Wait a few months? The hip thing here is not to do it at all, because “my baby isn’t going to grow up to be an IV drug user or a prostitute.” Which drives me batty on so many levels. The two main ones – you can get it very easily without being a drug user or a prostitute, and even if they weren’t wrong about that – if your kid _does_ grow up to use IV drugs or have lots of sex (or gets raped), all of a sudden, you withdraw your protection? That’s some mighty conditional love, there.

  • Mel

    I have several questions.

    1) What amount of microbes would an infant be shedding orally during a cold?How does that compare to a gastrointestinal illness or a localized ear infection?
    2) How much pressure is generated during the portion of the sucking reflex when the infant releases pressure on the nipple to let the milk refill the nipple?
    3) How many mL ( or microliters) of infant saliva would that draw into the nipple?
    4) Per feeding, how many microliters of saliva actually make it into breast duct system?
    5) What’s the percentage of microorganisms that make it to the maternal immune system and trigger a cellular and or humoral response in the absence
    of mastitis?

    I concede that babies are germ factories when ill. I suspect, though, that the pressure differential between the contractile forces in the breast and the weak negative pressure in the nipple during the refilling stage will cause the vast majority of infant saliva drawn into the breast to be expelled during the next suck. The tiny amount that makes it into the ducts will likely be destroyed by nonspecific immune reponses long before the cellular or humoral system gets to any microbes.

    Also, if the backwash hypothesis was true, you’d expect mastitis to be caused by infants w/ bacterial disease states. I doubt that happens very often compared to infections from transient bacteria from the skin.

    • Rosalind Dalefield

      I have a question too, but judging by Hinde’s response to Dr Tuteur, I doubt I would get a sensible answer. It seems to me that for the mother’s breast to detect the health or otherwise of the baby’s saliva, there would have to be a whole lot of immune cells (Langerhans cells, perhaps?) lining every duct in the nipples. Does Hinde have histological evidence that these are present?

      • Mel

        My husband pointed out last night a huge confounding variable on measles – how do you know that the mom is responding to a mammary-oral route of exposure rather than a respiratory exposure? Heck, how would they figure that out for anything except matching thrush and yeast infections of the nipple?

        • Rosalind Dalefield

          Exactly right! Measles is extremely contagious by the respiratory route. In fact for any pathogen, by the time you are wiping baby’s nose, changing baby’s diapers, cuddling and kissing baby, washing baby and baby’s clothes, if baby is shedding a pathogen then chances are you are going to pick it up by inhalation, inadvertent transfer from your hands to your mouth (hand-washing notwithstanding) and via fomites including your own clothes and baby’s toys, bedding etc. The idea that a maternal immune response in the milk must reflect exposure via the mammary gland seems silly.
          Even if you matched oral thrush in the baby to yeast infection of mom’s nipple, that doesn’t eliminate that baby caught vaginal thrush during delivery (which is very common) and mother independently infected her nipple by slack handwashing between changing her maternity pad in her panties and changing her nursing pad in her bra. Many, many women have Candida in the perineal region which only blows up into vaginal thrush if the normal vaginal flora balance is disturbed. I never had vaginal candidiasis in any of my pregnancies but all four of my kids caught thrush on the way out, and my mother had five kids and the same thing happened to all of them.

  • Amy Tuteur, MD

    I made a mistake in my original analysis:

    Since the authors used p<0.05 for significance, a p value of 0.046 means that the difference in leukocytes between babies with infections and healthy babies is a significant difference.

    However, there were only 3 infants with infections compared to 28 healthy infants. With such a small number of subjects, it is unclear if the comparison is likely underpowered and therefore shows nothing.

    • Rosalind Dalefield

      In fact even the 28 healthy controls isn’t enough, you need at least 30 according to my friend the statistician.

    • Young CC Prof

      Groups of 3 and 28 might be enough for a positive preliminary study IF the difference was dramatic, although I’d still want to see it confirmed by a study of real size.

      • Amy Tuteur, MD

        YCCP, do you have any insight into why the authors chose to express the number of cells as a natural logarithm x where x is loge(x+0.5)?

        • Young CC Prof

          “Owing to the measured zeroes obtained for leukocyte content (% and per ml milk) of some samples, these variables were transformed using the additive constant 0.5 for both the square root and the log transformations.”

          I don’t know much about the immune system, but I do know that you take a log of your variable if it’s got really enormous variation, like some values are a hundred times higher than other values. This makes it possible to draw graphs that are actually readable, and sometimes to observe correlations.

          As for the 0.5, you can’t take a log of zero. They added in the 0.5 to make sure their zero values could still be represented. (I don’t know whether this is a standard thing to do, but it seems reasonable, and since the nonzero numbers are pretty big, it won’t change the data significantly.)

          • Amy Tuteur, MD

            Why a natural log and not a log?

          • Young CC Prof

            Not sure there’s a really compelling reason to go with one over the other in this case. As a mathematician, I personally like natural logs better. Engineers tend to be base-10 people, but pure mathematicians tend to prefer base-e, because it has niftier mathematical properties.

          • Amy Tuteur, MD

            Thanks! I don’t know if you had time to read the paper, but if so, do you have an additional comments? After made a mistake with the significance I want to be sure that I haven’t made any other mistakes.

          • Young CC Prof

            I just don’t know enough about the basic biology to say a whole lot about the results. I will say, the side-by-side boxplots don’t scream “major difference” at me, they have a lot of overlap.

            Also, p-values like 0.046 don’t particularly excite me. Yes, it’s significant, but it’s meh significance. You know what p-hacking is? Either you run the study just until a p-value less than 0.05 appears, or you select the study question after your data’s in… there’s a lot of ways to get a barely-significant p-value out of nothing special, and it doesn’t require deliberate dishonesty of any kind.

          • Roadstergal

            1: It’s not FACS, because they didn’t sort. It’s flow cytometry. It’s a niggle, but FFS, get your terms right.
            2: The Y-axis isn’t cell count, it’s event count. That’s less of a minor niggle. Events depend on how much you run through the machine, not necessarily what was present.
            3: I looked at their Supplemental Figure A. It’s a mess. They definitely have issues with cell viability; there’s just tons of debris and dead cells (lymphocytes should be a pretty, distinct population), and their compensation ain’t pretty. They say FL4 was a viability stain, but there is no viability stain listed in the supplemental table. Basically, there’s a lot of opportunity for artifacts in their setup. Dying cells get sticky, sticky cells give false positives, so if you don’t have a decent experience base with troubleshooting problematic samples and blocking, it’s hard to trust the data. (Histograms in flow can be useful, but they can also make messy plots look prettier.)
            4: CD45 is on a host of cell types with myriad different function, so we don’t even know what those are. (Actually, plasma cells, the real factories for high-effector, affinity-matured IgG, downregulate CD45 – they don’t go negative, but it goes down).
            5: I invite ye to check out supplementary figure 1d.

          • Taysha

            *dons “I <3 roadster" outfit*

            Also, I hate flow. Just saying.

          • Roadstergal

            Ha! Flow is a powerful tool, but it’s gotten so easy to just stick in a sample and get a ‘result’ out…! *grumble* kids these days…

            Seriously, though, I’ve collaborated with academic labs were they don’t do isotype controls*, don’t even do single-stain controls for compensation, gate wherever, and publish the results. Scary. I suspect a lot of academic labs that have a machine in the lab, rather than in a flow core, don’t do calibration.

            Also, I just noticed they’re using a FACSCalibur. Yes, it was a good machine in its day, but its day is past. If you’re doing tricky flow – and they are – you need a better machine.

            *No, they’re not perfect, and I prefer positive and negative cell controls (and population gates) when possible – but it’s not always possible, and at least you get _some_ sense of how noisy your assay is, and if you have your PMTs cranked up to 11 to see a false signal.

          • Taysha

            Last time I used a Calibur was around 2007. Even we upgraded to the CaliburII in 2008 (and probably further since then).
            I’ll stick to my Guava for viability.

            I’m just fascinated they’re calling it a positive signal when you take into account the massive shift with mastitis. But I leave the analysis to others, as I’m nowhere near knowledgeable enough in flow. I can putter and I can put the tubes in the machine. Gating is someone else’s work.

          • Roadstergal

            I do my tricky work on an LSRII or Fortessa (oh, the Fortessa is sweet), and we have CantoIIs for workhorses. I do get a bit into flow porn – my background is flow, and even though I’m overall-biomarkers now, I still stick closely with it, because so much biomarkers work uses it…

            Ha, BD even calls the Calibur “Cell analyzer and sorter for fast, easy, and accurate results for routine applications.” Routine, yes. They won’t even list it as a research tool. The new thing now is CyTOF, which has some cool features, but really needs to be approached with more caution than it’s being approached with. :p

          • Taysha

            You just flew over my head 😉 I try to stay away from Flow as much as I can. I’m the genetics/Molecular person.

            In short, the jack of all trades.

          • Roadstergal

            Yeah, we default to ln here…

          • AirPlant

            Because natural is always better?

  • mythsayer

    I caught chicken pox at a Japanese hospital after my daughter was there for a week for a fever at 7 weeks (she had nothing basically but they are overly cautious and had to stay until all the cultures came back…so a full week…I caught chicken pox at her checkup a few days later).

    After I showed symptoms I knew she’d get it, too (already had, actually). I asked if breastfeeding would help at all. They said maybe…a little.

    It didn’t work AT ALL. She was COVERED. Pox on top of pox…entire body. Not a millimeter free of them. All over her mouth, too. She was bottle and breastfed and refused a bottle for two weeks while she healed bc she was so uncomfortable and being attached to me was her only comfort.

    I had maybe 100 pox. Very, very light case. I was lucky. My pretty much newborn infant was not so lucky.

    I call bs on this breast milk immunity. It’s not true. If it were, she’s have had a much lighter case.

    • Who?

      Rotten for both of you. If you weren’t immunised, or hadn’t had it before, you were really lucky to not be deathly ill yoursefl. All the adults I know who’ve had it for the first time as adults had a really rough time.

      • mythsayer

        I was VERY lucky. It was weird actually…my friend’s brother and sister had it when they were 4 and 6 and I was 13. They were told to stay away from me as id never had it but they didn’t. I found ONE bump on my knee and wondered whether it would get worse but it didn’t. These days I think they’d already scabbed over and weren’t infectious but who knows. I DEFINITELY had it as an adult although there was some speculation it was a wild strain as some vaccinated kids caught it, too. BUT they were all under 5 and had only had the first vaccine so it could have just failed with them. NO children who’d had both caught it. So but of a mystery there.

        As for me, I’m an only child, lived in a fairly remote mountain town and was born in 1978. Just never came into contact with an infected kid somehow. Totally weird.

        If you are born before 1980, they presume you had it. Presumed immunity. I was a senior in high school when the vaccine came out and no one thought to ask people like me. I didn’t even know there WAS a vaccine until I got pregnant, actually (why would I? I had no kids to vaccinate and no one thought to ask me if I’d had it).

        So yeah…VERY, VERY lucky on my end.

        It sucked when I had it though. My husband went away for a week the DAY I showed symptoms (Friday). By Monday, they’d quarantine me in my house. I didn’t even have any food. My PREGNANT friend brought me some. Telling her about it was the worst call I’ve ever made. I went to the clinic on Saturday bc I needed to know if it was chicken pox or not. Because was going to her baby shower…her 22ish week baby shower. They told me no, heat rash. I asked if okay to go to baby shower. Stupid dr said “sure.” I went. Monday I went to different dr who confirmed it. WORST CALL EVER to friend. Luckily she’d had it and her daughter is fine.

        I was stuck in my apartment, with chicken pox, with barely any food, with no help, for an entire week. Waiting for the baby to come down with it. It was horrible.

        • Who?

          What a nightmare, and how awful that your friend was mixed up in it. Your husband must have been frantic knowing how you were and not being able to get back and chip in. Shame you were quarantined but not helped out with the basics!

          Glad it all worked out okay with no permanent harm done.

          Presumed immunity seems to differ from country to country, and maybe it changes over the years too.

          Mum was telling me she saw a young teen with what she’s sure was measles in a local pharmacy. Her mother was buying her cough lozenges. We’re having a local epidemic, makes you wonder how many people have it and no one recognises it, so they don’t go to the doctor but just spread the bug around.

          We’re also having a nasty flu season, and my 21 year old has just had hand, foot and mouth (the doc read her the Riot Act about not going out while she had active lesions).

          Wash your hands, people, and stay home if you aren’t well, if you possibly can.

  • demodocus

    back wash into my boob? what a gross thought.

    • Nick Sanders

      Well, if you don’t trust in your baby’s spit, how is your body supposed to overcome that negativity?

      • demodocus

        *shudder*
        On a related and gross note, would there then be backwash for people receiving oral sex?

  • Dr. W

    I went to medical school, and I am smart enough to have some idea of the degree to which I do NOT understand immunology. Lord, I trained on transplant services and got lectures on chimerism, and I know even world class experts are still befuddled about many things. Knowing how ignorant you are is required to learn anything. See the Enlightenment et al.

    It is amazing to me that seemingly every boob nazi and antivaccine nutbar knows everything about about a system that makes brilliant people scratch their heads. Clearly these morons have an immunology algorithm that runs as follow: (Box 1) Crap I want to believe (arrow) (Box 2) A miracle occurs (arrow) (Box 3) Crap now true, post immediately.

    Their absolute belief is a sign of not just ignorance, but untreatable ignorance.

  • Amy M

    What mammary gland receptors is she talking about? The innate immune cells detect pathogens. Of course there ARE receptors in the mammary glands, but they have other jobs. And there would be various receptors on different types of cells….I am far from an expert in immunology, and accordingly, I don’t write articles “explaining” how it works to others. This woman doesn’t seem to know what she is talking about, and even a glance at wikipedia would be sufficient to know the basics. I guess she didn’t look at wikipedia.

    • Rosalind Dalefield

      This nonsense by Hinde popped up on my newsfeed, and I tried asking the person who posted it what cells the receptors are on. I got nothing but abuse and meaningless results from Google Scholar, wherein they had searched for ‘mammary receptor’ and got a whole lot of links about estrogen receptors, oxytocin receptors etc etc.

    • Rosalind Dalefield

      It seems to me that for the breasts to do what she says, the nipple ducts would have to be lined with Langerhans cells or monocytes, wouldn’t they?

  • Amy M

    What about the claim that breast milk somehow detects exactly what nutrients the baby needs at a given feed and adjust accordingly? That seems unlikely to me….I could see how the available nutrients could change depending on the mother’s diet. I could see how breast milk could change over time, as the baby ages and its needs change.

    Has anyone looked at samples of breastmilk from many women with newborns vs. samples from women with 6mos olds or 1yr olds? Then we might see if the milk is more similar based on the mother’s diet, or the age of the baby? And another way to look at this could be to get samples from women (lots of women) at each feeding and see if there are changes over the course of a day, a week, a month, etc. Breastmilk can be broken down and its nutritional content analyzed, right? Are the lactivists basing this claim on some research that has done that (adequately)?

    • Amy Tuteur, MD

      If that were the case, it would be a very good reason not to tandem breastfeed.

      • Amy M

        Ha! Well, I guess it wouldn’t matter that much, since the older baby/toddler should be eating mainly solids anyway. Though he might take away nutrients from his baby sibling. I tried to tandem breastfeed my newborn twins for a few days, but I suppose they would have had similar needs, from a nutritional standpoint. After they came home from the hospital, they were tandem bottle-fed and both got all the nutrition they needed.

        That’s another thing…even if the nutritional content of milk can change so dramatically, why should it? How much different can the needs of a newborn be over the course of a day or a week? I mean, the AMOUNT of food they need could change, but why would they need different amounts of vitamins, minerals, fat and carbs? Formula would be static, yet formula fed babies grow just the same as breastfed babies. Formula fed babies do fine on the same amounts of nutrients over time.

      • Poogles

        “If that were the case, it would be a very good reason not to tandem breastfeed.”

        Oh, but they already have an “answer” to that – you simply use one breast exclusively for the infant and the other exclusively for the toddler, so each breast “knows” exactly what to make for that specific child.

        • Rosalind Dalefield

          You’d might end up with lopsided breasts that way. I suppose they don’t care.

    • Rosalind Dalefield

      The composition of breastmilk does change a bit over the course of lactation, but I am not aware of any evidence that this is driven by what the particular baby that is suckling needs.

  • J.B.

    If Hinde is talking about antibodies is she really talking about white cells at all?

    • J.B.

      Heh, lots of one woman anecdata (or anecdatum?) in the article. Cause my kids eat the stuff I ate while nursing really. Personally in the highly unlikely event that I have another child I’d probably try to nurse for 3 months then shut the taps off.

      • Wren

        Your kids eat the stuff you ate while nursing? Teach me! My kids both had at least 12 months of breast milk and now at 8 and 9 their food likes are wildly different, which makes cooking for the family a total pain.

        • J.B.

          Maybe I didn’t denote my sarcasm well enough. I actually read the linked article and her kids are apparently mini foodies. Mine are not 🙂 And they want different things. My carb fiend did just surprise me by eating jambalaya, so spicy carbs.

          • Cobalt

            My kids eat a lot of the same stuff I ate during their first year, whether they were breastfed or not. My theory on how the formula fed child managed to figure out what he was supposed to eat in the absence of the mystical guidance of my breast milk (which had previously tried to kill him): I buy foods that are affordable and that I like. This is the food that was available to me when they were babies and to them when they were toddlers. Most of it got adopted as their base diet, with typical individual taste preference variation. Breastfeeding didn’t matter one bit.

        • Medwife

          Riddle me this: I did not have any chicken nuggets through the over 2 years I breastfed him. Chicken nuggets are not my bag. Now, they are one of like 4 foods he eats. Another is banana, which I am allergic to and hence never eat.

          • Amy M

            I have chicken nugget lovers too. And mac/cheese. I’m glad to learn its not just me. As my boys are 6, I’m hoping they outgrow toddler-palate soon.

    • Amy Tuteur, MD

      Sorry, I forgot to include that data. I added it:

      “In addition to breastmilk leukocyte response to maternal/infant infection, a less consistent but often significant humoral immune response was observed…”

      The authors note this humoral response to maternal/infant infection, but don’t present any data that it occurs specifically in infant infections.

      • Roadstergal

        This is the supplemental figure they base the Ig response info on. I am inclined to say it is all inter-assay variability. (Maybe even intra-, as that wasn’t shown and probably wasn’t even done.)

  • What is the division between live vs dead white blood cells that make it into the milk when the mother is infected? Lactivists try to imply the white blood cells can help heal the baby, but the description of pus makes it sound like it is just the left over waste product. Are there enough live white blood cells to make any difference?

    • Cobalt

      Does ingesting live white cells do anything? Do they survive the digestive process to enter the infant’s bloodstream to go to the site of infection? Does any amount of white cells in the milk actually make a difference?

      • Rosalind Dalefield

        They would be highly unlikely to survive the digestive process, I’d say.

        • Nick Sanders

          Isn’t the reason baby poop is so nasty that babies’ digestive systems aren’t strong enough to kill microorganisms yet? I know that’s why you don’t give them honey.

          Granted, bacteria are complete organisms while white blood cells are a body part not meant to survive on their own.

          • Rosalind Dalefield

            The thing about honey specifically refers to the risk of botulism because a baby’s stomach is not sufficiently acid to destroy C. botulinum spores. I cannot comment on whether a baby’s stomach is sufficiently acid to destroy bacteria that cannot form spores.

          • Allie

            According to lactivists, the poop of exclusively breastfed babies smells sweet and only babies fed nasty formula have stinky poop.

          • Kq

            They speak lies. My son latched like a pro at birth and never so much as had expressed milk for the first two months. His poop stank so much it would make a goat vomit.

          • Medwife

            I have heard by far enough people say this that I do believe it’s true, and that some breastfed babies’ poop smells like plain ol’ stinky feces. But honestly, my kid’s poop did not stink like poop! Not until he started on some solids. That’s how I know it didn’t stink before rather than my being osmially blinded by hormones, because damn, I sure noticed the change.

          • Inmara

            I was afraid that starting to supplement with formula will cause a stinky poop but turned out that poop just becomes thicker yet smell is still quite innocent.

          • Cobalt

            Is supplementing going well? It can be more work sometimes but can also give you the “best of both worlds” with having more options and making life easier and more comfortable for everyone.

            I wish you and your new family all the best.

          • Inmara

            Thanks for asking, baby is doing fine! Today we had 1 month checkup and pediatrician was impressed by his weight gain (he dropped from 25th percentile at birth to almost 5th (by WHO growth charts) but now is climbing back towards 25th). Seems that I have mostly the hassle from both worlds (feedings are taking no less than 40 minutes, I’m worried about getting clogged milk ducts or something similarly unpleasant, somebody has to prepare bottles etc. etc.) but as long as it’s possible I’ll continue combo feeding and give baby those trivial health benefits from breastfeeding 😀

          • Cobalt

            It should all get a lot easier over the next few weeks. Breastfeeding after the first 2 months is usually a lot less work than the newborn phase. Bottles get easier with practice, too.

            The biggest help is the baby starts sleeping more at a time!

          • Susan

            I have to agree on this. My three it only began to stink like poop when they started solids. Before that, seriously it smelled a little like microwave popcorn. I have changed enough diapers of other people’s kids and I think this is actually true, that exclusive breastfed baby poop isn’t as noxious. It isn’t that it smells good… Just much less awful.

          • Michele

            It seriously put me off popcorn until my baby’s poop started smelling more poop-y.

          • Rosalind Dalefield

            I didn’t mind the smell of my babies’ poops until they started on solids, and I had four. Just smelled like what it was, somewhat denatured milk.

          • Cobalt

            When mine had only breast milk, their poop was less noxious than a mixed diet. It was also so much easier to clean off the cloth diapers. I wish that stage lasted longer, it was a nice side effect!

            Worst was hydrolysed formula poop. That formula stinks going in and worse coming out. Solids IMPROVED the smell. I can’t complain though, because it also meant my baby could eat, and therefore survive, which is kind of a biggie.

          • fiftyfifty1

            I agree with you on this one. In my experience, most exclusively breastfed babies have the “breastfed baby poop” smell. But a certain percentage (maybe 20%?, I’m just guessing) smell like regular stinky shit right from the beginning. A close friend from med school exclusively breastfed her 3 kids and right from the start all 3 stank. If they would even pass gas it was like a total stink bomb. Must be differences in gut flora? Which is funny, because being GBS+ I has the evil antibiotics with both mine, while her 3 births were all antibiotic free.

          • KeeperOfTheBooks

            Whereas even I, who have a pretty sensitive nose, wasn’t really bothered by DD’s formula poop. Once she started solids, though…*gags*

          • Hiro

            Yeah, I was expecting my kid’s poop to smell worse from formula. I mix fed, and I could smell the difference between a breastmilk feed and a formula feed and honestly, the formula feed smelled like yogurt, and the breastmilk like popcorn. Neither were offensive. The solids poop though…wicked bad.

            Not related: I °HATE° the smell of my breast milk.

          • Fallow

            It speaks of how devoted they are to this belief system. Everything about breastfeeding must result in a perfect outcome. They even need breastfed feces to smell good. It can’t just be feces. It has to be special feces.

            It just shows how irrational it all is. If they had come to their conclusions in a rational way, they wouldn’t need every aspect of breastfeeding to be golden.

    • Amy Tuteur, MD

      Live white cells can’t survive stomach acid and they can’t get into the baby’s bloodstream.

      The research basically shows that breastmilk of uninfected mothers has very few white cells. The amount of white cells increases dramatically when the mother has an infection in her breast. That’s not surprising since they travelled to the breast to attack the infection. That they end up in the breastmilk (alive or dead) appears to be incidental.

      • Thanks for replying! Now I’ve also heard lactivists claim that babies don’t produce nearly enough stomach acid and have leaky guts…. so therefore what gets in does make it to their bloodstream. I’m guessing you have a good response to that too.

        • Amy Tuteur, MD

          There’s simply no evidence that maternal white blood cells in breastmilk end up in an infant’s bloodstream.

        • Rosalind Dalefield

          If newborn babies are anything like other baby mammals, they can absorb immunoglobulins directly from the gut for the first day or two only, but an immunoglobulin is obviously far, far, far smaller than a whole white blood cell.

          • SuperGDZ

            They don’t. Primates (including humans) transfer passive immunity via the placenta before birth and not through colostrum or breast milk after birth. Bovines are reliant on immunoglobulins in colostrum, because they don’t transfer through the placenta before birth. Rodents fall somewhere in between.

          • Rosalind Dalefield

            Not only bovines but all ruminantia, probably all artiodactyla. Also perissodactyla, including the horse, and carnivora, including dogs and cats.

          • Cobalt

            For horses, at least, colostrum is absolutely vital. As is preventing even tiny open wounds in the first days, their immune systems at birth are “blank” and they are frightfully susceptible to infection. On the plus side, their reliance on milk is much lower and they can be safely weaned much earlier in their development.

            The human system of providing immunity via the placenta is much safer. The long reliance on milk is kind of a pain though.

          • Rosalind Dalefield

            Safer unless there is an incompatibility such as Rh incompatibility. There are similar disorders in horses and in cats, but they don’t affect the offspring until it consumes the maternal antibodies after birth.

          • Rosalind Dalefield

            Agreed, if a mare won’t feed her foal it is essential to milk her and get at least a litre of colostrum into the foal, by stomach tube if possible to make sure the foal gets it all. After that, foals do extraordinarily well on foal milk replacer.

          • Azuran

            Actually, dogs and cats are closer to humans. They get most of their passive immunity through the placenta before birth and can manage just fine without colostrum.

          • Rosalind Dalefield

            Not my experience, as a veterinarian or a cat breeder. Kittens don’t manage just fine without colostrum at all.

          • Azuran

            Sorry, my mistake about the cat, they do get some from the placenta, but most from the colostrum. Sure, having the colostrum is better and without it, clearly some of them will die, but they can still make it. Unlike horse and cows, which are almost certain to die from just about anything without it.
            I’ve had many experience with kitten who did just fine with replacement milk straight from their birth.

          • Rosalind Dalefield
          • Rosalind Dalefield

            Why then do blood group incompatibilities between dam and kitten only show up after birth? Why do they not get fetal erythrolysis similar to Rh incompatibility?

          • Rosalind Dalefield

            I should have added that in my experience raising neonatal calves, lambs and kids, calves seem to be much less able to cope with colostrum deprivation that lambs or kids.

          • @SuperGDZ, you may want to check out 6000+ research papers mentioning human colostrum:

            http://www.ncbi.nlm.nih.gov/pmc/?term=human+colostrum

          • SuperGDZ

            The first 6 or 7 on that list were several relating to rats (“autistic rats!?!”), water buffalo and lambs. Another 2 were about administering bovine colostrum to humans and 1 was about isolating antibodies in the milk of HIV positive mothers for use in a vaccine. So perhaps you want to refer us to the relevant ones (that would be the ones that show that immunoglobulins are absorbed through the gut of full term human babies) – you have read them all, right? If not, then let me know when you’ve got through them and found what you’re looking for.

          • The first 6 all related to the biological activity of human colostrum. How important this is will probably depend on the individual circumstances.

          • Rosalind Dalefield

            I’ve done a bit of reading around this in the last couple of days and you are incorrect. Although human babies get *most* of their immunity across the placenta, they can and do absorb immunoglobulins directly into the systemic circulation from colostrum in the neonatal period. Mostly IgA and IgM. They don’t *need* colostrum nearly as much as other mammalian species do, but they nevertheless can absorb immunoglobulins from it. I think you are confusing ‘*can* absorb Igs from colostrum’ with ‘*must* absorb Igs from colostrum’.

          • SuperGDZ

            But insignificant in terms of establishing passive immunity, which is transferred in utero.

          • Rosalind Dalefield

            Yes it is insignificant, but nevertheless they do have the capability to absorb Igs directly in the immediate neonatal period, whereas you stated that they don’t.

          • SuperGDZ

            From my own reading, the evidence is that they don’t, or at best to a trivial or insignificant degree. If you have information to the contrary then please feel free to share it.

          • Rosalind Dalefield

            Well there’s this paper:
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1648139/
            and these abstracts:
            http://www.ncbi.nlm.nih.gov/pubmed/6875749
            http://www.ncbi.nlm.nih.gov/pubmed/577500

            I agree that it is to a trivial degree and that a human baby does not need colostrum the way many other mammalian neonates do, but that was never my point.
            My point is that the neonatal gut is more permeable than the adult gut, but nowhere near permeable enough to admit whole white blood cells.

          • Rosalind Dalefield

            Agreed, but that was not the point. My point was that the neonatal gut is *slightly* more permeable than the more mature gut, in that immunoglobulins can be absorbed intact, but it is nowhere near permeable enough for whole white cells to be absorbed.

          • Roadstergal

            They get IgG across the placenta, which is systemic and has high affinity and high effector function. IgA and IgM aren’t (IgA is mucosal and has low effector function, IgM is massive and low-affinity and I’d be surprised if it gets across intact*), so even though the baby can theoretically get some of that from BM, it doesn’t do much. Basically, the immunology is right in line with the effects seen in the best studies on BM vs formula – a small reduction in the chance of certain minor GI ailments.

            (*IgM is the first go-’round at immunity – low affinity, so it goes pentameric to try to make up for it with avidity. If you disrupt that massive pentameric complex, the avidity goes away. Naïve cells undergo somatic hypermutation to increase the affinity for a presented antigen (process called affinity maturation), and then class-switch to whatever is called for by the cytokine milieu – often some flavor of IgG. IgGs passed on from the mum in utero confer some protection until they go away – the half-life of an IgG is about two weeks, so after a month, protection is dropping right off. Vaccination gives a babe a nice reserve of memory B and T cells and long-lived plasma cells in the bone marrow.)

          • Rosalind Dalefield

            Thank you for the immunology lesson, but I already studied immunology to 400 level and know the roles of the different types of Ig. You have missed my point. My point is that SuperGDZ asserted that primate neonates cannot absorb Igs from colostrum directly across the intestinal barrier as other neonatal mammals can, and that assertion appears to be incorrect. They don’t *need* to absorb Igs from colostrum, as many other mammals need to, because of placental transfer, but that was not my point.

          • Roadstergal

            I apologize if I came across as condescending, that was not my intent. Most folk don’t know the difference between the different types of Igs, and the preceding part of the conversation hadn’t touched on that, so I wanted to put in a clarifying comment.

            The start of the conversation was about whether immune cells could be absorbed into the body through a healthy gut and pass into the bloodstream alive and functional, and that part is a no. Good thing, too.

          • Rosalind Dalefield

            Indeed. My original response was that while the neonatal gut can for a very short time absorb immunoglobulins intact, an immunoglobulin is far, far smaller than a whole cell. The notion that a whole white blood cell could be absorbed intact across the intestinal barrier is totally wrong. It makes you wonder how Hinde could come up with such a notion.

    • Young CC Prof

      The immune component of breastmilk isn’t white blood cells, alive or dead. It’s an immune system protein called IgA, that appears to defend baby’s digestive tract against bugs.