No, breastfeeding does not prevent maternal diabetes

Bullshit button

Another day, another bullshit breastfeeding study.

This one is Lactation Duration and Progression to Diabetes in Women Across the Childbearing YearsThe 30-Year CARDIA Study:

Among young white and black women in this observational 30-year study, increasing lactation duration was associated with a strong, graded 25% to 47% relative reduction in the incidence of diabetes even after accounting for prepregnancy biochemical measures, clinical and demographic risk factors, gestational diabetes, lifestyle behaviors, and weight gain that prior studies did not address.

In truth, the study didn’t show anything because it violated the  most important requirement for a breastfeeding study; it failed to correct for maternal education and socio-economic status.

It’s the intellectual equivalent of claiming that Volvo ownership prevents maternal diabetes.

How does this discredit the paper?

Breastfeeding in industrialized countries is closely associated with maternal education and socio-economic status. Adult onset diabetes is also closely associate with maternal education and socio-economic status. Unless the researchers correct for these factors (and they did not do so in this study), they end up demonstrating what we already know: the incidence of adult onset diabetes is a function of education and SES. It’s the intellectual equivalent of claiming Volvo ownership prevents maternal diabetes.

Researchers have confirmed the relationship between adult onset diabetes and socio-economic status in a wide variety of studies, including Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. The authors looked at 23 studies:

Compared with high educational level, occupation and income, low levels of these determinants were associated with an overall increased risk of type 2 diabetes; [relative risk (RR) = 1.41, 95% confidence interval (CI): 1.28–1.51], (RR = 1.31, 95% CI: 1.09–1.57) and (RR = 1.40, 95% CI: 1.04–1.88), respectively.

Similarly, there are a myriad of studies that confirm the relationship between breastfeeding rates and socio-economic status in industrialized countries. As an article in Quartz starkly illustrates, breastfeeding is basically a marker of education and income:

A59536D4-A203-4C87-B39E-B8B7D1F164F1

Why is it so closely associated with maternal education and socio-economic status?

Well-off parents have access to the infrastructure that supports breastfeeding: longer maternity leaves, jobs that allow for pumping breaks, the ability to hire outside help to support a new mother, and—perhaps most importantly—immersion in a culture that unconsciously views breastfeeding as a desirable status symbol and pressures them to continue to that hallowed six-month mark and well beyond.

Breast milk has become a luxury good, another example of what the sociologist Elizabeth Currid-Halkett calls inconspicuous consumption: the investments in intangibles like health and education that increase social capital for the modern wealthy. And because these costs are largely invisible, it’s easy to frame breastfeeding as a free good equally available to all. The truth is much more complicated.

How did the authors of the new paper account for the association between maternal education and income and both breastfeeding rates and rates of adult onset diabetes? They didn’t. That’s especially disconcerting when their own data (buried in Table 3) indicated a statistically significant difference in failure to graduate from high school [15% vs 13%; p <0.001] between those who developed diabetes and those who did not.

Adjusted models included covariables: examination years (time), race, family history of diabetes, baseline age, fasting glucose, BMI and waist circumference, time-dependent GD, parity and physical activity, and dietary quality score. Trend P values were generated from models of continuous time-dependent lactation duration. We evaluated potential confounders based on a priori hypotheses for selected baseline (BMI, fasting blood glucose and lipids, HOMA-IR, blood pressure, sociodemographics), and follow-up (smoking, dietary quality, physical activity, hypertension, medication use, and pregnancy outcomes) covariates.

C0E7BEBB-3DC1-4AF0-B317-31FC79F547A2

Maternal education and income were ignored. And that makes the study worthless.

The authors blithely ignore their failure; they don’t deign to mention it in their self-reported limitations of the study despite the fact that it is the most critical — and inexcusuable — limitation of all.

The authors claim:

Our findings may have implications for social policies to extend paid maternity leave to achieve higher intensity and longer duration of breastfeeding. Second, increased allocation of health care resources to increase breastfeeding rates through the first year postdelivery may be offset by lower health care costs associated with prevention of chronic disease in women. It is also imperative to improve breastfeeding practices to interrupt the transgenerational transmission of obesity-related diseases. Lactation is a natural biological process with the enormous potential to provide long-term benefits to maternal health, but has been underappreciated as a potential key strategy for early primary prevention of metabolic diseases in women across the childbearing years and beyond.

Wrong! Their findings have no implications at all because they showed nothing beyond what we already knew: both breastfeeding and diabetes are associated with maternal education and income.

It’s yet another example that at this point breastfeeding research has become a self-reinforcing farce. Researchers assume breastfeeding is beneficial and then go searching for the benefits without bothering to correct for critical variables that are well known to be confounders for both health status and breastfeeding incidence.

That’s not science; that’s bullshit.

  • KeeperOfTheBooks

    So, I lost my father a year ago yesterday to complications from diabetes. We’d been estranged for years, but, well, he was still my dad, and I wish things had ended differently for a lot of reasons, though I personally have no regrets.
    It was a major wakeup call for me. I was 50+ pounds overweight, and while my eating and exercise habits had gradually improved a bit over the last few years, they were still not great.
    In a seven-month timeframe, I lost over 30 pounds from eating sensibly (had to learn to count calories…ugh!) and exercising nearly every day. Got pregnant, have still kept most of the weight off despite being 30 weeks along, which means I’ve been steadily, if slowly, losing over the course of the pregnancy. (My OB is fine with this.)
    I’ve learned a lot of things along the way: portion sizing, caloric value (you can eat an awful lot of broccoli before hitting 100 calories, ice cream, not so much), better self-discipline than I had before, etc. One of the biggest things I’ve learned, though, is just how much SES plays a role in healthy eating. Our grocery bill increased significantly when I started eating more healthily, and I had to plan meals well in advance. That wasn’t a big deal for us (I phrased it to DH as “fruits, veggies, and Greek yogurt aren’t super cheap, but they’re cheaper than test strips, insulin, and medication”), but for someone who isn’t a SAHM with a solid income and enough time to do all that…? It would be really, really hard. Not impossible for many, but there are a LOT of barriers: finances (I grew up dirt poor), time (until I married, I was working 2-3 jobs all my adult life), family history/culture (all our food was slathered in butter and oil, portions were gigantic, lots of simple carbs, food as love, etc).
    I do think our culture makes food much more complicated than it needs to be (frozen veggies are just as good as fresh, and don’t spoil!), but it’s still taken a fairly impressive amount of my free time over the last year to learn how to eat healthily, even leaving out all the organic/gluten-free/silly elimination/keto/paleo/whatsit diet mumbo-jumbo. Many people don’t have that sort of free time, or the money with which to experiment.

    • The Vitaphone Queen

      Hugs!

    • Caylynn, RD, MPH

      Yes! I tell my clients “healthy easy is simple, but it isn’t easy” – in order words, it really isn’t very complicated, but that doesn’t mean it’s easy for the majority of my clients (low SES, marginalized, vulnerable for a variety of reason).

      I’ve never breastfed. Never been pregnant. Have no idea of my family history (I’m adopted). I don’t have type 2 diabetes, hypertension, hypercholesterolemia, or high triglycerides, unlike the majority of my clients who are my age. The big difference: I was adopted into a middle class / middle income family, whereas they are living in poverty / come from generational poverty / are living on welfare or disability.

      It’s very clear that SES plays a huge role in health outcomes. Of course, genetics play a large role as well, especially in certain diseases / health outcomes.

      As for education, I’ve counselled some CEOs / CFOs when I worked at a diabetes management centre. It was quite shocking how little these well educated, very intelligent, very successful individuals actually knew about healthy eating. Then I realized that, even before I become a dietitian, I was more interested in food and nutrition than the average person.

      • KeeperOfTheBooks

        Yes, exactly! Dad was very well-educated and even better-read, but he had these loony ideas about diet like “butter won’t raise your blood sugar, so there’s no reason to restrict it.” Well, no, butter doesn’t have carbs in it, true, but it has a LOT of calories, and calories do, in fact, translate to weight, which in turn won’t do your pancreas any favors in terms of managing your blood sugar.
        To be honest, while I do loooooove to cook, I wasn’t interested in nutrition until it applied so much to me, and found it terribly intimidating to boot. Like, budgeting calories over the course of the day–if my typical breakfast comes in at 600-700 calories, how in the world am I supposed to keep calories at 1500 plus whatever I burn in exercise?! So I’d just give up right there.
        (The answer, of course, was to find a breakfast that was filling but didn’t clock in at half my caloric allotment for the day, but that by itself was pretty intimidating at first. Thank goodness for MyFitnessPal and my Fitbit, which took a good chunk of the work out for me…but again, smartphone plus internet plus a device which, while decidedly helpful and worth the investment, was a bit of an investment at $100.)
        When I was in college 8-10 years ago, my week’s grocery budget was $15-$30/week, depending on how many hours I got that week and other expenses. That doesn’t allow for much wiggle room in food waste, and does mean you want to make every dollar count for as many calories as possible. While I ate very little processed food, I ate a lot more fat and calories overall than I needed to: fatty (cheap) cuts of chicken, potatoes with a lot of butter, eggs with a lot of butter and cheese, homemade bread with butter and jam…you get the idea. But salad literally wasn’t in the budget, and couldn’t be, so I filled up on the far higher-calorie stuff. Plus since my entertainment budget was nil, food was also for fun, and that meant more unhealthiness. I’ll bet I wasn’t the only person in that position back then, and I’m sure it’s still plenty true of a LOT of people today.

  • Ob in OZ

    Was trained by an expert in Diabetes and Pregnancy. So happy no one I know was involved in the study. I would have thought the reviewers would have made them include these shortcomings in their discussion, if not send it back until they corrected for these confounding variables.

    • Empress of the Iguana People

      I bet. i’d be pretty horrified if my ob were one of them and we were never friends

  • myrewyn

    My baby and I were both sick — something with a fever but not the flu. I made a comment that she didn’t have much appetite for solids but that she’d been nursing all day and I was glad my supply was keeping up. in addition to the saliva comment, she said “oh as long as she’s nursing more you’ll just make more”. So do you get into a discussion with an MD about how it doesn’t necessarily work that way?

  • Ms. Sweaterfan

    I have a breastfeeding question that is only tangentially related to this post but I’m hoping that some of the lovely contributors here might have some expertise to share:
    I had always heard and believed that babies got many of their antibodies via breastmilk after they were born. However, back a few months ago when I was contemplating quitting breastfeeding (due to DMER) I found a wonderful article from one of the founders of the Fed is Best organization that explained that the only antibodies transmitted by breastmilk involve the digestive tract and they are only effective for a very short time. Assuming this is true, what is the proposed mechanism for the oft quoted finding that breastfeeding reduces diarrheal illness AND COLDS up to 8 percent?

    • Ms. Sweaterfan

      It took some digging, but here is the article I mentioned:
      https://www.thescientificparent.org/passive-immunity-101-will-breast-milk-protect-my-baby-from-getting-sick/

      (hopefully I remembered the details correctly in my original post)

    • Roadstergal

      *immunology hat*

      Yes, indeed. In humans, temporary systemic protection (via IgGs) is passed through the placenta (which is why you get boosters in pregnancy – to raise your circulating IgGs so you can pass more along). The antibodies in breastmilk are IgA, and only have local action in the gut.

      What is the proposed mechanism? Honestly, I think it’s residual confounders. :p

  • PeggySue

    I guess I lack imagination. I can’t even really fathom a mechanism by which breastfeeding would impact risk for maternal diabetes.

  • Young CC Prof

    Let’s not forget the other giant problem with this study: Gestational diabetes increases the risk of insufficient milk supply by a lot. The authors tried to look at GD during pregnancy, but this is proudly titled a “30-year study.” Accurate GD testing is not universal even today, far less 30 years ago.

    The authors failed to adequately consider reverse causation, that is, that women already at risk of Type 2 diabetes due to PCOS, GD, or early-stage insulin resistance were more likely to have nursing problems.

    • Tigger_the_Wing

      Indeed. The only reason my own type 2 was picked up was because I’ve had to have regular blood tests for years for my other conditions. I was completely without any symptoms that would have alerted me to go and get tested, had I otherwise been healthy.

    • Caylynn, RD, MPH

      Even when women are diagnosed with GD, not all of them receive optimal treatment while pregnant. When I was a dietetic intern, I worked at a diabetes clinic that saw a lot of women who had been diagnosed with GD. It was scary the number of women who refused to go on insulin (despite repeated reassurances that insulin was safe and did not cross the placenta, unlike high maternal blood sugars), and who therefore had less than adequate control of their GD, resulting in poor outcomes. Then there were the moms who essentially starved themselves, and forced themselves to walk for hours after each meal, to try to control their blood glucose levels without insulin. That had poor outcomes for both mom and baby. We really did our best to listen, to reassure, to acknowledge challenges, difficulties, and barriers, and to try to problem solve those with the women, but some of them simply sadly couldn’t be convinced.

  • Casual Verbosity

    In sum, the breastfeeding literature is one giant circle jerk of confounding factors.

  • carovee

    Wait that was published in JAMA? How the heck did the editor and peer reviewers miss the fact that income was not controlled? Actually, it doesn’t look like the controlled for education either even though its on their list of follow-up characteristics.

    • Casual Verbosity

      Because breastfeeding.

      But seriously. The message that “breast is best” is so ubiquitous that it has transcended to the level of “truth”. As “truth” we don’t actually have to prove it. People will say: “Everyone knows that breast is best”, in the same way they would say: “Everyone knows that the earth is round” – except that those statements are not equivalent. As a consequence, we treat any studies reinforcing this truth less critically than we would treat almost any other study. You would hope that reviewers, people who are paid to think critically, wouldn’t be subject to the effect of this bias, but they’re only human. Unfortunately in science, it seems that breastfeeding is a protected topic. Even if one were to express dissent, you’d be hard pressed to get any organisation to back you.

  • pinktulip

    You do realize, Jamss Nicholas, that Courtney Jung’s book is one of the most poorly written, badly referenced pieces of drivel out there? And she has no qualifications in anything health-related whatsoever? What kind of Mickey Mouse course are you teaching?

    • Amy Tuteur, MD

      Actually, it’s well written, well sourced and correct. That’s no professional lactivists have been unable to rebut its central claims.

    • CSN0116

      I think you’re trying to reply to me, though I am not Jamss Nicholas?

      And that book is incredibly well-written. She does a brilliant job with the complicated WHO policies and interviews some key players that nobody else has yet to obtain. It is written from a political science perspective, and she’s upfront about that. I use it to generate discussion on public health policies — when they go wrong.

    • Amazed

      You do realize that no one has been able to refute Jung’s book with facts? Including you here. Breastfeeding “science” is in big trouble if all you fanatics can do is yap at people on blogs without providing an ounce of evidence.

      • It’s a lot easier to sling insults than to make substantive criticisms in the form of “Jung’s claim ‘X’ is wrong; this is the truth (appropriate, accurate source).”

    • Claire Secrist

      “You do realize”. So many statements of flowing bullshit and unearned certainty/smugness begin with this phase.

  • carovee

    I’ve been reading a lot lately about why clinical trials fail to agree with observational studies. Its astonishing how many studies fail to account for SES. Income has such a walloping effect on every aspect of life it should be considered scientifically unethical to publish results that don’t include at least some effort to adjust for it.

  • 3boyz

    Aw, shucks! You mean the fact that I’ve breastfeed each of my kids for two years won’t save me from my ridiculous diabetes risk? (Insulin resistant, GD in 2 out of 3 pregnancies, major family history of GD and Type 2)

  • The Vitaphone Queen

    https://youtu.be/jRDvAlIL1Jg

    COOKIE MONSTER, Y U NO BREASTFEED?? OR DRIVE A VOLVO??

  • Teasing out SES would be tricky, especially since people’s status changes over time. Not even to try, however, is ridiculous.

    • Casual Verbosity

      What’s worse is that it is entirely possible the researchers ran an analysis including SES as a controlling factor, found it reduced their results to nothing, and chose not to report it in the study. Unfortunately, stuff like that happens all the time in science. That’s why there’s a push by a small faction of the scientific community to establish a practice of pre-registering studies. My supervisor had me do this for my honours project. Basically you go to a pre-registration site and answer a short questionnaire for each experiment you plan to complete. You record things like what groups you’re going to have, roughly how many participants will be in each group (to prevent people from just collecting samples until they get a significant result), how people will be allocated to groups, what analyses you’ll do, and any specific hypotheses. You submit this form to the website who holds onto it until you’re ready to submit your study for publication. You then tell the website to make your pre-registration accessible to the public, and include your study’s ID number in your paper. That way anyone reading your paper can look up your form and they can see that you actually hypothesised a relationship between X and Y, and didn’t just go fishing for it. This system is designed to keep researchers honest and accountable. Unfortunately as it is completely voluntary at the moment, only people who already value transparency will use it, but imagine if we could make pre-registration compulsory for any paper that wishes to be submitted to a journal.

      • Roadstergal

        Yes, this should be done. Clinicaltrials.gov, but for research…

  • EmbraceYourInnerCrone

    Let’s see, if one is middle to upper middle class and/or college educated one can probably afford more fresh fruits and veg, have more access to fresh fruits and veg (harder to find in a food desert!) have more time for gym memberships and time dedicated to exercise, more access to outside areas that are safe to walk/run/bike in. Gee that wouldn’t have anything to do with being less likely to develop type 2 diabetes!!! oh wait…. /snark Sad thing is I know this and do not have a college education (but I was luck enough/privileged enough to be born white, middle class, neurotypical and able bodied in a first world country)

    • StephanieA

      I was grocery shopping today and picked up some apples. For just four honeycrisp apples, I paid $6, and that was on sale (I do realize that honeycrisp are one of the most expensive apple, but these were on sale and comparable in price to other types of apples). And I live in a small city in the midwest where cost of living is very low. How in the world are lower income people living on a tight budget supposed to afford that? And if they live in a high cost of living area, forget it. Not to mention that fruits and vegetables aren’t going to fill up your family.

      • EmbraceYourInnerCrone

        I don’t know. People denigrate poor people for eating fast food, but buying off the “dollar” menu etc means you can get a meal for not much money and there are usually fast food places everywhere (though you can’t always find an actual grocery store!) If you have to take public transit or walk to get and bring home your groceries you buy what you can carry, and make your money go as far as it can. I am pretty luck now but I do remember trying to handle an umbrella stroller, a toddler and groceries on the bus on the way home from work…good times. I always wish people who have never had to deal with that had to live in a small apartment, with a toddler, with a lot of steps(no elevator), a laundry room in another building and only public transit for a month or two.

        • StephanieA

          I totally get why people eat fast food. I took my boys to McDonald’s the other night and we ordered off the $ menu. We were all fed for $6. It’s hard to cook that cheap, and of course there’s the time factor.

          • AnnaPDE

            And the kids will rant and rave about that wonderful dinner for the next few days… As opposed to the home cooked one involving broccoli.

        • Roadstergal

          That’s why I’m happy to see fast food places offering salads and healthy options for kids (lowfat milk, apple slices). I’ve heard people talk smack about ‘who goes to a fast food place looking for healthy food?’ But if it’s the only reasonable option for a family to eat, the presence of healthier menu items can have a big impact.

          • Heidi

            We occasionally visit McDonald’s and I totally get the salads and a healthier side item in the Happy meal! I’ve managed to lose 50 lbs. since July and it’s great to have an option when we’re on the go or need to grab something close and quick. I wish all fast food would implement lower calorie options.

        • PeggySue

          Plus, if I am a parent with a limited income, I am going to be careful to purchase foods I know my child will eat. It’s a real luxury to be able to afford to discard uneaten portions and provide alternatives.

      • Anna D

        Counterintuitevily, in my very high cost area, fruits and veggies can be very inexpensive, especially in immigrant heavy areas. For example, nearest corner grocery in my Brooklyn neighborhood has really great crispin apples (similar in crispness to honeycrisp but with bit more tartness) for $.79/lb.

        • BeatriceC

          Same here. This is a small single location grocery store in a relatively nice part of town. And this was not a particularly great day as far as low prices were concerned. Broccoli was three times the price as the most recent sale price (though the normal “on sale” price is about $0.99/lb) and onions were twice the regular “on sale” price. My bill at this store is generally about 20-25% of the total I would spend at a regular supermarket. It’s also right by a trolley station so a person relying on public transportation could get to it fairly easily. La Mesa is a suburb of San Diego, so not a cheap area at all. https://uploads.disquscdn.com/images/9772c1ec9ca52f0f78d8905fb0161d8c6f02eb8ea36e4da9213757d693dbd420.jpg

          • StephanieA

            It’s good to know that there are places like this in expensive areas.

        • Roadstergal

          It seems to be very area-specific. I live in a hella ‘spensive area, and the little Spanish-speaking markets have very cheap produce – because it’s near heavily agricultural areas. There are places in Chicagoland and St Louis, conversely, where you have to sell a kidney to get fresh fruit and veg regularly. That’s if they’re even in stores.

          This is why I’m a big fan of canned fruit and veg, and get very annoyed at people who downplay it as ‘lesser.’ It’s a great way to make food cheap to get to stores, and easy to stockpile. It reduces food waste, which is a huge factor in food budget.

          • BeatriceC

            My only issue with canned fruit is that I really wish they’d figure out a way to can it without all that heavy syrup. That takes an already sweet food and makes it way too sweet for me to be able to eat.

          • Tigger_the_Wing

            On this side of the pond there has been a big push over several years to get syrup removed from tinned fruit, and now we can often get versions in apple juice or grape juice instead.

          • FallsAngel

            I/we don’t buy a lot of canned fruit simply because we can’t eat it up fast enough once it’s opened. However, I do know that low-sugar and juice packed fruits are available, and have been for many years.

          • Who?

            Yes we get tinned fruit in ‘natural juice’ which doesn’t seem to have any added sugar. It’s better for some things, like the pineapple my husband likes on his pizza, or tinned peaches, which I actually prefer to fresh peaches nine times out of ten.

            They are available in snack sized portions as well, which helps with the waste.

            Sour cherries out of a jar are my favourite, though our fresh cherries are pretty hard to beat at the moment. Black forest cake, anyone!

          • Roadstergal

            I’m lucky that the local Safeway has light-syrup and ‘no sugar added’ versions for some canned fruits. I think Del Monte has a line just for No Sugar Added, now?

            I like canned veggies – I get them plain, or a little spiced up (I love to cook with tinned diced tomatoes with chilies or olive oil and garlic, and try to always have some on hand).

          • jane

            Do you any particular kinds of canned fruit & veg that you recommend as holding up well? I know that frozen is generally good quality for peas, fruit, etc, but not sure which canned fruits & veggies are good too.

    • Caylynn, RD, MPH

      I currently work part-time as a dietitian as a health centre that caters to those who belong to marginalized and vulnerable populations. That means I have a lot of clients who are low income, surviving on Ontario Works (what we would have called welfare in the past) or ODSP (social assistance for the disabled). Those programs do NOT provide enough money for someone to live on. That is, after paying rent, even if living in social housing (i.e. rent geared to income), there is not enough money left over to purchase what we call the “nutritious food basket” which is a pretty simple measure of the cost of healthy food – not anything fancy. I have clients who know how to wring every single penny from the dollars they have, yet buying fresh fruit and vegetables (particularly in the winter, in Canada) is beyond their means. At least some of them can afford canned vegetables, but those are often high in sodium, or my clients have no idea what to make with them! Some of them have a hard time getting to grocery stores – they can’t afford the bus fare. It’s the same reason they often cancel appointments, especially if the weather is bad, as they can’t afford even the subsidized bus fare.

      On the other hand, most of the mothers of infants I counsel are breastfeeding, except in the few cases of failure-to-thrive for the infants. They’ve been so firmly convinced that “breast is best” that they will breastfeed, no matter what, until and unless their family physician tells them that their child in is danger (i.e. failure to thrive). Even then, some of them resist the idea of supplementing, or of pumping and fortifying their own breast milk. It’s so sad that the idea that formula is somehow bad has so thoroughly gotten through to these moms, some of them still teenagers.

      Of course, I also have client who just don’t like fruits and vegetables, but I’m convinced, in some cases, that they simply don’t know how to prepare them properly. I’m a super-taster, so a lot of vegetables (and coffee) taste super-bitter to me, yet there are still plenty of them that I can enjoy.

      • Mishimoo

        I thought much the same about “not preparing it properly” until I fed one of my dear friends a lovely risotto with freshly picked homegrown peas and discovered that he still hated them because they still tasted like ‘green’ (for lack of a better description).

  • Roadstergal

    Also – if all other factors are controlled for, does diabetes affect milk production?? I’m just wondering which direction this goes.

    • fiftyfifty1

      Absolutely. For example we know that PCOS is associated with lactational failure. It’s also associated with development of diabetes. Basically, insulin resistance causes both DM2 (adult diabetes) and poor milk production.

  • CSN0116

    Lactation research literally cannot be trusted anymore. These are all MPH people too, which is a field collectively going to shit in my opinion. As someone who submits work 10 times more carefully controlled, and gets rejected on a somewhat regular basis, I can only conclude that there are little to no critical evaluations of lactation research performed anymore. There can’t be! Not even a mention in the limitations?! I want to call out this editor.

    • Caylynn, RD, MPH

      As someone with an MPH, I can tell you that it’s pretty much indoctrinated into us (at least in the registered dietitian MPH programs) that breast is best, etc. It’s funny, they teach us how to critically analyze all kinds of epidemiology research (and other types, of course), but when it comes to breastfeeding, suddenly a blind eye is turned to things like confounders, etc. Instead, we examine the qualitative studies of breastfeeding which try to find out why women don’t breastfeed, the barriers, etc.

      I had the audacity to once mention that in term babies in Western countries, the benefits of breastfeeding were trivial. I was thoroughly scolded for stating this fact. Apparently if women knew that the benefits were trivial they would decide not to breastfeed, and for some reason that would be bad.

      It would be wonderful to do some breastfeeding research that actually looked at the causes of lactation failure, but that’s not my area.

      • CSN0116

        I’m in epi. I teach MPH students every spring semester and use “Lactivism” by Jung as a supplemental text in the class. We read the whole thing – cover to cover – and they write their own (mock) original breastfeeding policy at the end of the course, using factual supporting evidence. By week 3, they look at me like kids who just got told Santa isn’t real. When we divulge the saliva-backwash theory, heads roll. Then they get mad at what they’ve been taught. Then they tend to produce amazing final papers in response to. We also critically analyze several “breast is best” studies and take them line-by-line to better understand what it is they’re reading and what the “benefits” actually mean. It astounds me that they have no idea.

        I don’t thing the MPH Director likes me much.

        *And I agree that the feel-good bullshit has totally thwarted any efforts to understand lactation failure or how to assist those experiencing it. We know next to nothing.

        • Roadstergal

          You’re doing damn good work.

        • Emilie Bishop

          As they say on The Crown, on which I’m currently binging, well done you! I want to audit your class some day and add my two cents on how lactivism is as ablist as if the campaign were “20/20 Vision is Best.”

        • Caylynn, RD, MPH

          That’s awesome. I wish I had had an instructor like you in my program. Our epi profs were great (I took epi and then nutritional epi) but the “breast is best” was really hammered home in most of our nutrition courses.

          Since a large number of public health units have adopted the “baby friendly” designation, unfortunately even those of us who don’t believe the “breast is best” propaganda have to toe the line to stay employed.

          I really don’t understand how so many evidence-based health professionals can ignore the evidence when it comes to breastfeeding.

          • Casual Verbosity

            I really don’t understand how so many evidence-based health professionals can ignore the evidence when it comes to breastfeeding.

            I would say it’s because “breast is best” has been elevated to the same level as “the earth is round”. As such, any claims supporting the breast is best ideology are exempt from critical analysis. What I can’t quite figure out is how we allowed ourselves to get to this point.

        • StephanieA

          Your class sounds great! I’d love to be able to tear apart breastfeeding studies with my colleagues, but I don’t have the statistical or research background to back myself up.

        • aurora

          You are doing the lords work!!

        • Sarah

          Do we actually know where the saliva backwash thing even came from? I’m aware there’s no evidence for it but would be interested to know how it actually arose. Did someone just invent it one day, is it a misunderstanding of something?

          • Tigger_the_Wing

            This Irish blog makes claims for there being evidence, but there are no links to the ‘Geddes et al’ alleged papers, no titles, or even mention of which journal(s) they were published in, making it impossible to find out what the evidence actually is.

            Personally, I find the idea that the suckling infant causes a vacuum in the nipple to be extremely unlikely – on the face of it, isn’t it more likely that the ducts would collapse rather than suck whatever was in the infant’s mouth?

            http://mammalssuck.blogspot.ie/2016/01/breast-milk-baby-spit.html

          • Sarah

            Interesting. This reminds me of the ‘food before one is just for fun’ mantra, the one that Breastfeeding without BS took down. That too just seemed to have come from nowhere.

            I’d love to see you do a blog post about this sometime Dr Amy, if you’re reading and searching for ideas!

          • Casual Verbosity

            Because everyone knows that if it rhymes then it’s true! … except that statement doesn’t rhyme, so maybe it isn’t true…

          • Amy Tuteur, MD
          • Sarah

            What was that I said about doing a post…

          • Tigger_the_Wing

            Thank you! It seems that I have not read this site as carefully as I should have done.

        • jane

          That’s amazing. It seems like it could be applicable to all manner of public health propaganda campaigns. I’m thinking of things like the APA’s peanut ban debacle… Do you have any philosophers of medicine/ethicists on your faculty? Seems like you could put together a really interesting entire course on that.

        • myrewyn

          My pediatrician just fed me that saliva backwash story and I think she believed it!

        • Daleth

          I LOVE YOU! 🙂

      • The Bofa on the Sofa

        It’s funny, they teach us how to critically analyze all kinds of epidemiology research (and other types, of course), but when it comes to breastfeeding, suddenly a blind eye is turned to things like confounders, etc.

        As much as I detest Mayim Bialick, my current favorite Amy Farrah Fowler quote:

        “…you wouldn’t know a confounding variable if two of them hit you in the face at the same time!”

      • jane

        I have a theory that the reason why the public health community is so dogmatic about breastfeeding is that it is a PERFECT symbol for them: they can “latch on” (heh) to the ultimately compliant vehicle who will actually listen to “public health messages”) (the new mother) to achieve an ultimate public health victory (combat evil processed food, Nestle). The symbolic battle of nature over artifice, conquered by public health advice, is overwhelmingly compelling. The new mother’s body becomes the site over which the entire public health profession can declare victory over their worst enemies.