What does breastfeeding have in common with vitamins? It’s not what you think.

Female medicine doctor hand give prescription to patient

The NYTimes article Older Americans Are ‘Hooked’ on Vitamins starts with an anecdote:

When she was a young physician, Dr. Martha Gulati noticed that many of her mentors were prescribing vitamin E and folic acid to patients. Preliminary studies in the early 1990s had linked both supplements to a lower risk of heart disease.

She urged her father to pop the pills as well …

But just a few years later, she found herself reversing course, after rigorous clinical trials found neither vitamin E nor folic acid supplements did anything to protect the heart. Even worse, studies linked high-dose vitamin E to a higher risk of heart failure, prostate cancer and death from any cause.

Why were cardiologists prescribing vitamins that ultimately turned out to be not merely ineffective, but potentially harmful?

You can be sincere and be wrong at the same time.

Often, preliminary studies fuel irrational exuberance about a promising dietary supplement, leading millions of people to buy in to the trend. Many never stop. They continue even though more rigorous studies — which can take many years to complete — almost never find that vitamins prevent disease, and in some cases cause harm.

You could say almost exactly the same thing about breastfeeding. Indeed, a prominent breastfeeding researcher has. Dr. Michael Kramer, known for the PROBIT studies of breastfeeding gave a fascinating interview to Canadian radio in early 2016.

Dr. Kramer is a lactivist, but the interview is remarkably nuanced. There’s no transcript, but I’ve linked to the audio file.

When asked why lactivist organizations continue to insist on benefits that have been shown not to exist, he explained that these organizations rely upon preliminary data and simply refuse to accept anything that contradicts it. He was quite blunt about the fact that lactivist organizations won’t accept scientific evidence that doesn’t comport with what they believe.

Kramer was speaking before publication of a spate of papers that show that the benefits aren’t merely exaggerated, the risks and dangers have been completely ignored.

Such papers include:

Taken together they show that insufficient breastmilk is common (up to 15% of first time mothers), formula supplementation makes successful breastfeeding more likely, pacifiers prevent SIDS and extended skin to skin contact lead to babies falling from their mothers’ hospital beds or suffocating while in them. The leading cause of jaundice induced brain damage (kernicterus) is breastfeeding and breastfeeding doubles the risk of neonatal hospital admission leading to literally tens of thousands of hospital admissions per year.

When it comes to vitamins:

There’s no conclusive evidence that dietary supplements prevent chronic disease in the average American, Dr. Manson said. And while a handful of vitamin and mineral studies have had positive results, those findings haven’t been strong enough to recommend supplements to the general American public, she said.

The National Institutes of Health has spent more than $2.4 billion since 1999 studying vitamins and minerals. Yet for “all the research we’ve done, we don’t have much to show for it,” said Dr. Barnett Kramer, director of cancer prevention at the National Cancer Institute.

But, but, but vitamins are natural! And it seems like every week some researcher publishes a paper and a press release claiming this or that vitamin prevents cancer or heart disease.

Similarly, breastfeeding is also natural and it seems like every week some researcher publishes a paper and a press release claiming breastfeeding prevents cancer or heart disease or obesity or asthma or allergy or … the list goes on and on.

Why is the lure of vitamin supplements so attractive?

A big part of the problem, Dr. Kramer said, could be that much nutrition research has been based on faulty assumptions, including the notion that people need more vitamins and minerals than a typical diet…

But:

..[M]ost Americans get plenty of the essentials, anyway…

Also, American food tends to be highly fortified — with vitamin D in milk, iodine in salt, B vitamins in flour, even calcium in some brands of orange juice.

Without even realizing it, someone who eats a typical lunch or breakfast “is essentially eating a multivitamin,” said Catherine Price a journalist …

A big part of the problem with breastfeeding research is the faulty assumption that babies need whatever breastfeeding has that formula lacks. But formula provides everything a baby needs for health and growth. There’s no magic to breastmilk, just like there’s no magic to vitamins.

There’s another thing that breastfeeding has in common with vitamins: confounding variables.

People who take vitamins tend to be healthier, wealthier and better educated than those who don’t, Dr. Kramer said. They are probably less likely to succumb to heart disease or cancer, whether they take supplements or not. That can skew research results, making vitamin pills seem more effective than they really are.

We know that women who breastfeed are also healthier, wealthier and better educated than those who don’t. That inevitably skews research results. The purported benefits of breastfeeding are really benefits of better education, more money and easy access to health insurance.

Dr. Gulati’s experience is instructive. When she recommended vitamin D and folic acid to her dad, she believed that they would be beneficial. She was entirely sincere in her recommendation. Unfortunately, she was wrong but she was willing to change her mind and her recommendations in response to more complete data.

Dr. Gulati, the physician in Phoenix, said her early experience with recommending supplements to her father taught her to be more cautious. She said she’s waiting for the results of large studies — such as the trial of fish oil and vitamin D — to guide her advice on vitamins and supplements.

“We should be responsible physicians,” she said, “and wait for the data.”

It’s time for breastfeeding researchers to be responsible physicians and scientists, too. They need to wait for the results of large studies — and wait further until they are reproduced — before recommending breastfeeding for every mother and every baby.

It’s not enough to sincerely believe in the benefits of breastfeeding. You can be sincere and be wrong at the same time. Breastfeeding researchers must change their minds and their recommendations in response to more complete data like that in the papers linked above. Otherwise, babies will continue to suffer and die because lactation professionals’ irrational exuberance about the benefits of breastfeeding.

  • Peter Harris

    “It’s not enough to sincerely believe in the benefits of breastfeeding. You can be sincere and be wrong at the same time. Breastfeeding researchers must change their minds and their recommendations in response to more complete data like that in the papers linked above. Otherwise, babies will continue to suffer and die because lactation professionals’ irrational exuberance about the benefits of breastfeeding.”

    This is just sick and twisted junk science, and the author of this garbage should be thrown in jail for potentially killing and maiming young babies.

  • Twiga

    It is grossly misleading to summarize this study (http://www.jpeds.com/article/S0022-3476(17)31770-5/fulltext) as breastfeeding doubling the risk of hospital readmission. It shows that formula supplementation in earliest days of breastfeeding as compared to exclusive breastfeeding reduced hospital readmission in the first week of life.

    • Who?

      So it shows that supplementation in the early days of life halves readmissions?

      I’m sure that’s a message everyone is happy to get behind.

  • Felicitasz

    I don’t like the vitamine D analogy. Not this way, at least. For decades, I thought that eating healthy (and fortified milk, and all that) and sunshine (especially in a southern state) is enough. I was shocked when my lab test showed a deficiency; it took almost three years to fix, with increasing amount of supplements, 10 000 iu/ day at one point, for months. Now I take 4000 iu every day BESIDE a healthy diet and lifestyle (5’4″, 115 lbs, serious-recreational dancer and figure skater. I actually use the vitamin D issue and the need of early supplementation for exclusively breastfed babies to argue that nothing is “perfect”, not even a totally healthy diet, or, exclusive breastfeeding, come to that. It is personal variables/ parameters we need to attend to, and only science (tests and such) will tell you what really works, not your beliefs about what’s “healthy”.

    • Sue

      Some people would argue that the current “epidemic” of Vit D deficiency (which leads to the sale of supplements) is a form of over-diagnosis which is related to increased testing and lowered threshholds rather than a real health issue:

      IN BMJ 2012: The rise and rise of Vit D testing
      https://www.bmj.com/content/345/bmj.e4743.full

      If you have a good diet and plenty of sun exposure, it’s likely that your level is healthy for you.

      • Who?

        Did I read somewhere (maybe a while ago?) that the only people who benefit from supplementation ie lived longer were the bedridden elderly in nursing homes?

        Which isn’t nothing but hardly a compelling reason for widespread supplementation.

      • Sarah

        Isn’t there the issue of not being able to get plenty of sun exposure for several months of the year if you live in the UK? Because of the latitude I mean. I can’t see that article but I am guessing if it’s BMJ it relates to us.

        • Dabbledash

          I think that’s the reason populations that have been at that latitude for long periods of time have skin much lighter than the human average, right? Balancing the risks of sun overexposure (e.g., melanoma) vs the risks of under exposure (vit D deficiency).

          • Sarah

            That’s the impression I’ve been under. I thought we basically didn’t know that much about the impact of Vitamin D levels, but I do know that in the UK we are now outside less than we have been for most of the time humans have lived here. So we’re getting less from the sunshine anyway because of modern life, and even if you’re out for all the daylight hours in winter that’s still not very much. We also have to consider that over 10% of our population now are brown or black skinned, so there needs to be research on what they should be doing.

  • Roadstergal

    OT – I’ve become more and more convinced that there are some funny moms on-staff at The Onion:

    https://www.theonion.com/study-finds-eating-doctor-after-birth-can-provide-essen-1825048366

  • EmbraceYourInnerCrone

    OT but a good example of what not being able to vaccinate can do:

    https://www.afp.com/en/news/826/least-70-children-dead-venezuela-measles-outbreak-ngo-doc-13q5os1

    Most of the deaths are people belonging to an indigenous tribe whose remote location apparently means measles vaccination(and medical care in general) is not readily available.

    • BeatriceC

      You know the antivaxxers are just going to claim that the only reason the kids died is because they didn’t have access to real medical care. They’ll just gloss over the fact that they shouldn’t have had to be fighting the disease to begin with because that same lack of access prevented vaccination.

      • kilda

        I figure they’ll blame it on the lack of sanitation.

    • Allie

      God, I wish it were this article that was in the Onion because it was just too ridiculous that any child would lack access to vaccines in this day and age.

  • Cartman36

    I appreciate Dr. Kramer’s honestly but he does still push certain benefits of breastfeeding like intelligence as being established when I don’t think that is accurate. You can’t possibly separate the breastfeeding from other parental behaviors that could increase intelligence such as reading to the child or interacting with him/her.

    • CSN0116

      His own models only have statistical significance at the verbal IQ variable (other measures of IQ are not significant, huge CI’s) — and it’s like a measly 4 points… probably being confounded by SES anyway. That’s it. That’s all he got. That’s just higher SES people reading more to their children like we know they do. Enfamil can just start handing out children’t books with a formula purchase and solve that issue.

      • Roadstergal

        “Enfamil can just start handing out children’s books with a formula purchase and solve that issue”

        If a formula company would do this, they would win my heart. And actually do a fuckton of good.

        • Casual Verbosity

          Ahh but it will never happen, because a free children’s book might be enough to sway a woman who was set on breastfeeding to use evil formula!

      • Gæst

        Oh no! My son missed having a gifted IQ by just one point! It must be because I stopped breastfeeding at 6 months.

      • BeatriceC

        And I thought I read somewhere that even that result is tainted because the people evaluating the children’s IQ knew which kids were in which feeding group. Given that there’s a fairly subjective element to IQ testing to begin with, adding in subtle differences in the way the adult administers a test based on preconceived bias renders the whole thing utterly worthless.

    • fiftyfifty1

      I can’t believe he is still pushing the intelligence thing. It is total p-hacking on his part. That he still clings to it showcases how much difficulty he has giving up his biases even in the face of evidence. Contrast this with how he treats the overweight/obesity results. The data actually show that the breastfed group is MORE likely to be overweight/obese (and this is statistically significant) but he immediately dismisses it as statistical noise. But somehow this marginal difference on one subset of an intelligence test is real?