The title is dull, Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥ 35 Weeks, but the admissions within are blockbusters. Simply put, breastfeeding researchers have been forced to acknowledge that everything the Fed Is Best Foundation and I have been writing for years is true:

• Insufficient breastmilk is common
• Serious, life threatening dehydration can result
• Wet diapers are NOT a reliable indicator of hydration status
• Insufficient breastmilk is not “misperceived”
• Low blood sugar can threaten babies’ brain function
• Serious, life threatening jaundice can result from insufficient breastmilk
• Judicious formula supplementation does not harm breastfeeding
• Pacifiers bans have no basis in science
• The Baby Friendly Hospital Initiative has led to babies harmed by falling from or being smothered in mothers‘ hospital beds

There’s only one glaring omission: an apology for denying these facts for years.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Lactation researchers admit that insufficient breastmilk is COMMON![/perfectpullquote]

The authors, includIng stalwarts of the contemporary lactivist movement like Lori Feldman-Winter, MD, MPH, Joan Younger Meek, MD, MS, IBCLC, Alison M. Stuebe, MD, MSc, strive for a tone of dispassion, but their conclusions are bombshells.

1. Insufficient breastmilk is common, especially in the early days after birth.

Most, but not all, women experience lactogenesis II, referred to as “milk coming in,” by 72 hours post partum. In the Infant Feeding Practices Survey II, 19% of multiparous women and 35% of primiparous women reported milk coming in on day 4 or later…

Occasionally, a woman does not experience lactogenesis II and only produces small volumes of milk (prevalence 5%–8%).

So insufficient breastmilk isn’t rare; it doesn’t affect only a small proportion of infants and mothers. It is very common and can affect more than one third of first time mothers in the early days after birth!

2. Serious, life threatening neonatal dehydration can result

… characterized by lethargy, restlessness, hyperreflexia, spasticity, hyperthermia, and seizures, with an estimated incidence of 20 to 70 per 100 000 births and up to 223 per 100 000 births among primiparous mothers.

This is exactly the clinical picture exhibited by Christie del Castillo-Hegyi’s son leading to permanent brain injury and Jillian Johnson’s son Landon, leading to his death. Lactivists have repeatedly discounted their stories and found reasons to blame them for the tragic outcomes. Here they are the same outcomes in black and white with no mention that mothers are to blame.

3. Wet diapers are NOT a reliable indicator that a baby is receiving adequate breastmilk.

Importantly, elimination patterns during the first 2 days of life are neither sensitive nor specific as measures of infant intake. Infants may be voiding and stooling despite insufficient intake …

4. Women are not “misperceiving” insufficient breastmilk.

One of the cruelest lactivist deceptions has been the refusal to believe women who report insufficient breastmilk, claiming they are “misperceiving” the situation.

[A] prospective cohort study of 280 mother-infant pairs examined elimination patterns in relation to excessive weight loss (>10%) … The strongest association was with ,4 stools after 72 hours or maternal perception of delayed lactogenesis II.

5. Low blood sugar can cause permanent brain injury.

The threshold for neonatal glucose that is associated with neurotoxicity is unclear… In one cohort study, treatment of asymptomatic newborn hypoglycemia to maintain blood glucose levels >47 mg/dL had no effect on cognitive performance at 2 years; however, at 4.5 years, there were dose-dependent concerns regarding visual motor and executive function, with the highest risk in children exposed to severe recurrent (≥ 3 episodes) hypoglycemia.

6. Severe jaundice is potentially deadly complication of insufficient breastmilk.

…[P]athologic hyperbilirubinemia resulting from insufficient breastfeeding, sometimes referred to as breastfeeding jaundice, is better defined as suboptimal intake jaundice. In the United States and Canada, it is recommended that all neonates undergo bilirubin risk screening at least once before hospital discharge… This approach has led to a decrease in severe pathologic hyperbilirubinemia …

7. Judicious formula supplementation makes successful breastfeeding MORE likely.

In a pilot RCT (N = 40), early limited formula supplementation for infants with ≥ 5% weight loss increased exclusive breastfeeding at 3 months postpartum.

8. Pacifier bans have no basis in science.

…[T]here is insufficient evidence to limit pacifiers and other artificial nipples.

9. The Baby Friendly Hospital Initiative — mandating rooming in and closing well baby nurseries — has harmed babies.

Since the initial implementation of the BFHI, safety concerns have emerged, including case reports of inadvertent bed-sharing, suffocation, falls, and increased risk of neonatal jaundice.

The bottom line is that breastfeeding researchers have been forced to admit that EVERY risk of breastfeeding that the Fed Is Best Foundation and I have been highlighting for years is real, true and harming babies on an ongoing basis.

Whom should you trust on vaccines, an expert or a quaxpert? And how can you tell the difference?

1. An expert has formal education in the topic at hand, while the quaxpert has none.

This has several important implications. It means that the expert has been exposed to a wide variety of evidence and viewpoints. He or she tends to be familiar with ALL the scientific evidence, not merely cherry picked studies that the quaxpert has never read and wouldn’t understand if she did read. It means that the expert is fully conversant with any major controversies in the field, has thought a lot about them, has read both sides, and has come to a decision. The quaxpert generally views the controversy as a dichotomy between those with formal education and quaxperts, who claim to have personal experience.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Quaxperts take no responsibility for recommendations.[/perfectpullquote]

2. An expert understands both science and basic statistics and can reach an independent opinion about the existing scientific evidence. A quaxpert has to take the word of someone else.

An expert is giving you an expert opinion. A quaxpert is giving you the opinion of someone he likes with all the attendant drawbacks of relying on empirical claims just because you like who made them.

3. An expert recommends what’s good for YOU. A quaxpert recommends what’s good for himself.

Experts rarely have a one-size-fits-all recommendation. Even in the case of vaccination for childhood diseases, which ALL experts (pediatricians, immunologists, public health officials) recommend, there are exceptions and every effort is made to find out if your child is one of the exceptions. That’s why you are asked about your child’s allergies, previous reactions to vaccinations, and family history of vaccine reactions. The quaxperts generally have one-size-fits-all recommendations; you should do what the quaxpert did, regardless of how your circumstances differ from those of the quaxpert.

4. Experts change their recommendations based on new scientific evidence. Quaxperts never change recommendations regardless of what the scientific evidence shows.

For example, over the years experts have changed the formulation of vaccines, the timing of vaccines and the need for boosters. Quaxperts were opposed to all vaccinations 100 years ago and they’re opposed to all vaccinations now even though the scientific evidence has shown repeatedly that vaccines are extraordinarily effective and extraordinarily safe. It makes no difference to quaxperts what the evidence shows because quaxperts rely on unchanging beliefs systems, not science.
Experts also acknowledge when they are wrong. Consider this year’s flu vaccine. The experts, the same people who counseled everyone to get the vaccine, publicly announced that this year’s vaccine has only limited effectiveness. Although you should still get the vaccine, you should understand that it is not as effective in some years as in others. When was the last time a quaxpert acknowledged that he or she was wrong about a fundamental claim?

5. Experts take responsibility for their recommendations. Quaxperts ignore you, or even blame you when THEIR recommendations cause more harm than good.

It’s difficult to overstate the importance of this point. Experts pay a price if they are wrong. You can take action against them, and they are well aware of that. It is in THEIR best interest — professional, financial and personal — to give you state of the art recommendations based on the latest science. Nothing ensures accuracy like having skin in the game.

In contrast, quaxperts take no responsibility for their recommendations. If they are wrong, YOU pay the price and they just keep giving out the same bad advice. They win if you listen to them, regardless of whether listening to them harms or kills you or your child.

Sure, they dress it up by pretending that you are taking responsibility for your health by listening to them, but you are taking the SAME amount of responsibility for your health when you listen to your doctor. The difference is not in your level of responsibility; it’s in THEIRS.

The deadly coronavirus pandemic is a disaster for individuals, a disaster for public health and a disaster for the economy.

But one group is positively excited about the calamity: homebirth midwives.

Why? They view the tragedy as an awesome marketing opportunity.[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]One group is positively excited by the coronavirus calamity.[/perfectpullquote]

The Midwives Alliance of North America is all over it. Their latest blog post is The Impact of Coronavirus on Community Birth. MANA Vice President Sarita Bennett is positively gleeful about the deaths and economic havoc:

While thinking I’d much rather spend my time planning how to spread community midwifery, I realized how the two – virus and midwifery – may impact each other… It only makes sense for out of hospital birth to become the safer choice for the majority of people in a crisis like this.(emphasis in original)

To my knowledge, coronavirus has spread around the world so quickly because it is COMMUNITY acquired, NOT hospital acquired. Therefore, people face the greatest threat of getting coronavirus in routine interactions in daily life.

…[T]he best way for people to protect themselves and others is stay home and out of public places, making quarantine an important strategy to limit exposure. Is our best advice to pregnant/laboring people to travel out into the public, to a hospital full of those very people they need to stay away from? With medical facilities full of the sick and those caring for the sick, the benefits of staying home for physiologic childbirth and successful lactation become even more obvious.(emphasis in original)

Can you get coronavirus in a hospital? Healthcare workers have gotten it that way, but they spend their days dealing with the secretions of the very ill. As of yet, there have been no reports of individuals contracting coronavirus by visiting the hospital for some other condition.

So there’s NO REASON to think that hospital birth would put women at greater risk of getting coronavirus than riding the subway to get there. No matter, it’s a marketing bonanza.

What’s going on here?

Homebirth midwives adore homebirth. Very few women feel the same way.

Except in the Netherlands, homebirth is (and has been for decades) a fringe practice. Anything that engages 2% of the population or less is almost by definition a fringe practice. But maybe a deadly disease could spark increased interest!

Midwives are obsessed with homebirth for a number of reasons:

1. It is the natural end point of their obsession with promoting what they can do and demonizing what they cannot. They’ve gone from favoring the employment of midwives in maternity units, to midwife led units and birth centers. Homebirth is the logical next step, freeing them from any scrutiny by other health professionals.

2. It reflects the intellectually and moral bankrupt philosophy that the “best” birth is NOT the safest birth, but the birth with the least interventions.

3. It ensures that women cannot get effective pain relief.

4. It is a midwife full-employment plan. In contrast to a hospital based unit where one midwife can care for multiple women at a time, homebirth (in many countries) requires two midwives to care for one woman.

Lest you think that it is only American homebirth midwives who view coronavirus as a marketing opportunity, consider this tweet from British physician and homebirth advocate Susan Bewley who decorates her Twitter profile with her conceit that she is “speaking truth to power.”

Bewley is commenting on a Guardian article about midwives’ refusal to honor patient requests for epidurals.

I’m waiting for someone to write an article on the implications of coronovirus for birth & rediscover the place of birth recommendations…

Midwife Leah Hazard responds:

It would be so amazing if the pandemic encouraged more women to birth safely at home…

Amazing?

No doubt corona virus is a marketing bonanza for coffin makers, too, but at least they have the good sense to keep quiet about hoping to profit from deadly disease.

All anti-vaxxers share one very important thing in common.

Wait, let me amend that.

In addition to ignorance of basic science, statistics and logic anti-vaxxers share another important characteristic: they are ruled by fear!

Anti-vaxxers are afraid of anything they don’t understand and they don’t understand vaccines. They have chosen to band together and create an identity around that fear.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Anti-vaxxers are not victims of vaccines, merely victims of their own unreasoning fear.[/perfectpullquote]

Sure they tell themselves and others that their community is united by refusal to gullibly accept the assurances of experts, but they easily fall prey the unreasoning and unreasonable fear generated by gullibly accepting warnings from quacks and charlatans.

Imagine if our distant ancestors, the ones that anti-vaxxers believe they are emulating, had behaved in the same fearful manner.

“Fire? OMG, fire is dangerous. People could get burned. There is no way that I am cooking my meat before eating it!”

“Killing animals with spears? What if someone’s aim is off. They could kill me instead of the wild boar. No, I’ll take my chances getting in close and bashing wild animals over the head with my club.”

“Deliberately planting seeds in the ground? You have got to be kidding me! How do we know that the seeds we plant deliberately will grow into plants as safe and nutritious as the ones we gather? They might be poisoned so we better not eat them.”

Or much, much later:

“Sorry, but there is no way I am getting on an airplane. If we were meant to fly, we’d have been born with wings.”

Sounds ridiculous, right? The innovations that make life longer and less arduous today were new and poorly understood once. That made them scary, but being scary is not the same thing as being dangerous. Once people learned more about these innovations, and observed them in action, they embraced them.

Our distant ancestors could be forgiven for fearing innovations since they had no way to understand how they worked. Contemporary anti-vax advocates, in contrast, are ignorant because of their own actions. The knowledge of how vaccines work and their safety is available to anyone who cares to learn. But anti-vaxxers prefer to remain ignorant and afraid; indeed they proudly build their identity around their ignorance and fear.

In his first Inaugural Address, during the Great Depression, President Franklin Roosevelt famously said:

…[T]he only thing we have to fear is fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.

Roosevelt was right. Unreasoning fear made the economic disaster worse and more prolonged. Guided by his wise counsel and bolstered by the government programs he created, the economy began to recover and people shook off the debilitating effects of fear.

In truth, the only thing anti-vaxxers have to fear is fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat against disease into advance!

Unreasoning fear of vaccines and companies that produce them has allowed vaccine preventable diseases to claw back from the edge of extinction. The only effective way to protect ourselves from these diseases is to be guided by the counsel of experts in immunology, microbiology and public health. Only then can we shake off the debilitating effects of the nonsense peddled by the anti-vax movement.

Roosevelt also said this:

Men are not prisoners of fate, but only prisoners of their own minds.

Anti-vaxxers are not victims of vaccines, merely victims of their own unreasoning fear, the result of their ignorance of science and gullible acceptance of the nattering of quacks and charlatans.

People are dying, massive quarantines are in effect and the financial markets are reeling.

Why? Coronavirus.

After infecting tens of thousands in China, the novel coronavirus has reached dozens of other countries — at least 48 in total. Public health officials say it’s almost inevitable the illness will spread more extensively within the U.S. So what do we know about COVID-19, and how can we prepare for a broader outbreak? …”

It’s not easy to prepare when we aren’t familiar with the behavior of the virus. As infectious disease specialist Peter Hotez, MD explains:

Unfortunately, because this is a new virus agent, there’s more we don’t know than we do know. We think it’s highly likely that this virus is transmitted by what we call droplet contact. By that, somebody sneezes or coughs and releases micro -droplets into the air that either land on surfaces that people will touch with their hands and bring to their face, or the droplets will directly contact to the face, and they will rub that into their mucous membranes of their eyes and nose.

There is reason for concern:

However, the World Health Organization, Dr. Bruce Aylward, came out a couple of days ago, and he says he thinks that 2 percent number is real. And that’s a pretty significant mortality rate, because a typical seasonal flu, for instance, which still kills a lot of people in the United States, as the president pointed out last night, will kill around 0.1 to 0.2.

So we’re talking about something that is maybe 10 to 20 times more lethal than typical seasonal influenza. So, that’s really concerning, the fact that it’s so highly transmissible, and it has that high case fatality rate.

So I think we’re going to be — have to be — watch this very closely, especially in the United States in the coming weeks.

While the media is filled with medical experts attempting to get a handle on the virus and prevent transmission, notice who ISN’T being interviewed: no one in a responsible position is consulting anti-vaxxers and their charlatan “experts.”

Why?

The anti-vax movement rests on several fundamental premises, premises that its aficiandos can hold because they face no threat from the diseases vaccines are designed to prevent. These premises include:

Vaccine preventable illnesses were prevalent because of poor sanitation.
They weren’t that bad.
Natural immunity to disease is preferable to vaccine induced immunity.
Vaccines cause more health problems than they prevent.
Vaccines exist just to enrich pharmaceutical companies.

The potential coronavirus crisis gives us a window into what the crises of smallpox, diphtheria, polio, rubella and other diseases were all about: devastating diseases, easily transmissible, with no effective treatment and no way to prevent them.

While coronavirus may turn out to be less deadly in the US than it has been in China, no one is suggesting that it isn’t that bad.

There’s no evidence that it can be prevented by sanitation. Sure hand washing can help but the disease is transmitted by droplets sneezed out by those who are ill.

Natural immunity couldn’t save the hundreds who have already died and there’s some evidence that massive natural immune response leads to death in affected individuals.

Doctors and scientists are racing to develop a vaccine because they know that an effective vaccine will save lives on a massive scales.

People are desperate for a vaccine.

Are you afraid of coronavirus as it heads to the US? That’s how people felt about smallpox, diphtheria, polio and even the flu a century ago. They could strike anyone, at any time, and permanently maim or kill.

That’s why scientists developed vaccines.

If a safe vaccine could be developed, would you refuse it and take your chances with coronavirus? Probably not, right?

Do you think that coronavirus is a minor problem being hyped solely for the benefits of the pharmaceutical companies that will ultimately produce a vaccine? No? Then perhaps you can understand why a century ago people didn’t feel that way about smallpox, diphtheria, polio or even flu vaccines.

We are watching a viral scourge unfold in real time. I have no doubt that we will eventually develop a vaccine for coronavirus. We’ve done it many times before; there’s no reason we can’t do it again. And I have no doubt that if vaccination for coronavirus becomes routine in order to protect the health of future generations, there will eventually be anti-vaxxers wailing that the vaccine is unnecessary, that the disease is caused by poor sanitation, that “natural” immunity is better than vaccine induced immunity and that it was a scam developed to benefit pharmaceutical companies.

In the meantime anti-vaxxers might want to consider that their fundamental premises — which obviously don’t apply to coronavirus — don’t apply to other vaccine preventable diseases, either.

The new lactivist tactic is so vicious it defies belief.

It was pioneered by anti-vaxxers who target the mother of a child who has died of a vaccine preventable disease, claiming the she is lying or that she killed her child. Now lactivists are applying it to mothers whose babies have been brain injured or died as a result of insufficient breastmilk.

Consider Australian lactivist Lisa Bridger. She experienced her 15 minutes of fame back in 2018 when she boasted about breastfeeding her 7 year old autistic son.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Bridger is pathetic![/perfectpullquote]

She received many negative and even hateful comments. You might think she would be sympathetic to mothers who deal with the brain injuries and deaths of babies due to insufficient breastmilk. You would be wrong.

In an effort to discredit Jillian Johnson, whose baby Landon died 8 years ago, Bridger posted this on Landon’s birthday.

Baby Landon’s story is commonly posted by the fed is best foundation stating that he died from starvation from insufficient breastfeeding. The problem is that this babies coroner’s report doesn’t say this. Landon sadly was born unwell. He was dehydrated at birth after a difficult delivery. He was admitted to intensive care and found to have pneumonia…

None of that is true so how does Bridger feel confident in making such odious claims? She pretended to be a researcher and ordered the coroner’s report on another woman’s baby.

no I’m not personal involved. I saw the original story many years ago, it was then blasted all over via the fed is best foundation. Many people called out the inconsistencies within the two stories. Jillians original, Christie’s version, and what really happened. As a researcher I was interested, I chose to request, payed for the publicly available copy and have since done intensive research into it…

She’s not a “researcher” and perhaps that explains why she thoroughly misunderstands what she read. The coroner’s report COMPLETELY SUBSTANTIATES Jillian’s story; Landon died from insufficient breastmilk.

How do you read a report when multiple causes of death are listed?

According to the CDC guidelines in Medical Examiners’ and Coroners’ Handbook on Death Registration:

Part I is for reporting a chain of events leading directly to death, with the immediate cause of death (the final disease, injury, or complication directly causing death) on line (a) and the underlying cause of death (the disease or injury that initiated the chain of events that led directly and inevitably to death) on the lowest used line…

If an organ system failure (such as congestive heart failure, hepatic failure, renal failure, or respiratory failure) is listed as a cause of death, always report its etiology on the line(s) beneath it (for example, renal failure DUE TO Type I diabetes mellitus or renal failure DUE TO ethylene glycol poisoning).

Therefore, the coroner’s report on Landon’s death should be read as follows:

Hypoxic-Ischemic Encepalopathy (brain damage)

DUE TO

Cardiac Pulmonary Arrest

DUE TO

Hypernatremic Dehydration (dehydration accompanied by high sodium levels)

Nowhere does it say that Landon was born dehydrated or with high sodium levels. If such a thing were possible (I’ve never heard of it), it would be described as “congenital” and it’s not.

In fact, Landon’s tragedy is typical for cases of brain injury and death caused by insufficient breastmilk.

There are increasing reports on hypernatremia, a potentially devastating condition, in exclusively breastfed newborn infants… A total of 115 reports were included in the final analysis. Breastfeeding-associated neonatal hypernatremia was recognized in infants who were ≤ 21 days of age and had ≥ 10% weight loss of birth weight… In addition to excessive weight loss (≥ 10%), the following clinical findings were observed: poor feeding, poor hydration state, jaundice, excessive body temperature, irritability or lethargy, decreased urine output, and epileptic seizures…

Why does Bridger engage in such reprehensible behavior? For the same reason anti-vaxxers harass loss parents: narcissistic rage.

Wikipedia describes it best:

…Narcissistic rage is the uncontrollable and unexpected anger that results from a narcissistic injury – a threat to a narcissist’s self-esteem or worth. Rage comes in many forms, but all pertain to the same important thing, revenge. Narcissistic rages are based on fear …

My disgust for Bridger’s behavior is leavened by pity. Imagine the abject fear that drives her and other lactivists; their fear that they have been wrong all along about the perfection of breastfeeding and their rage that an innocent child dared to die in a way that exposes the hollowness of their ideology and fragility of their egos.

Bridger is pathetic and I’m not just talking about her fundamental ignorance of medicine, science and statistics.

I wish this situation were rare, but it’s not.

I wish this were a joke, but it deadly serious.

I wish were about mom’s intuition, but it’s really about her ego.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The baby is suffering to bolster his mother’s ego.[/perfectpullquote]

Does anyone have experience with slow-gainers or failure to thrive? I’m desperate for any advice/ information you have. What is “normal” weight gain by 3 months of age? My son is 3 months old today and is only 8oz over his birth weight. His pediatrician is now getting concerned. He “highly suggested” that I supplement with formula. I don’t believe that is the solution since we don’t even know what’s wrong. I told him I would not be supplementing and that he needs more time to grow. Now that I’m calm …. My mother’s intuition is saying we are missing something.

The baby was apparently 9lb 8oz at birth and has only gained 8oz in the three months since. This baby is STARVING.

He’s not meeting his milestones.

Why? Because he’s being STARVED.

It is difficult to comprehend the full depth of this child’s suffering. Imagine constantly being fed small amounts, never enough to satisfy. Imagine cannibalizing your body so you can feed (underfeed?) your growing brain.

It’s definitely a pride issue for me for sure. I had the natural birth. I gave him the best, healthiest welcome, Despite having so many negative feelings toward breastfeeding I still wanted that for him no matter the discomfort I would be in (past trauma). I feel like I did everything “right” just to come to this point of I think I missed something.

Yes, you missed something. You are letting your baby STARVE!

He is not a settled baby. He cries a very good portion of the day unless he is being fed…

Infants experience hunger as painful and profoundly distressing. Imagine the pain this baby experiences on a daily basis.

The mother insists that she has a plentiful supply that is moderate to extremely fatty. She gives no indication of what she thinks is “plentiful.” She says that he takes bottles of pumped milk from her mother while she is at work.

What would be the harm of supplementing with formula? The mother’s ego would take a hit. How do I know it’s about her ego? She writes:

100% natural 7 hour water birth, no vaccines for either of us, he never left my sight, uncomplicated delivery.

She’s absolutely sure of one thing: her baby’s profound and potentially deadly failure to thrive it can’t be her “fault.”

I’m aware that gaining 8 oz in 3 months is definitely room for serious concern. That’s why I feel like we’re missing something.

Yes, you’re missing the fact that you are STARVING your baby.

What needs to happen?

1. This baby needs to be hospitalized for a comprehensive evaluation and work up because he is suffering from profound malnutrition and his brain function and health are at risk.

2. The baby needs formula supplementation to get calories into him ASAP.

3. He needs weighted feeds to determine if he is receiving “plentiful” breastmilk as the mother claims.

4. If he is taking adequate volumes of fluid he may need special formula in order to digest what he is taking in.

5. If he is taking adequate volumes of fluid he needs metabolic and genetic testing to determine if he has an inborn error of metabolism that it is making him ill on breastmilk.

6. He needs evaluation for chromosomal syndromes that can impede both growth and development and might account for his constant crying.

The bottom line is that something is VERY wrong and this baby needs to be evaluated TODAY!

If the mother reads this, I have a message:

I BEG you to take your baby to the emergency room of the the closest university hospital you can reach as soon as you can! Forget about your ego. His brain and his life are at stake and you need to put YOUR BABY first!

Opponents are clear about one thing; women don’t understand the risks. They aren’t giving informed consent because they aren’t fully informed. Sure, they may be counseled about the major risks, the ones that could kill you, but deaths are rare. The other complications are so much more common. If women only knew of the myriad risks, they’d never choose it in the first place.

Opponents recommend more extensive counseling, preferably counseling that takes place long before the decision needs to be made. They helpfully offer books and websites as well as in person counseling about ALL the risks, not just the ones that doctors deign to mention.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Many lactivists, like many anti-choice activists, believe the ends justify the means.[/perfectpullquote]

Inevitably there has been a backlash against the opponents but the opponents claim the high ground with the retort: “Are you saying that there are NO risks?” Everyone knows that there are risks; opponents are providing a valuable service by carefully and extensively counseling women about the risks. Once women know, they will reject the choice.

Think I’m talking about anti-choice advocates who work tirelessly to prevent women from choosing abortion? Think again.

I’m talking about lactation professionals who work tirelessly to prevent women from choosing formula.

Consider the paper I wrote about yesterday. The lead researcher, graduate student Gemma Bridge, claims on The Conversation Some infant formula milks contain more sugar than soda drinks:

Some formula milks have double the sugar per serving than a glass of soda.

But that is a deliberate misrepresentation of what the authors found. Their OWN data shows that NO infant formulas have double the sugar per serving than the average glass of soda.

How did they arrive at their shocking “finding”? They disingenuously included milk drinks marketed to PRE-SCHOOLERS. I reached out to the Bridge on Twitter and she does not deny it.

It’s lie on par with the anti-choice lie that abortion causes cancer.

Tragically, neither lactivists nor anti-choice activists feel constrained by the truth. Reasoning that the ends justify the means, both groups routinely exaggerate and even fabricate “risks.” Seeking, above all else, validation of their personal philosophical beliefs, both groups struggle to convince women who would choose differently that those choices are wrong.

Both groups have zero regard for what happens to women (or babies!) once they make the choice. They care about women up to the moment that they are forced into the “correct” decision; whatever happens afterward to their physical or mental health must simply be endured by the women they have tricked.

Most of us can easily recognize the tactics of anti-choice activists for what they are, mendacious attempts to force women to make approved decisions. We should recognize the tactics of lactivists — including some breastfeeding researchers — for what they are, mendacious attempt to force women to breastfeed or feel guilty if they don’t.

Much of what passes for contemporary breastfeeding “research” is meant to demonize formula, not to accurately assess the risks and or tote up the trivial benefits of breastfeeding.

Consider a new paper is published in a journal of dentistry(?!). A cross-country exploratory study to investigate the labelling, energy, carbohydrate and sugar content of formula milk products marketed for infants is a perfect example of fake news.

What’s the difference between real news and fake news?

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The authors present NO evidence the sugar content of infant formula dramatically exceeds that of breastmilk.[/perfectpullquote]

Real news attempts to inform while fake news attempts to manipulate people by playing on their emotions and often resorts to mistruths, half truths and outright lies to do so.

The lead researcher, graduate student Gemma Bridge, claims on The Conversation Some infant formula milks contain more sugar than soda drinks:

Some formula milks have double the sugar per serving than a glass of soda. That was the key finding of our global investigation into the sugar content of infant formula and follow-on milks…

The “key finding” is a bald faced lie!

Bridge breathlessly writes:

Our findings revealed that over half of the products contained more than 5g of sugar per 100ml.

I should hope so! The average sugar content of breastmilk is 7 gm for 100 ml. Any product that contains substantially less sugar is inadequate and possibly deadly for babies.

In support of their claims, the authors offer a chart in their paper. I’ve taken the liberty of adding the typical sugar content of both breast milk and soda to the author’s chart.

The red line represents the sugar content of soda and the purple bar represents the range of sugar content in breastmilk. Not only is there no evidence that the sugar content of formula dramatically exceeds the sugar content of breastmilk, there is no evidence that ANY formula has double the sugar content of soda.

So how did the authors come up with their “findings”?

1. The authors are not entirely honest about the sugar content of breastmilk.

According to a 2013 paper in the Pediatric Clinics of North America:

The macronutrient composition of human milk varies within mothers and across lactation but is remarkably conserved across populations despite variations in maternal nutritional status… [T]he mean macronutrient composition of mature, term milk is estimated to be approximately 0.9 to 1.2 g/dL for protein, 3.2 to 3.6 g/dL for fat, and 6.7 to 7.8 g/dL for lactose…

So the sugar content of breastmilk varies across mothers and time and ranges from 6.7-7.8 g/dL (100ml).

2. The authors are not honest about the sugar content of soda.

There are 39 gm of sugar in a can of Coca-Cola. That works out to 11 gm/dL. The authors, however, use the misleading comparison of an iteration of Fanta Orange that has been specifically redesigned to remove sugar.

As part of our commitment to reduce the calories in some of our most popular drinks Coca-Cola European Partners changed the recipe for Fanta Orange in 2006 – it now contains 33% less sugar and calories than the previous recipe.

3. The authors are not honest about standards for infant formula.

According to Global Standard for the Composition of Infant Formula:

Data on the composition of human milk of healthy, well-nourished women can provide some guidance for the composition of infant formulae, but gross composi- tional similarity is not an adequate determinant or indicator of the safety and nutritional adequacy of infant formulae.

Instead:

…[T]he adequacy of infant formula composition should be determined by a comparison of its effects on physiological (e.g. growth patterns), bio- chemical (e.g. plasma markers) and functional (e.g. immune responses) outcomes in infants fed formulae with those found in populations of healthy, exclusively breast-fed infants.

The authors have IGNORED the fact that international experts determine the optimal composition of formula based on outcomes, NOT slavish recapitulation of breastmilk averages.

4. The authors pretend products marketed to preschoolers are “infant” formulas.

They deliberately mislead by including milks that are NOT for infants.

Total carbohydrate (g/100 ml) ranged from 4.7 (ready-to-drink milk formula for 1–3 years, UK) to 13.5 (milk formula powder for 2–3 years, Cambodia)… Across product categories, the highest average total carbohydrate content, in this sample, was in powdered milk formula products aimed at infants aged 2–3 years (8.84 g/100 ml).

NO formulas for infants dramatically exceed the sugar content of breastmilk and NO formulas for infants have double the sugar content of soda.

The paper is just fake news designed to demonize formula … which probably explains why the authors couldn’t get it published anywhere besides a journal of dentistry.

Yesterday I wrote about the disabling flaw that renders meaningless nearly every study that purports to show the benefits of breastfeeding.

Most breastfeeding studies compare babies who are breastfed with babies who are not breastfed at a moment in time weeks or months after birth (3 months, 6 months, one year). But when we only look at breastfeeding status at a particular moment in time, babies who develop complications from breastfeeding will mistakenly end up in the formula group. If we want to know the difference between babies who are breastfed and those who are formula fed, we must place the babies who failed to thrive on breastfeeding in the breastfeeding group, NOT the formula group.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Breastfeeding, like homebirth, must be studied with intention to treat analyses.[/perfectpullquote]

How could we correct the disabling flaw? The same way we do in research on homebirth: we compare groups based on intention. Just as homebirth studies compare intended homebirths with intended hospital births, breastfeeding studies should compare intended breastfeeding with intended formula feeding. This is known as an intention to treat analysis.

What happens when we take intention into account? The purported benefits of breastfeeding disappear!

To my knowledge there is only one study that has explicitly taken intention into account, The best of intentions: Prenatal breastfeeding intentions and infant health.

The authors looked at more than 1000 women and categorized them based on whether they intended to breastfeed or not.

They noted:

…Approximately one-third of mothers who intend to exclusively breastfeed are able to achieve this goal. There are several exogenous factors that may prevent mothers from fulfilling their intentions. For example, biological barriers include low milk supply, pain, infections (mastitis), or clogged milk ducts. The baby may have a poor latch, be an ineffective nurser, or have food intolerances…

Those babies belong in the breastfeeding group, NOT the formula feeding group where nearly all studies on the purported benefits of breastfeeding put them.

The authors looked at three infant health outcomes: ear infections, respiratory syncytial viruses (RSV), and antibiotic usage in the infant’s first year. They found that women who intended to breastfeed had infants with better health outcomes REGARDLESS of how soon babies with breastfeeding complications were switched to formula.

What’s going on?

Breastfeeding in industrialized countries is socially patterned. Privileged women are far more likely to breastfeeding. It is privilege that leads to the purported benefits of breastfeeding, not breastfeeding itself.

To my knowledge there is no other intention to treat analysis of breastfeeding. But since breastfeeding is socially patterned, we can approximate intention to breastfeed by correcting for social-economic factors.

The 2014 study Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons corrected for these factors by looking for the differences between breastfed and formula fed infants WITHIN families. When they did, there was no difference between breastfed and bottle fed babies.

Most studies of breastfeeding that correct for socio-economic factors yield similar results: the purported benefits of breastfeeding are markedly attenuated or disappear altogether.

There is another indirect way to account for intention to breastfeed vs. intention to formula feed. We can look at overall population statistics. For decades, lactation professionals have made detailed predictions of decreased infant mortality, severe morbidity and healthcare expenditures with rising breastfeeding rates. Though breastfeeding rates have soared in the US and other industrialized countries, NONE of those predicted benefits have occurred. One possible reason for this is that the benefits of breastfeeding are trivial.

Another possibility is that the purported benefits of breastfeeding are entirely offset by complications of breastfeeding. Exclusive breastfeeding has become the leading cause of newborn re-hospitalization leading to tens of thousands of re-hospitalizations each year at a cost of hundreds of millions of dollars. Aggressive breastfeeding promotion is literally making babies sick!

The bottom line?

Any study that claims breastfeeding has benefits but doesn’t use an intention to treat analysis is improperly done and therefore the results are deeply suspect.

That explains why the benefits of breastfeeding disappear when we correct for maternal socio-economic status and why the predicted benefits of increased breastfeeding rates have never come to pass.