The mother of all lactivist lies bites the dust

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Suppose I told you that there was a substance that when used judiciously in the first few days of life increases breastfeeding rates, reduces hospital readmissions and has no impact on the infant gut microbiome?

That substance exists; it’s called: formula.

Surprised? You might be if you believed the endless stream of lies that the breastfeeding industry has fabricated over the years. I wrote last week about the fact that the Fed Is Best Foundation has forced professional lactivists to acknowledge that breastfeeding, like all biological functions, has a failure rate; up to 15% of first time mothers will not make enough breastmilk to fully nourish an infant in the early weeks of life.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivist fetishizing of breastfeeding exclusivity is contradicted by the scientific evidence.[/pullquote]

Now a large and growing body of scientific evidence shows that the mother of all breastfeeding lies — the lie that “even one bottle of formula” obliterates the benefits of breastfeeding — is equally delusional. The lactivist fetishizing of exclusivity has no basis in science.

Don’t get me wrong. Most people in the breastfeeding industry did not believe that they were lying about the infallibility of breastfeeding. They simply substituted what they wished to be true for what the scientific evidence actually shows. They were willing victims of the contemporary iteration of naturalistic fallacy, the belief that whatever occurs naturally has been rendered perfect by evolution or else “we wouldn’t be here.” This despite the fact that the neonatal mortality rate in nature is hideous and the historical fact that many indigenous peoples traditionally offer infants prelacteal feeds.

The same thing applies to the lactivist belief in the imperative of exclusivity; but that wishful thinking is steadily being dismantled by the scientific evidence,too. The latest addition is a new paper in The Journal of Pediatrics The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial.

The press release offers a succinct explanation:

For infants in this study, offering formula after each breastfeeding for an average of two days did not stop new mothers from continuing to breastfeed, nor did it have a detrimental impact on the bacteria lining the infant’s intestines, the authors concluded in the study publishing in The Journal of Pediatrics on March 14, 2018.


Breastfeeding rates at 1 week did not differ by treatment assignment; 95.8% of infants receiving ELF were still breastfeeding, compared with 93.6% of controls (P = .54)… At 1 week of age, control newborns receiving formula received 13.7 ± 10.6 fl oz per day and newborns receiving ELF received 10.2 ± 9.6 fl oz per day (P = .32). Treatment assignment did not correlate with breastfeeding self-efficacy scores, maternal satisfaction with healthcare, postpartum depression, or state anxiety. In the first week, 4 control infants were readmitted to the hospital (3 for hyperbilirubinemia and 1 for which reason for readmission was not provided), and no infants receiving ELF were readmitted (P = .06).

At one week supplemented infants were MORE likely to be breastfed and were receiving LESS formula than those who had not been supplemented initially. No supplemented infants had been readmitted to the hospital in contrast to 4 infants in the control group.

That’s not all; the benefits of early limited formula persisted at one month of age.

Breastfeeding outcomes at 1 month did not differ by treatment assignment; 86.5% of infants receiving ELF were still breastfeeding compared with 89.7% of controls (P = .53). The risk ratio for the effect of ELF on the outcome of breastfeeding cessation by 1 month of age was 1.21 (confidence interval 0.55-3.16). Among the subgroup of infants enrolled at UCSF, breastfeeding prevalence at 1 month was 100% among those assigned to ELF and 97.6% among the control group (P = .35); among the subgroup of infants enrolled at Penn State, breastfeeding prevalence at 1 month was 73.7% among infants receiving ELF and 81.1% among the control group (P = .44). Among control participants, 43 (57.3%) had received some formula by 1 month of age. Current breastfeeding without formula at 1 month did not differ by treatment assignment; 65.8% of controls had received no formula in the past 24 hours, compared with 54.6% of the ELF group (P = .18). In total in the first month, 1 infant receiving ELF was readmitted for hyperbilirubinemia, and 5 control infants were readmitted (3 for hyperbilirubinemia, 1 for umbilical infection, and 1 for which reason for readmission was not provided)…

What about the vaunted infant gut microbiome? ELF had no impact.

All participants showed large shifts in microbial abundance between enrollment and 1 week of age and between 1 week of age and 1 month of age… The use of ELF did not reduce the abundance of Lactobacillus or increase the abundance of Clostridia in this cohort. In principal component analysis, ELF did not have sufficient impact to cause separation of control vs treated subjects at any time point.

The authors concluded:

Current public health initiatives emphasize the importance of exclusive breastfeeding during the birth hospitalization, but our randomized trial of 164 newborns did not demonstrate improved outcomes for infants receiving exclusive breastfeeding compared with limited formula supplementation using the ELF strategy…

[T]hese results suggest that using ELF in a carefully structured, temporary manner may not interfere with breastfeeding or maternal experience in the first month or have a negative impact on intestinal microbiota. At the same time, our results suggest that further studies are needed to assess whether ELF reduces the risk of neonatal readmission, especially in the first week after birth. Using small volumes of formula on a temporary basis for newborns with pronounced weight loss may have the potential to help clinicians and mothers provide the nutritional volume needed by babies without interfering with duration of breastfeeding or with the health benefits achieved from longer breastfeeding duration.

This paper is just the latest one to demonstrate the harms of the lactivist fetishizing of exclusivity. Others include:

  • Restrictions on pacifier use though pacifiers don’t interfere with breastfeeding and actually reduce the risk of SIDS.
  • The promotion of co-sleeping despite the fact that it dramatically increases the risk of infant death.
  • The closing of well baby nurseries leading to an increase in infants being smothered in their mothers beds or fracturing their skulls by falling from them.
  • The lie that newborn stomach capacity is only 5 cc when it is 20 cc or more.

The harm that lactivists have done with these lies is incalculable and if lactivists can’t tell the truth about the basics — the failure rate of breastfeeding and the fact that exclusivity is unnecessary — why should we believe anything they say?