Study finds formula & follow on contain aluminium - which brands are worst?

Firstly let me clarify this is NOT an anti-formula post!  It's to raise awareness of this contamination issue, because if I were using it I would be campaigning like crazy to stop manufacturers completely ignoring this significant health risk and take action!  I also hope the data allows parents to select brands shown to have a lower concentration of contamination.

A study published in BMC Paediatrics, August 2010 - found formula can contain upto 40 times the level of aluminium found in breastmilk; which is 16 times that allowed legally in water.

A team from Keele Uni in Staffordshire tested 15 ready-made & powdered formula milks for aluminium.

"In both types of milk, levels were still unacceptably high.  Recent research demonstrating the vulnerability of infants to early exposure to aluminium serves to highlight an urgent need to reduce the aluminium content of infant formulas to as low a level as is practically possible.  Previous research strongly suggests aluminium could cause some toxicity in premature babies with illnesses such kidney disease; In a healthy baby you wouldn't see any symptoms or problems but there is concern that it can accumulate & cause issues in later years.  It has been linked to neurological diseases and bone defects in later life and there are even links with dementia. Everyone has aluminium in their bodies but infants are especially prone to absorbing it and are not so good at getting rid of it"

Dr. Chris Exley

What's perhaps most worrying about this study is that the highest levels of all were found in a milk designed for the most vulnerable; Cow & Gate Nutriprem, a specialised breastmilk substitute for premature babies, topped the list of liquid formulas by a significant amount.  The worst offenders for liquid formula after Nutriprem were Cow & Gate First Infant Milk, Cow & Gate Follow-On Milk & Growing Up Milk and Aptamil Follow-On Milk.  In general though the aluminium content of formulas prepared from powdered milks were significantly higher than ready-made milks (with the exception of Nutriprem) with the worst powders being Sma Wysoy Soya, Aptamil Follow-On Milk, Hipp Organic Follow-On Milk (dya think that will be organic aluminium ? ;)) and Cow & Gate Follow-On Milk.  So all in all Cow & Gate didn't fare too well!

As all manufacturers insist that aluminium is not knowingly added to their products, the suggestion is that these products are 'contaminated' with aluminium. The likelihood is that many of the individual constituents of the formulas are contaminated, which may include equipment used in both processing and storing of bulk products. In addition many of the formulas were packaged for sale using aluminium-based materials!

What makes me most cross about the study is it also states:

There has been a long and significant history documenting the contamination of infant formulas by aluminium and consequent health effects in children. Manufacturers of infant formulas have been made fully aware of the potentially compounded issue of both the contamination by aluminium and the heightened vulnerability, from the point of view of a newborn's developing physiology, of infants fed such formulas. There have been similar warnings over several decades in relation to aluminium toxicity and parenteral nutrition of preterm and term infants. To these ends the expectation would be that the aluminium content of current infant formulas would at the very least be historically low and at best would be as low as might be achieved for a processed product

The aluminium content of infant formulas measured herein are not significantly different to historical values and this lack of improvement in lowering their content suggests either that the manufacturers are not monitoring the aluminium content of their products or that the manufacturers are not concerned at these levels of contamination.

It is clear that aluminium in infant formulas is a significant component of early life exposure to this ubiquitous contaminant and as such every effort should be made by manufacturers to reduce the aluminium content of these products to an achievable practical minimum while at the same time manufacturers should be compelled to indicate the level of contamination by aluminium on the packaged product.  Aluminium is non-essential and is linked to human disease.

This link is another compelling reason why mothers should not use fluoridated water to make up formula powder (a topic I plan to blog about soon!).  There is evidence Fluoride in Drinking Water Increases Toxicity of Aluminum - with potentially fatal consequences.   As liquid formula contained generally lower levels, where possible this may be the safer option.
 
I hope those pro-formula or using it, DO something to force manufacturers to address this issue.  Write, email, petition, campaign!  It's not just for the lactivists ;)

The aluminium content of milk powders (P) used in formulas.
Commercial Name of Product N = 5	[Al] μg/g Mean (SD)	[Al] μg/g Range	[Al] μg/L*
Sma Wysoy Soya Infant Formula	4.3 (1.0)	3.7-6.0	629.0
Sma First Infant Milk	2.4 (1.4)	1.3-4.6	333.3
Hipp Organic Follow-On Milk	3.6 (1.6)	2.1-6.3	500.0
Hipp Organic Good Night Milk	2.9 (1.5)	1.7-5.5	406.0
Cow & Gate First Infant Milk	2.8 (0.6)	1.8-3.5	424.0
Hipp Organic First Infant Milk	2.7 (1.3)	0.2-4.2	394.4
Aptamil Follow-On Milk	3.1 (0.5)	2.3-3.8	592.4
Cow & Gate Follow-On Milk	2.5 (3.4)	1.7-10.8	477.8
*Based upon manufacturer's instructions for preparing the milk.
Burrell and Exley BMC Pediatrics 2010 10:63   doi:10.1186/1471-2431-10-63

The aluminium content of ready-made (RM) milk infant formulas.
Commercial Name of Product N = 5	[Al] μg/L Mean (SD)	[Al] μg/L Range
Sma First Infant Milk	267.9 (40.9)	210.1-322.5
Sma Follow-On Milk	245.8 (59.0)	174.5-309.8
Cow & Gate First Infant Milk	338.8 (34.8)	293.0-371.0
Hipp Organic Growing-Up Milk	175.5 (34.7)	131.4-236.8
Aptamil Follow-On Milk	296.1 (13.9)	279.3-314.2
Cow & Gate Follow-On Milk	303.7 (10.8)	285.3-316.8
Cow & Gate Growing-Up Milk	430.0 (214.8)	285.3-856.5
Cow & Gate Nutriprem 1	700.4 (93.6)	602.5-863.0
Burrell and Exley BMC Pediatrics 2010 10:63   doi:10.1186/1471-2431-10-63

Boosting Bottle Feeding Bonding - 5 top tips...

Some readers may remember I posted about breastfeeding and bonding here - so I thought I would follow up about how mums not breastfeeding can maximise bonding with their baby.

There are various processes and hormones involved with bonding, but the one we hear most about is oxytocin; often nicknamed the "cuddle hormone".  It has been heavily linked with feelings of trust, security, and love - whilst for parents it can influence maternal/paternal behaviour and even drastically reduce the risks of abuse and neglect.  It even causes nerve junctions in the mother's brain to reorganise, making her maternal behaviors "hard-wired."

When mum breastfeeds, oxytocin is released - and many who work with breastfeeding mothers have commented it can be observed when feeding is going well.  Mums gaze at and preen their babies, playing with baby's ears, toes and fingers, sometimes almost glazing over and losing interest in chatting.  It is also oxytocin that causes mum to be so drawn to the smell of her breastfed baby, and many joke their babies are so used to their heads being scattered with kisses, they proffer that for a kiss when they get older!  Baby makes his own oxytocin in response to nursing and mum transfers additional amounts in her milk.

All that said, mothers can still fail to bond when breastfeeding - if other factors are in play, perhaps trauma after a difficult delivery or postnatal depression; breastfeeding problems, nipple trauma and so on.... It's certainly no guarantee but more of a massive helping hand along the way.

Oxytocin isn't a hormone exclusive to breastfeeding mums; a large surge happens at the start of labour (which is one of the reasons why many experts now recommend letting labour commence - even if a Caesarean section is planned) and again as baby moves down the birth canal.  It is also produced through touch and warmth ie the act of nurturing behaviour and is cyclic - so the more oxytocin is produced, the more you want to nurture, which in turn produces more oxytocin, and so on.

So going back to the breastfeeding mum - breastfeeding increases levels, which provokes nurturing behaviour and in turn more oxytocin.  Mum HAS to hold baby to breastfeed, but what about the bottle feeding mum?

I'm sure many of us have been in a cafe and seen the baby still in a pushchair, mum holding bottle with one hand whilst she sits and reads a magazine - perhaps eating her own lunch.  Sometimes baby is left to feed themselves entirely with absolutely no contact, and worryingly there is an increasing range of items on the market, designed to facilitate feeding without any human touch or "nurturing behaviour" - at what cost?  Well apart from the very obvious choking risk which is why parents in the UK are advised never to prop bottles!

A growing body of scientific evidence shows that the way babies are cared for will determine not only their emotional development, but the biological development of the brain and central nervous system as well. The research also shows mother's love acts as a template for love itself and has far reaching effects on her child's ability to love throughout life.  Research conducted at UCLA first months of an infant's life constitute what is known as a critical period - a time when events are imprinted in the nervous system.

"Hugs and kisses during these critical periods make those neurons grow and connect properly with other neurons.  You can kiss that brain into maturity"

Dr. Arthur Janov, in his book Biology of Love.

How can bottle feeding mums boost bonding?
Some mums are naturally very maternal - regardless of how they feed, perhaps having higher natural levels of oxyocin, prolactin and other natural morphine-like chemicals.  For others bonding is a process that takes time, and there are lots of things bottle feeding mums can do to help boost levels of the several important hormones:

1. Skin to skin - whilst  breastfeeding mums are often encouraged to do this for milk supply, it's often not suggested to bottle feeding mums beyond immediately after birth.  All mums and babies benefit from this contact on several levels - physically, emotionally and neurologically.

Touch-especially between parent and child- induce opioid release, creating good feelings that will enhance bonding.  Prolonged elevation of prolactin in the attached parent stimulates the opioid system, heightening the rewards for intimate, loving family relationships.

Linda F. Palmer, DC

2.  Hold and cuddle your baby - consider a pouch or sling to keep baby close, the warmth and closeness of baby boosts hormones all round.  Regular body contact produces a constant, elevated level of oxytocin in the infant, which in turn provides a valuable reduction in the infant's stress-hormone responses.

2.  Feed baby yourself - in the early days when relatives and friends come round, it can be tempting to let them feed baby whilst you get on with other jobs.  Swap roles and let them help out with chores as they would for a breastfeeding mum, whilst you relax and spend the time feeding baby.

3.  Interact whilst feeding - gaze into your baby's eyes, stroke them, examine their fingers, ears - maximise touch all round.  Feeding for a breastfed baby is a full sensory experience, mimicking this when bottle feeding makes the experience more fulfilling for both baby and mum.
One study found:

Oxytocin levels were associated with parent-specific styles of interaction. The levels were higher in mothers who provided more affectionate parenting — including gazing at the infant, expression of positive affect, and affectionate touch (Biological Psychiatry)

4.  Bathe with baby - ditch the baby bath and hop in!  Warm water and skin contact is a double whammy - dads often love this too.

5.  Don't bottle prop! - Really who doesn't have time to pick a baby up and feed them every few hours?  Seriously if you don't have this time, do you have time for a baby at all?

A more variable release of oxytocin is seen in bottle-fed infants, but is higher in an infant who is "bottle-nursed" in the parents' arms rather than with a propped bottle.

Linda F. Palmer, DC

Lactivist Draw Winner

The winner of the Lactivist Draw is *drum roll*:

Emma (no surname given - replied on the blog, has a picture of pandas)

Congratulations!  Please email me to arrange your prize :)

How "Breast Is Best" Came To Be......

Recently I wrote about how "Breast Isn't Best" and in response to that someone sent me a link to a fantastic blog entry I just had to get permission to reproduce.  Here it is:

Breast is Best, Sponsored by Simfamil: Don Draper Explains It All For Us.

INT: STERLING COOPER DRAPER PRYCE, DON DRAPER's OFFICE. PEGGY OLSON and PETE CAMPBELL sit expectantly on the sofa, an easel bearing the Simfamil logo and a photo of a smiling baby next to them. A box with canisters of various brands of formula is on the floor.

Enter a typically taciturn DON. He glances at the easel and continues to the liquor cabinet without breaking stride, pours himself a scotch.

DON: I'm not sure why this took 2 weeks. This should have come easily to you, Peggy.

PEGGY: Well, I've bee-

DON: Just tell me what you have.

PEGGY: (takes a moment to square her shoulders, then continues) This has been trickier than you might think. We've been reviewing the latest improvements by Simfamil as well as the improvements to formula made by competing brands and -

DON: Competing brands don't matter.

PETE: (leans forward) What? What do you mean?

DON: The other brands aren't the problem we have to worry about. That part's easy.

PETE: (huffily) Listen Don, I've worked long and hard to get us this account. Simfamil is not going to want to hear that Enfilac isn't a threat that we take seriously. The market data shows that coupons and sampl-

DON: Enfilac, Simfamil, Nestle, their strategies have all been the same. Look at this.  (He grabs a one canister after another out of the box, reading their labels aloud, then tossing them aside.)

"More like mother's milk". "The closest thing to mother's milk." "Now with more of the same ingredients found in breast milk". They're all vying to make their product more like breast milk than any other brand. What's the problem with that, Peggy?

PEGGY: (thoughtfully) Well, because there's just no comparison with breast milk. We've looked at all the research, and the brand never matters. Formula just can't measure up, no matter what brand. So . . . (she gestures at the discarded canisters) . . . how do we set Simfamil apart from them?

PETE: (enthusiastically) A new package design? Some prettier, younger models as the mothers?

DON: We take on breastfeeding itself.

PEGGY: But you just sai . . . didn't we just say there's no comparison to breastmilk?

DON: There isn't. Formula can't compete with breast milk. We can't fight the research and mothers know this. Almost every mother in America wants to breastfeed. There's no suppressing the truth. Women know that breastfeeding is best. So we're not going to argue with that.

PEGGY and PETE look at each other silently. DON tosses back the rest of his drink and pours another.

PEGGY: I give up. You don't want to promote the new ingredients of Simfamil. Are you saying we should try to find research that makes it look like formula is better?

PETE: We've tried. It doesn't exist. (PEGGY nods.)

PEGGY: So what do we do?

DON: We promote breastfeeding.

PETE: What?  (He goes to the liquor cabinet and pours himself his own drink, gesticulating)
I can't believe you're not taking this seriously. This account is one of the biggest we've ever had a shot at! With everything I've gone through with my father-in-law and losing the -

DON: Breast . . . is best.

PEGGY: looks incredulous, then seems to start thinking.

DON: walks over to the easel and rips down the poster with the logo and baby on it, and writes "Breast is best" on the blank sheet underneath.  The research says so, doctors say so, there's no arguing it. And if we attack breastfeeding itself, it backfires, because the facts are the facts, and that makes us not only the bad guys, but liars too. What does the word "Best" imply?

PEGGY: listens intently, then starts to write.

DON: Best. Perfect. Ideal. They all have one thing in common. They're impossible. Unattainable. There is no such thing.

PEGGY: (catching on) Women may dream of being perfect mothers, but they know it's just a dream. So if breastfeeding is perfect, we need to give them permission to be imperfect. Not just permission, but encourage them to be imperfect.
DON: Exactly. So how do we get them from understanding that breast is best to buying formula?

PEGGY: We hire our own experts.

PETE: AHA! Actors pretending to be breastfeeding experts who will say that formula is better! I get it.

PEGGY: No, no, not at all. We hire real experts. And we set up our own hotlines for women to call when things go wrong, and promote those hotlines. And we sponsor information that's given out by doctors themselves, too.

DON lights a Chesterfield. A confused PETE shakes his head and shrugs helplessly, sitting back on the couch.

PEGGY: (building momentum) And we make up pamphlets and other resources that look like they're designed to help moms with all the problems that mothers are likely to encounter, emphasizing how many things can go wrong. We focus the whole campaign on helping women navigate the terrible, perilous, grim experience that breastfeeding is likely to be. We mention every single thing we can think of: Sleep deprivation, slow weight gain, cracked and bloody nipples, [PETE winces] how hard it is to nurse in public and how hard it is to have to stay home instead, and on and on. We're the good guys, we're just trying to help - it's not our fault that breastfeeding is so difficult and unpleasant. We look altruistic and supportive - we're not trying to get women not to breastfeed, we're just here to support them in case it doesn't work out.

PETE: (lightbulb finally going off, however dimly) And then we make sure it doesn't work out. What about that part of it?

DON: The information we give. Do we give out accurate information?

PEGGY: Some of it is, and some of it isn't. Little things that undermine breastfeeding, subtle things, things that will jeopardize her supply. Like telling her to never nurse a newborn more than 15 minutes at a time, for example; and saying that frequent feedings for a newborn are 3 to 4 hours apart. The mom will be lucky if she can make enough milk, and when it doesn't, she'll just think something was wrong with her. Because she's not perfect - and that's okay.

DON: And then we swoop in to save the day.

The three look satisfied. PETE and PEGGY stand.

DON: Come up with a new slogan by the time we meet with Simfamil tomorrow.

PEGGY: I'll have it by the end of the day, actually.
(She exits. PETE follows behind.)

PETE: (turning back for a last word, hand on the doorknob) Bert Cooper is going to think you've gone off the deep end, you know.

DON: He's thought so before. He always gets used to it.

PETE raises his eyebrows, shakes his head and exits. DON goes behind his desk, puts out his cigarette, and reaches for the phone.

CUT TO: INT: JOAN HOLLOWAY's office. She picks up the ringing phone.

JOAN: Yes, Don? . . . Of course I have the best . . . Model them? . . . In your office? Now? . . . You're lucky I'm such a liberated woman, you know. I'll have your secretary hold your calls.

ZOOM IN to her cleavage, then FADE to black.
 
Many thanks to Dou-la-la for permission to reproduce this piece :)

Breastfeeding/Nursing Strikes - Top tips for dealing with one..

Weaning from the breast is a gradual process and infants cut down over a period of time.  If baby has been fed to a schedule, this may be as soon as his nutritional needs are met by food ie the last few months of the first year or early into the second.  Evidence suggests the biologically normal age of weaning is much later, and indeed infants who are allowed to breastfeed as and when they want - are likely to continue until at least 2-3 years of age.

This gradual reduction is important to baby, often from a psychological/emotional point of view (ie many can become very distressed when the breast is suddenly withheld) but also from a health perspective.  As feeds are reduced, milk becomes "transitional" - becoming much more like colostrum and packed with extra antibodies to help protect the nursling.  If cessation is sudden, the infant misses this valuable "boost".

But what if baby suddenly refuses the breast?

Babies can go "on strike" for many different reasons and at any time from a few months (earlier due to suction as one example is usually termed breast aversion), common ones include:

• Early introduction of bottles or too many bottles - even more so if mum has reduced supply and slow flow at the breast.  If you do decide to introduce one, get baby to suck a clean little finger for a few moments before getting milk, so they have to work for a few minutes as they would at the breast for letdown.
• Thrush or other oral discomfort
• New found independence eg they find a sippy cup is good fun and portable
• Negative association with feeding - perhaps baby has bitten and mum has inadvertently yelped or raised her voice.
• illness eg ear infection or cold/blocked nose which can both cause discomfort when feeding.
• Early introduction of bottles 
• Return of menstruation (can make the milk very salty for a short time)
• A major disruption in your baby's routine, such as you returning to work*
• An unusually long separation from you*

* The last two can also have the opposite effect  of "glue baby", one who wants to be ALWAYS attached!

Pamela Morrison IBCLC suggests sometimes the cause may not always be immediately obvious:

The cause of a nursing strike can be sometimes difficult to identify, at least initially. Perhaps baby has had to wait too long for breastfeeds or been left to cry - something got in the way of his close relationship with his mother. Anything can cause this and sometimes the mother doesn’t find out what it was until much later. I’ve known this happen from 3 months.

Strikes can be very upsetting for mum; in a young baby there may be concern over milk intake and mums can feel as though it is a personal rejection of them as a parent.  My own lil one had a strike aged around 18 months when a virus caused several tiny mouth blisters - feeding was quickly associated with pain and the strike lasted for around two weeks before feeding resumed.

What can you do to encourage baby to resume nursing?
Nursing strikes can last anything from a few hours or a few days, to a few weeks - staying calm, positive and relaxed is difficult yet it's importance is often underestimated.  I noticed during our strike that the more I tried to encourage, the less interest - as soon as I backed off and became casual, interest resumed! 

Pam's top tips:

1. Express or pump breastmilk to keep the breasts thoroughly and regularly drained.  For a young baby rule number one is to ensure baby is sufficiently fed; depending upon the cause of the strike and the age of the baby, finger feeding, cup or if needs be bottle are all options.  For the older nursling established on food, some mums use the expressed milk in smoothies, puddings or on cereal, if baby wont take from a cup.

2. Don’t force breastfeeds, keep baby happy and calm. 

3. Where possible abandon all other responsibilities for several days and devote 24 hours/day to the baby. Hold him all the time, wear him all day, play with him a lot, bath with him, sleep with him, lots of skin to skin - attempt to get back “in touch” with the baby and regain his trust. If mother needs to draw the curtains and go around half-naked for most of the time, then that’s what it takes.

4. Offer the breast a lot, but don’t force it. If baby starts to struggle/arch/cry; stop offering, smile and laugh, then when baby is happy and relaxed (in an hour or so), offer again. When offering breast, make sure there are no clothes in the way, mother and baby are alone (no distractions, TV, other children, etc) in a quiet darkened room (or in the bath), offer “favourite” breast first, in “favourite” position, in “favourite” place etc. Often offering the breast while standing and/or rocking the baby can help. Some babies become enraged if placed horizontal, so the mother needs to slide the baby down from her shoulder and offer the breast with the baby upright. Sometimes having the baby upright straddling her leg can also work. She can “play” at dabbing the baby’s lips with the nipple, taking it away, dabbing again, laughing, keeping everything light and happy, as if this is a big game ..

Whilst I find the above tactic fantastic with younger babies and some older infants - I found with my child that alone, without distractions in a favourite nursing place- was actually the worst place to offer as it was clearly linked with an expectation to feed.  More interest was shown when I was watching TV or reading ie without any focus on feeding - so this may be something else worth trying for the slightly older nursling.

5. Other helpful measures include safe co-sleeping with the baby. And offering the breast once he is already asleep (sometimes the baby will take it and then wake up, realize what he is doing and reject it again), and eliminating all perfumes, deodorants and possible food sensitive.

6. Mother to be charming, do all the things that baby likes and keep him very happy, treat him like Dresden china, keep offering the breast.

7. If the mother becomes distressed by baby’s refusal, she must try not to show it - put baby down somewhere safe, go outside and scream or kick something, but hide frustration from the baby (easier said that done, but she is bigger, cleverer, smarter than he is).

8. Keep offering breast. Eventually baby will try it out. May take one or two swigs and then come off. Mother is to “reward” baby with biiiig smiles and congratulations for even the smallest attempt, and let him call the shots, i.e. let him stop when he wants to, and offer again later. Tiny swigs may start to become longer. Eventually the baby is willing to breastfeed. When this happens the mother should offer the breast a lot, at every excuse, before she can start to relax and realize that the strike is over.

9. At this point, mothers often realise what went wrong in the first place, and become determined not to let it happen again - i.e. they become much more “careful” mothers of this quite sensitive baby.

I’ve never known these measures to fail if the mother is willing to embrace them. Often the strike is over within hours, not days. But the longer it took to happen, the longer it is likely to take to resolve.

Ask The Armadillo - Do pacifiers reduce SIDS for breastfed babies?

Q.  I have heard it mentioned anecdotally and in some posts on websites that the research publicised by FSID recommending dummy use to prevent SIDS was sponsored by a dummy manufacturer.  When I have had a quick search around, I haven't been able to find any direct evidence of this; can you shed any further light?
Thanks
Amy
Q.  My health visitor has advised me to give my 3 month old (breastfed infant) a pacifier to reduce the risk of SIDS, do you agree with this?
Jane

A. Hi Amy & Jane, thought I would kill two birds with one stone on this one!  My comments only pertain to the exclusively breastfed baby.

The Science:
Firstly funding - yes certainly an interesting one.  June 2007 FSID announced that putting baby down to sleep with a pacifier reduced the risk of SIDS, they announced this was a promotion in association with MAM pacifiers.  Their balance sheet shows a v large "donation" from MAM - so I guess everyone can make their own judgement on the ethics of that one...

FSID quoted two studies as the basis for this claim, in their recommendation no definition was made between exclusively breastfed infants, or those mix fed/ fully substitute fed.  One study was a meta analysis from 2005, which starts off with very impressive sounding figures, but because so many didn't meet their criteria ultimately states:

Results. Seven studies were included in the meta analysis

So of course I had to dig out the 7 studies....

1. Dummy use, thumb sucking, mouth breathing and cot death - 1999.
In that study there were 73 cases of SIDS,  7 of which were exclusively breastfed for more than 13 weeks - none of the known risk factors were adjusted for eg was baby bedsharing with a smoker, on a soft suface, placed prone in a cot etc

Exclusive breastfeeding for more than 6 and more than 13 weeks appeared to decrease the risk of cot death, but statistical significance was not obtained.

It is important to study whether it is not having a dummy that is risk increasing or whether it is being used to a dummy but then being denies it that puts the baby at risk.

A dummy might also offer protection in breast-fed babies, but since these were under-represented in our group and the effect on breast feeding is unclear, no conclusions can be drawn yet.

Conclusion: We recommend dummy use at least for bottle-fed infants.

In response to the study, Schald and Poets felt the study method was flawed:

There is unequiovocal agreement amongst leadin epidemiologists that the use of statistical tests is in fact inappropriate to assess confounding.  One factor that could be particularly important as a confounder in the study is birth order.  The authors indicate that there was a negative association between pacifier use and birth order of the child.  Since in many studies birth order in itself has turned out to be a risk factor for SIDS, it may be some source of major confounding in their data. (Eur J Paediatrics 2000 159:542-544)

2.  Sudden unexplained infant death in 20 regions in Europe: case control study
This study doesn't adjust at all for feeding method, no distinction was made between breast or substitute fed.

Dummy ever used was correlated with dummy used in last sleep. When these variables were combined, it emerged that it was only when the dummy was used and used for the last sleep that the adjusted OR was significantly less than 1.

3. Environment of infants during sleep and risk of the sudden infant death syndrome

There was no difference in the proportion of the babies who died and controls who routinely used a dummy, but for the last or reference sleep there was a significant excess of control infants (52.8%) who used a dummy compared with babies who died.

 These findings should not be used to claim that dummies prevent cot death, but it may not be appropriate for health care professionals routinely to discourage the use of dummies in young infants

Table 5 shows that in the univariate model there was a significant risk associated with usually using a pacifier but not doing so for the last/reference sleep.

4. Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population:

Decreased risk of SIDS was found with pacifier use during last sleep and with breastfeeding for any length of time

Parents who already use pacifiers for their infants and those who are not breastfeeding need not be discouraged from using them

5.  Factors relating to the infant’s last sleep environment in sudden infant death syndrome in the Republic of Ireland.
No distinction made between breast and non breastfed.

The prone sleeping position remains a significant SIDS risk factor, and among infants using soothers, the absence of soother use during the last sleep period also significantly increased the SIDS risk.

6.  Dummies and the sudden infant death syndrome 1993

 Use of a dummy in the last sleep for cases of SIDS or in the nominated sleep for controls was significantly less in cases than controls (OR 0.44, 95% CI 0.26 to 0.73). The OR changed very little after controlling for a wide range of potential confounders. It is concluded that dummy use may protect against SIDS, but this observation needs to be repeated before dummies can be recommended for this purpose.

7.  Mattresses, microenvironments, and multivariate analyses
As the title suggests, this article focusses on mattresses and doesn't mention either pacifiers or breastfeeding.

The second study FSID quoted is: "Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study"
Again feeding method was not examined at all in this paper and the focus is dummy used for last sleep.

Comments:
What the research appears to indicate is that a pacifier at the last sleep, is significantly associated with reduced risk of SIDS.  Generally having a pacifier, appears to offer little protection unless it's in place at the sleep during which SIDS would have occured - futhermore, there also seems to be suggestion of increased risk if an infant normally has a pacifier, but does not have one at the last sleep.

How on earth does a parent guarantee pacifier use will be continued once introduced?  My first had one for a few months, before refusing to take it again - which is not uncommon for the breastfed baby; I'm extremely glad I wasn't aware of this link at the time!  A lot seems to be based on assumption baby will ALWAYS take one when offered.

HOWEVER, we can only really even apply any of this to non breastfed infants, because there simply isn't the evidence to support giving breastfed babies a pacifier.  More on this in a moment...

Two years earlier the AAP had made a similar blanket recommendation, the Academy of Breastfeeding Medicine immediately released a statement here, calling the guideline ill-advised and ill-informed:

As exclusively breastfed infants feed frequently through the night, breastfeeding is thought to reduce SIDS by the same proposed mechanism as supine sleep and pacifiers, namely less deep sleep and frequent brief awakenings. Breastfed babies do not need artificial pacifiers to get stimulation since they already have the protective effect of suckling during the night.

Dr Brian Palmer proposes that as one or two of the studies suggest, using a bottle and pacifier can change development of the throat - placing the infant at risk if the pacifier is not used.  Well worth a read in full here.

There are no studies examining whether pacifiers reduce the rate of SIDS for the exclusively breast (milk) fed infant.  Any study would also have to examine feeding method ie from breast, bottle or both, and also how the mum breastfed ie to a strict three hour schedule with no feeding to sleep and restricted nightfeeds compared to those feeding frequently on demand with baby frequently falling asleep at the breast.  In order to be accurate, it would also need to compare sleep environment - ie has sleep training taken place to try and develop an abnormally long sleep spell; but I'm guessing it's probably not in anyones interest to fund this, certainly no great donation from MAM ;)

The Logic..

A pacifier is ultimately a copy of a nipple, therefore logically any "protection" that may come from a pacifier, would also be obtained from a nipple.  Infants drop a pacifier once asleep, and the guidelines are that it should not be put back in - ie any apparent protection doesn't come from it being constantly sucked.  Yet for some reason, the assumption seems to be that a plastic copy could potentially hold magical powers and lets just assume this will be the case for breastfed infants too, despite the fact they have the real thing.  There is also strong evidence suggestin pacifier use can shorten duration of breastfeeding (with other health implications) and in the early days. introducing a bottle or pacifier can cause real problems to the baby who hasn't yet established the technique required to milk the breast.
If anything what this research does suggest is that instead of scaring mothers their infant will never sleep if they allow them to "use the breast", it would seem prudent to actually encourage mothers to feed their infant to sleep at least in the first six months - so they are falling asleep sucking as per the "last sleep" research.  Certainly it would appear babies are supposed to fall asleep at the breast, as it contains nucleotides that include sleep:

Results published in Nutritional Neuroscience showed that breastmilk produced during the evening and at night contained more sleep-inducing nucleotides than milk produced during daylight hours.  Researchers also found that certain nucleotides, including some that have been shown to induce sleep, demonstrated a circadium rhythm, increasing with the onset of darkness

There is already significant evidence that not breastfeeding is in itself a risk factor for SIDS, and we also know breastfed babies rouse more frequently and sleep lighter than substitute fed peers.  We know oral development is different and we know thymus and other levels of hormones differ - why would we assume a breastfed baby needs a pacifier?

RELATED POST: Baby is using you as a pacifier, it's just for comfort...

Surrender - how is it relevant to childbirth and motherhood?

My last entry was about pain relief during labour, and whilst hunting for inspiration I met an antenatal teacher who passionately believes that the mind affects the way a woman births. Tamara has also trained with Birthing From Within and dedicated her life's work to preparing women for birth and motherhood on a psychological level.  I thought although less "sciency" and evidence based than normal - this article was very apt and worth a share...

Surrender - Tamara Donn

I first learnt about the meaning of surrender many years ago when I was travelling. Two weeks into my journey, while camping on a remote island in Fiji, I got a bad bug – high fever, vomiting, no doctor and no way to escape the intense heat of the day, I rode the waves of the illness. In my weakened state, I continued my journey to Australia and although the intensity of the bug had subsided, I was still very vulnerable and developed an exhausting relentless cough, with extremely low energy. Gradually all my joints started aching and all this time I am repeating the mantra “I mustn’t be ill, I must get better now, I am travelling and must make the most of it and enjoy myself”. For me, the last straw was when, with all these symptoms I got caught out in the rain with no protective clothing and my inner judge was saying “Now you will really pay for it, you’ll probably get pneumonia”. All of a sudden I was forced into a place where I could go no further. I was cornered. And I just said to myself “I surrender” and in that moment everything shifted for me. I was no longer fighting my symptoms. I was the way I was, for better or for worse and there was no fight or resistance left in me. It may sound like a powerless position but in fact it was quite the opposite. I had allowed myself to “be” and felt waves of relief and acceptance wash over me. As I felt myself soften to the experience, almost immediately my joints stopped hurting. It was a turning point for me towards my recovery.

So what has surrendering got to do with giving birth and becoming a mother?

In a man’s world, the unconscious expectations and pressures on a woman are huge. A woman is expected to be level headed and logical every day of the month instead of embracing the ebb and flow of a woman’s cycle. Surrender seems to be a dirty word in our left brain culture of being in control of our lives. Women absorb images of career success in a society where material and professional status are highly rated on one hand and motherhood, child rearing and staying at home are downgraded. The modern career woman typically favours structure, control and logic in her life. When she is called to motherhood, she finds herself in a new world of unpredictability, loss of control and sometimes chaos. The tools she has accumulated in her career world no longer serve her as she searches for new ways to be in her new role. The process of surrendering is essential in order move through this transition, this rite of passage from maiden to mother.

Transition into motherhood is a rite of passage and an initiation. Within the process is the death of the maiden, the letting go and therefore the surrendering of the known that creates a space and an opening for the possibility of the welcoming and embracing of the unknown – and the mother is born.

Nowadays women are encouraged to be in control of their birth experiences. This can manifest in a number of ways by choosing to avoid pain, choosing the date of the birth, wanting to be in control or stay calm. All these choices go against the wildness, unpredictability and the essence of birth which is surrendering into the unknown. The choices give rise to unrealistic expectations of how the birth will unfold and attachment to the outcome. Whether the attachment be to homebirth, breastfeeding, epidural or caesarean birth, the point is that birth is a rite of passage and the unexpected may arise so the more prepared the woman is to surrendering to the unknown, the easier she can embrace her birth into motherhood and gradually integrate her new role into all aspects of her being. Once the baby is born, mothers are also expected to continue soldiering on like a man without acknowledging sleepless night, breastfeeding and the emotional rollercoaster of motherhood.

In my own journey into motherhood I eventually experienced surrender after a long labour of holding onto my ideal birth with all my might. This holding actually slowed down my labour process. This is because the act of holding creates tension in the body and tension releases stress hormones that slow down the release of oxytocin (the birth hormone), hence labour was slow to progress. After 6 days of labouring and clinging tight to my perfect image of having a home birth, I went to hospital ready to have my baby cut out of me. When I got to the ugly hospital and saw the ugly labour ward with the ugly view from the window, I suddenly knew that that was the right place for me to birth my baby and I did it, but only after letting go of everything I believed to be true about the way I was going to give birth.

In my work as an antenatal teacher, I have explored the issue of surrendering with my clients. In this example I asked the women to draw what surrendering into the unknown meant to them and this is what they came up with:

Laura Newman (pregnant in her third trimester with first child)

Starting with willingness as a small bright yellow dot in the centre of emptiness and unknown and allowing white and yellow light and support to come in and gradually my ‘self’ growing as a dot to a more intense wonder of surrender then more colours coming in and from out of me until I meet what is ‘out’ there and connect and join up to

a vital web, then all the colours and intensity of the universe join up and we explode in light and joy and surrender is no longer suffering but an experience of wonder and joy, vitality and colour of the universe

Priya Mahtani (pregnant in her third trimester with second child)

Surrender is simply acceptance an allowing of what is and of what has ever been, an allowing of that which seeks to express itself within you, through you and around. Fear not that in surrender you shall lose yourself sweet child, but … to embrace the wholeness by all that you are. In surrender you shall accept the light that is within to shine ever more brightly than before, to awaken that which you seek in surrender to thy love, be not afraid for I shall be with you as I have ever been, illuminating your world with light.

So what are the conditions that allow for surrendering? What catalyses the turning point? Is it still possible to surrender when you have choices?

These are questions I have asked myself. There is no formula and each woman will find her own unique way. The essential qualities I have found so far that help are: accepting the situation (even if it is not the way you would like it to be), relaxing into the not knowing and allowing it to be there, noticing how you have been able (or not) to surrender in other areas of your life. An exploration of what that means to the pregnant woman can her help to prepare for the unknown, the transition and the rite of passage into motherhood.

Tamara Donn, based in Hertfordshire, runs the Birth Art Cafe and EFT for pregnancy and other workshops for women trying to conceive, pregnant women and new mums. For more information on Tamara’s work see http://www.birthartcafe.co.uk/ and http://www.eftforwomen.co.uk/

How does pain relief in labour affect breastfeeding?

I've touched on this in other entries, but as a couple of mums have contacted me for further information - I thought a blog post focusing on it a bit more was appropriate.

Opiates: eg Pethidine, Meptid
These cross the placenta and have been heavily linked with making baby sleepy and uncoordinated. Below is a clip showing the difference between non medicated and medicated infants at the breast immediately after birth.



Epidurals:

The research on epidurals is very mixed - many studies only look at breastfeeding rates at X weeks, but realistically there can be so many factors influencing this; are mums who don't have epidurals more into natural birthing and thus more likely to breastfeed anyway?  There has been no causal effect proven.  A couple of studies suggest baby may be less co-ordinated/more sleepy, but again no adjustment was made for duration or ease of labour/delivery or baby's condition at birth.   One study found infants exposed to epidural had less feeds in the first 24 hours, but again did the mum have the epidural as it was a very long labour and so this is why baby and perhaps also mum are more sleepy? is it because mum isn't mobile and so less likely to nurse baby or be sleeping herself?

Both epidurals and opiates may impact in another way though; they have been linked to longer labours (likely because mum is on back) with increased risk of instrumental delivery (ventouse/forceps) and cesarean section.  Birth immediately shifts to a different path and mum and baby have to be more closely monitored, with staff often getting nervous quicker if things aren't progressing quite as quickly as hoped.

Both are more heavily linked to breastfeeding problems postparum and shorter duration of exlusive feeding - either because baby is unco-ordinated/sleepy or because mum has found the birth very traumatic.  Epidurals can also increase the risk of excess fluid retention causing breast oedema - which can result in baby then struggling to latch on the overfull breast.

Perhaps we should consider birthing in the same way we do breastfeeding - by establishing the biological norm?

According to the Academy of Breastfeeding Medicine (www.bfmed.org),

“unmedicated, spontaneous, vaginal birth with immediate skin-to-skin contact leads to the highest likelihood of baby-led breastfeeding initiation.”

Because this is how our bodies are intended to birth - thus with any veering from this ie analgesics, we should be looking for evidence they don't impact, not that they do.

The reality of cultural norms surrounding birth at the moment are such that many women choose a medicated birth unaware of all the above (including myself with my first as I worked my way through the drugs cabinet and had both pethidine and epidural following induction!), rates of intervention and section are far higher than necessary because so many of our birth practices inhibit normal labour. 

Does that mean all is lost?  Absolutely not!

When things "go wrong" with breastfeeding, more often than not it's a "cascade effect" - just like that described above.  Let's go back to the mum with the sleepy/uninterested newborn - if they've had forceps, probably a headache too.  Expecting baby to feed straight after birth, mum maybe tired gets concerned baby isn't latching on, next the midwives get twitchy and perhaps start talking about blood sugars and suchlike.  Somewhere in and amongst this, baby is likely to have been taken off for routine weighing, which has also been shown to hinder effective establishment of breastfeeding.

Next perhaps grandparents pop in for a quick visit- and skin to skin is again cut short so the baby can be passed around for a cuddle; exposed the foreign microbes and not yet receiving any protection from mum's breastmilk.  By now even the unmedicated, responsive term baby has settled down for a good snooze - let alone those that were tired or uncoordinated to begin with. 

Baby rouses, but is now placed in a position that hinders his natural reflexes (ie on his back rather than skin to skin on mum), perhaps even wrapped in a blanket, quite possibly still very tired he may do his best to follow his instincts.  Those caring for mum and baby might suggest a good feed will get him going, perhaps a bottle?  even more itchy now about blood sugars/protocols and often ill equipped in both skills and time to sit and help mum establish feeding.  On hand are lots of "ready made convenient disposable bottles" of substitute and I've regularly heard of mums being told "we need to see you feed before you leave, a bottle will mean you get home quicker" (aka we get our bed back on our busy ward, and ultimately we don't have to deal with follow up problems!)

Next feed, mum may try again - or may decide already that baby took the bottle so easily he "clearly preferred it".  Perhaps it hurts, mum can't get baby comfortable - which is more likely if feeding wasn't initiated immediately after birth, perhaps baby won't open wide enough to latch - due to his sore head; the solution again, another bottle.

Is the cascade inevitable?
NOPE!

This sounds too easy but ask for help - many many mothers don't.  If the person who is looking after you isn't helping, ask to see someone else - ask if the hospital has a specialist, a lactation consultant or infant feeding advisor.  If you don't take the bottle - often you find help is found somewhere, because after all they're all twitchy about blood sugars remember?  Whilst there are times that supplementation is genuinely required - there are a lot more times that babies are needlessly supplemented.  Read, read and read some more before your baby arrives - so you know what to expect, and what to do if things aren't working as well as you'd hoped.

For anyone who fancies a deeper read into the subject of how birth impacts this book is a fantastic read (Amazon US has reviews but not UK for some reason.)

On the subject of "normal birth", this is one of my favourites.

Hipp Organic Formula Brain Claim Banned!

An advertising campaign for Hipp Organic has been banned for claiming the product helps develop the brain and nervous system of young children, ruled the ASA. 

The magazine ad was headlined "We've learnt from the breast" and said the follow-on milk contained essential Omega 3 fatty acids for healthy brain and nervous system development, adding: "All this ensures organic goodness to complement Mother Nature's good work. Trust your natural instincts."


The Advertising Standards Authority (ASA) challenged whether Hipp Organic's claim that the milk aided brain and nervous system development could be substantiated.  It said that information given by Hipp Organic "was not sufficiently robust to support the product's claims in relation to healthy brain and nervous system development", adding: "We therefore concluded that the ad was misleading."

The ASA ruled that the ad must not appear again in its current form and told the company not to use claims in future that refer to children's development and health that do not comply with advertising regulations.

Ask The Armadillo - what's in breastmilk?

You can now read this article in Spanish here

Book your visit with AA at Milk Matters Infant Feeding Solutions here 

Q.  Dear Armadillo
I've seen lots of things that talk about ingredients in breastmilk that are not in formula, could you give me some more details please?
Lisa

A.  Hi Lisa
I will try!  although it's always a difficult one to pitch in terms of how sciency to go - giving enough information without overloading people.

It's quite interesting to talk about constituents because when it comes to research outcome of breast v formula, many will argue "x" wasn't taken into account, or "y" skews the study or suchlike; even if there are numerous studies all indicating a similar outcome, if there's one that isn't as conclusive, people will say "ah but there's conflicting evidence".  Looking at what may cause the different outcome tackles things from another angle - as the question becomes what is the impact of depriving a child of a particular constituent?

Breastmilk contains around a hundred constituents that cannot be replicated in formula, with more still regularly being found as science advances.  What's also worth bearing in mind is that it's not just about each element working alone to influence something specific - many properties can impact in more than one area, and a combination can also work together to affect something else entirely.  Furthermore the basic makeup protein, carbs, fat etc are all different because every mammalian milk is species specific.

As an example the protein in breastmilk does a whole host of things; it contains all required essential amino acids, it provides protective factors (which I will come onto more in a moment) and it carries hormones and vitamins.  Protein isn't about obtaining calories for growth, in fact it's a minimal source of energy in breastmilk.

It's also not just about the milk, but the delivery method.  Mum creates antibodies specifically tailored to protect against pathogens acquired from her baby’s immediate surroundings. New antibodies are produced whenever she comes in contact with harmful microbes, or when baby breastfeeds, passing into mother’s body via saliva on her nipple. This signals her immune system to provide or produce the antibodies, which are passed back at subsequent feedings. If baby is not breastfeeding, he has only his own very low antibody levels support him; this, compounded by an immature immunological system, make him extremely vulnerable to infection, which can quickly spread.

I will try and cover some of the main constituents we know most about in terms of "defenses against illness/disease". 

Interesting Constituents:

αlpha lactalbumin: the main protein in human milk, making up 10-20% of total protein.  Perhaps the most exciting discovery of 2010 is that researchers discovered it causes cell suicide in over forty types of cancer.  The team were exploring the antibiotic properties of breast milk when a researcher noticed that cancerous lung cells in a test tube died on contact with breast milk. They discovered that when alphalactalbumin was mixed with acid (as also found in breastmilk and the stomach of breastfed infants) a compound named HAMLET was formed (human alphalactalbumin made lethal to tumour cells) Researchers gave a period of 5 days treatment to patients with bladder cancer and discovered patients urinated dead cancer cells after each treatment.  Studies with rats showed that after just seven weeks a highly invasive brain cancer called glioblastoma was seven times smaller in those treated with HAMLET.  The most important factor is that the substance has no side effects, it only eliminated cancer and does not harm healthy cells.  Karlsson predicted that this therapy would be widely used for adult cancer patients in 5 years. a-lactablumin also binds calcium and zinc, and during digestion forms antibacterial and immunostimulatory properties.

Stem Cells: Have a remarkable ability to develop into many different cell types in the body, serving as a sort of internal repair system. Evidence suggests these cells remain in the body long after cessation of breastfeeding. Stem cells from other sources are already being used to treat leukaemia and could soon help treat eye conditions. Scientists are also researching their potential in the longer term for treating conditions such as spinal injuries, diabetes and Parkinson’s disease.

Lymphocytes: kill infected cells directly or send out chemical messages that mobilise other components of the immune system (see T cells).

T cells: are a sub-group of lymphocytes that play an important role in establishing and maximizing the capabilities of the immune system. These cells are unusual in that cannot kill infected host cells or pathogens, and without other immune cells they would usually be considered useless against an infection. However they have an important role to play activating and directing other immune cells.

Macrophages and neutrophils: are amongst the most common leukocytes in human milk, and they surround and destroy harmful bacteria. The macrophages also manufacture lysozyme, an enzyme that destroys bacteria by disrupting their cell walls. Macrophages in the digestive tract can rally lymphocytes into action against invaders

Immunoglobulins: IgA, IgG, IgM and IgD  are all found in human milk. Of these the most important is IgA, which is both synthesised and stored in the breast. It ‘paints’ baby's tract and gut, covering the mucosal surfaces to prevent the entry of pathogenic bacteria and enteroviruses. It affords protections against E. coli, salmonellae, shigellae, streptococci, staphylococci, pneumococci, poliovirus and the rotaviruses.

Lysozyme: Enhances the ability of IgA and attacks E. coli along with with lactoferrin and sIgA.

Lactoferrin is a protein that binds to iron, preventing disease-causing bacteria from consuming it. It also kills various bacteria including E coli and also helps prevent the immune system from overreacting. Lactoferrin is currently being investigated as a treatment for auto-immune conditions such as rheumatoid arthritis, multiple sclerosis and septic shock.

Mucin: Attaches to bacteria and viruses that enter the baby’s body. When this happens, other cells in the immune system will destroy the disease-causing substance.

Cytokines are believed to play a significant role in the immune-modulation and immune-protection of breast milk. Most of the cytokines that are known to be deficient in the neonate have been found in significant amounts in breast milk.

Anti-infective factors: During the first 10 days there are more white cells per ml of human milk than there are in blood.

Oligosaccharides: These prebiotic carbohydrate molecules resemble binding sites for bacteria,  then attach to it to form a compound that the baby excretes - carrying it out of the body.  They influence the microflora producing increased proliferation of probiotics, which defend against pathogens that cause otitis media, respiratory tract infections, urinary tract infections and diarrhoea.

Milk lipids (fats): Milk lipids damage the outer surface of certain types of viruses. When the viruses are damaged, they are unable to replicate and cause an infection in the baby.

Linoleic acid: Associated with anti-cancer properties, can reduce the risk for cardiovascular disease and help fight inflammation.

Anti-secretory factor: protects the infant against diarrhoea.

IL-7: is linked to the size of the thymus, the central organ in the immune system. It has been found to be up to half the normal size in artificially-fed infants. IL-7 also has an important role in promoting the production of B lymphocytes, the antibody producing cells.

Growth factors: including epidermal, insulin-like and transforming growth factor; these promote gastrointestinal maturation in the infant.  Epidermal growth factor leves are highest in the milk of mums who have premature infants, which dramatically reduces the rate of necrotising enterocolitis (NEC) & intestinal inflammation.  There is also theory these factors may play a role in "early life programming" which suggests that the adult individual's physiology (eg obesity) and potential morbidity (eg cancer) is predetermined early in life.

This list is by no means exhaustive;

Breastmilk contains a myriad of other factors that work to protect and enhance the development of the breastfed child. These include:

• nucleotides
• defensins
• hormones
• anti-inflammatory components
• soluble CD14 and soluble Toll-like Receptor (health-e-learning)

What is interesting is that as we are discovering more about what the constituents do, it supports what research has been highlighting in terms of outcome.  Studies have long linked not breastfeeding with higher rates of ear infections, cancers, diabetes, meningitis, respiratory illness, rheumatoid arthritis (and other diseases of the immune system) gatrointestinal illness and NEC to name just a few from a long list.  As we begin to understand more about which part of breastmilk does what, it gives more understanding as to why non breastfed infants are more susceptible - not just as infants but in terms of life long health.  What's perhaps the most worrying is that science has hardly scraped the surface yet and so potentially massess of other diseases could also be intricately linked eg researchers are currently exploring links with a number of conditions including multiple sclerosis and chronic fatigue syndrome.

Full list of what's in Breastmilk V Formula

BREASTMILK - bear in mind some are plural and that new constituents are still being identified and their function understood within breastmilk

Water
Carbohydrates (energy source)
Lactose
Oligosaccharides (see below)
Carboxylic acid
Alpha hydroxy acid
Lactic acid
Proteins (building muscles and bones)
Whey protein
Alpha-lactalbumin
HAMLET (Human Alpha-lactalbumin Made Lethal to Tumour cells)
Lactoferrin
Many antimicrobial factors (see below)
Casein
Serum albumin
Non-protein nitrogens
Creatine
Creatinine
Urea
Uric acid
Peptides (see below)
Amino Acids (the building blocks of proteins)
Alanine
Arginine
Aspartate
Clycine
Cystine
Glutamate
Histidine
Isoleucine
Leucine
Lycine
Methionine
Phenylalanine
Proline
Serine
Taurine
Theronine
Tryptophan
Tyrosine
Valine
Carnitine (amino acid compound necessary to make use of fatty acids as an energy source)
Nucleotides (chemical compounds that are the structural units of RNA and DNA)
5’-Adenosine monophosphate (5”-AMP)
3’:5’-Cyclic adenosine monophosphate (3’:5’-cyclic AMP)
5’-Cytidine monophosphate (5’-CMP)
Cytidine diphosphate choline (CDP choline)
Guanosine diphosphate (UDP)
Guanosine diphosphate - mannose
3’- Uridine monophosphate (3’-UMP)
5’-Uridine monophosphate (5’-UMP)
Uridine diphosphate (UDP)
Uridine diphosphate hexose (UDPH)
Uridine diphosphate-N-acetyl-hexosamine (UDPAH)
Uridine diphosphoglucuronic acid (UDPGA)
Several more novel nucleotides of the UDP type
Fats
Triglycerides
Long-chain polyunsaturated fatty acids
Docosahexaenoic acid (DHA) (important for brain development)
Arachidonic acid (AHA) (important for brain development)
Linoleic acid
Alpha-linolenic acid (ALA)
Eicosapentaenoic acid (EPA)
Conjugated linoleic acid (Rumenic acid)
Free Fatty Acids
Monounsaturated fatty acids
Oleic acid
Palmitoleic acid
Heptadecenoic acid
Saturated fatty acids
Stearic
Palmitic acid
Lauric acid
Myristic acid
Phospholipids
Phosphatidylcholine
Phosphatidylethanolamine
Phosphatidylinositol
Lysophosphatidylcholine
Lysophosphatidylethanolamine
Plasmalogens
Sphingolipids
Sphingomyelin
Gangliosides
GM1
GM2
GM3
Glucosylceramide
Glycosphingolipids
Galactosylceramide
Lactosylceramide
Globotriaosylceramide (GB3)
Globoside (GB4)
Sterols
Squalene
Lanosterol
Dimethylsterol
Methosterol
Lathosterol
Desmosterol
Triacylglycerol
Cholesterol
7-dehydrocholesterol
Stigma-and campesterol
7-ketocholesterol
Sitosterol
β-lathosterol
Vitamin D metabolites
Steroid hormones
Vitamins
Vitamin A
Beta carotene
Vitamin B6
Vitamin B8 (Inositol)
Vitamin B12
Vitamin C
Vitamin D
Vitamin E
a-Tocopherol
Vitamin K
Thiamine
Riboflavin
Niacin
Folic acid
Pantothenic acid
Biotin
Minerals
Calcium
Sodium
Potassium
Iron
Zinc
Chloride
Phosphorus
Magnesium
Copper
Manganese
Iodine
Selenium
Choline
Sulpher
Chromium
Cobalt
Fluorine
Nickel
Metal
Molybdenum (essential element in many enzymes)
Growth Factors (aid in the maturation of the intestinal lining)
Cytokines
interleukin-1β (IL-1β)
IL-2
IL-4
IL-6
IL-8
IL-10
Granulocyte-colony stimulating factor (G-CSF)
Macrophage-colony stimulating factor (M-CSF)
Platelet derived growth factors (PDGF)
Vascular endothelial growth factor (VEGF)
Hepatocyte growth factor -α (HGF-α)
HGF-β
Tumor necrosis factor-α
Interferon-γ
Epithelial growth factor (EGF)
Transforming growth factor-α (TGF-α)
TGF β1
TGF-β2
Insulin-like growth factor-I (IGF-I) (also known as somatomedin C)
Insulin-like growth factor- II
Nerve growth factor (NGF)
Erythropoietin
Peptides (combinations of amino acids)
HMGF I (Human growth factor)
HMGF II
HMGF III
Cholecystokinin (CCK)
β-endorphins
Parathyroid hormone (PTH)
Parathyroid hormone-related peptide (PTHrP)
β-defensin-1
Calcitonin
Gastrin
Motilin
Bombesin (gastric releasing peptide, also known as neuromedin B)
Neurotensin
Somatostatin
Hormones (chemical messengers that carry signals from one cell, or group of cells, to another via the blood)
Cortisol
Triiodothyronine (T3)
Thyroxine (T4)
Thyroid stimulating hormone (TSH) (also known as thyrotropin)
Thyroid releasing hormone (TRH)
Prolactin
Oxytocin
Insulin
Corticosterone
Thrombopoietin
Gonadotropin-releasing hormone (GnRH)
GRH
Leptin (aids in regulation of food intake)
Ghrelin (aids in regulation of food intake)
Adiponectin
Feedback inhibitor of lactation (FIL)
Eicosanoids
Prostaglandins (enzymatically derived from fatty acids)
PG-E1
PG-E2
PG-F2
Leukotrienes
Thromboxanes
Prostacyclins
Enzymes (catalysts that support chemical reactions in the body)
Amylase
Arysulfatase
Catalase
Histaminase
Lipase
Lysozyme
PAF-acetylhydrolase
Phosphatase
Xanthine oxidase
Antiproteases (thought to bind themselves to macromolecules such as enzymes and as a result prevent allergic and anaphylactic reactions)
a-1-antitrypsin
a-1-antichymotrypsin
Antimicrobial factors (are used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses.
Leukocytes (white blood cells)
Phagocytes
Basophils
Neutrophils
Eoisinophils
Macrophages
Lymphocytes
B lymphocytes (also known as B cells)
T lymphocytes (also known as C cells)
sIgA (Secretory immunoglobulin A) (the most important antiinfective factor)
IgA2
IgG
IgD
IgM
IgE
Complement C1
Complement C2
Complement C3
Complement C4
Complement C5
Complement C6
Complement C7
Complement C8
Complement C9
Glycoproteins
Mucins (attaches to bacteria and viruses to prevent them from clinging to mucousal tissues)
Lactadherin
Alpha-lactoglobulin
Alpha-2 macroglobulin
Lewis antigens
Ribonuclease
Haemagglutinin inhibitors
Bifidus Factor (increases growth of Lactobacillus bifidus - which is a good bacteria)
Lactoferrin (binds to iron which prevents harmful bacteria from using the iron to grow)
Lactoperoxidase
B12 binding protein (deprives microorganisms of vitamin B12)
Fibronectin (makes phagocytes more aggressive, minimizes inflammation, and repairs damage caused by inflammation)
Oligosaccharides (more than 200 different kinds!)

FORMULA
Water
Carbohydrates
Lactose
Corn maltodextrin
Protein
Partially hydrolyzed reduced minerals whey protein concentrate (from cow’s milk)
Fats
Palm olein
Soybean oil
Coconut oil
High oleic safflower oil (or sunflower oil)
M. alpina oil (Fungal DHA)
C.cohnii oil (Algal ARA)
Minerals
Potassium citrate
Potassium phosphate
Calcium chloride
Tricalcium phosphate
Sodium citrate
Magnesium chloride
Ferrous sulphate
Zinc sulphate
Sodium chloride
Copper sulphate
Potassium iodide
Manganese sulphate
Sodium selenate
Vitamins
Sodium ascorbate
Inositol
Choline bitartrate
Alpha-Tocopheryl acetate
Niacinamide
Calcium pantothenate
Riboflavin
Vitamin A acetate
Pyridoxine hydrochloride
Thiamine mononitrate
Folic acid
Phylloquinone
Biotin
Vitamin D3
Vitamin B12
Enzyme
Trypsin
Amino acid
Taurine
L-Carnitine (a combination of two different amino acids)
Nucleotides
Cytidine 5-monophosphate
Disodium uridine 5-monophosphate
Adenosine 5-monophosphate
Disodium guanosine 5-monophosphate
Soy Lecithin

Courtesy of http://www.bcbabyfriendly.ca (reproduced with permission)

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