Comment by brownbat | Hacker News Reader

Comment by brownbat | Hacker News Reader

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> breastfed... is ideal whenever possible

The AAP and WHO both endorse this position, and I can't find a reputable leading health org that argues otherwise.

The more I read about the basis of the claim though the more confused I get.

Parenting advice sites all point out that it helps child immunity. But the underlying studies are based on the ingestion of immunoglobulin, which doesn't even survive digestion. So essentially it protects the esophagus against waterborne illnesses, ie, mainly those no longer common in the developed world. That definitely makes sense in terms of evolutionarily-relevant child mortality threats, but that context is always omitted.

Or you get claims of improved cognition, then find meta-analysis that can't reproduce any results after five years.

http://pediatrics.aappublications.org/content/early/2017/03/...

https://www.theatlantic.com/magazine/archive/2009/04/the-cas...

Parenting guidance seems full of replication crisis issues, even in the medical literature. That's been the most eye opening thing about becoming a parent... people's strong interest in parenting makes it hard to explain the poor state of the data on the topic.

That's not the whole story (re: immunoglobulin). You're right in broad-brush strokes. The abstract at https://www.ncbi.nlm.nih.gov/pubmed/12850343 has some quick notes on the broader context. For immunoglobulin in particular, when you say "doesn't survive digestion," you're missing the substantial amounts of IgA (ok, milk sIgA) in the intestine. There it will bind with lots of bad stuff, preventing said bad stuff from causing an immune response. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257684/ is one place to read about this.)

You also must consider all the leukocytes in breast milk. Both maternal and infant infections cause huge increases in leukocyte production. There is a theory (hard to test) that babies like to stick their hands in mom's mouth while breastfeeding so that mom gets baby germs, and then mom will make appropriate leukocytes. Bizarrely, baby backwash (into the breast! while feeding!) also leads to maternal immunological response. Fun fact: breast milk from the same mom can vary in color dramatically (from blue to white to yellow) and a lot of that has to do with the contents, with yellow in particular generally having a high leukocyte content.

Highly interesting, thanks!

That's fascinating and good info.

I'm a little biased. We got a lot of information pushing us not to supplement from health professionals and organizations, and nothing on the risks of failure to thrive or the case for supplementation. We had a calorie deficit no one caught, because measuring breast milk consumption is opaque, and no one talks about low consumption with the same fervor. They should though, it's an issue that drove an entire industry of wet nurses before formula (who were in turn criticised as unnatural in their day). They say breast if possible, but never detail how to tell the difference between just doing the hard work, or just banging your head against an immovable wall.

This inconsistency in advice, even though calorie deficits are incredibly dangerous, and more clearly so,[0] worries me there's a bias against technological development that keeps us from giving advice about both risks (or really much at all about the more important risk here).

[0] insofar as there are conflicting metaanalyses on breastmilk, but the signal is far stronger here, no one is publishing research suggesting failure to thrive is no big deal.

Don’t overlook the benefits to Mom too. Breastfeeding lowers risk of breast cancer:

https://www.mdanderson.org/publications/focused-on-health/oc...

That's actually a great example of what troubles me.

If you click through to read the underlying research you get a massive jumble of conflicted studies, including several meta-analyses that fail to find any significant results.

This gets reduced to "breastfeeding lowers the risk of breast cancer" in parenting lit without any context about how radically uncertain this area is.

Becoming a parent and actually reading the underlying lit has nearly destroyed my faith in medical research.

What's troubling is that there is no rational discussions, its always "breast is best" or "emotional impact statement here"

Of course we can all agree that in ideal circumstances, breast milk is the best thing for babies, its unique biologically adapted (even between feeds) formula is impossible to mass manufacture and biologicals like leukocytes are impossible to add in.

However, if the mother does not produce enough milk, then failure to thrive concerns take over, supplement.

If mother is post partum, dad can take over and supplement.

People just eat the tagline these days instead of doing a basic cost/benefit analysis and thinking a little bit for themselves.

Add to that the seeming acceptance of bad science and you end up with anti-vaxxers.

> The more I read about the basis of the claim though the more confused I get.

The “breast is best” narrative is partly an outgrowth of the Nestle boycott. In developed nations, the difference between breastfeeding and formula feeding is pretty minimal. Minor immune benefits for breastfeeding. Minor weight benefits for formula feeding (formula fed babies gain weight more rapidly as nutrition is always available). However, in developing nations, (powdered) formula is far less safe due to lack of sanitation and formula producers have gotten a lot of justified criticism over their marketing campaigns in developing nations.

In an ideal case, breastfeeding seems strictly superior in terms of the baby’s health even in developed nations. The benefits of breastfeeding vs sanitary formula are small but seem to exist. However, the ideal case is often not the actual situation.

My problem with the lactation advocacy is that many advocates ignore actual difficulties with breastfeeding. Low/insufficient milk supply, pain during feeding, inability to share the burden with a partner, sleep impact, isolation (for women uncomfortable with public breastfeeding or living in places where this is frowned on), career impact, etc. It’s often presented as if any issues are failings of the mother. “Pain? You’re definitely doing it wrong. Supply issues? Just keep breastfeeding exclusively and your underweight baby will be fine. The fact that your baby is in the 1st percentile for weight at 3 months and always hungry doesn’t mean you need to supplement.” Etc.

There's a bit of advocacy at Fed is Best:

https://fedisbest.org/

Of course, some people see that as an anti-breastfeeding movement.

The rhetoric around breastfeeding is insane. Trying to do legitimate research online about it is almost impossible.

My least favorite part of breastfeeding advocacy is when people say it's free. Yes, it's free, as long as you ignore the extra time it takes for the mother that can't be shared with other caregivers (unless you pump, which takes more time), extra food you have to eat, the pump and various accessories, and the time spent cleaning all the little pump parts. Yeah, other than that it's free.

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