Dear Colleagues, If we, as breastfeeding experts, have an opportunity to comment about reports of toxins in milk, I think it’s important to avoid knee-jerk responses saying “there’s bad stuff in formula too.” We’ll never win that argument. The evidence indicates that human milk does have higher levels of POPs (persistent organic pollutants) than cows’ milk. This makes sense, because cows are vegetarians and don’t eat other animals that have eaten other smaller animals that have eaten other smaller animals, increasing the body burden of toxics with each step in the food chain. (Fish are a good example of this accumulating effect.) Here is some background material that I gathered this week about the EWG (Environmental Working Group) and the toxins (AKA ”body burdens”) issue. I. Info about WABA’s link with the environmental community: Brief history: As an international treaty on the topic of POPs was being developed, breastfeeding advocates and environmental advocates began working together to address the issue of how we should speak about toxins in human milk. They looked for ways that environmental groups can use information from studies that have measured toxins in milk without subverting breastfeeding promotion. Marian Tompson of LLLI and Susan Siew of WABA addressed a meeting of environmental groups in Bonn in 2000; later that year Susan and Penny Van Esterik attended an intergovernmental negotiating committee (INC) meeting in Johannesburg. Susan was at the May 2001 meeting in Stockholm where the Stockholm Convention was signed. The Stockholm Convention is an international treaty that follows up on the Earth Summit that was held in Rio in 1992. It is an attempt to rein in and ultimately halt the proliferation of toxic chemicals. A joint statement was drafted by WABA and IPEN (International POPs Elimination Network) at a special meeting in Bolinas, California, in 2001 and further discussed at the LLL conference in Chicago that year. Penny's monograph "Rights, Risks and Regulation: communicating contaminants and infant feeding" was introduced at the conference. You can find it online at http://www.waba.org.my/RRR/penny1b.htm (I think it's worth a trip to the WABA website just to see the "Corridor of Bellies" silent demonstration that the NGOs staged at the INC meeting. Click on "Breastfeeding and Environmental Social Justice Advocates at Work" in Penny's document.) You can see the joint statement on the WABA website at http://www.waba.org.my/RRR/joint.pdf Why are these documents relevant? They are the result of serious joint effort by environmental advocates and breastfeeding advocates to find words to express the dangers we face as a global community—without undermining anyone's efforts to promote and support breastfeeding. In this arena, you can see that finding the right words is a key to PROTECTING breastfeeding--one of the Innocenti strategies. II. Info about the EWG (Environmental Working Group) Word came out on Lactnet in February 2003 that EWG was doing a project to test human milk for toxic substances. I queried a contact of mine from a (non-radical) environmental group in California, who told me that, in her dealings with EWG, the group was sensitive to the issues of how to disclose findings so as not to undermine breastfeeding. Such sensitivity is important, but it is only the first step, because then comes. . . . III. What the media does with the information This is a crucial aspect of the problem. Look at it as a series of steps, like in the game of “Gossip” that I used to play at birthday parties. (In my kids’ generation, it was “Whisper Down the Lane.”) 1. A study looks for toxic substances in human milk (because that’s an effective way to monitor toxic body burdens) 2. The study findings are announced in a press release as “All human tissues carry a body burden of toxic substances, as shown by a study of human milk.” 3. The media interpret the findings as “Human milk is toxic!!!!!” So what we say in reaction to such announcements can be an important counter-weight to potential mis-interpretation of the study findings. It is important to go back and look at what the researchers really said in their press release. Also, if we can, to see what the real conclusions were in their study. One announcement that I read said, “these levels in breast milk indicate that babies in the womb are exposed to high levels during crucial brain development.” That’s the important point! ALL babies are exposed before they ever have a taste of human milk, and they are exposed whether or not they are later breastfed. If we need a sound bite response to this news item, I think that’s it. I also had some time yesterday to look carefully at the article, Ribas-Fitó N, E Cardo, M Sala, ME de Muga, C Mazón, A Verdú, M Kogevinas, JO Grimalt, J Sunyer (2003) Breastfeeding, exposure to organochloride compounds, and neurodevelopment in infants. Pediatrics (on line) 111:5, May 2003, e580-85. http://www.pediatrics.org/cgi/content/full/111/5/e580. The study looked at 84% of the babies born over a two-year period in a small area in Spain where the population had been exposed to various organochloride pollutants for over 40 years because of a factory in the area. Adults in the area had the highest levels of hexachlorobenzene (HCB) ever reported, and cord blood samples in babies were also very high in HCB. The study reported on p,p’DDE (dichlorodiphenyl dichloroethylene), HCB, and PCB (polychlorinated biplenyl)—not on the PBDEs of the US flame-retardant study that’s in the news now. In this study, babies were divided into “short-term breastfeeding” (2-16 weeks) and “long-term breastfeeding” (over 16 weeks). 16 weeks was the median length of breastfeeding in this population, so I assume that’s why they chose 16 weeks---not for any clinical reason. Half the nursing babies nursed more than 16 weeks, and half nursed less than 16 weeks. The babies were also divided according to their cord blood levels of p,p’DDE, indicating low or high prenatal exposure to the chemical. Here is a modified table that help you see the findings. The numbers are the mean test scores for the groups of babies. I rounded the scores and did not show the SD. The population mean scores on these standard tests is 100. The groups were controlled for many confounders, such as maternal age, paternal occupation, maternal smoking or alcohol use, maternal education, baby’s gender and attendance at kindergarten (I assume this is group care, since we’re talking about 1 year olds.) ___________________________________________________________ bf > 16 wks bf < 16 wks formula fed mental score low cord blood level 111 103 101 high cord blood level 107 97* 101 psychomotor score low cord blood level 97 86 92 high cord blood level 91 81* 87 * P<.05 compared with babies with low cord blood levels and bf >16 weeks. _____________________________________________________________ The babies were tested on mental and psychomotor development at 1 year of age. Babies with high p,p’DDE levels in cord blood had lower scores on both developmental tests, regardless of feeding method, compared to babies with lower cord blood levels. Babies who breastfed over 16 weeks had better scores than babies who breastfed less than 16 weeks and babies who had no breastfeeding, regardless of cord blood p,p’DDE levels—that is, long-term breastfeeding helped raise developmental scores in all groups of babies, no matter how much prenatal exposure they had. That’s the good news. What concerns me is the report that, for the group of babies with high cord blood levels of toxics, the short-term breastfeeding group scored significantly lower than the long-term breastfeeding group, with the formula fed group in a middle position. The difference was statistically significant only when comparing long-term bf to short-term bf…but with the formula babies scoring better than the short-term breastfed babies, people could conclude that, if you’re not going to breastfeed for at least 16 weeks, and if you think you might have had high exposure to environmental toxins (because you live in the USA, for instance!), or if you “just want to be safe,” formula could be a better choice than breastfeeding. These authors also report, citing another article which they have submitted for publication, that “we have observed in the infants of this population that those who breastfed increased their concentrations of organochlorine chemicals during the first weeks of life.” Their next sentence, is “Long-term breastfeeding, however, seems to be beneficial to the infant.” I think we need to be aware of this article. There are many things to consider. For instance, 1. This was a special population, with long-term exposure to a toxic environment. Still. . . we need to be able to make recommendations for every woman, not just the lucky ones who can limit their exposure. AND, we are all “living downstream” these days. 2. We don’t know HOW the breastfed babies were breastfed—only how long they had any breastfeeding. If the short-term breastfed group were partially breastfed more and earlier and longer than the long-term group, that might affect how they handled any toxins they took in by the GI route. Think of the effect of mixed feeding in HIV-exposed babies, for instance, where true exclusive bf is protective and partial bf is risky. 3. It appears to me that the 16 week figure was chosen for statistical reasons, not because there’s something magical about the age of 16 weeks. Maybe there are age-related changes in the baby’s GI tract that we don’t know about. It could be that the critical period to get a protective effect of “long-term breastfeeding” is really 12 weeks or 9 weeks. I know very little about statistical methods…so all I can do is ask the question. I know that we all want breastfeeding to be the best choice in every circumstance. I just want to be sure we examine the available evidence and make an evidence-based recommendation. Where the evidence is too scanty to base a recommendation on, we need to know this, and acknowledge it. In the case of the Ribas-Fitó article, I think it indicates that we need to know a lot more about short-term breastfeeding before we endorse any notion that formula would be a better choice. Cheers, Chris Chris Mulford, RN, IBCLC LLL Leader Reserve working for WIC in South Jersey (Eastern USA) Co-coordinator, Women & Work Task Force, WABA *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html