Dear Susan,

Thanks for this post.  When I saw the title, I thought it would be a much
different post.  I was thinking it would be urging us to do something that
I've been mulling around for a long time---go to the researchers and tell
them what we want them to check out/study so that we are not "at the effect"
of research but actually steering researchers toward what we need on the
playing field.  I would love to see some research done that would link the
recent studies on how preemies do better (as far as anemia) when their cords
are left to pulse for at least 3 minutes (I'd prefer 30 mins, but hey, it's
a start) with breast feeding.  In other words, do infants who have a
physiological third stage (cord left alone until the placenta is birthed
without drugs) AND are breastfed need iron and zinc supplementation at 6
mos. I'm sure it wouldn't be difficult to set up studies to investigate
things like this and, if researchers were made aware of the need, perhaps
they would undertake such a project.

Gloria Lemay, Vancouver, BC Canada

http://www.glorialemay.com/blog

 

I will post on this again.  Two of the important researchers:  Kathryn De=
wey and Ken=20 Brown have conducted very solid research on infant nutrition
for DECADES.=  Kathryn=20 Dewey did an EXCELLENT presentation at the Academy
of Breastfeeding Medci= ne about=20 three or four years ago that made the
case for iron and zinc as well as f= ocusing on the=20 NUMBER of meals
rather than whether food or breast is offered first at a = particular meal.

 

I want to make it very clear that infants everywhere are the same. Race i= s
actually a=20 social construct, not a biologic one.  There is very little
difference in=  growth patterns on a=20 population basis among infants and
young children to age five.  Almost al= l differences are=20 INDIVIDUAL
genetic variation and nutritional, not ethnic or cultural or r= acial.

 

So, well designed studies ANYWHERE apply to infants and young children.  =
The research=20 suggests that infants typically start needing more iron and
zinc in very = high quantities=20 around six months of age. At six months of
age, most healthy full term in= fants have used=20 up much of their iron
stores that they acquired in the last trimester of = pregnancy.  Iron=20
deficiency (even BEFORE ANEMIA) has been implicated in cognitive delays. =
Hematocrit=20 and hemoglobin tests are LATE-TERM indicators because you have
already be= en in iron=20 deficiency for a while before you get to ANEMIA.
Some of the cognitive d= elays have bene=20 shown to be irreversible.  AND
having tested the HemoCue device that is c= ommonly used=20 in
pediatrician's offices in large-scale evaluations in developing countr= ies,
I would pit any=20 one of my former survey workers against the practices I
have seen in pedi= atricians=20 offices in Manhattan.  It is very easy to
skew the results of these tests=  by squeezing the=20 child's finger, not
filling the cuvette, or not waiting for the alcohol t= o dry on the
finger.=20=20 The International Nutritional Anemia Consultative Group
actually deemed t= his device so=20 inaccurate (which I believe was going
way too far from the evidence I loo= ked at) that=20 they wouldn't want it
used in survey work.  Statistically, you need a far=  GREATER degree=20 of
accuracy for diagnostic purposes for an intervention in an individual = than
for deciding=20 whether to implement a large scale program.

 

Moreover, after having just presented my talk to the Cornell medical stud=
ents I find that=20 there are the same flaws in logic being applied to
solids as being applie= d to breast milk.=20=20 What the formula industry
used to do was criticize the research that show= ed higher=20 mortality
rates for infants that were not bresatfed and these mortality r= ates were
much=20 much higher in developing countries.  One criticism was that the
research=  in developing=20 countries were flawed and therefore, the
mortality rates were not that hi= gh.  This was=20 completely debunked by a
very well designed study in Malaysia that showed=  that it lack=20 of
latrines coupled with not breastfeeding that dramatically increased th= e
risk of death.=20=20 Another analogy is smoking and asbestos.  Both are
deadly --- together th= ey actually=20 have a multiplicative effect
dramatically increasing the risk of death to=  very high levels.=20=20 This
also blows the argument that babies in "developing" areas are differ= ent
genetically=20 or nutritionally different out of the water as well.  It is a
flawed argu= ment that I am=20 increasingly finding leads to an "us" and
"them" mentality.  "They" have = problems=20 because "they" don't have
enough food, "they" have too many babies, "they= " aren't using=20 modern
agricultural techniques--- take your pick of the sometimes patroni= zing=20
conclusions we reach when thinking about "those less fortunate". Pamela M=
orrison really=20 got me started thinking about this issue when she posted
long ago about h= ow women in=20 developing areas are physiologically no
different than women in developed=  areas and=20 they have problems
breastfeeding too.

 

As with any population based conclusion, there are individual variations =
that are=20 EXTREMELY important on an individual case basis.  As lactation
consultant= s, most of us=20 work with individual clients.  So we all know
the children that are on th= e ends of the=20 population curve that need
something sooner and those for whom delaying s= omething=20 (e.g. solids) is
entirely warranted.  Food allergies and esophageal reflu= x disease=20
immediately come to mind.  And I think we are a long long way from figuri=
ng out how to=20 appropriately handle these conditions.=20=20

 

I will strongly suggest that those who are not familiar with nutrition re=
search spend some=20 time with the peer-reviewed journals first.  Both the
cognitive and the s= ix months issue=20 can be found.  My former field
actually did have many dedicated researche= rs who=20 received funding from
sources that did not have conflicts of interest wit= h the food=20 industry.

 

 

Best,

 

Susan E. Burger, MHS, PhD, IBCLC

 


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