Why Care About Breastfeeding Research?

Since becoming a mom, and especially since starting this blog, I have paid particular attention to new breastfeeding research. After all, my training is in nutrition, and breast milk is one of the most interesting foods around. Plus, I’m currently lactating and still breastfeeding my daughter a few times per day, so it’s on my mind.

When I look back at the papers that I have covered and those that I find on other blogs and media outlets, I notice that many focus on how breastfeeding improves outcomes in babies.

But I also notice that when I blog about breastfeeding research, I have to spend a big chunk of the piece talking about the limitations of the study. Breastfeeding research – at least when conducted in humans – will always have big limitations that require disclaiming and explaining. The problem is that it is impossible to randomize breastfeeding trials or to “blind” the subjects to feeding type. It is difficult to know, despite the fanciest statistical methods, if it is breast milk that makes those babies thinner, smarter, stronger, cry more, etc, or if there are other factors at play in this complex thing called human life. Sometimes, by the time I’ve listed the problems with interpreting a breastfeeding study, I wonder if these findings were actually meaningful, and I’m sure my readers feel the same way.

Elsewhere around the Internet (not so much on my blog), I often see comments to this effect on articles about the latest research on the benefits of breastfeeding:

“Another useless study. Obviously we mammals were meant to feed our babies breast milk. I don’t know why scientists waste their time and our money with this stuff.”

Why bother doing more research on outcomes associated with breastfeeding? It is pretty clear that breastfeeding is a great way to feed an infant. Maybe it is time to stop oohing and awing over breast milk.

There is something to this. I think we see a lot of papers published that report on the benefits of breast milk just because this is a hot topic now. These data are often pulled from a larger epidemiological data set. A positive association is found between breastfeeding and some good outcome, and the authors throw it together to make a separate paper. It is accepted for publication in part because breastfeeding promotion is a public health priority now. I’d be willing to bet that there are lots of researchers out there that have checked for an association between breastfeeding and an outcome in their data set, found none (or even a negative one they can’t explain), and not bothered to write up a paper or had their paper rejected because a non-association is just not that exciting.

Still, I do think that these observational studies can have some value. One that I wrote about a couple of weeks ago found an association between exclusive bottle-feeding, whether formula or expressed breast milk, and increased weight gain in infants. There were LOTS of limitations to this study. However, I thought that the data raised an interesting question: Can we modify the way we bottle-feed babies such that growth in bottle and breastfed babies starts to look more similar? At the very least, it is something for us to think about, and it could also inspire a hypothesis for a future study, one that could ultimately improve the way we feed babies. Regardless, not all papers can be groundbreaking. Most add to a body of evidence over time. Some are flukes, which we realize when they can’t be replicated. But all ideas have to start somewhere, and in science, they start with observation. The problem is not as much in the research (scientists are usually all too willing to point out the limitations of their work) as it is in the media’s spin of stories to make them seem urgently relevant to the parenting public.

Of course, the really important lactation research is probably happening in laboratories – in petri dishes and in lab animals, not within an epidemiological data set. These studies, the ones that are slowly starting to illuminate what it is about breast milk that makes it so good for babies, may not catch the eyes of bloggers and journalists because the paper titles contain words that we don’t understand or the outcomes are more subtle: a small change in cell growth or difference in oligosaccharide composition. It is harder to explain and write about, and we often assume that it will feel less relevant to a reader. I’m guilty of this attitude as well, but I’m trying to change my ways.

Recently, Fearless Formula Feeder posed this question to her readers, many of which are women who have struggled with breastfeeding: what type of breastfeeding research would you like to see? The truth is that if you’re breastfeeding and having a good experience with it, you probably love to see these reports on the benefits of breastfeeding. But if you’re feeding formula – for whatever reason and no matter how fearlessly – you undoubtedly get tired of these stories, particularly when the studies have the limitations I discussed above. Reading FFF’s post, it occurred to me that moms like these are also the most likely to benefit from new breastfeeding research. After all, a better understanding of breast milk will pave the way for better formula. A better understanding of the etiology and risk factors for problems with breastfeeding will pave the way for targeted, specific support for moms who want to breastfeed but struggle to do so. And in fact, the FFF’s came up with some really great research questions in the comment thread on that post. Are scientists working on their questions, and we just aren’t hearing about it?

One of the major sources of funding for breastfeeding research in this country is the National Institutes of Health. These are taxpayer dollars. Did you know that there is an open-access database where you and I and anyone with access to the Internet can learn how our tax dollars are being spent to support research?

Just use the text search box on the top left to search for your topic of interest.

If you’re curious, do a search for any health-related topic, and you can learn what NIH-funded researchers are working on today. If a particular grant interests you, you can do a Pubmed search for the Principal Investigator (PI) to see what they’ve published on that topic in the past, and you can expect to see papers coming from the current grant in the next couple of years.

I did a few quick searches for “breastfeeding” and “infant formula,” and I found some really cool studies in the works:

Clinical Epidemiologic and Biologic Studies of Donor Human Milk and Breastfeeding, Tarah T. Colaizy, University of Iowa

Prevention of Overfeeding During Infancy, Kathryn G. Dewey, University of California, Davis (This grant speaks directly to some of the questions that came out of that bottle-feeding and weight gain study I mentioned earlier.)

Mechanisms by which Human Milk Oligosaccharides Protect Against Rotavirus, Sharon M. Donovan, University of Illinois

Structure, Functions, and Genetic Diversity of Oligosaccharides in Milk, Carlito B. Lebrilla, University of California, Davis

Establishing the Vitamin D Requirements During Lactation, Bruce W. Hollis, Medical University of South Carolina

Estrogenicity of Soy Formula, Walter Rogan, National Institute of Environmental Health Sciences (This grant is targeting many of the questions FFF raised in her post on the recent study comparing development in babies fed soy formula, cow’s milk formula, or breast milk.)

Boosting Breastfeeding in Low-Income, Multiethnic Women: A Primary-Care Based RCT, Karen A. Bonuck, Albert Einstein College of Medicine

Mediating Factors in the Relationship Between Obesity and Poor Lactation Outcomes, Laurie A. Nommsen-Rivers, Children’s Hospital Medical Center, Cincinnatti

I can’t wait to read the papers that come out of these grants, even though I know they’ll all have limitations and create more questions. That’s science for you. But seeing many of the questions that I’ve wondered about myself articulated by scientists and dollars allocated towards answering them gives me renewed enthusiasm for the value of science to humanity and to my life.

What questions do you hope scientists are working on today?

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22 thoughts on “Why Care About Breastfeeding Research?

  1. I found your blog very interesting. Have you read the book The Ultimate Breastfeeding Book of Answers by Dr. Jack Newman? I think before I read that book, I assumed that “Breast is best, but formula is a close second” Reading that book was jaw dropping. I am floored by how intricately made breast milk is. I love that research is being done, as it will be neat to see even closer up how unique breast milk is. With that said, I think the more things we learn about breast milk the more it shows that formula will never be anywhere close to breast milk. Learning more about breast milk will not make formula awesome, it will just reveal that humans cannot even begin to recreate what God created to begin with.
    (On a side note, I am intrigued on the study of donor breast milk, as I am collecting breast milk for a baby right now)

    • Hi and thanks for stopping by with your thoughts! It’s true – the more we learn about breast milk, the more we are amazed by it. However, I believe that one of the most compelling reasons for researching breast milk is to improve formula. It has come a long way over the last century, but I believe that we’ll find new ways to make it better. Will we ever be able to engineer formula to be quite like breast milk? Nope. But we will always have a need for high-quality formula, so the more we learn about breast milk, the better (but kudos to you for donating your milk!).

    • Really ?? Consider the child with severe life threatening genetic disorder , unable to consume protein and can only survive on something MAN created, or the allergic child so allergic that even the most stringent avoidance diet will cause life threatening anaphylaxis. Your thinking is so limited to YOUR situation. Man created god.

      • I think that genetic disorders are very unique situations. I am sorry you had a child that experienced that. That would be very hard to deal with, and I am thankful you were able to feed your child formula designed for him. As for being limited to my situation…Nursing started out horribly. I had gaping wounds, not cracks, wounds on my breasts. Then my son started pooping blood (it was red, so it came from him not me). So I was on the most extreme avoidance diet to help him not have that, and that thankfully for us worked. My wounds after a month of excruciating nursing weren’t healing so I had to go to a wound care center have them scrape the scab off with a metal blade on a weekly basis. I had to switch to exclusive pumping because of that treatment. Then the wound care center gave me MRSA, My husband never saw me that sick. I exclusively pumped for a year. So all that said, if you read my comment I made no remarks against Moms of formula fed babies. All I said was that it is impossible to recreate breast milk, and the more you research it the more that will be shown to be true.

    • For the record, I will add that I think breast milk evolved to meet the needs of human babies. It’s a pretty amazing mix of nutrients, immunoglobulins, hormones, and other biological factors, and to me it illustrates the power of evolution. You are of course free to disagree.

  2. Love this post- and it totally made my day to see those links at the end. I’m off to check them out right now, and I’ll promise right now to post about them when the results are available. Hopefully if science freaks like us give this type of research good press, it will start to provoke real change in the discourse.

    Thanks, as always, for being such a rational and inquisitive voice in the blogosphere!

    • Thanks, and I really appreciate your blog as well! Your post was the one that really got me thinking about the value of research and about the irony that we don’t often hear about the most useful stuff. That said, I was disappointed that I didn’t find more NIH-funded research on breastfeeding support, IGT, etc. It does seem that our understanding of the reality of breastfeeding challenges is pretty fuzzy, and I’d like to see more work on that.

  3. In Australia, I think breastfeeding rates are higher than the US yet it is still a mtter of government health strategy priority, particulaarly increasing the rate from 3 months on.

    As a Maternal and Child Health nurse ( a community program with free access for every mother and child under 6 months) I found that the rates, (and generally problem free experiences) tended to be highest among those who were new to the country, especially from South East Asia and the Middle East. There are also high rates from the more educated mothers.

    In hospitals, mothers are generally expected to breatfeed, and it is often after a few months home that the rates drop off. This can be the result of a mix of factors, including lack of support, need to return to work and pressure from the wider family.

    While research is valuable, perhaps the community attitude that assumes that mothers will breastfeed is the most important factor in increasing the rates.

    • I agree that community attitude is essential, particularly to breastfeeding initiation, but also to encouraging women to keep going. I do think that we have to balance that public health message of encouraging women to breastfeed without making women who don’t, for whatever reason, feel like they have failed their babies. There’s a lot more to being a mom than lactation:) But anyway, I do think that the observational studies, even with their limitations, help to get the word out about possible benefits of breastfeeding to the wider community, and that helps from a public health standpoint.

    • I actually think you’re on to something there, based solely on anecdotal and personal experience (so worth just exactly that, as data) – I BF my first for 18 months, and today I hit 9 months with #2, and I credit a lot of that to coming from a breastfeeding family. It’s just what we do – it never occurred to me that I might not be able to do it.

  4. I’d like scientists to compare long term health and intelligence between siblings who were fed differently. In my family, the eldest- me – was breastfed , the middle formula, and the last breastfed. Only one to NOT struggle with weight gain was the middle child.,she breastfed her son, who weighs to pounds more than his non breastfed cousin. I’d say we all have equal intelligence , although I find the IQ test severely limiting. Someone who can do calculus , but can not play piano, is no more brilliant. Moms need to get over themselves.

    • I think your story illustrates the value of research: we can only learn so much from looking at those around us. We need big populations with lots of data to sort out the outcomes of feeding type, and even then, we can’t be sure because of all the confounding factors. Comparing siblings can help, but it doesn’t eliminate every factor. I’m pretty sure that there are some studies comparing siblings, but I don’t know if they have looked at IQ or obesity. I’m not really interested in if breast milk makes a kid smarter (and that will always be hard to tease out – intelligence is complex), but if it is, why that might be. That would be useful to know! And yes, moms DO need to get over themselves:)

      • There have been 2 sibling studies dealing with infant feeding that I am aware of. One is by Evenhouse and Reilly, and it found no significant differences between siblings fed formula or breastmilk, except a slight IQ advantage for the breastfed siblings. It did look at obesity, I think. The other study (can’t remember the author’s name at the moment, but I think if you google “sibling study breastfeeding infant formula” it will come up) I believe found NO differences at all. It’s certainly the best type of study we can use for infant feeding research considering our limitations.

  5. Best breatfeeding research to me is like any other, direct. Talking to mom’s going to LLL meetings when I had difficulties & got the love & support & extreemly helpful advice from other moms. Also of course, best was that feeling of sucessfully breastfeeding (& by successfully I mean it didn’t hurt because she was properly latched on, which is the norm, & my daughter was eatting & content), that moment of love, comfort & accomplishment was worth everything & more.

  6. Reblogged this on Daughter of the Moon and commented:
    For me, breastfeeding was the perfect moment of love, comfort & accomplishment. No, it wasn’t always easy, but if we’re talking honestly it was easier than most other things I’ve done inmy life ebcause I had my mommy instincts to fall back on, biology, my infant who knew what to do & told me when I didn’t, & all the other moms who reached out & helped me & supported me, becuse that’s what we do.

  7. “After all, a better understanding of breast milk will pave the way for better formula. A better understanding of the etiology and risk factors for problems with breastfeeding will pave the way for targeted, specific support for moms who want to breastfeed but struggle to do so.” Breastfeeding is wonderful for those who are able to do so, but there needs to be more compassion & support for the THOUSANDS of moms who struggle to do so (for whatever reason) but are made to feel “less than” – thanks for this post! Very interesting!

  8. Because I come from a public health policy background, I would like to see studies on the association between 1) family leave policies, and 2) workplace lactation support and breastfeeding outcomes (months of breastfeeding, infant health outcomes).

  9. Being a scientist myself it puzzles me why the research community is not being fair (has it ever been fair?). I don’t support either approach. I do science. So I know how it works.

    Studies should point the benefits and limitations of each technique. Probably neither is optimal. While presenting conclusions, they should not create stigma over one technique. For some mothers, there is simply no alternative. If some mothers are unable to breastfeed, they need (lots of) support, not stigma. Therefore we need to clearly evaluate both approaches, and discuss it openly and without bias.

    But…

    Breastfeeding is a hot topic. Therefore, it will be easier to get grants supporting breastfeeding, to get more PhD students, and to publish more results. Is this approach correct? I don’t think so. Science is not being as impartial as it should. Scientist are being highly biased (e.g. follow trends similar to the Gartner Hype Cycle).

    Also, competition around grants is so high that grant proposals often promise a lot more than researchers actually are able to provide. And they know it! Some studies are simply too complex for the duration of the grant, or there are too many variables to consider (like it is frequent in this case). In the end what it matters is to produce properly written deliverables, reports and publications. If one digs over the results, lots of flaws just undermine many conclusions.

    Well, like you say: that’s science for you.

    Keep up this great blog!

  10. Reblogged this on Surviving River Blogs and commented:
    I think it’s great that research is being conducted in so many areas relating to breastfeeding. I have to agree that formula producers and users would see benefits from this research since the more we know about breastmilk, the better we will be at reproducing its benefits.

  11. Why do all the studies focus on exculsively one or the other option? As a mother, I was not able to breastfeed exclusively. My daughter needed suplimental formula since day 2. As a scientist myself, I know that all or nothing is often not the same as a mix. Take the recent studies on coffee – lots was proven to damage the heart, but a moderate amount was suprisingly beneficial to the heart.
    Also, do any studies differentiate between being bottlefed breastmilk and being bottlefed formula? In other words, is it the delivery system or the material that matters? I think all of us mothers who have to use daycare at a young age would really like to know that. Frankly if the bottle gives the same outcome, I don’t have to huddle in a dark room off the back of the factory floor to pump any more.

    • Hi Maggie,
      I think there were many earlier studies that included groups of babies with some breastfeeding but that were not exclusively breastfed. Many outcomes were found to be in between exclusive formula-feeding and exclusive breastfeeding. The problem is that it is hard to collect data and quantitatively model all of the variation in %s of types of milk, so I think more recent studies have tried to simplify the comparisons. You’re right, though, this leaves out a large proportion of moms and infants who are doing their own cost/benefit analysis of breastfeeding. We do know that any breastfeeding is beneficial, and to a certain point, more is better. On the question of bottle-feeding breastmilk, there was this one recent study showing that method of delivery of milk changes weight gain – infants exclusively fed expressed breast milk have weight gain similar to those exclusively fed formula. But that’s just one outcome – certainly many of the well-documented health benefits of breast milk probably hold no matter the delivery method. Of course, if pumping in a closet is compromising your own health, that’s a factor worth considering as well!

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