Breastfeeding is best. Breast milk is nature's perfect food for babies. Breast milk contains special substances that give the growing baby immunity to infection and disease. Breastfeeding bonds a mother to her baby, stimulates important hormonal activities in her body, helps her lose weight after pregnancy and protects her against future breast cancer and osteoporosis.

Breastfeeding is best. . . in a perfect world. But the world is not perfect and self-evident statements are not always true. Breastfeeding advocates argue that breast-fed children have lower mortality rates and better levels of health than formulafed children. In third world countries, where the cleanliness needed for safe bottle-feeding is lacking, this is undoubtedly true. But a perusal of recent studies comparing breastfed and formula-fed infants presents a real dilemma for breastfeeding advocates because the research does not provide a clear case of benefit.

DISTURBING STUDIES

A study published in July, 2001, for example, found that breastfed children in Japan had more asthma than bottle-fed infants.¹ A European study found that breastfeeding was not related to iron status in one-year-old children. Those with the best iron status were those who received iron-fortified formula.² A Swedish study found that breast fed infants were just as likely to develop childhood cancer compared to formula-fed babies.³ In fact, babies breastfed for one month or more had a higher risk of non-Hodgkins' lymphoma, although this finding was based on low numbers of cases. A study from Norway found that breastfeeding did not provide protection against frequent ear infections.⁴ A report in Pediatric Clinics of North America noted that many breastfed babies suffer from failure-to-thrive and dehydration.⁵ The author warned: "Those who enthusiastically promoted breastfeeding for its many health benefits must confront the reality of breastfeeding failure and implement necessary changes in medical education and support services to foster successful outcomes in breastfed infants."

Only one study carried out during the past two years found a clear-cut benefit for breastfeeding. Researchers at the Harvard Medical School found that children who were breastfed we much less likely to be overweight as adults.⁶

Studies on the relationship between breastfeeding and cognitive skills are mixed.⁷ Some studies have shown that breastfed infants are more intelligent while others show no difference. Critics contend that better cognitive scores in breastfed infants are due to the fact that mothers with higher levels of educational attainment are more likely to breastfeed.

Formula manufacturers are quick to use the lackluster performance of breastfed children as proof that formula is "just as good" as breast milk. Breastfeeding advocates retort that the studies were designed to give results that benefit the formula makers. Our interpretation is the following: the diet of modern American women is so appalling, and their preparation for successful breastfeeding so lacking, that their breast milk provides no better nourishment for their infants than factory-made formula.

DOES DIET MATTER?

"Breastfeeding mothers do not need to worry about their diets. As long as they are getting enough calories, their milk will be fine." This is the dogma of most of the groups promoting breastfeeding throughout the world. "The message that diet has an influence on milk quality will discourage mothers from breastfeeding," they say.

Typical advice to pregnant women is as follows: "Include fruits, vegetables, grains, meat or meat alternative and lowfat milk products in your diet every day. Avoid caffeinated beverages and alcohol." Lactating women are advised to eat "vitamin-A rich foods" such as "carrots, spinach, sweet potatoes and cantaloupe." Above all, say the "experts," don't worry too much about what you eat. "Your diet does not have to be 'perfect' to nourish your baby well."⁸

Lactation consultants cite one study that found no difference in levels of several factors between "well-nourished" and "undernourished" mothers. These factors were the immune-protecting compounds sIgA, lysozyme and lactoferrin.⁹ We are tempted to ask how researchers with such an abysmal knowledge of nutrition--promoting lowfat milk as nutritious, meat alternatives as the equivalent of meat, and vegetables as a source of vitamin A (which they are not)--how such researchers could be trusted to know the difference between "well-nourished" and "undernourished" mothers?

But even if there is little variation in certain immune factors as claimed, there can be huge variations in other nutrients depending on what the mother eats.

LONG-CHAIN FATTY ACIDS

Mother's milk contains long-chain polyunsaturated fatty acids (LCP) that the baby needs for the development of its nervous system. These special fats accumulate in the brain and retina. If they are absent in the infant diet, the child is likely to suffer from learning disabilities and reduced visual acuity.¹⁰ The most important LCP's are arachidonic acid (AA) of the omega-6 family, docosahexaenoic acid (DHA) of the omega-3 family and eicosapentaenoic acid (EPA), also of the omega-3 family. (For more information on long-chain fatty acids, see "Tripping Lightly down the Prostaglandin Pathways.")

The LCP composition in the tissues of growing infants is largely determined by the LCP content of the milk that the baby consumes. The recognition that these LCPs are vital for the optimal development of the infant has led to efforts to mandate their inclusion in commercial formula—as is done in other countries, notably Japan. Formula manufacturers have resisted because the fatty acids add considerably to the cost of making the formula and also require special handling to prevent oxidation. However, so compelling is the research that on July 16, 2001, the US Food and Drug Administration approved the addition of two fatty acids derived from blue-green algae to infant formulas.

What is less well known is that the levels of LCPs in human breast milk greatly depend on the mother's diet. An important 1997 study compared the fatty acid composition of breast milk of mothers in two Chinese provinces with that of Canadian mothers.¹¹ Mothers in the traditional province of Chongqing had higher levels of milk fat than those from westernized Hong Kong, and higher levels of AA, due to a special period of feeding for the first four weeks after the birth of the baby during which Chongqing mothers consume up to ten eggs per day and large amounts of chicken and pork. The diet of Hong Kong mothers was much lower in fat and calories, but because of high fish consumption, their levels of DHA were as high as those of Chongqing mothers. But breast milk levels of AA and DHA in both provinces were much higher than those of Canadian mothers.

The Chinese breast milk study proves that the levels of important fatty acids in mother's milk are strongly influenced by the mother's diet. For example, the content of erucic acid (a long-chain monounsaturated fatty acid) increased in the milk of Chongqing mothers during the later weeks of lactation, reflecting a dietary switch from animal fats to rape seed oil. Levels of omega-6 linoleic acid were high in the milk of Hong Kong mothers, reflecting their use of high-omega-6 vegetable oils derived from corn and soy.

Ideal breast milk contains high levels of both saturated fats and LCPs. This can be accomplished by consuming high levels of animal fats plus eggs, cod liver oil and oily fish throughout the lactation period. Saturated fats in mother's milk stimulate the immune system and work synergistically with LCPs to maintain them in the tissues where they belong.¹² Levels of fat in a mother's milk will decrease with each baby unless she takes special care to consume high levels of nutrient-dense fats between pregnancies and during each lactation.¹³

VITAMINS AND MINERALS

A recent study found that breast milk did not meet the minimum requirements for many nutrients.¹⁴ Vitamin D was especially low. A study in Nigeria found that calcium and potassium levels in human milk varied by a factor of 2, magnesium and copper by a factor of 3, chloride levels by a factor of 4, iron and selenium by almost 5, iodine and sodium by almost 7, and zinc, which is vital to the nervous system, by over 7.¹⁵ In other words, some mothers had seven times more zinc in their milk than others.

Another survey found large variations in the levels of B vitamins.¹⁶ Vitamin B₆ concentrates in breast milk and B₆ requirements are increased in lactating women.¹⁷ More B₆ is required if the woman is exercising--an important reason for adequate rest during the nursing period. The same study found that vitamin C ranged from 0 to 11.2 mg per 100 grams and vitamin A from 15 to 226 IU.

Vitamin A is vital for the development of the infant. Vitamin A is found only in animal fats. Mothers can convert some of the precursors in fruits and vegetables into true vitamin A and these will then show up in her milk, but adequate supplies can only be met with consumption of animal foods rich in the true form of this nutrient.¹⁸ A 1992 study carried out in Indonesia found that mothers who received vitamin-A supplementation had higher levels in their blood and milk than those who received a placebo and the infants of the supplemented group were less likely to be vitamin-A deficient.¹⁹ Deficiency was measured by the presence of conjunctivitis in the eyes. Incidence of conjunctivitis fell in infants nursing from mothers taking a vitamin-A supplement. The authors noted that vitamin-A status was lowest in women who were thin and who had had many babies—a warning not to lose weight too quickly after birth of a baby and to put sufficient space between children so that vitamin-A stores can be rebuilt.

Adequate B₁₂ is essential for the development of the infant. One study found a B₁₂ deficiency in a breastfed infant of a strict vegetarian.²⁰ Another found lower levels of long-chain polyunsaturated fatty acids in the blood of babies born to vegetarian women.²¹

While protein levels in human milk remain constant at about 11 percent under various conditions, levels of fat and lactose—both essential for the development of the nervous system—vary widely.²² Even the various anti-inflammatory and antibacterial compounds in a mother's milk vary markedly according to her diet.²³

TRANS FATS. . . AND OTHER BAD THINGS

Trans fats from partially hydrogenated vegetable oils are present in margarine, shortening and many processed foods. The accumulated evidence is that trans fats are bad news indeed. They interfere with many enzymatic processes, cause reduced learning ability, disrupt the endocrine system, and contribute to allergies, asthma and many other diseases.²⁴ (However, small amounts of one form of trans fats naturally occurring in butterfat are not harmful.)

If exposure to trans fats is bad for adults, it is even worse for babies and children during their growing years. Formula makers know better than to put trans fats into baby formula—yet human milk will contain high levels of trans fats if the mother consumes margarine, fried foods and commercial baked goods. The Chinese study found that Canadians had 33 times more trans fats in their milk than the traditional Chongqing mothers who did not consume processed foods! Hong Kong mothers had four times more trans fats in their milk than the Chongqing mothers, reflecting the inroads that processed foods have made in westernized Hong Kong.

Many other bad things can end up in mother's milk, including pesticides, mercury (from amalgam fillings), and high levels of phytoestrogens, if the mother eats a lot of soy. (However, phytoestrogens in the milk of mothers who eat a lot of soy is still about 3000 times less than levels in soy-based formula.²⁵)

One study discovered peanut proteins in mother's milk and warned that lactating women who eat peanuts may cause peanut allergies in their infants!²⁶ Even mother's milk can cause allergies.

MILK SUPPLY

According to La Leche League literature, insufficient milk supply is rare. The problem, they say, is not a deficiency in the mammary gland, but a "shared belief" among women or health workers "that insufficient milk is a common phenomenon." Baby's frequent crying, they say, should not be interpreted as a sign of insufficient or poor quality milk—even though this is what a mother's instincts tell her. According to the La Leche League handbook, "The word ‘insufficient' is like the word ‘inadequate'—once it has been directed at a mother it can never be retracted, and her confidence in her body's ability to nurture and nourish at the breast often plummets."

Yet ancient medical literature abounds in treatments for lactation failure.²⁷ Modern studies show that a mother's milk supply can vary and that it is influenced by her diet. In 1981, investigators in Gambia found that milk output diminished during the five-month rainy season when food supplies were less, although there was a greater fall-off among mothers nursing babies older than three months.²⁸ Milk was more plentiful during the non-rainy season, and the growth of the infants was much more satisfactory. First-time mothers were better able to maintain milk output than mothers with multiple children. The researchers found no correlation between milk supply and frequency of feeding. The main factor was the amount of food available to the mother.

Concern about milk supply is not a modern phenomenon, inculcated by evil formula manufacturers in order to sell more formula—although the formula makers are indeed quick to exploit this concern. Most traditional cultures use special foods or "galactogogues" in the belief that they increase milk flow, ranging from powdered earthworms in India, to fish soup in China and Japan, to a variety of special teas.²⁹ Soup made from roosters is a galactogogue used in several areas of the world. Weston Price recorded the practice of special feeding for pregnant and lactating women. The foods given were animal foods rich in fat-soluble vitamins and, in a few cases, soaked cereal gruels.³⁰ Modern literature on breastfeeding dismisses the notion of galactogogues as mere superstition, but future generations would be better served if researchers devoted their efforts to determining which of them actually worked.

Mothers from all societies and in all ages have naturally been concerned about having enough milk for their infants. An 1885 votive painting from Japan depicts a mother praying for an abundant milk supply for her newborn infant.³¹ The adjoining painting shows her prayer being answered, as milk flows from her breast to a bowl. If adequate milk were automatic for all women, there would be no need to offer prayers.

The percentage of mothers who begin by breastfeeding has not changed over the past 20 years. A federal survey in 1995 found that 58 percent of all women began breastfeeding, the same percentage as in the early 1980s. But almost 20 percent fewer mothers were still nursing after three months than in the mid-1980s, and this in spite of the fact that breastfeeding is now universally promoted as best for babies.³²

A common reason for discontinuing breastfeeding in the US is, "I don't have enough milk." Proof is given by baby's frequent crying or failure to gain weight. We do a woman a great disservice by telling her that it is "all in her head." In addition to adequate rest and help, she needs special milk-inducing foods or, failing that, readily available nutritious alternatives for her infant.

Consumption of trans fats lowers the overall fat content of mother's milk.³³ The poor quality of the American diet, including very high levels of trans fatty acids in commercial foods, is another reason why so many mothers abandon breastfeeding after the first few weeks—they know better than any lactation consultant that they do not have enough milk, or that their baby is not happy with the quality of milk that it is getting from her breast.

WEB OF DECEPTION

"Oh what a tangled web we weave, when first we practice to deceive." Behind the simple mantra "breastfeeding is best," gliding easily off the tongues of lactation consultants, sales reps, government officials and pediatricians, lurk several gross deceptions that usher millions of women into the arms of the formula industry. First is the deception that insufficient milk is rare. Yes, it is rare in a society of truly healthy people but the western nations are not inhabited by truly healthy people. The production and release of milk is governed by a complex interaction of hormones, involving the hypothalamus, pituitary gland and thyroid gland. There are plenty of places where it can go wrong and given the high levels of thyroid and endocrine problems in western women, it's a wonder that so many nurse successfully at all. Insufficient milk supply is a problem more common than the medical profession wants to admit, as many a valiant breastfeeding mother, starting off with the best of intentions, has learned to her sorrow.

Second is the deception that "Almost all mothers can produce good milk, even if their diet is not perfect." With this statement we turn our backs on the accumulated wisdom of traditional people throughout the globe, most of whom recognized that nursing mothers need special diets to meet the special needs of the growing infant. As early as the 1940s, Weston Price observed a decline in the quality of human breast milk, as evidenced by the extensive dental problems he found in his breastfed patients.³⁴ The recent poor showing of breastfed infants in comparison trials indicates that modern human milk is not better—and possibly worse—than it was in Price's day.

The final deception is that babies should not be given homemade formula made with cow or goat milk. Early books on infant feeding recognized that milk from a cow (or goat, water buffalo, camel, sheep, reindeer or llama) was the logical substitute. How wise these early writers seem in comparison to our modern "experts":

Nature does not always confer upon a woman the important capacity for nursing her baby, but the women who are able should do so. Every pregnant woman should not only be impressed with the importance of this duty on her part, but with the essential preparation for accomplishing it. However, there are women who for some reason cannot perform this natural function—for these, it is necessary to learn to take advantage of the way now available to them to feed the infant artificially. The logical substitute for human milk is cow's milk (or goat's milk).³⁵

A mere fifty years ago, part of the preparation for women during pregnancy, aside from a diet enriched by special animal foods, was the scouting out of a cow that would be given the best of pasture and whose milk would be available to the infant throughout its infancy. Today we know that we should dilute the milk and add other whole foods, but even before we knew these things, thousands of babies thrived on rich whole milk from a variety of animals. Yet some of the strongest words in the medical literature today are aimed at commercial formula's only competition—homemade formula based on cow or goat milk.

Today the new mother who finds herself struggling with nursing, and frantic at the frequent cries of her baby, is first told that she should have more confidence. When she gives in to the inevitable and switches to bottle feeding, she is told that formula made in factories is better than milk produced by living animals. Another formula customer is born.

REALISTIC GOALS

Instead of engaging in wishful thinking, let's establish some realistic goals. Top of the list would be to have virtually 100 percent of all women nursing during the first month. The anti-immune factors in the first few weeks of mother's milk are indeed unique to human milk, and cannot be duplicated or provided in any formula. Ninety-eight percent first-month nursing has been accomplished in Sweden by banning the distribution of free formula samples in the maternity wards. Free samples should be strictly forbidden—not just in the maternity wards, but through the mail and in government programs like Women Infants and Children (WIC), which distributes free formula to low income mothers.

Second, let's provide accurate nutrition advice to our young people through sex education classes, childbirth classes and breastfeeding support groups. Future parents need to know that the "average America diet" is not likely to produce healthy children and not likely to give a mother healthy milk.

Third, let's tell mothers who are struggling with poor milk supply about the wonderful little device called the Lact-Aid, a little plastic bag with a tube that lets a mother give her baby a supplement through a tube laid over her breast while she continues to nurse. Sometimes just a few weeks with the Lact-Aid is enough to get mother and baby "over the hump" and increase milk supply for the newly relaxed and rested mother. This device has been around since the early 1970s but breastfeeding support groups have only recently endorsed it.

Finally, let's accept the inevitable. Breastfeeding for several months should always be encouraged, but in today's society it is not a luxury available to many. The need to return to work, problems with milk supply, unsatisfactory progress of the infant—these are compelling reasons for mothers to turn to formula feeding (although every effort should be made to allow breastfeeding in the workplace). But mothers need to know that formula made with good quality milk and other whole foods is vastly superior to factory-made formula.

Above all, let's keep in mind the ultimate goal. The goal is healthy children—not breastfeeding for the sake of breastfeeding and not convenience feeding with store-bought foods—but healthy children. It is a goal that requires wisdom, dedication, patience, hard work and mutual support among breastfeeding and non-breastfeeding mothers. Above all, it requires knowledge, not deception, and there is no better place to start than with the teachings of Dr. Weston A. Price.

Note: The Lact-Aid system can be ordered from (423) 744-9090. Visit their website at www.lact-aid.com.

MYTHS AND TRUTHS ABOUT BREASTFEEDING

MYTH: Every woman can breastfeed successfully.
TRUTH: Even in traditional societies, a portion of the women did not have adequate milk supply. When a wet nurse was unavailable, babies of mothers with inadequate milk supply were given milk of cows, goats, sheep, water buffalo, camels, reindeer or llamas.

MYTH: Most diets provide adequate nutrition for nursing mothers. There is no need for nursing women to add special foods to their diets.
TRUTH: Human milk will be lacking in vitamins A, D, B₁₂ and other fat soluble vitamin if the mother's diet is poor. Human milk will also lack long-chain fatty acids if these are not present in adequate amounts in the mother's diet. In addition, mothers on calorie-restricted diets will have lower levels of fat and lactose in their milk. Weston Price found that in traditional societies, women continued to consume special foods during the lactation period.

MYTH: Breastfeeding can prevent dental problems such as crowded teeth, underdeveloped jaw, etc.
TRUTH: The development of the face and jaw depends on the nutrients available to the child from preconception through childhood. Breastfed children can have dental deformities if their nutrition in the womb and the breast milk they received were lacking in nutrients.

TIPS FOR SUCCESSFUL BREASTFEEDING

Follow the Diet for Pregnant Women and Nursing Mothers, ideally from before conception. Eat plenty of food. When you are breastfeeding, it is no time to diet!

Try to arrange to have good help for the first four weeks after the baby is born so that you will have adequate rest. Husband, grandparents, relatives, friends, housekeepers or even a professional baby nurse should be on hand so that the nursing mother can concentrate on getting optimal nourishment and plenty of sleep.

Fermented foods and beverages, and porridges of soaked grains, are said to increase milk supply.

If you have any qualms or fears about not having enough milk, assemble the ingredients for homemade formula, and purchase the Lact-Aid breastfeeding support system so that you have what you need to provide a nourishing supplement, if that is required. Sometimes just a few days of supplementing using the Lact-Aid can increase milk flow, and just having the supplies on hand can be enough to give you the peace of mind that allows your milk to keep flowing. While you are pregnant, be sure to scout out the best quality milk available in your area—you will need this for yourself, and for the baby after weaning, even if the breastfeeding goes well.

If, in spite of these measures, your milk supply dries up, don't feel guilty. You have done the best you could and your baby can still grow up healthy, strong and smart on a homemade, whole foods baby formula.

WHEN BREASTFEEDING MAY NOT BE BEST

GALACTOSEMIA: This is a rare genetic disorder in which the infant cannot digest galactose. The child will die if it is breastfed.

VEGANISM: The milk of vegan mothers will be lacking in vitamin B₁₂ and important long-chain fatty acids. If a vegan mother insists on breastfeeding, her baby's diet should be supplemented with cod liver oil, egg yolks and liver, all animal foods.

JUNK FOOD DIET: Junk foods full of trans fatty acids will reduce the fat content of mothers' milk and cause trans fatty acids to be present in mothers' milk. Homemade whole food baby formula will be more nutritious than the milk of mothers on a junk food diet.

INSUFFICIENT MILK SUPPLY: This is uncommon, but not as rare as is indicated in the medical literature. A supplemental homemade formula should be given using the Lact-Aid breastfeeding aid (www.lact-aid.com).

ADOPTED BABIES: It has been reported that breast milk has been stimulated in non-biologic mothers, but this is rare. Adopted babies should be given homemade baby formula.

WHEN BREASTFEEDING IS FINE, IN SPITE OF WHAT THE DOCTORS SAY

PHENYLKETONURIA: This is a rare genetic disorder in which the infant must avoid phenylalanine, an amino acid. With careful medical supervision, these children have been successfully breastfed in combination with a phenylalanine-free protein substitute.

HIV POSITIVE: Mothers who test HIV positive are told not to breastfeed. But a South African study found that the HIV virus is not passed to breastfeeding infants when the mother's diet contains sufficient vitamin A Other studies have found that a low viral load also prevents transmission from mother to child.

DIABETES: Although diabetic mothers are often warned not to breastfeed, breastfeeding actually diminishes complications in the infants of diabetic mothers. Once again, adequate maternal nutrition is vital.

LA LECHE LEAGUE

Founded in 1956, La Leche League is considered the world's foremost authority on breastfeeding. The organization offers information and support in sixty countries around the world for mothers who choose to breastfeed their babies. They have lobbied for the rights of mothers to nurse on the job and in public places, and they conduct support groups for nursing mothers of all income levels.

No one can dispute the service that La Leche League has performed in raising awareness of the benefits of breastfeeding. However, the organization is also the most influential proponent of the fallacy that "all mothers can nurse successfully." Furthermore, they have down-played the influence of diet on the quality of mothers' milk. In fact, their literature denies the role of human milk fat in the development of the nervous system.

The organization has also failed to use their influence to warn mothers about factors that can compromise the quality of their milk. When Dr. Bev Teter discovered that dietary trans fatty acids can lower the fat content of mothers' milk, she immediately contacted La Leche League so that they could warn all nursing mothers to avoid them. La Leche League did not respond, perhaps because they did not understand the role of fats in the development of the infant. They also ignored the input of another concerned scientist, that mercury from amalgam fillings can cause high levels of mercury in human milk.

REFERENCES

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2. C Male and others. Prevalence of iron deficiency in 12-mo-old infants from 11 European areas and influence of dietary factors on iron status (Euro-growth study). Acta Paediatrics. May 2001;90(5):492-8.
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About the Authors

Sally Fallon Morell is the author of Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats (with Mary G. Enig, PhD), a well-researched, thought-provoking guide to traditional foods with a startling message: Animal fats and cholesterol are not villains but vital factors in the diet, necessary for normal growth, proper function of the brain and nervous system, protection from disease and optimum energy levels. She joined forces with Enig again to write Eat Fat, Lose Fat, and has authored numerous articles on the subject of diet and health. The President of the Weston A. Price Foundation and founder of A Campaign for Real Milk, Sally is also a journalist, chef, nutrition researcher, homemaker, and community activist. Her four healthy children were raised on whole foods including butter, cream, eggs and meat.

Mary G. Enig, PhD is an expert of international renown in the field of lipid biochemistry. She has headed a number of studies on the content and effects of trans fatty acids in America and Israel, and has successfully challenged government assertions that dietary animal fat causes cancer and heart disease. Recent scientific and media attention on the possible adverse health effects of trans fatty acids has brought increased attention to her work. She is a licensed nutritionist, certified by the Certification Board for Nutrition Specialists, a qualified expert witness, nutrition consultant to individuals, industry and state and federal governments, contributing editor to a number of scientific publications, Fellow of the American College of Nutrition and President of the Maryland Nutritionists Association. She is the author of over 60 technical papers and presentations, as well as a popular lecturer. Dr. Enig is currently working on the exploratory development of an adjunct therapy for AIDS using complete medium chain saturated fatty acids from whole foods. She is Vice-President of the Weston A Price Foundation and Scientific Editor of Wise Traditions as well as the author of Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils, and Cholesterol, Bethesda Press, May 2000. She is the mother of three healthy children brought up on whole foods including butter, cream, eggs and meat.

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