July 11th, 2022

The AAP recommends:
• Exclusive breastfeeding for the first 6 months. There is no need to introduce infant formula or other sources of nutrition for most infants. Beyond 6 months, breastfeeding should be maintained along with nutritious complementary foods.
• AAP recommends that birth hospitals or centers implement maternity care practices that improve breastfeeding initiation, duration, and exclusivity.
• There are continued benefits from breastfeeding beyond 1 year, and up to 2 years especially in the mother. Long-term breastfeeding is associated with protections against diabetes, high blood pressure, and cancers of the breast and ovaries.

• Mothers who choose to breastfeed beyond the first year need support from their medical care providers, as well as protections against workplace barriers.
• Policies that protect breastfeeding, including universal paid maternity leave; the right of a woman to breastfeed in public; insurance coverage for lactation support and breast pumps; on-site child care; universal workplace break time with a clean, private location for expressing milk; the right to feed expressed milk; and the right to breastfeed in child care centers and lactation rooms in schools are all essential to supporting families in sustaining breastfeeding.

I would also add my own recommendations:
• Mothers should be supported with education and access to high quality foods that support high quality breastmilk.
• Mothers should be allowed to have access to probiotics prenatally like evivo to help with breastmilk metabolism post birth if they are unable to afford it. We should continue to promote a healthy maternal microbiome through diet and lifestyle education based on emerging data every year.
• The state governments should directly help mothers receive lactation support through outpatient clinics or health departments. With the amount of money that would be saved on not using formulas, these costs would be minimal.
• Mothers should be supported through education on how to avoid chemicals in their environment that could adversely affect the child as a pass through in breastmilk

I am most pleased by these changes as the dynamic nature of breastmilk is far beyond anything that formula can ever do to try and be an equivalent food source. Here is a list of the added benefits:

1) Reduces the risk of illness from most forms of bacterial and viral disease in infancy
2) Reduced rates of sudden infant death syndrome by 30%
3) 50% reduction in necrotizing enterocolitis, a life-threatening intestinal disease of preterm infants
4) Reduces hospital readmission rates for preterm infants during their first year of life
5) Better neurodevelopmental outcomes
6) Infant mortality rates are reduced by 21%
7) Provides protection against the development of allergies, especially with a strong family history of allergic disease
8) Reductions in inflammatory bowel disease and celiac disease
9) Reductions in autoimmune diabetes and some forms of cancer
10) Reduced metabolic disease and excess weight gain

Two major thoughts:

1) Fats make up 4% of breast milk and the critical fat is the polyunsaturated fats known as PUFAs, linoleic and alpha linolenic acid. The most important of which is EPA and DHA which are precursor molecules to resolvins and protectins which decrease inflammation broadly after an insult especially in the brain. Eighty percent of brain's DHA is acquired from the 26th week of gestation until birth. Premature babies lack the enzymes to convert the PUFA fats to the DHA and EPA which poses a great risk to these early babies. Mothers provide these fats during pregnancy and through breast milk assuming that she herself has adequate stores. Thus, it is critical that premature infants receive some breastmilk to prevent disease like Necrotizing enterocolitis from the dysbiosis.

2) Let's look at the microbiome here as well as it is a major source of human derived health. Breastmilk provides for over 220 milk oligosaccharides (HMO) or small sugars that are indigestible by the human infant but are digestible by the infants intestinal microbes. This is an incredible evolutionary task for a mother to use her energy to make a food source for bacteria that is roughly 15% of breastmilk composition. The reason is clear. There is a profound symbiosis between a human and the intestinal microbiome. As discussed in the podcast with Dr. Shafizadeh, the specific intestinal microbes that are present in the intestines will dictate which HMOs' are metabolized and thus conferring health benefits to the child. Breastmilk is loaded with diverse HMO's and are giving a child the best health outcomes. Formula has recently added 2 HMO's out of the 220+ in order to meet this scientific health understanding. Thus, with the lack of diversity, it is only a matter of time until we learn about all of the missing benefits of the other HMO's in breastmilk.


Newsletter on Donor Breastmilk safety and use: Link
Newsletter on Breastmilk in general: Link
Apple podcast on Breastmilk with Dr. EA Quinn: Link
Apple podcast on HMO and microbiomes: Link

Lifestyle choice is key,

Dr. M

AAP Breastfeeding
USDA Formula Information