#56 The Biology of Breast Milk

Posted on August 25th 2020 (over 4 years)

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Nutrition in the first year of life is crucial to an infant's development and lifelong health. An abundance of scientific evidence demonstrates that insufficient or inadequate nutritional support impairs mental and physical growth. Consequently, the risk of developing metabolic and cardiovascular diseases such as obesity, diabetes, and hypertension in childhood – as well as later in life – is likely determined by early feeding and nutritional status.

Breastfeeding provides the biologically superior means to feed an infant. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of an infant's life, and then continued breastfeeding while introducing age-appropriate foods until an infant is 12 months old or older. The goal of these recommendations is to supply an infant optimal nutritional support and immunity during critical windows of growth and development.

Episode highlights:

  • Breast milk composition and production
  • Human milk oligosaccharides in breast milk establish the infant gut microbiome
  • Omega-3 fatty acids and other components in breast milk boost brain development
  • Vitamins and minerals in breast milk
  • Breast milk stem cells and multi-organ microchimerism
  • Harmful substances transferred to the infant via breast milk
  • The effects of breastfeeding on the infant's immune system
  • Effects on brain development and intelligence
  • Breastfeeding as a benefit to maternal health

Breast milk is uniquely tailored to the needs of a human infant

Breast milk is a species-specific product, containing both nutritional and non-nutritional components that are uniquely tailored to the needs of a human infant. But breast milk is also dynamic, changing in composition during a single feeding, from day to night, and throughout the lactation period in response to a growing infant's requirements.

The primary nutritional components of breast milk – proteins, fats, and carbohydrates – play double- or even triple-duty, providing not only basic nutrients for growth and survival but also serving in critical roles that might be somewhat surprising.

Proteins, for example, support the growth of muscle and other tissues. But they also facilitate the digestion of other nutrients while supplying antimicrobial and immunomodulatory factors that contribute to defense against pathogens. Interestingly, the presence of many of these proteins is regulated by circadian rhythms that are synchronized with the infant's needs.

"Emerging evidence suggests that some of the immune and health benefits that infants acquire during breastfeeding may be lifelong." Click To Tweet

Fats are the predominant source of energy provided in breast milk, supplying roughly half of its total calories and providing necessary energy for growth. Fats also aid in the maturation of an infant's gastrointestinal and central nervous systems and provide protection from pathogens. Perhaps the best known of the fats in breast milk is docosahexaenoic acid, or DHA, an omega-3 fatty acid that plays critical roles in brain development.

Carbohydrates in breast milk also provide energy for a growing infant, but in a surprising twist, a significant portion of these carbohydrates provide no nutrition at all, existing for the sole purpose of inducing and supporting a healthy population of commensal bacterial in the infant's gut. These unique carbohydrates, called human milk oligosaccharides, or HMOs, play many other roles in infant immunity and, subsequently, survival.

Breast milk serves as compensatory immune system

But HMOs are just one aspect of immune function. An infant's immune system is the last of the biological systems to develop, taking months or even years to match that of an adult's capacity for defense. Breast milk contains a multitude of components that work together synergistically to provide a compensatory immune "system" that confers both passive and active immunity.

This surrogate system provides protection against respiratory infections and certain types of cancer in childhood and might even contribute to lifelong immunity. Some of these protective components have demonstrated the capacity to prevent the translocation of infectious pathogens across the gastrointestinal tract, kill or inhibit the growth of pathogenic bacteria (including Escherichia coli), and interfere with postpartum transmission of human immunodeficiency virus, or HIV.

Breast milk can contain harmful substances

Of course, breast milk also provides a vehicle for delivering harmful substances to an infant. Heavy metals and prescription drugs, especially those used to treat cancer, readily transfer to breast milk and pose considerable threats due to an infant's limited capacity to metabolize drugs. But commonly used "social drugs," such as alcohol, nicotine, caffeine, and cannabis all carry some risk to a breastfed infant, as well. Alcohol, in particular, can have negative effects on a breastfed infant, including altered sleep patterns, decreased milk intake, and impaired motor development, among others.

Breastfeeding benefits mothers and infants

Infant benefits of breastfeeding

As one would expect, breastfeeding provides a wide range of benefits to infants, including enhanced neurological development, evidenced by children who were breastfed as infants scoring nearly three points higher on intelligence tests than those who were not breastfed, even after taking maternal intelligence into consideration. In fact, breastfed babies tend to have 20-30 percent higher amounts of white matter in their brains than children who are not breastfed. Breastfeeding also appears to confer a measure of protection against the cardiovascular-related complications associated with pre-term birth.

Maternal benefits of breastfeeding

But breastfeeding benefits mothers, too. Women who breastfeed are more likely to return to their pre-pregnancy weight, typically sooner than women who do not breastfeed. Having excess body fat carries considerable risks, including greater likelihood of developing cardiovascular disease, type 2 diabetes, and cancer. Interestingly, research indicates that women who breastfeed are less likely to develop ovarian or breast cancer. The mechanisms behind the protective effect on the breast, in particular, are not well understood, but some evidence suggests they may be related to breastfeeding's capacity to moderate the deleterious effects of involution, a process that occurs when lactation ends.

Breastfeeding rates are low

Despite breastfeeding’s superiority, breastfeeding rates in the United States are low. Among children born between 2010 and 2013, approximately 80 percent were breastfed initially, but only 20 percent of those children were breastfed exclusively (receiving no formula or other foods) at six months of age Several factors influence whether a woman chooses to breastfeed her infant, including the mother's age, race, ethnicity, education level, socioeconomic status, family structure, and mental status.

But some of the primary contributors to whether a woman continues to breastfeed stem from more personal factors, ranging from sore nipples and plugged ducts to lack of family support and concerns about physical image and sexual intimacy. Working with a lactation consultant during the first few weeks of breastfeeding may be helpful, especially for mothers of preterm infants. If a woman's milk is insufficient to meet the needs of her infant or if she has a health concern that prevents her from breastfeeding, donor milk may be an option for healthy, full-term babies.

In this episode, Dr. Rhonda Patrick describes the production and composition of breast milk and discusses the benefits of breastfeeding to both infant and mother. She also provides practical information for dealing with the challenges associated with breastfeeding.

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