Studies that on the surface look very positive and supportive of breastfeeding should be given a closer look. As we discussed in an earlier blog, you can’t simply believe every breastfeeding study you see.
A press release “Why is Breastmilk Best? It’s all in the Genes” sent out this morning got picked up on Twitter. The gist of the press release is that a small “proof-of-concept” study (small sample size) suggests that the intestinal genes that regulate gut development and immune protection respond differently (i.e. much better) in the presence of breastmilk than in the presence of infant formula.
For the first time, we can see that breast milk induces genetic pathways that are quite different from those in formula-fed infants. Although formula makers have tried to develop a product that’s as much like breast milk as possible, hundreds of genes were expressed differently in the breast-fed and formula-fed groups,” said Sharon Donovan, a U of I professor of nutrition. . . . Understanding those differences should help formula makers develop a product that is more like the real thing, she said. The scientists hope to develop a signature gene or group of genes to use as a biomarker for breast-fed infants. Many of the differences found by the scientists were in fundamental genes that regulate the development of the intestine and provide immune defense for the infant.
So this study, funded by Mead Johnson, is to help formula makers improve formula. What a shame, because I think the “gut” reaction to this study should be to help more moms beat the “Booby Traps” and breastfeed successfully! Nonetheless, I asked Alison Stuebe, MD, FABM, a well-known and respected researcher to share her thoughts on the validity of the study. Here are her comments:
It’s hard to make an intelligent comment based on the press release when we can’t see the real study. Sometimes the press release is an accurate reflection of the science, and sometimes it’s completely different. I assume from the release that Mead-Johnson did this research to develop a bioassay for how close formula is to breast milk, and will be modifying their product and measuring “closeness to mothers’ milk” by this index. Their new “premium” formula has prebiotics, and it appears from their marketing materials that they are trying to build the case that it creates a gut environment that’s more similar to a breastfed infant. I anticipate that they will soon have side-by-side graphs of an older formula, their “premium,” and breast milk showing that theirs is “much closer to breastmilk” than the other leading brands. That’s what they have done in their marketing materials for DHA/ARA formulas, with bar graphs of infant IQ’s at 18 months that compare their current product to their older formula. Those graphs do not mention, by the way, that the Cochrane Review found no evidence to support the claim that formula w/ DHA/ARA improves neurodevelopment outcomes in term babies. ( http://www.cochrane.org/reviews/en/ab000376.html)
Nevertheless, I think they may have shot themselves in the foot here. Though I can’t tell from this press release, these molecular techniques typically measure hundreds of different genes, and there’s no telling which ones are critical for healthy development. Even if they are able to show that their “new, improved” formula is 50% similar to breastmilk, we won’t know if that 50% is what matters — or, for that matter, if turning on some, but not all, of the normal genes expressed in early development is even worse than turning on none of them.
Think of the baby’s gut as a complex machine, such as an automobile. A breastfed baby turns on all the systems in the car so that it can operate safely. Suppose that a “new, more like breast milk” formula can turn on some of those systems — such as the accelerator — but not the brakes or the airbag. The “new” formula turns on more genes, but it’s not giving you a safer car, or a healthier baby.
So, we know why Mead Johnson is funding this study–ultimately to sell more infant formula. But the question is, why are they sending out a press release that so clearly proves the inferiority of infant formula and the amazing ability of breastmilk to turn on the right genes that cause the intestine to grow and develop the right way, and that reduces the body’s risk for serious diseases for decades to come? The researchers go on to state:
“An infant’s gut has to adapt very quickly. A new baby is coming out of a sterile environment, having received all its nutrients intravenously through the placenta. At that point, babies obviously must begin eating, either mother’s milk or formula. They also start to become colonized with bacteria, so it’s very important that the gut learns what’s good and what’s bad. The baby’s body needs to be able to recognize a bad bacteria or a bad virus and fight it, but it also needs to recognize that even though a food protein is foreign, that protein is okay and the body doesn’t want to develop an immune response to it,” [Donovan] said. If anything goes wrong at this stage, babies can develop food allergies, inflammatory bowel disease, and even asthma. “We’re very interested in frequent sampling at this early period of development,” she added. . . . Of potential clinical importance: The gene expressed most often in breast-fed infants is involved in the cell’s response to oxygen deprivation. Lack of oxygen is a factor in the development of necrotizing enterocolitis (NEC), a kind of gangrene of the intestine that can be fatal in premature babies. NEC is a leading cause of disease and death in neonatal intensive care units, with a reported 2,500 cases occurring annually in the United States and a mortality rate of 26 percent.
Doesn’t pointing out how critical breastmilk is undermine Mead Johnson’s marketing efforts? My guess is no. I suspect that Mead Johnson is sending out this press release for the same reason that McDonald’s sponsors the Olympics. Mead Johnson is aligning its brand of infant formula with scientific research and statements like “breast is best” in order to persuade expecting mothers, health care providers, key influencers and the public at large that it really cares about mothers and breastfeeding, when actually it cares about its shareholders and selling formula. Formula companies have done such a great job with this marketing tactic that they have persuaded mothers to blame each other, not the aggressive marketing tactics that keep them from making informed decisions and carrying them out, and having access to donor milk if they can’t breastfeed. Mead Johnson also knows that people will remember the positive brand association but forget the details of the press release rather quickly, and that the massive multi-million dollar ad campaigns and marketing materials Mead Johnson launches throughout the health care system and in the media have far more staying power and influence over expecting parents’ decision-making and purchasing habits. Make no mistake about it, this was a win-win for Mead Johnson. And as long as our government does not enforce the WHO Code that bans the unethical marketing of breastmilk substitutes to mothers, doctors, hospitals and the public; it is very hard for scientific proof of the inferiority of infant formula in this study, and its coverage in the media, to make a long-term difference. No wonder breastfeeding rates have declined again.