Pros and Cons of Breastfeeding in Developed Countries
including Correlations with Autism and Childhood Cancer
Breastfeeding was relatively rare in the United States in the middle of the 20th Century.(1) But it started to become more common in 1971 and rapidly became the normal kind of infant feeding in the U.S., as it did in most developed countries. A number of studies were conducted that generally found benefits of breastfeeding as opposed to the alternatives. Those studies were all of the "observational" kind,(2) which can only find "associations" between factors being studied and certain health data. (Studies can provide high-quality evidence if the subjects being studied are randomly selected and assigned to study groups, but for various reasons that was not done in those studies.) From the observational studies on this subject were drawn what the U.S. Surgeon General acknowledges to be only "inferences" about benefits of breastfeeding.(2) The U.S. Agency for Healthcare Research and Quality recognizes that such studies and the resulting inferences are subject to false conclusion.(3) This is true mainly because of the inevitable possibility of confounders, which could be the real underlying causes of the associations that occur. Observational studies would find high death rates in Florida (inhabited by many elderly people) to be associated with sunshine. The high average age of Florida residents would be a confounder; in that case, the confounder is easy to see, but in many cases confounders may not be recognized or properly dealt with by the researchers. (Information about confounders that applied in the case of breastfeeding can be found in Section D at www.breastfeeding-benefits.net.)
In contrast with the studies that have found associations of breastfeeding with health benefits, at least 52 scientific studies have found associations of breastfeeding (or more breastfeeding) with adverse health outcomes. See www.breastfeeding-studies.info.
Note: What follows is well worth reading if you have some time to devote to it. If you have only a little time available right now, a very brief introduction can be read at www.breastfeeding-subject.info. A more complete summary, but still much shorter than the text below, can be read at www.breastfeeding-effects.info.
Now that three decades have passed since the transition from low breastfeeding to high levels of breastfeeding, sufficient historical health data is available to allow an educated assessment as to whether the inferences about breastfeeding's presumed benefits turned out to have been correct. Assuming some validity to the claims about beneficial effects caused by breastfeeding, it would be reasonable to expect improvements in much of the health data of the generations of children who came to be highly breastfed.
As it turns out, not a single one of the favorable health outcomes that would have been predicted on the basis of the claims about benefits of breastfeeding has materialized, as shown by actual historical health data. And in fact, the actual outcomes have turned out to be very significantly worse in all but one of the disorders that would have been expected to improve based on those claims. In addition, substantial increases have also taken place in other important adverse conditions following the transition to much higher rates of breastfeeding, including ADHD, childhood cancer, developmental disorders, and (apparently) autism.
But these have not merely been general increases while many things have been increasing. The precise times and locations of the increases and slow periods in diseases and adverse conditions have correlated well with precise times and locations of increases and slow periods of breastfeeding rates; Figure 2 seen in relation to Figure 1 below is only a beginning of the evidence. (much detail later) Highs and lows of disease rates have typically been pronounced in specific demographic groups, specific age groups, and specific geographic areas in which exposures to breastfeeding were correspondingly high or low, as will be related in detail below, with one example shown in Figure 10.c below.
The conflict between conventional wisdom about breastfeeding and current reality stems from the greatly increased pollution in contemporary environments in developed countries. Many or most of these pollutants are attracted to fat, and they accumulate in the human body and are excreted in breast milk. Experts on the subject of toxins in breast milk pointed out in 2004 that "these substances have caused contamination of human milk only during the last half century."(3d) Researchers in 1982 identified 200 different chemical contaminants in the milk of U.S. mothers,(3e) and many new chemicals have been added to the environment since then. There is substantial high-quality evidence showing that levels of developmental toxins in human milk are scores to hundreds of times higher than in formula or cows' milk. (see Section 10.b below and, for a more complete discussion, see www.breastfeeding-toxins.info) Conventional wisdom that was well suited to the realities of earlier decades needs to be reexamined in relation to contemporary life in developed countries.
Children of WIC (assistance) recipients have autism rates 40% as high as children of college graduates; relevant to that, U.S. high-school-graduate mothers breastfeed at half as high a rate as college-graduate mothers. A fourth child’s risk of autism is half as high as that of a firstborn, on average, and the odds of being diagnosed with autism continuously decrease from first to later children; in line with that, infants later in birth order are less likely to be breastfed, they are likely to be breastfed for shorter periods, and the milk they receive has toxin levels that have been reduced as a result of excretion to earlier-born infants during previous breastfeeding. For sources on the above and for much more on the topic of breastfeeding and autism, go to www.breastfeeding-and-autism.net.
To read about variations in childhood cancer in close correlation with variations in breastfeeding, along with high-quality scientific evidence related to known and probable carcinogens in typical contemporary human milk, go to www.breastfeeding-and-cancer.info. Significant special information about increasing obesity, diabetes, asthma, and allergies among children, as related to changing breastfeeding rates, will be presented farther down in this article. Also later is discussion of SIDS, incidence of which has not been reduced by breastfeeding, contrary to what should have been expected according to the claims of breastfeeding’s proponents; included will be discussion of how poor the evidence for those claims was.
Increases in ADHD and serious psychological problems (in relation to increasing exposures of infants to environmental toxins in breast milk) are discussed at www.breastfeeding-health-effects.info.
Below will be a look at each of the claims for specific benefits of breastfeeding, seeing (in government health records) what actually happened with respect to prevalence of each of the diseases or conditions in question, following the major increases in breastfeeding.
It will seem surprising how far off the inferences about "risks" of not breastfeeding turned out to have been in relation to what actually happened. As mentioned, confounders can cause the inferences from observational studies to be in error; and there were major confounders present in those studies that were done about breastfeeding, which were either not recognized or properly adjusted or controlled for: low income conditions and household smoking, both of which are known to be disproportionately present in bottle-feeding households. Details about those confounders, and about how each of them is known to cause the same adverse health outcomes that have been attributed to lack of breastfeeding, can be found in Section D at www.breastfeeding-benefits.net.
Considerations that explain why breastfeeding can be harmful to an infant are not only the increases in toxins in the environment and consequently in breast milk, but also the increasingly well-accepted theory that proper development of an infant's immune system depends on the immune system's being challenged by everyday microbes. It is well known that breast milk contains immune cells that kill microbes, but few people think about the fact that microbes that are being killed could otherwise be stimulating proper development of the immune system. The "hygiene hypothesis" (seeing harm caused by lack of microbial exposure) is generally discussed in reference to improved sanitation and cleanliness in contemporary developed countries, compared with earlier times. But modern sanitation and hygiene had already been achieved early in the 20th Century; and it was apparently not until the 1970's that a great many children's immune systems started failing to develop well; this came directly following the great increase in breastfeeding, with its injection of immune cells from outside an infant's body. Some details and sources for the above will follow in this paper, with more complete details at www.breastfeeding-and-asthma.info.
A document dealing with findings of a research team of the Norwegian University of Science and Technology referred to the PROBIT study in Belarus as "the largest study that has been done on breastfeeding and health." (That study was apparently also the only study on effects of breastfeeding that has minimized effects of confounders by means of randomization of participants.) Quoting from that document (provided in the University's website): "This study cuts the legs out from underneath most of the assertions that breastfeeding has health benefits, the researchers say."(3b)
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It is noteworthy that
this is a recent statement from the University of Science of Norway, a
country that might have the highest breastfeeding rates in the entire world,
and whose up-close experience with the effects of breastfeeding probably has
no parallel. Notice in this chart that apparently only one other
European country even approaches Norway's long-term high breastfeeding rate.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The case in favor of breastfeeding has been extensively presented by U.S. Surgeon General Regina Benjamin, and that case will be dealt with in detail below. The first three areas to be dealt with are the ones that a publication on the website of the National Institutes of Health calls the "three key issues" involving alleged "poor child health outcomes" of formula feeding: obesity, diabetes, and atopy (allergies).(3a)
Pro: "Children who were not breastfed are at increased risk of obesity."
The above statement is from the website of the American Academy of Family Physicians (AAFP). U.S. Surgeon General Regina Benjamin says there is a 32% excess risk of obesity in children who were not breastfed. She acknowledges that this is only an inference(2) from observational studies referred to in this footnote: (2a)
Con: Historical data show outcomes that are very different from what would have been predicted on the basis of the claims by breastfeeding's promoters:
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From the vantage point of 2012, with the large amount of accumulated historical health data that is now available regarding the last five decades, we can see what happened in childhood obesity incidence over the period of a transition that took place from low to high breastfeeding in the U.S. Notice in Figure 1 that breastfeeding rates in the U.S. before 1972 were stable and not increasing. Then a rapid increase began in 1972.
Childhood obesity data from the U.S. Centers for Disease Control and Prevention are shown in Figure 2 below. Notice that
- - obesity levels were low and not increasing among 6-to-11-year-olds as of the second time period shown, in comparison with the earlier period;
- - a rapid increase began as of the very next time period shown (the third one); and obesity continued to increase rapidly after that.
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- - Looking at Figure 1, above, in relation to the sharp increase in obesity seen in Figure 2, observe that a major increase in breastfeeding occurred 6 to 8 years before the period of the major increase in obesity among the 6-to-11-year-old age group.
It is worthwhile to stop and think about that: Stable, low obesity rate while breastfeeding was stable and low, then a major increase in obesity in the very first measurement period in which a large number of the children in that age group would have gone through their infancies during a time of greatly increased breastfeeding.
- - As the infancies of a higher percentage of that age group came to be within the period of higher breastfeeding, and as breastfeeding rates during their infancies had come to be higher, their obesity percentages rose still farther.
Among 12-to-19-year-olds, the increases in obesity were very similar to the above, but with a lag that was commensurate with the older age of this group. Children in this group as of 1976-1980 would not have been infants during the period of increased breastfeeding, but those in this age group as of 1988-1994 would have been infants during times of much greater breastfeeding. Observe the doubling of the obesity rate of this age group as of the 1988-1994 period, precisely at the time of the transition from infancies without increasing breastfeeding to infancies with greatly increased breastfeeding. And children in this age group as of the next period after that (with 16% obesity) would have been infants during a period of a still higher rate of breastfeeding.
Fig. 3
A very similar pattern is visible among 18-to-29-year-olds, as shown in this chart. Between 1971 and 1980, when that age group's infancies would have been unaffected by the increase in breastfeeding, their obesity percentage remained a flat and relatively low 7.9%. As with the other age groups, in the very first period by which time a significant percentage of this age group's infancies could have been affected by the increase in breastfeeding (1988-1994), their obesity percentage changed from flat to a major increase (nearly doubling in this case). And obesity continued to increase as a higher proportion of this group's infancies came to coincide with the period of higher breastfeeding, until the group's obesity percentage had tripled, as of 2005-2006.(4)
The three age groups for which data is shown above had increases in obesity between 1971-74 and 2003-2006 of 325%, 289%, and 206%, in order from youngest to oldest. Notice that these percentages go from high to lower in correlation with the groups' varying recentness and completeness of exposures to the increases in breastfeeding.
Obesity during this period also increased among the older age groups, but the increases among the older people were (a) much smaller than those of the age groups affected by the increases in breastfeeding, and (b) largely explainable by the transition from farm and factory work to sedentary work. For more information about obesity increases in the older groups, and for information about chemicals in breast milk that probably underlie increases in obesity following increases in breastfeeding, see www.child-obesity.us .
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(Discussion of diabetes logically follows discussion of obesity, since the two often go together.)
Pro: "Type 2 diabetes is 64% more likely among children who are not breastfed."
The U.S. Surgeon General acknowledges that her statement above is merely an inference,(2) based on observational studies referred to in this footnote: (4a)
Con: Historical data show that diabetes is apparently actually higher among children who have been breastfed.
The evidence linking increases in breastfeeding with increases in diabetes, and low levels of breastfeeding with low levels of diabetes, is so extensive that a proper presentation of the evidence requires too much space to allow inclusion in full here. Therefore just a brief summary of that section will be included below, and the full text, including sources, can be read by going to www.causeofdiabetes.net
According to a 2002 statement by the president of the American Diabetes Association, type 2 diabetes as of that time was on its way to being what she called a "new epidemic" among children and young adults. Major increases in diabetes in the U.S. occurred among those born following the major increases in breastfeeding that began in the early 1970's.
Within the overall long-term major increases in childhood diabetes, what was apparently the only extraordinary shorter-term increase took place among the only specific group of children whose breastfeeding rates were increasing extraordinarily rapidly during that same shorter period: African-Americans, with breastfeeding rates almost doubling 1993-2002.
Prevalence of type 1 diabetes (the predominant type among children) for U.S. 0-9-year-olds is highest among non-Hispanic whites, just over half as high among African Americans, and Hispanics are in between. This correlates with the well-established fact that breastfeeding rates are highest among whites, about half as high among blacks, and Hispanics are in between.
In Western Europe, type 1 diabetes among children aged 0-14 is 2.6 times as prevalent in the highest-breastfeeding as in low-breastfeeding countries, on average.
Increases and decelerations in childhood diabetes rates have tracked accurately with increases and decelerations in breastfeeding rates in all readily-found cases of changing breastfeeding rates among nations, including several examples in Western Europe.
"Especially striking" increases in childhood diabetes occurred in a very specific region, time period and age group (central and eastern Europe, 1989 to early 2000's, 0-4 age group). An extraordinary increase in breastfeeding took place in that same very specific region, time period and age group. Both of these isolated increases appeared to be exceptional in the entire world in their separate categories, and it may be more than coincidence that the two were so well synchronized with each other.
At the opposite extreme: While childhood diabetes incidence and breastfeeding rates were apparently both increasing in most of the world, they were both declining in only one world region, the same region (Central America and the West Indies).
According to a major report on childhood diabetes incidence worldwide as of the 1990's, the age-adjusted incidence of type 1 diabetes was found to be at a world low in Venezuela.* And Venezuela also appears to be essentially at the bottom level of the world's rates of exclusive breastfeeding. The only non-African country for which UNICEF statistics showed exclusive breastfeeding rates to be as low as or lower than Venezuela was Suriname (Venezuela's neighbor). It is noteworthy that Suriname also shares Venezuela's position at the bottom level of the world's childhood diabetes incidence.
And there is excellent scientific evidence supporting the biological reasons why a large number of increases, decelerations, decreases, highs, and lows in breastfeeding and diabetes should correlate so closely; that evidence is explained in detail in the full text version of what is summarized above.
For the full text and authoritative sources of the evidence for all of the above, please go to www.breastfeeding-and-diabetes.info.
And now a word from the author:
Q: If authorities are advising mothers to feed infants a food that (in today's developed countries) is known to the EPA to typically contain high concentrations of developmental toxins,1
and if that is at a time when there are several epidemics of unknown origin that have arisen among children since frequency of that feeding went from low to high,2
shouldn't those authorities be prepared to answer some questions from a serious inquirer about the evidence on which they base their advice?
A: They obviously ought to respond to such an inquiry. But they don't.3
What does that say about the probable quality of their advice?
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1) dioxins in concentrations that the EPA has found to be over 300 times their estimated safe dose during early breastfeeding, and in concentrations many times higher than in formula; also containing PCB's, PBDE's and often mercury; see www.breastfeeding-toxins.info.
2) U.S. breastfeeding rates went from low to high during the 1970's, when childhood diabetes, obesity, allergies, asthma and ADHD all started increasing rapidly; see www.breastfeedingprosandcons.info.
3) The American Academy of Pediatrics, American Academy of Family Physicians, American Congress of Obstetricians and Gynecologists, and the World Health Organization have all failed to respond to any of two or more letters to each of them from the Director of Pollution Action, challenging the evidence on which they base their positions on breastfeeding, as of two and nine months after mailing of the letters.
Any reader is invited to see if you can get a response from those organizations on this subject. A suggested one-page set of points, any of which you could to ask for response to, is at www.breastfeeding-subject.info. If they respond to you, please send a copy of it to dm@pollutionaction.org or Pollution Action, 33 McWhirt Loop, Ste. 115, Fredericksburg, VA 22406 USA, since they don't respond to us.
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Introductory note to discussion about allergies and some other conditions related to breastfeeding or non-breastfeeding:
According to the NIH (www.ncbi.nlm.nih.gov) ”an allergy is an immune response or reaction to substances that are usually not harmful."
It is well-known and not disputed that immune cells from the mother are transmitted to an infant in breast milk, and that is clearly helpful to an infant in areas with poor sanitation. But in developed countries, the benefits of those immune cells are very much in question. A web page of the U.S. Food and Drug Administration favorably presents a line of reasoning according to which proper infant development depends on “the necessary exposure to germs required to “educate” the immune system.... In the period immediately after birth the child’s own immune system must take over and learn how to fend for itself.” The FDA reports that this “hygiene hypothesis” is supported by epidemiological studies. A prominent doctor uses stronger language, describing the “critical importance of proper immune conditioning by microbes during the earliest periods of life.” A study found on the NIH’s website discusses “the microbial exposure which may be critical for immune priming” and suggests it would be helpful to re-name the “hygiene hypothesis” as “microbial deprivation hypothesis.” (9) According to the UCLA Food and Drug Allergy Care Center, "Overwhelming evidence from various studies suggests that the hygiene hypothesis explains most of the allergy epidemic."(9a) Given the above, there are strong reasons to question whether breastfeeding's transmission of immune cells to an infant, and the resulting reduction in exposure to everyday microbes (below the already historically low levels in developed countries), is anything but harmful to a child's long-term health.
In addition to the above-suggested indirect effect of breast milk on development of the immune system, there are also known harmful direct effects on the immune system resulting from toxins known to be contained in breast milk. According to an extensive 2011 study on environmental toxicants and the developing immune system, toxins including dioxins, PCBs, PAHs, BPA, and phthalates can harm development of the immune system.(10) A 2007 study listed those plus other environmental toxicants seen to harm development of an infant's immune system, including heavy metals, tobacco smoke, and pesticides.(10a) Note that all of the above toxins (or, in the case of tobacco smoke, components of that toxin) have been found in breast milk; dioxins have been found in human milk in doses scores of times higher than the EPA-determined safe level. Moreover, in the only comparisons that can be readily found, the doses of these toxins in human milk have been found to be many times higher than those in cow's milk or infant formula. Extensive evidence for the above statements, from the EPA and other authoritative sources, can be found at www.breastfeeding-toxins.info, Section 2.
The above section about probable harm of breast milk to immune function is relevant not only to sections to follow but also to the preceding section on diabetes, since type 1 diabetes is basically an autoimmune disease.
Pro: Children who are not breastfed have an excess risk for asthma of 67% or 35%,
with the specific percentage depending on whether or not there is family history of asthma, according to Surgeon General Benjamin. She acknowledges that this is only an inference,(2) based on observational studies referred to in this footnote: (12)
Con: Historical data show outcomes that are the opposite of what would have been predicted according to the above.
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Fig. 4
Observe the rate of hospitalizations for asthma for 0-to-4-year-olds, those most closely affected by the increases in breastfeeding: Serious cases of asthma in this age group actually increased over 60% from 1980 to 2004, a period in which effects of the transition to much higher breastfeeding rates would have been occurring. (Remember from Section 3 about probable effects of breast milk on the developing immune system.).
The above contrasts with what happened among those age 15 and above: There were declines in serious cases of asthma among those least affected by the relatively recent increases in breastfeeding. Those declines are as would have been expected following advances in practices for treating this disease. And notice that for the 5-14 age group, affected much less directly but nevertheless affected by the increases in breastfeeding, asthma hospitalizations wavered up and down; there was probably a fluctuating balance between (a) declines resulting from advances in treatment and (b) increases resulting from some effect of the increases in breastfeeding of that group; in any case, there was no decline such as should have been expected if there had been validity in the Surgeon General's risk assessment regarding asthma.
The above is only a minor part of the evidence linking increases in asthma with increases in breastfeeding. Because of space limitations here, the complete statement of the evidence on this specific subject will be found at www.breastfeeding-and-asthma.info.
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Pro: Atopic Dermatitis is 47% more likely among children who are not breastfed.
The U.S. Surgeon General acknowledges that her statement above is merely an inference,(2) based on an observational study referred to in this footnote: (19)
Con: Historical data show that the opposite is more likely to be true
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Atopic dermatitis is a form of skin allergy. Notice in this CDC chart what has been happening in prevalence of allergies as breastfeeding rates have been rising, including a 65% increase in skin allergies for the 0-4 age group in just 11 years, and a 37% increase in food allergies in that age group and period. In Figure 1 above, the increases in the two U.S. breastfeeding rates shown for the years for that period (1996 to 2007) were about 100% and 22%, such that the increases in these allergies would fall into the middle range between those two breastfeeding rate increases.
For the period before the years shown in the above chart, the following from an article in the New England Journal of Medicine fills in as follows: (as published in 2008) "The prevalence of atopic dermatitis has doubled or tripled in industrialized countries during the past three decades, affecting 15–30% of children."(20) That doubling or tripling over that time period bears a close resemblance to the increases in breastfeeding beginning in 1972, allowing a few years of lag after the beginning of increased exposure before the possible effects became conspicuous.
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Pro: Not breastfeeding means a 257% excess risk of hospitalization for lower respiratory tract diseases in the first year, according to the U.S. Surgeon General. But she acknowledges that this is only an inference, based on observational studies referred to in this footnote: (21)
Con: Historical data show outcomes that are very different from that, in the period following the transition from low breastfeeding to high breastfeeding.
According to the U.S. "National Hospital Discharge Survey, 1980-87 and 1988-96," bronchiolitis was the first-listed diagnosis in 83% of records of hospitalizations for lower respiratory tract disease, and 81% of those were among infants.(22) According to a publication of the NIH, "Among children younger than 1 year, annual bronchiolitis hospitalization rates increased 2.4-fold, from 12.9 per 1000 in 1980 to 31.2 per 1000 in 1996...."(23) In correlation with that increase, CDC information says that breastfeeding at 12 months increased 2.37-fold during the applicable time period, from 4.5% in 1980 to 10.7% in 1995.(24)
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Pro: Not breastfeeding means a 178% excess risk for gastrointestinal infection, according to the U.S. Surgeon General. But she acknowledges that this is only an inference, based on observational studies referred to in this footnote: (25)
Con: Historical data show outcomes that are very different from that assessment, following the transition from low breastfeeding to high breastfeeding.
Salmonellosis is the
leading cause of gastrointestinal infection,(26) and it is a
condition that often results in serious complications plus about 600 deaths in
the U.S. every year.(27)
Shigellosis is another cause of gastrointestinal infection. The CDC's web pages
on these two diseases confirm that they mainly affect children, especially
those age 0-5. This chart from the CDC shows far higher prevalence of
salmonellosis in the entire highly-breastfed period, and a higher rate
of shigellosis for most of the years of higher breastfeeding, as compared
with prevalences in the low-breastfeeding years.
Both salmonellosis and shigellosis are very much subject to reduction by improvements in hygiene, so it is not surprising to see declines as well as increases taking place in those diseases during this period, despite a likely overall decline in immune function among children during this period.
Pro: Not breastfeeding means a 100% excess risk for otitis media (ear infection), according to the U.S. Surgeon General. But she acknowledges that this is only an inference, based on observational studies referred to in this footnote: (28)
Con: Historical data show outcomes that are very different from that assessment, following the transition from low breastfeeding to high breastfeeding. A study in the journal Pediatrics, based on a major U.S. national survey, provides what appear to be the only readily available statistics regarding trends in this illness. It shows an average increase of 10% just between the periods of 1988-1991 and 1991-1994.(29) Looking at breastfeeding rates for a time span that is relevant to the above period, breastfeeding for at least 6 months increased from 12.7% in 1987 to 14.7% in 1994, a 16% overall increase; other applicable intervals and other levels of breastfeeding showed other rates of increase, such as a 7% increase between 1987 and 1993 for breastfeeding at least 12 months.(30) The research team concluded by expressing concern about this "continued increase" in the prevalence of otitis media among preschool children in the United States; that wording indicates that increases had already been going on for years. The researchers had been looking at various possible risk factors for this illness that could explain the increase, including early breastfeeding discontinuation as what they considered to be such a risk factor; and they acknowledged their inability to find any risk factor whose increase turned out to be associated with the continued increase in this illness. To be more specific, they were unable to find anything to explain the increase while assuming that breastfeeding was protective against ear infection. If they had reversed that assumption, they would have been able to find an infant exposure whose simultaneous increase correlated reasonably well with the increase in otitis media – including 7%-16% increases in breastfeeding leading up to the disease increase percentage that was well within in that range. Given the harm to the developing immune system that is to be expected from toxins normally contained in breast milk, as well as the reduction in the stimulation needed by an infant's immune system to develop properly (see Section 3, above), greater susceptibility to infection among breastfed than bottle-fed children should be no surprise.
An additional finding from one of the studies cited above: "The prevalence (of otitis media) was higher for affluent children." Affluent mothers are known to breastfeed at higher rates than lower-income mothers.
It is worth noting that the above study found that otitis media had increased especially rapidly among low-income children (33% increase in those few years, from 1988-91 to1991-94), and the authors were unable to offer an explanation for that remarkable increase in that particular social group. It has long been known that low-income mothers in the U.S. have very low breastfeeding rates, so that group has received special attention from the promoters of breastfeeding in the form of "peer counseling" programs targeted at inner-city low-income mothers. The 1991-94 period is apparently the period in which these programs were first having their reportedly great success in increasing breastfeeding among low-income mothers; and that happened to be simultaneous with the rapid increase in otitis media among low-income children.(31) Also, according to the (U.S.) Academy of Nutrition and Dietetics, the demographic groups with the largest reported increases in breastfeeding initiation since 1990 included the less educated and those participating in WIC (food assistance to low income groups).(32) So the rapid increase in otitis media that was reported for low-income children during that period doesn't need to be a mystery; one only needs to be familiar with the ways in which toxins known to be contained in breast milk can harm the immune system, as described in Section 3 above.
Pro: Not breastfeeding means a 56% excess risk of Sudden Infant Death Syndrome (SIDS), according to the U.S. Surgeon General. But she acknowledges that this is only an inference, based on observational studies referred to in this footnote: (28)
Con: Historical data as well as the Surgeon General's own source document show that there is apparently no such excess risk.
Bear in mind that there was a major upturn and surge in breastfeeding rates in the U.S. that began in the early 1970's. But apparently this major upturn, which should have reduced SIDS rates if the claims about benefits of breastfeeding had been valid, had no such effect. According to the American Academy of Pediatrics, "Although SIDS was defined somewhat loosely until the mid-1980s, there was minimal change in the incidence of SIDS in the United States until the early1990s." (The AAP issued a new recommendation regarding sleeping position, after which there was apparent reduction in SIDS cases).(33)
The allegation of "increased risk" of SIDS associated with not breastfeeding should also be seen in light of information taken directly from the source that the Surgeon General cites for that statement,(28) with the relevant table from that document shown below. The screenshot below, taken from the top of Table 21, shows all three of the studies that received "A" ratings from the reviewers.
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As shown, two out of three of these best three studies on the subject showed
no benefit of breastfeeding in reducing odds of SIDS, once confounders were
adjusted for. (There are many confounders to be adjusted for in the
case of SIDS, as explained in Section D of www.breastfeeding-benefits.net.)
Two of these three studies didn't even adjust for confounding factor of low
income, which, if it had been done, would have caused the results to be even
less favorable to breastfeeding. The only one of these three studies
that found a protective effect of breastfeeding adjusted neither for income nor
for household smoking other than that of the mother. In addition, in
Table 21 of the same document is information about a separate meta-analysis
that included six studies that made some kind of adjustment for potential
confounders, and four out of those six studies found no protective effect of
breastfeeding.
Pro: Not breastfeeding means 23% and 18% excess risks for two forms of leukemia, according to the U.S. Surgeon General. But she acknowledges that these are only inferences, based on observational studies referred to in these footnotes: (28) (34)
Con: Historical health data show the opposite to be true.
Childhood leukemia has increased greatly since the days of the low-breastfed generation, according to these data provided by cancer.gov. These figures show a 68% increase in acute lymphocytic leukemia, the form that the Surgeon General alleges would be especially greatly reduced for children who are breastfed.
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A closer look at this chart shows
that essentially all of the increase that took place in childhood leukemia took
place between 1975 and 1985. In that regard, note that (judging by Figure
1)
breastfeeding in the "ever" category increased about 170% just between 1972 and 1983, shortly
before the major increases in childhood leukemia; then came an extended
lag, with a total increase of only about 18% during the entire 20 years that followed the 1983 peak. Notice how well that major increase
followed by extended flatness correlated with the major increase followed by
extended flatness in leukemia 
incidence.
It is relevant to note that the major 1975-1985 increases in childhood leukemia did not correlate with a significant increase in leukemia in the general population. (see chart on right) There seems to be no reason to look for a source of environmental toxins that could explain a general increase in leukemia. However, seeing the increases specifically among children makes it apparent that there was very likely an increase in a source of toxins to which children, specifically, were exposed.
In connection with the above, it is worth looking at the considerable evidence about presence of various toxins, including known carcinogens, in typical human milk in contemporary developed countries. Dioxin is a known carcinogen as well as developmental toxin; what appears to be the only EPA estimate of infant exposure to dioxins predicts that an infant breastfed for one year would receive over 80 times what the EPA has determined to be a safe dose of that chemical.(35) And according to another EPA report, providing estimates for typical exposure in the U.S. based on EPA data but also drawing on studies of populations in three European countries, "Breast-feeding for 6 months or more is predicted to result in an accumulated (dioxin) exposure 6 times higher than a formula-fed infant during the infant's first year of life.”(36)
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Notice (above left) the especially high concentrations of dioxins in breastfed infants during their early years. Then observe (above right) the rates of childhood cancer in those same early years.
Aside from leukemia, childhood cancer in general increased in both the U.S. and Europe during the period of greatly-increased breastfeeding, despite reductions in environmental carcinogens that led to declines in cancer in adults in both continents during that period. To read much more about childhood cancer and its close association with breastfeeding, go to www.breastfeeding-and-cancer.info .
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Section 11
The above completes the last of the diseases and conditions for which non-breastfed full-term infants are said by Surgeon General Benjamin to be at excess risk. (The Surgeon General's complete list of those "excess health risks" is shown here.) It is hard to imagine how a set of risk assessments could prove to be any more inaccurate than those turned out to have been.
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But the complete list shows benefits of breastfeeding for the mother also, as discussed in the next section.
Section 12
Pro: Mothers who do not breastfeed are said to have a 4% increased risk of breast cancer and a 27% increased risk of ovarian cancer, according to the studies referred to in these footnotes: (28) (37)
Con: This might be true, but the reason for this possible health benefit ought to be sufficient to cause mothers to think twice about it.
As indicated above, dioxins are highly concentrated in breast milk, in an average dosage over a year’s breastfeeding of over 80 times higher than what the EPA has determined to be a safe dose, and in many times the concentration found in infant formula.(35) (36) Those toxins (and others) get into breast milk because they are already in the mother's body. Lactation efficiently excretes large quantities of those toxins to the breastfeeding infant, to the probable benefit of the mother.(37) But how many mothers would knowingly cleanse their own bodies by means of a process that causes their infants to ingest those toxins in such recognized extraordinary concentrations, and to do so at the most vulnerable times of the infants' lives?
Section 13
Pro: Breastfeeding is sometimes said to improve the infant's mental development.
Con: That is almost certainly untrue.
"A large study co-conducted by the University of Edinburgh and Scotland’s Medical Research Council found that breastfed babies do indeed tend to be smarter than formula-fed babies. But it also found that mothers who breastfeed also tend to have higher IQs and more education, and tend to provide more stimulating home environments than formula-feeding mothers. Once the numbers were corrected to account for the mom’s IQ, the relationship between breastfeeding and intelligence disappeared. (And there was no statistical difference between siblings when one was breastfed and one wasn’t.) The study, analyzing data on nearly 5,500 American children, was published in the British Medical Journal in October 2006. Previous studies, for the most part, hadn’t factored in the mom’s IQ when declaring that breastfeeding made babies smarter."(37a) For a very similar report, also see (37c)
Also note that even breastfeeding's most prominent proponent, Surgeon General Benjamin, doesn't claim that breastfeeding is better for an infant's mental development. The AHRQ-contracted 2007 review that she uses, and which is often used to try to support claims for benefits of breastfeeding, acknowledges, "there was no relationship between breastfeeding in term infants and cognitive performance."(37b)
A 2002 American study concerning effects of PCB exposure also helped to confirm the absence of neurodevelopmental benefits of breastfeeding, with analysis finding that apparent benefits of breastfeeding were actually a result of the more advantageous home environments of children who were more likely to be breastfed.(37d) A 2015 U.K. study reached a similar conclusion, stating in its conclusion that they interpret their “findings as evidence for the lack of any benefits of breastfeeding on cognitive development from early life through adolescence.”(37e)
Also bear in mind that dioxins are endocrine disruptors, which are known to be toxic to neurological development. (See www.breastfeeding-toxins.info about the high concentrations of dioxins in breast milk, far higher than in formula.) The developed countries and U.S. states that have the highest rates of autism all have high rates of breastfeeding. The European countries and U.S. states that have the lowest rates of breastfeeding all have relatively low rates of autism. (see www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm)
A U.S. study of all 50 U.S. states and 51 U.S. counties, carried out by a scientist who is also a Fellow of the American College of Nutrition, found that "exclusive breast-feeding shows a direct epidemiological relationship to autism" and also, "the longer the duration of exclusive breast-feeding, the greater the correlation with autism."(38)
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Section 14 Bonding between mother and child
Another benefit claimed for breastfeeding is that it builds a mother-child bond. But, as nice as that sounds, one should consider the long term effect, especially for male infants. The reader is encouraged to read in Sections 1.2.b.2-3 of www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm about the mostly-effeminate (or at minimum mostly non-masculine) generation of young Japanese men that became conspicuous during the 2000's following Japan’s changeover during the 1980’s to a very high level of breastfeeding. Be sure to notice what is quoted about the typical attachments of these young men to their mothers, as opposed to their female contemporaries, in a nation that is extremely worried about its recently-far-below-replacement level birthrate.
Also, for some mothers, nursing is difficult, stressful and even painful, and feeling pressured to breastfeed is probably not conducive to the mother's having a mental state of a kind that is beneficial for the child or for mother-child relations.
Aside from the above, consider whether it ought to be fundamental in parenting to prepare the child to eventually become an independent person. How is it known that such a transition can be easily made following extended growth in the opposite direction, at the most formative stage of the child's personality?
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For mothers who are experiencing difficulties or problems in breastfeeding, there are some very relevant considerations to think about, related especially to the question of why you should be encountering those problems in a process that is so natural to mammals, to be found at www.breastfeedingdifficulties.info .
Bear in mind that information about increases in ADHD and serious psychological problems is presented in a paper at this link.
Considering the widely and emotionally-held views about the virtues of breastfeeding, stating that breastfeeding has little or no benefit is probably the most extreme stance that most people would be willing to take in this contentious matter. So it merits some attention when authoritative sources do publicly take such a stance:
a) as summarized in a 2014 news release of Ohio State University, “A new study (by Ohio State faculty member) comparing siblings who were fed differently during infancy suggests that breast-feeding might be no more beneficial than bottle-feeding for 10 of 11 long-term health and well-being outcomes in children age 4 to 14.” The exception was asthma, “which was associated more with breast-feeding than with bottle-feeding.”(36a)
b) Also note the statement by a research team of the Norwegian University of Science and Technology, quoted in the introduction to this article.
Summary
So the establishment opinion is that breastfeeding is protective against certain diseases and conditions in full-term infants; yet, during the period of greatly increased breastfeeding, all except one of those conditions have actually increased substantially, in comparison with levels prevalent for the low-breastfed mid-century generation.
When seeing the conflicts between the Surgeon General's "excess risk" assessments and actual historical data from totally trustworthy sources such as shown above, the reader should remember that the Surgeon General acknowledges that the evidence for benefits of breastfeeding consists "only" of inferences (p. 33 of her Call to Action to Support Breastfeeding 2011). According to the American Heritage dictionary (Fourth Edition, 2009), a synonym of ”infer" is "surmise;" and "surmising" is defined as something done "without sufficiently conclusive evidence." Quite justifiably, the Surgeon General is proposing that "scientifically sound and rigorous studies on breastfeeding topics" should be carried out in the future, which would be expected to be improvements over the research that has been carried out in this field thus far. Studies that have found benefits of breastfeeding have not properly taken into account the effects of low income and household smoking that are known to be disproportionately prevalent in bottle-feeding households; low income conditions and household smoking are known to cause the same adverse health effects that the Surgeon General surmises are results of formula feeding (see the Appendix), and higher-income parents are known to be far more likely both to breastfeed and to provide environments that lead to better health outcomes in children, leading to studies’ finding “associations” of breastfeeding with better health outcomes.(36a) It should be amply clear from the preceding sections how justified the U.S. Agency for Health Research and Quality is in pointing out that findings from such studies can be expected to consist of an unknown amount of "error" and "false conclusion."(37)
Message to health professionals and scientists reading this paper: This author cordially invites you to indicate your reactions to the contents presented here. As of now, new parents almost never hear anything but completely one-sided promotion of breastfeeding, with no mention of possible drawbacks except in cases of serious problems on the part of the mother. If you feel that parents should be informed about both sides of this question and thereby enabled to make an educated decision in this important matter, please write to the author of this paper. Also, if you find anything here that you feel isn't accurately drawn from trustworthy sources or based on sound reasoning, please by all means send your comments, to dm@pollutionaction.org.
Comments from readers:
From the inception of these publications in early 2012 until present, the invitation has been extended to all readers to submit criticisms, asking them to point out how anything written here is not well supported by authoritative sources (as cited) or is not logically based on the evidence presented. As of August 1, 2013, after about 17 months, only two criticisms of contents of our articles have been received in response to that invitation. (That is significant, considering the many thousands of visits we receive from readers every month.) Our publications have been improved as a result of those two criticisms, and we look forward to receiving more. To read those criticisms and our responses to them, as well as to read several other e-mails containing comments or questions and our responses to them, go to www.pollutionaction.org/comments.htm. All comments are welcome, especially those that point out any deficiencies in our evidence in relation to conclusions drawn or any lack of quality in the reasoning as presented. Please send comments, criticisms, or questions to dm@pollutionaction.org . Quite clearly, many people don't like our conclusions; they just can't find anything wrong with the evidence or reasoning that leads to the conclusions. Those who can't provide any criticisms of any of our content also include officials of government agencies that promote breastfeeding, who have received several letters from us, as well as the World Health Organization and the American physicians' associations that advocate breastfeeding. The latter organizations haven't even responded to our letters (two to each organization) questioning them about the evidence on which they base their advocacy of breastfeeding.
* About Pollution Action and the author of this article: Go to the bottom of this page.
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Endnotes:
Some of the full articles below are available for free online, but to obtain the full text of some of these articles for free, you may have to visit a university library or ask at the reference desk at your local public library.
(1) "Breastfeeding, Family Physicians Supporting (Position Paper)" -- AAFP Policies -- American Academy of Family Physicians;
another source refers to the U.S. period in which breastfeeding was rare as beginning in 1930 (Wolf, Low Breastfeeding Rates and Public Health in the United States, Am J Public Health. 2003 December; 93(12): 2000–2010. PMCID: PMC1448139 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448139)
(2) "Surgeon General's Call to Action to Support Breastfeeding, 2011," p. 33 at http://www.surgeongeneral.gov/library/calls/breastfeeding/calltoactiontosupportbreastfeeding.pdf (2a) Arenz S, Ruckerl R, Koletzko B, von Kries R. "Breast-feeding and childhood obesity—a systematic review." Int J Obes Relat Metab Disord 2004;28:1247–1256.
(2b) at http://www.cdc.gov/CDCTV/ObesityEpidemic/Transcripts/ObesityEpidemic.pdf
(3) Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, "Systems to Rate the Strength of Scientific Evidence, Evidence Report/Technology Assessment: Number 47" at http://archive.ahrq.gov/clinic/epcsums/strengthsum.pdf
(3a) A History of Infant Feeding J Perinat Educ. 2009 Spring; 18(2): 32–39. doi: 10.1624/105812409X426314 PMCID: PMC2684040 Emily E Stevens, et al., at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684040/
(3b) "Breastfeeding is not as beneficial as once thought" (06.01.2010) published by the Norwegian University of Science and Technology, at http://www.ntnu.edu/news/breastfeeding Quoting especially Professor Sven M. Carlsen, Manager of Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU. The statement was based on findings of the PROBIT study in Belarus. (This article, on the website of the Norwegian University of Science and Technology, indicated no author; it therefore appears to be an established, official statement of the University, dated 2010 and accessed in 2013.)
(3c) See www.breastfeeding-rates.info, noting Norway's 6-month rate in the Europe chart and then seeing the 6-month breastfeeding rates in the World data set, with only Mongolia and Rwanda sharing the top position.
(3d) Grandjean and Jensen, BREASTFEEDING AND THE WEANLING’S DILEMMA Am J Public Health. 2004 July; 94(7): 1075.
PMCID: PMC1448391
(3e) E.D. Pellizarri et al., Purgeable Organic Contaminants in Mothers' Milk, Bulletin of Environmental Contamination and Toxicology, 28(1982):322-28
(9)http://www.fda.gov/biologicsbloodvaccines/resourcesforyou/consumers/ucm167471.htm Also Clin Exp Allergy. 2006 April; 36(4): 402–425. Blackwell Publishing Ltd "Too clean, or not too clean: the Hygiene Hypothesis and home hygiene," SF Bloomfield et al. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448690/ Also Cell Research advance online publication 24 April 2012; doi: 10.1038/cr.2012.65 "Early exposure to germs and the Hygiene Hypothesis" Dale T Umetsu Division of Immunology, Karp Laboratories, Children's Hospital Boston, Harvard Medical School, Boston, MA http://www.nature.com/cr/journal/vaop/ncurrent/full/cr201265a.html
(9a) http://fooddrugallergy.ucla.edu/body.cfm?id=40 "About Allergies/ Why Are Allergies Increasing?"
(10) "Environmental toxicants and the developing immune system: a missing link in the global battle against infectious disease?" Bethany Winans, et al., Reprod Toxicol. 2011 April; 31(3): 327–336. Published online 2010 September 22. doi: 10.1016/j.reprotox.2010.09.004 PMCID: PMC3033466 NIHMSID: NIHMS245165 accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033466/ citing the following:
Heilmann C, Grandjean P, Weihe P, Nielsen F, Budtz-Jorgensen E. "Reduced antibody responses to vaccinations in children exposed to polychlorinated biphenyls." PLoS Med. 2006;3:e311. [PMC free article
Weisglas-Kuperus N, Patandin S, Berbers GA, Sas TC, Mulder PG, Sauer PJ, et al. "Immunologic effects of background exposure to polychlorinated biphenyls and dioxins in Dutch preschool children." Environmental health perspectives. 2000;108:1203. [PMC free article]
Glynn A, Thuvander A, Aune M, Johannisson A, Darnerud P, Ronquist G, et al. "Immune cell counts and risks of respiratory infections among infants exposed pre- and postnatally to organochlorine compounds: a prospective study". Environmental Health. 2008;7:62. [PMC free article]
Dallaire F, Dewailly E, Muckle G, Vezina C, Jacobson SW, Jacobson JL, et al. "Acute infections and environmental exposure to organochlorines in Inuit infants from Nunavik." Environ Health Perspect. 2004;112:1359–63. [PMC free article]
Dewailly E, Ayotte P, Bruneau S, Gingras S, Belles-Isles M, Roy R. "Susceptibility to infections and immune status in Inuit infants exposed to organochlorines.” Environ Health Perspect. 2000;108:205–11. [PMC free article]
Jedrychowski W, Galas A, Pac A, Flak E, Camman D, Rauh V, et al. "Prenatal ambient air exposure to polycyclic aromatic hydrocarbons and the occurrence of respiratory symptoms over the first year of life." European journal of epidemiology. 2005;20:775–82.
Weisglas-Kuperus N, Vreugdenhil HJ, Mulder PG. "Immunological effects of environmental exposure to polychlorinated biphenyls and dioxins in Dutch school children." Toxicol Lett. 2004;149:281–5.
Guo YL, Lambert GH, Hsu CC, Hsu MM. Yucheng: "Health effects of prenatal exposure to polychlorinated biphenyls and dibenzofurans." Int Arch Occup Environ Health. 2004;77:153–8.
Vos JG, Moore JA. "Suppression of cellular immunity in rats and mice by maternal treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin." International archives of allergy and applied immunology.
(10a) Potential for early-life immune insult including developmental immunitoxicity in autism and autism spectrum disorders: Focus on critical windows of immune vulnerability Dietert and Dietert, Journal of Toxicology and Environmental Health, PartB, 11:600-680, 2008 Taylor and Francis Group, LLC
(11) U.S. EPA. "Estimating Exposure To Dioxin-Like Compounds - Volume I": U.S. Environmental Protection Agency, Washington, D.C., EPA/600/8-88/005Ca., 2002, revised 2005 – http://cfpub.epa.gov/si/si_public_record_Report.cfm?dirEntryID=43870, Section II.6, "Highly Exposed Populations" (nursing infants are considered to be one of the highly-exposed populations), 4/94 (p. 39): "Using these procedures and assuming that an infant breast feeds for one year, has an average weight during this period of 10 kg, ingests 0.8 kg/d of breast milk and that the dioxin concentration in milk fat is 20 ppt of TEQ, the average daily dose to the infant over this period is predicted to be about 60 pg of TEQ/kg-d."
In its most recent dioxin assessment, issued February, 2012, the EPA set the threshold for safe dioxin exposure at a toxicity equivalence (TEQ) of 0.7 picograms per kilogram of body weight per day. http://www.epa.gov/iris/supdocs/dioxinv1sup.pdf in section 4.3.5, at end of that section: "...the resulting RfD in standard units is 7 × 10−10 mg/kg-day." (that equals 0.7 pg) In the EPA’s “Glossary of Health Effects”, RfD is defined as follows: “RfD (oral reference dose): An estimate (with uncertainty spanning perhaps an order of magnitude) of a daily oral exposure of a chemical to the human population (including sensitive subpopulations) that is likely to be without risk of deleterious noncancer effects during a lifetime.”
- - "Lactational Exposure to Polybrominated Diphenyl Ethers and Its Relation to Social and Emotional Development among Toddlers," Kate Hoffman, et al., Environ Health Perspect. 2012 October; 120(10): 1438–1442. Published online 2012 July 19. doi: 10.1289/ehp.1205100 PMCID: PMC3491946 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491946/
- - ATSDR "Public Health Statement for Polychlorinated Biphenyls (PCBs)," November 2000, Balfanz et al. 1993; MacLeod 1981; Wallace et al. 1996, Sec. 6, p. 565, see Section 6.4., 1
- - "Transfer of Polycyclic Aromatic Hydrocarbons to Fetuses and Breast Milk of Rats Exposed to Diesel Exhaust," Tozuka, Watanabe et al., Kanazawa University and Tokyo Metropolitan Public Health Research Institute; Journal of Health Science 50(5) 2004 pp. 497-502
- - Chemosphere. 2007 Apr;67(7):1265-74. Epub 2007 Jan 26. "Polycyclic aromatic hydrocarbons (PAHs) in human milk from Italian women: influence of cigarette smoking and residential area." Zanieri L, et al., University of Florence, Department of Chemistry, Florence, Italy. At http://www.ncbi.nlm.nih.gov/pubmed/17258279
- - Quotation to be found concerning BPA and other chemicals in breast milk at http://www.scientificamerican.com/article.cfm?id=earth-talks-breast-feeding
- - "Effects of developmental exposure to bisphenol A on brain and behavior in mice". Palanza P, et al., Environ Res. 2008 Oct;108(2):150-7. At http://www.ncbi.nlm.nih.gov/pubmed/18949834
- - Main KM, et al. 2006. "Human Breast Milk Contamination with Phthalates and Alterations of Endogenous Reproductive Hormones in Infants Three Months of Age." Environ Health Perspect 114:270-276. http://dx.doi.org/10.1289/ehp.8075
- - 2009 EPA Polybrominated Diphenyl Ethers Action Plan at http://www.epa.gov/oppt/existingchemicals/pubs/actionplans/pbdes_ap_2009_1230_final.pdf , p. 12
Major trustworthy sources indicating higher concentrations of dioxins, PBDEs, PAHs and other toxins in human milk than in cow's milk or formula can be seen at http://www.babyfeeding.info/toxins-in-breastmilk-and-formula.htm , or by request to dm@pollutionaction.org.
(12) Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. "Breastfeeding and maternal and infant health outcomes in developed countries: evidence report/ technology assessment no. 153". Contracted report for Agency for Healthcare Research and Quality; 2007. AHRQ Publication No. 07-E007.
(12a) Cited inThe Future of Disability in America, Ch. 3, p. 77 Institute of Medicine (US) Committee on Disability in America; Field MJ, et al., ed., National Academies Press (US); 2007 bookshelf ID: NBK11437 found at http://www.ncbi.nlm.nih.gov/books/NBK11437
(12b) from CDC: Summary of Trends in Breastfeeding 2011 Pediatric Nutrition Surveillance National Table 13D Children Aged < 5 Years
(15) Table 13d of CDC's 2011 Pediatric Nutrition Surveillance at http:/www.cdc.gov/pednss/pednss_tables/pdf/national_table13.pdf
(16) "Environmental toxicants and the developing immune system: a missing link in the global battle against infectious disease?" Bethany Winans, et al., Reprod Toxicol. 2011 April; 31(3): 327–336. See footnote 10 for details.
(16a) Thorax. 2006 April; 61(4): 276–278. doi: 10.1136/thx.2005.052662 PMCID: PMC2104623 The childhood asthma epidemic G Russell et al. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2104623/ Also The Asthma Epidemic Waltraud Eder, M.D., et al., N Engl J Med 2006; 355:2226-2235November 23, 2006DOI: 10.1056/NEJMra054308 Also HHS at http://aspe.hhs.gov/sp/asthma/overview.htm Also
"While increasing numbers of Britons are suffering from allergies, more believe - falsely – that they are." Barbara Lantin investigates, Daily Telegraph 24 Apr 2006" "...in the past 20 years, asthma, hayfever and eczema have increased two- to threefold." http://www.telegraph.co.uk/health/alternativemedicine/3338707/The-allergy-epidemic.html Also The epidemic of asthma and allergy Stephen T Holgate, DSc FRCP J R Soc Med. 2004 March; 97(3): 103–110. PMCID: PMC1079317 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079317/
Also see footnote 9a for source about "allergy epidemic."
(18) "Breastfeeding in the United States: Findings from the National Health and Nutrition Examination Survey, 1999-2006"
http://www.cdc.gov/nchs/data/databriefs/db05.pdf
(19) Gdalevich M, Mimouni D, David M, Mimouni M. "Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies". J Am Acad Dermatol 2001;45:520–527.
(20) "Atopic dermatitis" Bieber T N Engl J Med. 2008 Apr 3; 358(14):1483-94.
(21) Bachrach VR, Schwarz E, Bachrach LR. "Breastfeeding and the risk of hospitalization for respiratory disease in infancy: a meta-analysis." Arch Pediatr Adolesc Med 2003;157:237–243.
(22) Shay DK,et al., JAMA. 1999 Oct 20;282(15):1440-6. "Bronchiolitis-associated hospitalizations among US children, 1980-1996."
(23) "Bronchiolitis-associated hospitalizations among US children, 1980-1996." Shay DK et al., JAMA.
1999 Oct 20; 282(15):1440-6. At http://www.ncbi.nlm.nih.gov/pubmed/10535434
(24) "Summary of Trends in Breastfeeding (National)" 2011 Pediatric Nutrition Surveillance (CDC) Table 13D Children Aged < 5 Years Page 34 at http:/www.cdc.gov/pednss/pednss_tables/pdf/national_table13.pdf
(24a) Table 27 of CDC's Health, United States, 2011 http://www.cdc.gov/nchs/data/hus/hus11.pdf#listtables
(25) Chien PF, Howie PW. "Breast milk and the risk of opportunistic infection in infancy in industrialized and non-industrialized settings." Adv Nutr Res 2001;10:69–104.
(26) at http://ec.europa.eu/food/food/biosafety/salmonella/13_gastrointestinal_infections_2001.pdf
(27) at http://ageconsearch.umn.edu/bitstream/20050/1/sp04ad01.pdf
(28) Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al. "Breastfeeding and maternal and infant health outcomes in developed countries: evidence report/ technology assessment no. 153." Contracted report for Agency for Healthcare Research and Quality; 2007. AHRQ Publication No. 07-E007.
(29) (Increases from 66.7% to 69.7%, 41.1% to 45.8%, and 34.8% to 41.1% average out to growth from 47.5% to 52.2%, constituting a 10% overall growth for the period.) "Trends in otitis media among children in the United States." Auinger P et al., Pediatrics. 2003 Sep;112 (3 Pt 1):514-20. at http://www.ncbi.nlm.nih.gov/pubmed/12949276
(30) "Summary of Trends in Breastfeeding (National)" 2011 Pediatric Nutrition Surveillance (CDC) Table 13D Children Aged < 5 Years Page 34 at http:/www.cdc.gov/pednss/pednss_tables/pdf/national_table13.pdf
(31) The breastfeeding promotion programs to low income groups were especially in connection with the WIC programs (federal assistance for low-income mothers and young children). A reasonable search for the year when such programs began has yielded only the following: The US Department of Agriculture describes many studies that have been conducted about programs promoting breastfeeding to low-income mothers, the very first of which was a 1991 study; and there were several studies dated 1994. (http://www.nal.usda.gov/wicworks/Learning_Center/research_brief.pdf p. 12) A 1990 article about USDA's WIC infant nutrition programs made no mention of promotion of breastfeeding, as of 1990. (J Pediatr. 1990 Aug;117(2 Pt 2):S101-9. Impact of the Special Supplemental Food Program on infants. Batten S et al. http://www.ncbi.nlm.nih.gov/pubmed/2380844) So the 1991-1994 period is apparently the period in which these programs were first having their reportedly great success in increasing breastfeeding among low-income mothers.
(32) http://www.eatright.org/search.aspx?search=breastfeediing&type=Site
(33) American Academy of Pediatrics "Policy Statement on Sudden Infant Death Syndrome" at http://pediatrics.aappublications.org/content/116/5/1245.full.pdf+html
(34) Kwan ML, Buffler PA, Abrams B, Kiley VA. "Breastfeeding and the risk of childhood leukemia: a meta-analysis." Public Health Rep 2004;119:521–535.
(35) In its most recent dioxin assessment, issued February, 2012, the EPA set the threshold for safe dioxin exposure at a toxicity equivalence (TEQ) of 0.7 picograms per kilogram of body weight per day. (http://www.epa.gov/iris/supdocs/dioxinv1sup.pdf in section 4.3.5, at end of that section) Note that the EPA estimates that an infant breastfed for one year would receive an average daily dose of about 60 pg of TEQ/kg bw/day. ("U.S. EPA. Estimating Exposure To Dioxin-Like Compounds - Volume I": EPA/600/8-88/005Ca., 2002, revised 2005 – http://cfpub.epa.gov/si/si_public_record_Report.cfm?dirEntryID=43870, Section II.6, "Highly Exposed Populations" (p. 39) "... the average daily dose to the infant over this period (one year) is predicted to be about 60 pg of TEQ/kg-d.") So the average daily dose of 60 pg, over the period of a full year of rapid development, is 86 times the estimated safe dioxin exposure of 0.7 pg.
(36) "Infant Exposure to Dioxin-like Compounds in Breast Milk," Lorber and Phillips Volume 110 | Number 6 | June 2002 • Environmental Health Perspectives http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=54708#Download Also EPA Home/Research/Environmental Assessment: "An Evaluation of Infant Exposure to Dioxin-Like Compounds in Breast Milk," Matthew Lorber (National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency) et al.
(36a) “Breast-feeding Benefits Appear to be Overstated, According to Study of Siblings”, 2/25/14, The Ohio State University, University Communications, at http://researchnews.osu.edu/archive/sibbreast.htm
(37) Agency for Healthcare Research and Quality, U.S. DHHS, Systems to Rate the Strength of Scientific Evidence, Evidence Report/Technology Assessment: Number 47 at http://archive.ahrq.gov/clinic/epcsums/strengthsum.pdf
(37a) This quotation found at http://www.babble.com/baby/baby-feeding-nutrition/breastfeeding-vs-bottle-feeding-why-baby-formula-is-not-so-bad/ referring to: G. Der et al., Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis BMJ2006;333doi: http://dx.doi.org/10.1136/bmj.38978.699583.55 (Published 2 November 2006)
(37b) Evidence Report/Technology Assessment Number 153 Breastfeeding and Maternal and Infant Health, Outcomes in Developed Countries Prepared for: Agency for Healthcare Research and Quality quote from "Structured Abstract" section
(37c) Holme et al., The effects of breastfeeding on cognitive and neurological development of children at 9 years, Child: Care, Health and Development Volume 36, Issue 4, pages 583–590, July 2010, Wiley Online Library
(37d) Jacobson et al., Neurotoxicol Teratol. 2002 May-Jun;24(3):349-58.Breast-feeding and gender as moderators of teratogenic effects on cognitive development. at http://www.ncbi.nlm.nih.gov/pubmed/12009490
(37e) von Stumm, Breastfeeding and IQ Growth from Toddlerhood through Adolescence, Published: September 25, 2015
DOI: 10.1371/journal.pone.0138676 at http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138676
(38) Autism rates associated with nutrition and the WIC program. Shamberger R.J., Phd, FACN, King James Medical Laboratory, Cleveland, OH J Am Coll Nutr. 2011 Oct;30(5):348-53. Abstract at http://www.ncbi.nlm.nih.gov/pubmed/22081621 The full text, including the quoted passages, can be purchased for $7 or reference librarians at local libraries could probably obtain it at no charge.
Known Effects of Low Income Conditions and Tobacco Smoking on Health of Children, often Confused with Effects of Bottle Feeding on Health of Children:
It is important to know some of the health effects of low-income existence and smoking, which are crucial in understanding the basic differences between breastfeeding and bottle-feeding households. Bear in mind that those two groups differ greatly according to income levels, with bottle-feeding mothers being very disproportionately of low income, according to the Surgeon General’s own data for the U.S. and according to studies in the U.K. and Australia. (see Section 1.2.s.1.a of www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm, ) According to a major study funded by the U.S. Public Health Service, “Disparities in childhood asthma can be directly tied to several factors which disproportionately affect lower income children and children of color, including substandard and over-crowded housing, poor ambient air quality (often related to living near freeways, ports, or industrial sources of pollution); exposure to pesticides, particularly among migrant families but also children attending schools close to fields where pesticides are sprayed; and attendance in older schools with poor indoor air quality. Lower income children are also more likely to face barriers to quality health care to treat and control their asthma. Obesity and its consequences, such as diabetes, are widespread in this country, especially among poor, ethnic and racial groups. Children covered by Medicaid are nearly six times more likely to be treated for a diagnosis of obesity than children covered by private insurance.”(9)
Many other studies have extensively documented adverse health effects of poverty on children, including not only frequency but also severity (including the severity that leads to hospitalization for respiratory diseases.(10) For children in low-income households, frequency of delayed immunization is three times the average, and asthma and bacterial meningitis are twice as common. “In the first year of life after the neonatal period, death rates are double to triple those of other children; after the first year, death rates due to disease are triple to quadruple among low-income children…. A study in Toronto demonstrated that children living in socioeconomically deprived areas were far more symptomatic than the adults in these areas from exposure to ambient air pollution in their neighborhood…. Several studies have linked pesticide exposure in childhood to increased rates of leukemia and brain cancer.”(284) It should be noted that pesticide exposure would be increased not only in agricultural areas but also in crowded, low-income conditions where insects such as roaches would be more likely to be a serious problem. Strong correlation between low-income neighborhoods and childhood obesity has been found recently in a study cited by the NIH. (284b)
Effects of confounders related to socio-economic status in studies dealing with cognitive effects of toxins that are heavily present in human milk (PCBs, specifically) have been well reported in the journal, Environmental Health Perspectives.(285b1)
In trying to explain the reasons why lower-income children “suffer disproportionately from almost every disease and show higher rates of mortality,” poor housing, lower-quality nutrition, and reduced access to quality medical care are key factors that are focused on. The lower an individual is in socioeconomic status, the more likely he or she is to experience adverse environmental conditions, such as exposure to pathogens and carcinogens. (285) The reader should bear in mind that the adverse outcomes alleged by the Surgeon General to result from not breastfeeding are known to result from conditions that are typical in low-income households, and bottle feeding is very disproportionately common in the low-income households.
Even if researchers were to try to properly adjust or control for the confounders that apply in these studies, there is no way of knowing all of the confounders that apply, or their full significance (illustrative example will follow); and there is no evidence that good efforts have been made to properly adjust for all of the confounders – the major review of breastfeeding studies that is pointed to by breastfeeding proponents (the AHRQ-contracted report) doesn't even attempt to determine whether adjustments for confounders have been properly made. New findings continue to come out, such as about the many adverse health effects of close residential distance to vehicular traffic, which varies inversely according to income levels (and therefore inversely according to breastfeeding rates); strong preliminary evidence about those effects was just published in 2012.(286)
According to the U.S. CDC, in 1995, infants born to non-Hispanic white mothers with less than 12 years of education were 2.4 times as likely to die in the first year of life as those whose mothers had at least 16 years of education. ((285b) Highlights page) Other statements from that same CDC page, connecting adverse health outcomes in children with the socio-economic conditions that tend to characterize bottle-feeding households: (1) Overweight was also inversely related to family income among non-Hispanic white adolescents; "Poor white adolescents were about 2.6 times as likely to be overweight as those in middle- or high-income families." (2) During 1994–95, poor and near-poor children under 6 years of age were only about one-half as likely to have seen a physician in the prior year as middle- or high-income children. (3) Children 1–14 years of age living in low-income areas were more than twice as likely to be hospitalized for asthma as those in high-income areas during 1989–91, suggesting to the CDC they may have been unable to receive outpatient care that could prevent such a hospitalization. (Think about how this could be the real explanation for the connection between bottle feeding and hospitalizations for lower respiratory tract diseases, even while various studies found no association between bottle feeding and non-hospitalization cases of such diseases; there is a standard term -- used by the CDC -- for hospitalizations that could have been prevented with proper earlier care: "avoidable hospitalizations.") (4) In 1995 poor adults were about four to seven times as likely (depending on ethnicities and genders compared) as high-income adults to report that their health status was fair or poor; although this reporting applied specifically to adults, the same factors of reduced quality of personal care, hygiene, diet, housing and medical care that affect health of adults would almost certainly affect their children as well. (3) (Bearing in mind that prenatal care serves important purposes in promoting the health of the infant) the CDC points out, "Pregnant women who have more education are more likely to start prenatal care early and to have more visits." (6) Two studies from New Zealand, targeting people who lived in homes with inadequate heating, found that, after adding insulation to better regulate the homes' temperatures, the number of children and adults listed in "poor or fair health" fell by about 50 percent, relative to a comparison group with no housing changes. (http://www.nlm.nih.gov/medlineplus/news/fullstory_134998.html) Breastfeeding enthusiasts will focus on the "association" between bottle feeding and bad health outcomes, but the CDC apparently recognizes that the bad health outcomes actually result instead from conditions related to the low education levels and low income that disproportionately go along with bottle feeding.
Bearing in mind that low-income mothers and smokers are disproportionately likely to bottle-feed, note the following (from a Columbia University study) about what are likely to be some real causes of the worse health outcomes of bottle-fed infants: "Inner-city minority populations are high-risk groups for adverse birth outcomes and also more likely to be exposed to environmental contaminants, including environmental tobacco smoke (ETS), benzo[a]pyrene B[a]P, other ambient polycyclic aromatic hydrocarbons (global PAHs), and residential pesticides."(285c)
Smoking: Smoking is known to be more prevalent in families in which infants are bottle fed. According to the CDC, smoking cigarettes during pregnancy was found in a study to be strongly associated with lower socioeconomic status (and therefore with bottle feeding) among all racial and ethnic groups. And also, among various associated health outcomes for infants of mothers who smoke are Sudden Infant Death Syndrome and asthma. In the CDC's words, "In every race and ethnic group, the more education women had, the less likely they were to report smoking during their pregnancy."(285b) Among non-Hispanic white mothers with less than a high school education (who are very likely to bottle feed), smoking during pregnancy was found to be 15 times as prevalent as among white mothers with 16 or more years of education (who are least likely to bottle feed). (The difference was only 10 times when comparing lower- vs. highly-educated mothers in general.) To read about the known correlation of educational levels with breastfeeding rates, see Section 1.2.s.1.a at www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm .
Data from the U.K. (in this chart) shows the different rates of smoking across socio-economic groups; those socio-economic differences are known to equate with higher or lower rates of breastfeeding in the U.S., U.K. and Germany.
The following is taken from the “WHO Report on Tobacco Smoke and Child Health,” 1999: “…maternal smoking during pregnancy causes well-established, demonstrable harm by reducing birth weight and increasing infant mortality… Parental smoking is an important cause of lower respiratory tract illnesses … during the first years of life…. Both asthma and respiratory symptoms … are increased among children whose parents smoke, on the basis of over 60 studies…. Over 40 studies with different designs have investigated effects of parental smoking across a range of outcomes from acute otitis media to surgery for glue ear. Pooled relative risks for these outcomes range from 1.2 to 1.4…. Overall, parental smoking, particularly by the mother, appears to be responsible for between a third and a half of all SIDS cases…. Children of smokers… have lower scores in cognitive functioning tests… and have more behavioural problems, including conduct disorders, hyperactivity, and decreased attention spans…. Tobacco smoke, whether voluntarily or involuntarily inhaled, includes numerous carcinogens.” According to a Spanish study, pregnant women who smoke or inhale secondhand smoke put their children at risk for learning difficulties, attention-deficit/hyperactivity disorder and obesity. (http://www.nlm.nih.gov/medlineplus/news/fullstory_129421.html )
According to an American/Czech/Slovakian study, "early life vulnerability to cigarette smoke manifests as increased rates of lower respiratory infections, asthma or wheeze, middle ear disease and sudden infant death syndrome.... An experiment in primates indicated that cigarette smoke exposure in either the prenatal period or the first few months of life, alters maturation of the immune system. (285d)
According to a more recent study cited by the NIH, "spending just 10 minutes in the backseat of a car with a smoker in the front increases a child's daily exposure to harmful air pollutants by up to 30 percent. And cracking a car window doesn't help.... Exposure to PAH (found in tobacco smoke) has been linked to immune system problems, wheezing, IQ changes and allergy development, the researchers noted."(285a)
According to KidsHealth.org, "African-American infants are twice as likely.... to die of SIDS as caucasian infants. Other potential risk factors include: smoking, drinking, or drug use during pregnancy, poor prenatal care, prematurity or low birth weight, mothers younger than 20, tobacco smoke exposure following birth ...." (287a) Notice how extremely well this profile of risk factors for SIDS fits the profile of typical bottle feeding mothers: low-income, smoking, young, often African-American, less likely to get prenatal care. Is it any wonder that a higher percentage of bottle-fed than breastfed babies end up dying of SIDS? And how likely is it that the SIDS cases normally result from bottle feeding rather than from other factors, including the apparent major genetic vulnerability of African-Americans, low-income conditions, immature mothers, and (especially) smoking, all of which disproportionately go along with bottle feeding? See the many references to the recognized connection of smoking with SIDS in the previous paragraph as well as in this one. (Aside from blacks and Native Americans, SIDS affects about one out of 2000 U.S. children (287b))
Unmarried women breastfeed at about half as high a rate as married women. (Section 1.2.s.2 at www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm. “Adolescent mothers (most of whom are unmarried)… have less healthy babies overall than do older mothers.” (288) This reinforces the connection between low income, bottle feeding, and adverse health outcomes, with low income life being the probable underlying cause of the adverse health conditions, and bottle feeding going together with the low income but not being a cause of the illnesses.
“Poverty tends to be associated with an increased incidence of malnutrition, and malnourished individuals are more susceptible to infectious diseases. Overcrowding is known to promote the spread of infectious diseases.” (288a) Aside from malnutrition, it is clear that low-quality foods (high in calories, fat, sugar and refined flour) are less expensive than foods of the kind (especially fruits and vegetables) that build good immune systems and healthy bodies without obesity. The Surgeon General's Call to Action to Support Breastfeeding (p. 32) recognizes that low income leads to poorer health and health care, quite aside from any effects of breastfeeding. Low-income families are more likely to live in noisy neighborhoods, near trains, airports or major highways, with the result that they have greater difficulty gaining the restorative benefits of proper sleep, in addition to poor air quality in such areas.
*As the author of the above, my role has not been to carry out original research, but instead it has been to read through very large amounts of scientific research that has already been completed on the subjects of environmental toxins and infant development, and then to summarize the relevant findings; my aim has been to put this information into a form that enables readers to make better-informed decisions related to these matters. The original research articles and government reports on this subject (my sources) are extremely numerous, often very lengthy, and usually written in a form and stored in locations such that the general public is normally unable to learn from them.
My main qualification for writing these publications is ability to find and pull together large amounts of scientific evidence from authoritative sources and to condense the most significant parts into a form that is reasonably understandable to the general public, while maintaining accuracy in what is said. My educational background included challenging courses in biology and chemistry in which I did very well, but at least as important has been an ability to correctly summarize in plain English large amounts of scientific material. I scored in the top one percent in standardized tests in high school, graduated cum laude from Oberlin College, and stood in the top third of my class at Harvard Business School.
There were important aspects of the business school case-study method that have been helpful in making my work more useful than much or most of what has been written on this subject, as follows: After carefully studying large amounts of printed matter on a subject, one is expected to come up with well-considered recommendations that can be defended against criticisms from all directions. The expected criticisms ingrain the habits of (a) maintaining accuracy in what one says, and (b) not making recommendations unless one can support them with good evidence and logical reasoning. Established policies receive little respect if they can’t be well supported as part of a free give-and-take of conflicting evidence and reasoning. That approach is especially relevant to the position statements on breastfeeding of the American Academy of Pediatrics and the American Academy of Family Physicians, which statements cite only evidence that has been
(a) selected, while in no way acknowledging the considerable contrary evidence(1) and
(b) of a kind that has been authoritatively determined to be of low quality; former U.S. Surgeon General Regina Benjamin acknowledged that essentially all of the research supporting benefits of breastfeeding consists merely of observational studies.(1a) One determination that evidence from observational studies is of low quality has been provided by Dr. Gordon Guyatt and 14 of his associates;(2) Dr. Guyatt is chief editor of the American Medical Association’s Manual for Evidence-based Clinical Practice, in which 26 pages are devoted to examples of studies (most of which were observational) that were later refuted by high-quality studies.(2a) A similar assessment of the low quality of evidence from observational studies has been provided by the other chief authority on medical evidence (Dr. David Sackett),(2c) writing about “the disastrous inadequacy of lesser evidence,” in reference to findings from observational studies.(2b)
When a brief summary of material that conflicts with their breastfeeding positions is repeatedly presented to the physicians’ associations, along with a question or two about the basis for their breastfeeding recommendations, those associations never respond. That says a lot about how well their positions on breastfeeding can stand up to scrutiny.
The credibility of the contents of the above article is based on the authoritative sources that are referred to in the footnotes: The sources are mainly U.S. government health-related agencies and reputable academic researchers (typically highly-published authors) writing in peer-reviewed journals; those sources are essentially always referred to in footnotes that follow anything that is said in the text that is not common knowledge. In most cases a link is provided that allows easy referral to the original source(s) of the information. If there is not a working link, you can normally use your cursor to select a non-working link or the title of the document, then copy it (control - c usually does that), then “paste” it (control - v) into an open slot at the top of your browser, for taking you to the website where the original, authoritative source of the information can be found.
The reader is strongly encouraged to check the source(s) regarding anything he or she reads here that seems to be questionable, and to notify me of anything said in the text that does not seem to accurately represent what was said by the original source. Write to dm@pollutionaction.org. I will quickly correct anything found to be inaccurate.
For a more complete statement about the author and Pollution Action, please go to www.pollutionaction.org.
Don Meulenberg
Fredericksburg, VA, USA