Breastmilk production

Q: Do you have any suggestions to encourage production of breastmilk? Am doing frequent feedings but not so good about using the breast pump. My son was born 3 weeks ago and I do not have enough breastmilk to sustain him and am having to use supplement-Similac Advance. I am B+ and he is A+. He is getting progressively fussier, gassier, and sleeping less deeply for shorter periods of time. He came home with jaundice and we had to do the billi-lights for several days. I am a 42 year old first time mom. I have had great success with the ER4YT personally and would appreciate your assistance. Thank You. Alice.

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A: There are many theories on the evolution of the mammary gland and mammalian lactation, one paper suggests that the process is an evolution of the innate immune system, and may have partly evolved as an inflammatory response to tissue damage and infection, the nutritional function of milk arising subsequent to its protective function.[1] It is one of the marvels of human physiology that a mother can carry throughout pregnancy and produce the perfect milk for a baby with a different blood group to her own.

When an infant has problems feeding there are usually three possible explanations:

1. The baby is not latching on correctly either due to a problem with the baby's suckling mechanism or the feeding position

2. There is a problem with milk production

3. The baby has a digestive disturbance

Failure to produce sufficient milk can relate to any of these three, as when the baby does not take enough milk it does not stimulate the mother's breast enough to lactate properly, creating a vicious circle.

Research by a midwife suggests that the mother's feeding position is significant in successful breastfeeding,[2] with mothers who recline having more success than mothers who sit at 90 degrees (being the position often shown in books to be 'correct' for breastfeeding). In addition, a biological nurturing position, with the baby's stomach in contact with the mother, can help to increase suckling and reduce the incidence of sore nipples, thereby enhancing milk flow.[3] A midwife experienced in breastfeeding or a member of La Leche League[4] may be able to advise further.

If the baby has difficulty latching on due to a problem with swallowing or a mechanical disturbance in the jaw, osteopathic manipulative medicine in the form of osteopathy in the cranial field may be helpful. Premature babies or those with other neurological delays in jaw development may benefit from a check with an osteopath skilled in this field of treatment.[5]

Difficulty with lactation other than the above can be due to maternal emotional stress, a very hungry baby, a baby who has been separated from his or her mother for the first hour immediately after birth (i.e. due to a caesarian birth or neonatal incubation) or whose mother has been subjected to certain anaesthetics such as pethidine during delivery.[6] A breast pump may help to increase production, but the device is not always easy to use. There are certain herbs that have traditionally been used to stimulate milk flow, and this approach is now being recognised by midwives.[7]

Some of the following herbs have been used historically to promote milk supply:[8]

* Milk thistle (Silybum marianum)

* Blessed thistle (Cincus benedictus)

* Fennel seeds and powder combined (Foeniculum vulgare)

* Fenugreek seeds and powder combined (Trigonella foenum-graecum)

* Dandelion leaf (Taraxacum officinale) - best eaten as a fresh green cooked vegetable

Auricular or ear acupuncture, was discovered outside China by a French doctor, and is founded on the principles of reflexology, a therapy that the biomedical establishment does not consider scientific.[9] Treatment of the mother using this method has been found to resolve hypogalactia (increase milk flow).[10][11]

Breastfeeding is not just good for the baby. Research by the Society of Obstetricians and Gynaecologists of Canada Breast Disease Committee found that there is evidence that the risk for premenopausal breast cancer is reduced in mothers who have breastfed, and the more breastfeeding she has done the greater the protective effect.[12]

Despite the benefits of breastfeeding for baby and mother, formula milk does sometimes have to be used, and may be helpful when weaning early. There are various types of formula milk available, it is a good idea to check for the one that is compatible with the baby's blood group, and also to ensure that weaning is done according to blood group.[13] Baby formula can be expensive, costing over $200 a week in the U.S. There is obviously big money to be made, and most of the mothers on the WIC free formula programme (see previous column[14]) are likely to be receiving the minimum wage. A writer skeptical about infant problems with cows' milk[15] is also suspicious of the association between the Act Against Allergy, the "interactive communication program"[16] and SHS International, the company who make Neocate, a hypoallergenic infant formula. This interactive communication program is also supported by the British Dietetic Association, and tricked BBC news into thinking Act Against Allergy is a "medical task force" that polled doctors - the BBC later changed their news page to reflect the fact that they are sponsored by a formula milk manufacturer.[17]

Incidentally, some studies have reported that mothers taking supplemental vitamin B6 may cause suppression of the pituitary hormone prolactin, which is raised after giving birth and responsible for milk production.[18][19] Other studies contradict these findings,[20] saying that 'nutritionally relevant' levels of B6 do not affect milk production. The 'nutritionally relevant' dose of vitamin B6 in thePediatrics study (no effect) was up to 4 mg per day, whereas the Italian study (significant effect) investigated the influence of vitamin B6 in 2 doses of 300 mg in one day. The method of action is believed to be through inhibition of pituitary cell proliferation and hormone secretion, in part mediated through pyridoxal-induced cell-cycle arrest and apoptosis.[21] Anyone taking large doses of vitamin B6 should be monitored by a healthcare professional.

Loneliness can affect your genes, according to a landmark study in Genome Biology [1] There were differences in the expression of 209 genes in the white blood cells of people experiencing chronic subjective social isolation (loners) compared to those in the blood of people who experience frequent social interaction (party-goers).

Although there is a recognised association between social interaction and health, the paper by professor Stephen Cole of UCLA Medical School shows for the first time the mechanisms behind what makes lonely individuals more prone to the inflammatory response: their genes were affected by particular pathways of transcription factors (which copy DNA to RNA) altering the activity of the genes that are specifically involved in activating the immune system through inflammation; they also have increased numbers of immune cells. Another finding was that even though the lonely individuals were producing slightly higher levels of anti-inflammatory cortisol, the effects of this were down-regulated due to their cortisol receptors not responding properly. Cole describes this as the immune system thinking that the cortisol is "crying wolf".

The adverse health effects of loneliness is not related to the number of friends that a person has, but to how many they think they have. This creates a subjective view of the world that others cannot be trusted, and a perception of the world as relatively more threatening. Now if we could just find the gene that creates the perception of loneliness in a person ...



References

1. Cole SW, Hawkley LC, Arevalo JM, Sung CY, et al. "Social regulation of gene expression in human leukocytes." Genome Biol. 2007 Sep 13;8(9):R189 PMID: 17854483

2. Blog: Genes Get Lonely Too

A study on the effects of milk consumption on growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in children suggests that milk drinking may cause increases in pituitary growth hormone levels of prepubertal girls and boys.

The article, published in Nutrition Journal[1] measured the effects of drinking three 8-ounce tetrapak “boxes” (710 ml) of conventional U.S. UHT-pasteurized vitamin D fortified whole milk daily for one month (the producer of the milk accepts milk only from dairies that do not use bovine somatotropin). A class of Mongolian children (who rarely consume milk) were compared with American children: the Mongolian children experienced rapid linear growth (the equivalent of 12 cm/year) compared to an average height velocity of 5-6 cm/year in U.S. children age 10-11 years. It is suggested that this was not the effects of correcting undernutrition, but that milk intake may raise GH levels. This is a novel finding, and the authors suggest that "nutrients or bioactive factors in milk may stimulate endogenous GH production," that is, secretion of hormones from the pituitary gland may be increased by drinking milk.

Apart from stimulating abnormal growth in prepubertal children, what could be the long-term side-effects of an increase in the pituitary growth hormone in those with otherwise normal growth hormone levels? Another study [2] notes how GH/IGF-1 provides an anti-apoptotic environment (a situation where programmed cell death is delayed) that may favour survival of genetically damaged cells.

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The ability to digest starch may have given our human ancestors an evolutionary advantage in certain circumstances, according to an article by George Perry et al. in Nature Genetics.[1] The enzyme amylase, secreted by salivary glands (and also by the pancreas), helps to hydrolyse or break down starch in the diet when mixed with water. The gene that produces the enzyme in saliva, called AMY1, is on chromosome 1, other authors have theorised that the salivary amylase gene evolved from the pancreatic amylase gene via an upstream retrovirus insertion.[2]

Perry's team took salivary and DNA samples from people of Datog, Hadza, Mbuti, Biaka, Japanese, Yakut and European-American populations and analysed their typical dietary protein and starch intake. The results indicate that geographically distinct groups of humans tend to have variable levels of the AMY1 gene according to the level of starch in their diets: Those whose diets consist of higher protein levels tended to have on average fewer copies of the gene, and vice versa. More copies of the gene leads to a higher level of salivary amylase. Fruit-eating chimpanzees however have few copies of the gene. The authors suggest that: "This behavioral variation raises the possibility that different selective pressures have acted on amylase", i.e. it could be evidence for genetic adaptation to the availability of starch in the environment.

Another study in the American Journal of Human Genetics[3] published just a month prior to Perry's article suggests that the gene for lactase persistence (LP, the ability to digest the lactose sugar in milk after childhood) came about through evolution of two groups geographically and chronologically distinct, and that "there is a still-ongoing process of convergent evolution" of the LP alleles in humans".

It appears that we are still evolving according to what we eat, but can our genes keep up with the pressures inflicted on us by modern western diets?

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Announcing two lectures at the RDS in Dublin, Ireland. This year the date and location have changed, so check the website for details.

Both lectures are on Saturday 1st September 2007; in the first lecture at 1.00 pm Tom Greenfield ND will introduce the concept of the GenoType Diet in the forthcoming book by Dr. Peter D'Adamo ND. The venue is the Nutrition Theatre, places are limited.

In the second lecture at 4.00 pm Ingrid Greenfield of Artisan Bread Original will be demonstrating how to make sandwiches compatible with all blood groups, and samples for tasting will be available. The venue is Centre Hall.

Both speakers will be available at the Artisan Bread stand in the main exhibition hall on Saturday and Sunday.

There is a charge for entry to the event on the day, but free tickets can be obtained in advance from the website.

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