Tagged Breastfeeding

Breast-Fed Babies May Have Longer Telomeres, Tied to Longevity

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Credit Roberto Schmidt/Agence France-Presse — Getty Images

Breast-fed babies have healthier immune systems, score higher on I.Q. tests and may be less prone to obesity than other babies.

Now new research reveals another possible difference in breast-fed babies: They may have longer telomeres.

Telomeres are stretches of DNA that cap the ends of chromosomes and protect the genes from damage. They’re often compared to the plastic tips at the end of shoelaces that prevent laces from unraveling. Telomeres shorten as cells divide and as people age, and shorter telomeres in adulthood are associated with chronic diseases like diabetes. Some studies have linked longer telomeres to longevity.

The new study, published in The American Journal of Clinical Nutrition, is a hopeful one, its authors say, because it suggests telomere length in early life may be malleable. The researchers, who have been following a group of children since birth, measured the telomeres of 4- and 5-year-olds, and discovered that children who consumed only breast milk for the first four to six weeks of life had significantly longer telomeres than those who were given formula, juices, teas or sugar water.

Drinking fruit juice every day during the toddler years and a lot of soda at age 4 was also associated with short telomeres.

Socioeconomic differences among mothers can muddy findings about breast-feeding because the practice is more common among more educated mothers. However, this group of children was fairly homogeneous. All of them were born in San Francisco to low-income Latina mothers, most of whom qualified for a government food program.

“This adds to the burgeoning evidence that when we make it easier for mothers to breast-feed, we make mothers and babies healthier,” said Dr. Alison M. Stuebe, an expert on breast-feeding who is the medical director of lactation services at UNC Health Care in Chapel Hill, N.C., and was not involved in the study. “The more we learn about breast milk, the more it’s clear it is pretty awesome and does a lot of cool stuff.”

The study did not establish whether or not breast-feeding enhanced telomere length. It may be that babies born with longer telomeres are more likely to succeed at breast-feeding. A major drawback of the research was that telomere length was only measured at one point in time, when the children were 4 or 5 years old. There was no data on telomere length at birth or during the first few months of life.

“We don’t have a baseline to see if these kids were different when they came out,” Dr. Stuebe said. “It could be that really healthy babies can latch on and feed well, and they already had longer telomeres. It could be successful breast-feeding is a sign of a more robust kid.”

The researchers were following children who were part of the Hispanic Eating and Nutrition study, a group of 201 babies born in San Francisco to Latina mothers recruited in 2006 and 2007 while they were still pregnant. The goal of the research was to see how early life experiences, eating habits and environment influence growth and the development of cardiac and metabolic diseases as children grow.

Researchers measured the babies’ weight and height when the children were born. At four to six weeks of age, they gathered detailed information about feeding practices, including whether the baby had breast milk and for how long, and whether other milk substitutes were used, such as formula, sugar-sweetened beverages, juices, flavored milks and waters. Information was also gathered about the mothers.

Children were considered to have been exclusively breast-fed at 4 to 6 weeks of age if they received nothing but breast milk, as well as medicine or vitamins.

When the children were 4 and 5 years old, researchers took blood spot samples that could be used to measure the telomeres in leukocytes, which are white blood cells, from 121 children. They found that children who were being exclusively breast-fed at 4 to 6 weeks of age had telomeres that were about 5 percent longer, or approximately 350 base pairs longer, than children who were not.

The new findings may help explain the trove of benefits that accrue from breast-feeding, said Janet M. Wojcicki, an associate professor of pediatrics and epidemiology at the University of California, San Francisco, and the paper’s lead author.

“What’s remarkable about breast-feeding is its ability to improve health across organ systems,” Dr. Wojcicki said. “Telomere biology is so central to the processes of aging, human health and disease, and may be the link to how breast-feeding impacts human health on so many levels.”

There are several possible explanations for the correlation between breast-feeding and longer telomeres. Breast milk contains anti-inflammatory compounds, which may confer a protective effect on telomeres. It’s also possible that parents who exclusively breast-feed their babies are more scrupulous about a healthy diet generally.

Yet another possibility is that breast-feeding is a proxy for the quality of mother-child attachment and bonding, said Dr. Pathik D. Wadhwa, who was not involved in the research but studies early-life determinants of health at the University of California, Irvine School of Medicine. “We know from studies looking at telomere length changes in babies who came from orphanages that the quality of the attachment and interaction, and more generally the quality of care that babies receive, plays a role in the rate of change in telomere length,” he said.

When children are exposed to adversity, neglect or violence at an early age, “psychological stress creates a biochemical environment of elevated free radicals, inflammation and stress hormones that can be harmful to telomeres,” said Elissa Epel, one of the authors of the study who is a professor at the University of California, San Francisco, and director of the Aging, Metabolism and Emotions Lab.

“The idea that breast-feeding may be protective for telomeres is heartening because we don’t know much about what’s going to help protect them in children, besides avoiding toxic stress. And boy, do we want to know,” Dr. Epel said.

Although genes can’t be changed, Dr. Epel said, “This is part of the genome that appears to be at least partly under personal control.”

The Benefits of Spicing Up a Breast-Feeding Mother’s Diet

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Credit Anna Parini

When I had my children I felt that there was a tendency by experts, including those in my own pediatric profession, to push certain principles that took all the fun out of life. This played out for me, in particular, after I gave birth to my first child, and was told as part of my breast-feeding “support” that I should avoid all spicy foods, because they would upset the baby. Like any good Cambridge, Mass., mother, I turned this into an argument about multiculturalism (“What about the mothers in Sichuan?”), but what I really thought was that it harked back to some old ideas about spices heating up the blood, and generally making life too interesting for the nursing mother.

Why are women told to avoid strong flavors when breast-feeding?

Twenty-five years ago, researchers asked a group of nursing mothers to load up on garlic. In the study, “Maternal Diet Alters the Sensory Qualities of Human Milk and the Nursling’s Behavior,” which ran in 1991 in the journal Pediatrics, nursing mothers who ate garlic produced breast milk with a stronger smell, as evaluated by researchers who didn’t know which sample was which. What was most interesting was how the milk tasted to the babies, those poetically named “nurslings.” When the garlic effect was there, the babies stayed longer on the breast, and nursed more vigorously.

Julie Mennella, a biopsychologist at the Monell Chemical Senses Center in Philadelphia, was the lead author on the 1991 study; she has continued to study the effect of early exposures on the development of taste. “Amniotic fluid and mother’s milk have a lot of sensory information,” she told me. “The baby gets the information when they feed on the milk.”

Another study, published in 2001, showed that babies who had been exposed to a flavor in utero or while nursing were more likely to like that flavor when they were weaned.

What goes into your stomach goes into your bloodstream, broken down into molecules of protein, carbohydrate, fat. The flavors cross as well, including potent molecules called volatiles, which carry scent, which in turn heavily influences taste, as you know if you have ever tried to eat something delicious when you have a bad head cold.

The variety of flavors that you eat during pregnancy go into your blood and then into the amniotic fluid, which the baby is constantly drinking, in utero, and the flavors that you eat while nursing cross from the blood vessels that supply the mammary glands into the breast milk. So instead of restricting the maternal diet, there’s now good evidence that by eating a wide variety of healthy and tasty foods during these periods, we are actually doing our babies a major favor.

“Breast-fed babies are generally easier to feed later because they’ve had this kind of variety experience of different flavors from their very first stages of life, whereas a formula-fed baby has a uniform experience,” said Lucy Cooke, a psychologist specializing in children’s nutrition, who is a senior research associate at University College London. “The absolute key thing is repeated exposure to a variety of different flavors as soon as you can possibly manage; that is a great thing for food acceptance.”

Her own research has included working with children at the age of weaning to increase the acceptance of vegetables by offering repeated exposures to them.

“Babies are tremendously adaptable and very accepting of all sorts of strange flavors,” Dr. Cooke told me.

What about the idea that some foods in the mother’s diet can make a baby fussy or gassy or colicky? By definition, the foods that cause gas in the mother do so because they are not absorbed, and sit in her intestine, making trouble. On the other hand, a number of studies suggest that some colicky babies do better if their mothers stay away from cow’s milk, so doctors may advise nursing mothers to cut that out for a 10- to 14-day trial, while making sure they still get plenty of calcium.

Caffeine is sometimes also a culprit, pointed out Dr. Pamela High, a professor of pediatrics at Brown University and medical director of the Infant Behavior, Cry and Sleep Clinic at Women & Infants Hospital of Rhode Island. But mothers of colicky babies often restrict their diets further and further, and many ultimately give up nursing, Dr. High told me in an email, even though this usually doesn’t help.

So yes, the flavors we eat when we’re pregnant, or when we’re nursing, go to the baby, aromatics and all. But this should be a positive message rather than a list of thou-shalt-nots, since it means that we are providing something beyond protein and calories; we’re actually letting our babies, unborn and born, into some of the joys of our human omnivory.

“A diet of the healthy foods she enjoys is modeling at its best,” Dr. Mennella said. “The baby only learns if the mother eats the foods.”

When, as a nursing mother, I ate the spicy foods that I love so well, I’ll have you know that I was actually modeling. My children, after all, were going to grow up in a family in which spicy food was part of every possible family occasion.

And if the flavors of the foods you love can make the experience of childbearing and child rearing a little tastier, or spicier, for mothers, that’s all to the good as well, and very much in line with what we hope our children are drinking in mother’s milk.

“Food gives pleasure,” Dr. Mennella said. “There’s a lot of biology underlying the pleasure of eating.

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Support for Breast-Feeding, in a Multitude of Ways

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Credit Paul Rogers

In 2001, when Dr. Alison Stuebe was pregnant with her first child, breast-feeding was a personal challenge that soon morphed into a professional research interest. Her son Noah was 3 months old when she began her residency in maternal-fetal medicine at Brigham and Women’s Hospital in Boston. Determined to nurse him for a year, she arrived at the hospital carrying a breast pump and, through sheer determination, more than met her goal. Noah was 2½ before he was weaned.

In the years since, with two more breast-fed sons, Dr. Stuebe has become a leading expert in the health value of breast-feeding for both mother and baby and a tireless advocate for new mothers trying to navigate its all-too-frequent challenges.

As the leading author of new guidelines from the American College of Obstetricians and Gynecologists, Dr. Stuebe insists that, given timely information, professional and workplace support, and hands-on help when needed, many more women would breast-feed their babies, and do so exclusively for the first half year of life, as recommended by the college, the American Academy of Pediatrics and the World Health Organization.

“Moms deserve better support, and obstetric providers can and must help, both by assisting their patients and by advocating for policies and practices that enable women to achieve their goals,” she said. And, the guidelines maintain, that support should begin as early as the first trimester of pregnancy.

To be sure, much has changed for the better since 1972, when breast-feeding by American women reached its nadir of 24 percent. Just three years prior, when my twin sons were born and a serious postpartum infection kept me in the hospital for 13 days, isolated from them, I had to beg for a breast pump every four hours. My desire to breast-feed was belittled by the nurse in charge: “You can always feed them formula,” she said dismissively as I dissolved in tears.

Today, more than three-fourths of women start to breast-feed, although more than half end up weaning their babies sooner than they would have liked, often short of six months. The target set byHealthy People 2020, a federal initiative to promote good health, would have nearly 82 percent of babies breast-fed initially, 60.6 percent at six months and 34 percent at one year.

Faced with financial and logistical stresses, many new mothers find it challenging to meet such a goal. Working women rarely get more than six weeks of paid maternity leave, and once back at work, the obstacles to expressing and storing breast milk can be daunting.

Accordingly, the new guidelines urge policy changes that “protect the right of a woman and her child to breast-feed,” including “paid maternity leave, on-site child care, break times for expressing milk,” and a place “other than a bathroom” to do so. Two decades ago, a former colleague of mine gave up her dream job after two frustrating months pumping milk in the office lavatory.

“Breast-feeding is optimal and appropriate for most women,” the new guidelines state. However, they add, while advice and encouragement by obstetric professionals are recommended, no woman should be coerced, pressured or unduly influenced to breast-feed.

Among the few medical contraindications to breast-feeding are infections in the mother – H.I.V., untreated tuberculosis, chickenpox or a herpes lesion on the nipple – and mothers being treated with cell-killing cancer drugs. Although clear-cut data are lacking on the effects of marijuana on breast-fed infants, the drug can get into breast milk and the guidelines discourage marijuana use by nursing mothers. Babies with the genetic disorder galactosemia, which impairs digestion of a sugar in milk, should not breast-feed.

During pregnancy, women trying to decide whether to breast-feed deserve to be informed about both its benefits and barriers and be given an opportunity and assistance to find ways around any obstacles, the guidelines state.

Both mother and baby benefit from breast-feeding. Women who breast-feed have a lower than average risk of developing breast cancer, ovarian cancer, diabetes, hypertension and heart disease later in life. Breast-fed infants enjoy greater protection from infections, sudden infant death syndrome and metabolic disease. Babies born prematurely especially benefit from breast milk, which lowers their risk of infections, especially necrotizing enterocolitis, a serious intestinal disease.

Assessing the health of a woman’s breasts and her prior experience with breast-feeding should be part of prenatal care, the guidelines urge. Past or anticipated difficulties and concerns should be discussed, ideally in conjunction with the woman’s partner, and strategies devised to make the desired feeding plan compatible with the needs and values of the woman and her family.

Ultimately, the obstetric guidelines conclude, a well-informed woman is best qualified to decide whether to breast-feed exclusively, combine breast with formula-feeding or feed only formula.

“Physicians should not be dogmatic,” Dr. Stuebe said. “Formula is not poison. Like antibiotics, if it’s needed, it should be used judiciously.”

I created my own plan when I could produce only a quarter of the milk my twins were consuming and faced conflicting advice from the obstetrician and pediatrician. I chose to combine the advice, first offering each baby the breast, then topping it off with formula. When I finally began producing enough milk, they all but gave up the bottle.

As in the past, the new guidelines disparage an all-too-common practice of outfitting new mothers at discharge with a “gift bag” that contains samples of formula, which can suggest that the hospital endorses formula feeding. Direct-to-consumer marketing of infant formula is also disparaged.

But even the most determined breast-feeder can sometimes have difficulty at first establishing successful nursing. Such women face an increased risk of developing postpartum depression “and should be screened, treated and referred appropriately,” the guidelines note.

Accordingly, there is now a growing legion of professional lactation specialists who can help. Some hospitals have them on staff. More good news: The services of a certified lactation consultant or counselor are now covered as preventive care under the Affordable Care Act.

A lactation specialist may also be helpful to women who stop nursing before they want to because of problems with pain, low milk supply or difficulty getting the infant to latch on to the breast.

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