Discussion on Breastfeeding

MY ORIGINAL POST:

There are so many reasons where formula milk is essential. Here are a few: many women do not produce any or enough milk; some women are separated from their baby due to postpartum health issues (mother or baby); many women take essential medication that passes into milk and is unsuitable for their baby; some women are too ill to breast feed or express milk; some women die in childbirth; some babies are immediately taken from their mothers due to rejection (sometimes planned); there might be need for extra fluid or nutrition due to diarrhoea including illnesses such as cholera or typhoid. There are many others.

A REPLY TO MY ORIGINAL POST:

If you look into breastfeeding and breastfeeding support you'll see that, yes, formula can be vital for many of those points you're making, but in the vast majority this is not true. If it was the human race wouldn't have survived so long. The biggest obstacle to breastfeeding is lack of support and formula companies pushing their products and misinformation. The statement that many women do not produce enough milk is simply wrong. With support and letting baby nurse whenever it wants to, the vast majority will produce enough milk. In the vast cases breastfeeding friendly medication can be given. And in case of illness, esp where diarrhoea and or vomiting are involved, no better fluid can be given than the mother's breastmilk with all its antibodies and nutrients. If the mother cannot nurse for whatever reason, there is also the option of donor milk. Humanmilk4humanbabies is one of those organisations. But many hospitals have their own donor milk bank for premature babies, as there is nothing superior for a little baby, especially if sick and or premature than human milk.

MY REPLY TO THE REPLY

YOU: if you look into breastfeeding and breastfeeding support you'll see that, yes, formula can be vital for many of those points you're making, but in the vast majority this is not true. If it was the human race wouldn't have survived so long.

ME: Firstly, I am a great supporter of breast feeding. In normal circumstances it is the best. But, contrary to your reply, many circumstances are not 'normal', whether in the western or developing world and your assumptions seem to be derived from anecdotes rather than empirical evidence. I'll comment on your 'vast majority' comment several times below. I've provided references supporting my points for you to browse at your leisure.

The human race wouldn't have been maintained in such a healthy, numerous and long-lived form without countless interventions from the scientific and medical professions. Breast milk does not protect against most pathogens, but luckily we have vaccines, antibiotics and more recent novel antimicrobial treatments such as antibody therapy and affimers.

In the developing world, there are many issues with breast feeding, including undernourished and dehydrated mothers, and disease transmission, particularly HIV transmission through breast milk (http://www.who.int/bulletin/volumes/86/3/07-041673/en/). What would you decide to do, knowing that nutritionally breastfeeding might be best, but that if choosing to breastfeed you would transmit HIV to your baby? The numbers involved are far from trivial. Here are some details: http://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures. Of course, the HIV issue also applies to the developed world, but the involvement of readily available health care mitigates the issue a little, though it's still a serious problem.

YOU: The biggest obstacle to breastfeeding is lack of support and formula companies pushing their products and misinformation.

ME: The biggest obstacle to breastfeeding in the western world is lifestyle, and the freedom to choose activities that hamper breastfeeding, especially those related to work. One possible solution, expressing milk for use by, for example, child carers sounds very good, but the logistical problems are great. There is a great deal of scope to improve this, but if mothers prefer to use formula for convenience, that is their right and choice. Likely their children will still grow up fit and healthy and any problems with their dissociation from breastfeeding could be more psychological than physical.

That there are companies producing and marketing formula does not equal compulsion to purchase and use. You do women a disservice by criticising their choice to use formula. I think there is sufficient information to counter any, as you call it 'misinformation' from formula suppliers. Indeed, mothers are bombarded, if not intimidated, by information suggesting they should breast feed.

YOU: The statement that many women do not produce enough milk is simply wrong. 

ME: There are many mothers (from the 3.7 billion females in the world an estimated 2 billion are mothers) who have issues leading to poor milk stimulation/production. Some causes:

• The baby is not attaching well at the breast.
• The baby does not feed often enough. (Nearly all babies need to feed at least 8 to 12 times in 24 hours).
• The baby does not feed effectively at the breast.
• The mother had breast surgery that is effecting milk supply.
• The mother as recently had mastitis.
• The mother is taking oral contraceptive pills containing oestrogen.
• The mother smokes cigarettes.
• Some medications, including over-the-counter and herbal preparations such as cold/flu tablets, may reduce your milk supply.
• There may be reduced or no milk production because of a medical condition. (Although this occurs in less than five per cent of mothers of the 2 billion mothers this cause alone would affect 100 million).

So your numbers game is not a sufficient argument here, unless 100s of millions of mothers with problems are not a sufficient problem, in your opinion.

YOU: With support and letting baby nurse whenever it wants to, the vast majority will produce enough milk. 

ME: Your numbers game pops up again here. The same argument relating to numbers, as mentioned above, applies - there are 100's of millions of mothers with poor milk supply. And again, in the west, lifestyle and the freedom to choose activities that are hampered by breastfeeding, especially those related to work, are a factor. From above, nearly all breastfed babies need to feed at least 8 to 12 times in 24 hours. Working mothers, single mothers, ill mothers, fatigued mothers do not all choose to be disturbed to breastfeed. The same points arise as earlier with expressing milk for later use.

YOU: In the vast cases breastfeeding friendly medication can be given.

ME: It sort of goes against the natural status of breastfeeding if drugs (that are almost all synthetic) are used to stimulate it. As with all medications, side effects are possible, and many have been reported with all such medications currently available. There are so many that I wouldn't be able to discuss them all here. The two most popular drugs, according to medical and lactation experts, are Reglan, which has been found in rare cases to cause an irreversible facial muscle-spasm condition called tardive dyskinesia, which can resemble Tourette’s Syndrome or Parkinson’s disease, and Domperidone, which is not FDA-approved and mostly found via Canadian online pharmacies. One of Reglan’s side effects, according to the FDA, is depression - a condition some new mothers are already at risk of. Take it from me, (I have an MSc in Medicinal and Pharmaceutical Chemistry), there is no such thing as a 100% safe drug.

Also, while there is anecdotal evidence that the drugs appear to help some women make more milk, a 2011 report released by the American Academy of Breastfeeding Medicine found no conclusive evidence of “correlation between baseline prolactin levels and rates or milk synthesis or measured volumes of milk production.” The study also found that previous studies on the effectiveness of the drugs in increasing milk supply have “generally been of poor quality,” lacking randomisation and having small sample sizes for testing. “The case for using pharmaceutical galactogogues [substances used to increase lactation] has grown weaker,” the report found. (http://www.bfmed.org/Media/Files/Protocols/Protocol%209%20-%20English%201st%20Rev.%20Jan%202011.pdf)

Personally, if I had to choose, I would select formula anytime over using drugs to stimulate breastmilk.

YOU: And in case of illness, esp where diarrhoea and or vomiting are involved, no better fluid can be given than the mother's breastmilk with all its antibodies and nutrients.

ME: I have a PhD in microbiology and lectured in the areas for many years. So it would be my pleasure to discuss this matter till the cows come home. (Was that a pun? Almost, but a bad one.) The three major causes of neonatal deaths worldwide are infections (36%, which includes sepsis/pneumonia, tetanus and diarrhoea). In the developing world diarrhoeal disease is a major, if not the major cause of infant death. Acute diarrhoea in babies and young children can be life threatening due to the risks of dehydration. Some of the infectious agents known to cause diarrhoea include:

• Viruses – such as calici virus, adenovirus and rotavirus;
• Bacteria – such as E. coli, Campylobacter, V. cholerae, Shigella, Salmonella and Staphylococcus aureus;
• Parasites – such as Giardia lamblia, Cryptosporidium parvum and tapeworm.

Breastmilk does not and cannot abate these conditions. Medical intervention does. Sometimes it is a very simple treatment but saves millions of lives. Babies and young children with diarrhoea need prompt medical attention. Treatment for diarrhoea depends on the cause, but includes:

• Plenty of fluids to prevent dehydration;
• Oral rehydration drinks to replace lost salts and minerals;
• Intravenous replacement of fluids in severe cases;
• Medications such as antibiotics and anti-nausea drugs;
• Anti-diarrhoeal medications;
• Treatment for any underlying condition, such as inflammatory bowel disease.

Newborn passive immunity is very temporary (hence the importance of beginning childhood immunisations when the babies are two months old). Breastmilk does contain antibodies, especially in colostrum, but the antibodies are derived from the mother and only provide immunity for some of the conditions that the mother has experienced, such as chickenpox. Antibodies against certain infectious diseases such as whooping cough are not transferrable so the baby cannot depend on maternal antibodies for protection in all cases. Premature babies are particularly vulnerable as their immune systems are not well developed and they are less likely to have benefited from passive protection. Vaccines can be particularly beneficial for premature births. Protection for most of the important killer diseases will not be available to babies from breastmilk. 

YOU: If the mother cannot nurse for whatever reason, there is also the option of donor milk. Humanmilk4humanbabies is one of those organisations. But many hospitals have their own donor milk bank for premature babies, as there is nothing superior for a little baby, especially if sick and or premature than human milk.

ME: Donor milk networks - a nice idea but unlikely to be widespread or popular enough to make a real impact, aside from the logistics especially in rural areas and the developing world. That the initiative states only 1000s of donors over the 52 countries where it is active suggests a 'hug a tree' type enterprise that might be popular with the middle class Greens. Hopefully it might have an explosive expansion but with Health Canada and the FDA (amongst others) issuing warnings about the potential risks of milksharing it will be an uphill struggle. A study has shown that of 1091 potential donors, 3.3% were infection positive on screening serology, including 6 syphilis, 17 hepatitis B, 3 hepatitis C, 6 HTLV [human T cell lymphotropic virus] and 4 HIV (http://fn.bmj.com/content/95/2/F118.abstract). Can the donated milk be tested for HIV and other milk transmissible pathogens economically and rapidly enough? Would you really want to risk using these sources of milk? (http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/PediatricAdvisoryCommittee/UCM235629.pdf).

Hospital donor milk banks are also a good idea although premature babies are the minority of births. But you might want to look into the statistics as I know you're fond of the numbers game. 😉

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Nothing is perfect in this world and certainly not human physiology - we sit on a branch of the evolutionary tree and that tree has no perfection, just an ongoing fight to adapt to changing environments - a fight that will be never ending. In the meantime we have to use our noggins to try and outwit our predatory and parasitic enemies, amongst other trials and tribulations.

All the best, and keep pushing the cause. Just be aware of the problems.

Cutting through mucus with the influenza virus neuraminidase

Neuraminidase is one of three different viral proteins embedded in the lipid membrane of influenza virus (NA is blue in the illustration at left). This enzyme has a clear and proven role in virus release from cells. NA is also believed to be important during virus entry, by degrading the mucus barrier of the respiratory tract and allowing virus to reach cells. This role is supported by the finding that treatment of mucus-covered human airway epithelial cells with the NA inhibitor Tamiflu substantially suppresses the initiation of infection. Further evidence comes from the recent finding that influenza virus binds to sialic acids in mucus and that NA cleaves these sugars to allow infection. Virology BLog, 9 Jan 2014 01:54 by Vincent Racaniello

A feline and human pathogenic fungus joins the new species list

A new species of fungus that causes life-threatening infections in humans and cats has been discovered by a University of Sydney researcher.

"This all originated from spotting an unusual fungal infection in three cats I was seeing at the University's cat treatment centre in 2006," said Dr Vanessa Barrs, from the University's Faculty of Veterinary Science, whose findings have just been published in PLOS One.

"These cats presented with a tumour-like growth in one of their eye sockets, that had spread there from the nasal cavity. The fungal spores are inhaled and in susceptible cats they establish a life-threatening infection that is very difficult to treat."

Six years of investigation followed, including working with some of the world's leading fungal experts at the CBS-KNAW fungal biodiversity centre in The Netherlands.

"Finally I was able to confirm this as a completely new species, Aspergillus felis, which can cause virulent disease in humans and cats by infecting their respiratory tract. We were able to demonstrate that this was a new species of fungus on a molecular and reproductive level and in terms of its form.
"Similar to the closely related fungus Aspergillus fumigates, this new species of fungus can reproduce both asexually and sexually - and we discovered both phases of the fungus."

Since the first sighting of the new species, more than 20 sick domestic cats from around Australia and one cat from the United Kingdom have been diagnosed with the fungus. The fungus appears to infect otherwise healthy cats but in the two humans identified it attacked an already highly compromised immune system. The disease is not passed between humans and cats but its study in cats will not only help their treatment but provide a good model for the study of the disease in people. There is only a 15 percent survival rate of cats with the disease and it has so far proved fatal in humans. To date only one case has been identified in a dog.

"We are right at the start of recognising the diseases caused by this fungus in animals and humans. The number of cases may be increasing in frequency or it may just be we are getting better at recognising them," Dr Barrs said.

"Fungi like Aspergillus felis can be easily misidentified as the closely related fungus Aspergillus fumigatus, which is a well-studied cause of disease in humans. However, A. felis is intrinsically more resistant to antifungal drugs than A. fumigatus and this has important implications for therapy and prognosis."

The next step for Dr Barrs and her team is studying fungi in culture collections throughout Australia to determine the prevalence of A. felis infections in people with previously diagnosed aspergillosis. They will collaborate with researchers at the Westmead Millenium Institute for Medical Research.


(Left) A cat with a swollen eye due to a fungal granuloma in its eye socket. (Right) The same cat after being successfully treated. The disease has only a 15 percent survival rate.

Media enquiries: Verity Leatherdale, 02 9351 4312, 0403 067 342, verity.leatherdale@sydney.edu.au

DNA in Human Genomes

A new study finds strong evidence that bacteria can transfer genes into human genomes, especially in cancer cells. By Ed Yong | June 20, 2013 | The Scientist A team of scientists from the University of Maryland School of Medicine has found the strongest evidence yet that bacteria occasionally transfer their genes into human genomes, finding bacterial DNA sequences in about a third of healthy human genomes and in a far greater percentage of cancer cells. The results, published today (20 June) in PLOS Computational Biology, suggest that gene transfer from bacteria to humans is not only possible, but also somehow linked to over-proliferation: either cancer cells are prone to these intrusions or the incoming bacterial genes help to kick-start the transformation from healthy cells into cancerous ones. “It really does seem that human genome sequence data from somatic cells show signs of LGT events from bacteria, and so do cancer cells,” said Jonathan Eisen from University of California, Davis, who coordinated the peer review of the new study but was not involved in the work. “Wild stuff does happen.” The trillions of bacteria in our bodies regularly exchange DNA with each other, but the idea that their genes could end up in human DNA has been very controversial. In 2001, the team that sequenced the first human genome claimed to have found 113 cases of such lateral gene transfers (LGT), but their conclusion was later refuted. This high-profile error “had a chilling effect on the field,” according to Julie Dunning Hotopp who led the new study. Although her team has since found several cases of LGT between bacteria and invertebrates, “it’s still difficult to convince people that it may be happening in the human genome,” she said. Rather than looking for bacterial genes that had become permanent parts of the human genome, Dunning Hotopp’s team searched for traces of microbial DNA in somatic cells—the cells of the body that do not form gametes. Lab members David Riley and Karsten Sieber scanned publicly available data from the 1000 Genomes Project and found more than 7,000 instances of LGT from bacteria, affecting around a third of the people they studied. When they analyzed sequences from the Cancer Genome Atlas, they discovered 691,000 more instances of LGT 99.9 percent of these came from tumor samples rather than normal tissues. Acute myeloid leukaemia cells were particularly rife with bacterial sequences. A third of the microbial genes came from a genus called Acinetobacter, and had been inserted into the mitochondrial genome. Stomach cancer cells also contained lots of bacterial DNA, especially from Pseudomonas. Most of this DNA had been inserted into five genes, four of which were already known to be proto-oncogenes that can give rise to cancer, emphasizing a possible link between LGT and cancerous growth. “Finding these integrations in multiple individuals, as well as in the proto-oncogenes, really spoke to how significant this might be,” said Dunning Hotopp. “We know already that a significant proportion of cancers are due to insertion of genetic material from viruses,” said Etienne Danchin from the French National Institute for Agricultural Research, who reviewed the paper. “But this is the first time, as far as I know, that HGT from bacteria could be suspected as a cause of cancer.” However, Dunning Hotopp is very clear that her results tell us nothing about whether the inserted bacterial DNA contributed to causing the cancers, or were just along for the ride. To get at the question of causation, researchers could deliberately add bacterial DNA into the same sites within human cell lines to see if they turn cancerous, she said. But even if the bacterial LGT can initiate over-proliferation, it would be hard to prevent such transfers with antibiotics. “You don’t know when these transfers occur, and you can’t give people antibiotics their entire life,” said Dunning Hotopp. “A vaccine would be nice, but that is assuming these are causative.” “LGT is incredibly important in evolution but many claims of specific cases of LGT have been seriously flawed,” said Eisen. “I came into this as a serious skeptic. It just seemed so improbable.” But the team won him over. They ran an extensive set of checks to make sure that these bacterial sequences were not laboratory artifacts and had not come from contaminating microbes. For example, they showed that LGT was more common in cancer cells than healthy tissue, and two out of ten cancer types were particularly hard hit. If the bacterial integrations were artifacts of the methodology, it should be equally common in any tissue sample. The team also focused on sequences with high coverage—that is, those which had been read many times over. When the team found evidence of LGT, it was consistent across all of these reads. “In the end, the authors addressed every single question that I and the reviewers raised,” said Eisen. Hank Seifert from Northwestern University, who was not involved in the study, remains cautious. “This paper is very interesting and potentially important,” he said. “However, until the direct analysis of specific tumor cells can be performed to validate that these are real events, this work [is] still speculative.” But Dunning Hotopp’s team cannot do these validation studies herself. For privacy reasons, they cannot access the original tumor samples that their data came from. “People with access to the samples need to validate that the integrations are correct,” she said.  Danchin agrees that the results need to be validated but said, “I am personally convinced what they have found by screening the different databases is true. I think LGT happens much more frequently than we imagine but, most of the time, is just not detectable.” D. R. Riley et al., “Bacteria-human somatic cell lateral gene transfer is enriched in cancer samples,” PLOS Computational Biology, tbc, 2013.

Key host–pathogen interactions for designing novel interventions against Helicobacter pylori

Helicobacter pylori is a Gram-negative bacterium which has exquisitely adapted to survive in the acidic, hostile environment of the stomach. H. pylori is extremely motile and is found in the mucus layer lining the stomach. By penetrating this thick mucus layer, the bacteria can attach to gastric epithelial cells, thus avoiding being ‘washed’ through the stomach. H. pylori infection tends to persist for the life of the host and, with more than half the population of the world being infected, it is not surprising that H. pylori strains have co-evolved with Homo sapiens. For this reason, and due to several cunning adaptations, the bacteria are able to induce low-level inflammation to gain access to the nutrients required for them to grow and survive, but simultaneously evade host immune responses. Importantly, H. pylori is presently the only bacterial species classified as a type 1 carcinogen by the World Health Organization (WHO) and remains a significant cause of morbidity and mortality worldwide. Approximately one in five infected individuals develop disease, including either peptic ulcer disease, gastric mucosal-associated lymphoid tissue lymphoma and, in the worst case (approximately 1–2% of infected individuals), gastric adenocarcinoma. Gastric cancer remains the second leading cause of death from malignancy worldwide and, with H. pylori being a major cause, it is clear that H. pylori infection still has a major impact on the global disease burden. Clearly there is a need to develop novel therapies and, ideally, a highly efficacious vaccine, based on a sound understanding of H. pylori and its interplay with the human host. This review will summarize recent findings in the context of host–pathogen interactions and modulation of inflammation as well as highlighting recent advances in vaccine development.

Every, A.L (2013) Key host–pathogen interactions for designing novel interventions against Helicobacter pylori Trends in Microbiology, 21, 253–259.

Don't touch?

Next time you enter a new hotel room, you might think twice before touching the light switch or reaching for the remote. Those are two of the top surfaces most likely to be contaminated with bacteria, according to a study aimed at boosting hotel cleaning practices.

For more see: http://vitals.msnbc.msn.com/_news/2012/06/17/12241651-germiest-hot-spots-in-hotels-tv-remote-light-switch-study-finds?chromedomain=testblog

Your Computer Mouse Carries More Germs Than A Toilet Seat

The average computer mouse is three times dirtier than a toilet seat, according to an alarming new study.
Researchers blame the results on  workers who eat at their desks, turning work stations into breeding grounds for harmful bugs and germs. And men are far more filthy than their female counterparts - with 40 per cent more bacteria lurking in male mice.Keyboards were the second most grubby item in the office, ahead of phones and chairs.Initial Washroom Hygiene, which carried out the tests, said computer mice also carried twice as many bugs as a toilet flush handle.
Researchers swabbed 158 items seized from 40 desks at three office locations and compared the results with data on toilet hygiene, including 28 loo seats, obtained from other buildings. Four-in-10 desks were home to at least one item with very high levels of bacteria and surface contamination which posed a risk to health.
Initial Technical manager Peter Barratt said: 'It is now common for office workers to spend their lunch hour eating at their desk - often surfing the web or continuing to type at the same time.
'This leaves crumbs and other food residue all over the work station, particularly on mice and keyboards, making them ideal places for bacteria and other microorganisms to survive and multiply.
'In addition because they are electrical devices these items aren’t cleaned as regularly or as thoroughly as other parts of the office, or even as the desks themselves.'
The mouse isn't the only everyday item found to be filthier than the average toilet seat - research has discovered more bacteria on kitchen work surfaces, steering wheels, restaurant high chairs, shopping trolleys and even lift buttons.
–Daily Mail, London