by Bianca Garilli, ND and Ashley Jordan Ferira, PhD, RDN
History of breast milk: then and now
The “breast is best” and “liquid gold” taglines made their return to conventional pediatric conversations in recent years, diverging from a previous school of thought that led Western mothers to believe their naturally produced, free breast milk was inferior to factory made synthetic formulas with a price tag. Interestingly enough, this was not the first time natural breastfeeding had gone out of vogue.
A brief history of infant feeding includes the acceptance and widespread use of “alternative” or “artificial” feedings (e.g. crude clay feeding vessels [“bottles”] dating back to 2000 BC) and wet nursing for thousands of years.1 Initially wet nurses were employed when nursing one’s own baby was not possible (physically or logistically), but eventually wet nursing grew into a reputable, well-organized profession complete with governing laws and contracts.1
There were brief spans of time during the Middle Ages and the Renaissance however, where the public and professional sentiment encouraged mother’s milk over wet nursing with the belief in the “mystical qualities” of breast milk which could transmit both physical and psychological characteristics from feeder to baby, and therefore the use of the natural mother’s breast milk was encouraged and looked upon as a “saintly” duty.1
It wasn’t until the 19th century that the practice of wet nursing truly began to wane, with the introduction of infant bottles and alternative feeding sources.1 Breast milk alternatives such as animal’s milk, particularly cow’s milk, along with evaporated, condensed, and powdered milk options became widely available.1 In the 1940s, formulations were heavily marketed to physicians who in turn, encouraged their patients to utilize formula over nursing.1 By the 1970s this widely propagated mainstream healthcare message led to a significant decline in the number of American mothers who breastfed their infants, and marketing of formulas to the public in the 1980s further exacerbated the issue.1 Eventually, the influence was mirrored globally, where the global sales in 2014 for breast milk substitutes totaled $44.8 billion in US dollars.1-2
Throughout history “substitutes” for breastfeeding have been associated with an increased risk of poor outcomes, such as:1
- Non-attachment of mother and baby (when wet nurses were used)
- Malnutrition (when milk substitutes such as evaporated and condensed milks were used)
- Infections and infant death (when unsterilized “bottles” were used, prior to advent of the germ theory)
More recently, studies indicate that formula feeding, when compared to breastfeeding, is associated with a higher risk for various long-term health issues in the infant/child.1-3 This most likely has to do with dynamic and sensitive periods in early development that create lasting, programming effects on the risk of disease as the child matures.3 The presence vs. absence of breastfeeding critically impacts these developmental periods, with more recent evidence demonstrating that the effects are modulated through altered protein content, hormones, metabolites, neurotransmitters, as well as the composition of the gut microbiota.3-4
Breast milk: unique composition and health benefits
Perhaps the Renaissance belief in breast milk’s “mystical qualities” which transmitted both physical and psychological characteristics to the baby is much closer to the truth than what might have previously been thought. In fact, the unique design and myriad health benefits conferred by breast milk truly are like “magic”, making it a superbly nourishing and protective first food source, potentially setting up the infant’s health trajectory.
Breast milk is often discussed in terms of being a complete food. This concept goes beyond basic nutrition. In fact, formula producers know full well how unique and nutritionally replete breast milk composition is because it is extremely challenging to synthetically reproduce. This is because we are not just talking about macro- and micronutrients. No, we are also talking time; breast milk composition is dynamic, varying with the mother’s diet, baby’s needs, and time postpartum.
And what about the unique nutritional bioactives? If you start including the other, diverse constituents, namely secondary plant metabolites known as phytochemicals (AKA phytonutrients), then breast milk becomes virtually impossible to recreate. These antioxidant phytonutrients become a part of the breast milk makeup via the mother’s consumption of foods like fruits, vegetables, grains, and targeted supplementation.5 This fact underscores the importance of mothers being well-nourished and coloring their plates with nutrient-dense foods.
Over 20 phytochemicals, including a variety of flavonoids (a subgroup of polyphenols, one of the largest phytochemical groups present in crops), carotenoids, and garlic acid metabolites are phytonutrients that have been identified in human breast milk from research to date.5
Not only have phytonutrients been shown to contribute to the oxidative stability of the mother’s milk, studies also indicate that the phytonutrients present in breast milk may contribute to infant health, including potential for positively impacting oxidative stress, redox balance, inflammatory status, and visual acuity.5 And since this area of research is still in its “infancy,” we should expect many additional, fascinating roles to be illuminated in the future for phytochemicals in breast milk.
When compared to breastfed infants, formula feeding has been associated with lower intelligence, type 1 and type 2 diabetes, and childhood obesity in the infant/child.1-4,6,7 Research also shows that infants who are breastfed experience fewer GI tract infections, fewer upper and lower respiratory tract ailments, and less otitis media.6-7 They also have a lower incidence of atopic dermatitis and asthma (as young children), and have a lower risk of experiencing childhood leukemia and sudden infant death syndrome.6-7
Breastfeeding continues to be the best method of feeding during infancy, providing a natural, free, portable, low-carbon footprint method to support development and long-term health in children. Future research will undoubtedly continue to discover novel bioactives in breast milk and attempt to leverage the molecular makeup of breast milk for clinical translation via novel prevention and treatment approaches for health conditions in the broader population.
- Stevens EE et al. A history of infant feeding. J Perinat Educ. 2009;18(2):32–39.
- Rollins NC et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491-504.
- Koletzko B et al. Can infant feeding choices modulate later obesity risk? Am J Clin Nutr. 2009;89(5):1502S-1508S.
- Forbes JD et al. Association of exposure to formula in the hospital and subsequent infant feeding practices with gut microbiota and risk of overweight in the first year of life. JAMA Pediatr. 2018:e181161.
- Tsopmo A. Phytochemicals in human milk and their potential antioxidative protection. Antioxidants (Basel). 2018;7(2):E32.
- Ip S et al. A summar of the agency for the healthcare research and quality’s evidence report on breastfeeding in developed countries. Breastfeed Med. 2009;4(Suppl 1):S17-30.
- Dieterich C et al. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin North Am. 2013;60(1):31–48.
Bianca Garilli, ND, USMC Veteran is a former US Marine turned Naturopathic Doctor (ND). Dr. Garilli works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current President of the Children’s Heart Foundation, CA Chapter.
Ashley Jordan Ferira, PhD, RDN is Manager of Medical Affairs and the Metagenics Institute, where she specializes in nutrition and medical communications and education. Dr. Ferira’s previous industry and consulting experiences span nutrition product development, education, communications, and corporate wellness. Ashley completed her bachelor’s degree at the University of Pennsylvania and PhD in Foods & Nutrition at The University of Georgia, where she researched the role of vitamin D in pediatric cardiometabolic disease risk. Dr. Ferira is a Registered Dietitian Nutritionist (RDN) and has served in leadership roles across local and statewide dietetics, academic, industry, and nonprofit sectors.