Bite Back with Abbey Sharp - Breaking Up with “Breast is Best”: Breastmilk vs Formula Myths and Truths with Dr. Lauren Hughes

Starting point is 00:00:00 Every problem with our children seems to circumvent back to, well, it must be mom. I think we put such an emphasis on providing breast smoke, but you walk down the street, tell me who was formula fed and who was breastfed. Tell me, you don't know. Welcome to another episode of Bite Back with Abbey Sharp, where I dismantle dye culture rules, call out the charlatans spinning the pseudoscience, and help you

Starting point is 00:00:29 achieve food freedom for good. Today's episode is something I really could have used like seven years ago when my first son was born, and I was driving myself into the ground trying to breastfeed a colicky, severely tongue-tied baby. Before I gave birth, I had read all of the Lelush Group blogs about the benefits of breastfeeding and about what a magical and natural and critical act of motherhood it was. So when things weren't going well, I flat out refused to give up. I spent thousands of dollars on private lactation consulting visits, physio, OT, dentistry, all the things just trying to get that kid to latch. After weeks of tears, I admitted defeat on breastfeeding and then spent the next 13 months attached to a pump. Yes, I felt accomplished being able to exclusively pump

Starting point is 00:01:31 breast milk for the first year of life and fill my freezer with another 35 liters for year two, but I also felt like I had sacrificed precious time with my son and my own experience of motherhood just to calm my own guilt around not being able to breastfeed. So when I was pregnant with my second I promised myself that if breastfeeding didn't work out that I would formula feed without second thought. And luckily it just happened to be a much easier ride and a truly enjoyable experience for all but I

Starting point is 00:02:04 wanted to shed light on the dangers of rigid breastfeeding pressure and help you feel confident in your own infant feeding journey, whatever that looks like. My guest today is Dr. Lauren Hughes, a board-certified pediatrician, lactation consultant, mom, and founder of Bloom Pediatrics. If you like my sassy, no BS approach to nutrition, you are going to really appreciate Dr. Hughes' approach to childhood health. Today, we are going to be going over the risks of various activities and substances while

Starting point is 00:02:37 breastfeeding, debunking common breastfeeding myths, and I will be discussing what the data actually says about the benefits of breastfeeding myths, and I will be discussing what the data actually says about the benefits of breastfeeding over formula. A quick note here that even though I breastfed and pumped for my two kids, I unequivocally believe that fed is best. So I want to make sure that what I'm sharing is not misinterpreted as me pushing formula or dismissing the benefits of breastfeeding. But rather, I want moms to feel empowered to make the best decisions for themselves, weighing all of the potential costs and risks to

Starting point is 00:03:13 their own physical and mental health, rather than relying on fear-mongering anti-formula rhetoric. Also, I will be using exclusive women-centered language for simplicity, even though I fully acknowledge that this doesn't capture everyone's motherhood identities. Finally, a quick reminder that the information in this episode is for educational and entertainment purposes only, and is never a replacement for one-on-one healthcare advice. And I would love if you would please give Bite BackBack a five star review and leave me a comment. It really, really does make my day. All right friends, let's get into it.

Starting point is 00:03:51 So, Lauren, thank you so much for joining me. I am like obsessed with your TikTok series on social media. I just find it so helpful for new moms who are like drowning in misinformation and conflicting information. So I'm sure my listeners are going to really appreciate our conversation today. It talk was not intentional. I just happened to say we're going to do a little tit talk and then now it's a thing. But let's talk about tits. I mean, when it comes to milk and tits, but you are a pediatrician and a lactation consultant. So obviously you can

Starting point is 00:04:35 appreciate that breast milk has benefits. Like it's kind of amazing, crazy, cool stuff. I am also sure that you probably see a lot of stressed out, you know, overtired moms every single day who, you know, many of which a lot of stressed out, you know, overtired moms every single day who, you know, many of which are probably struggling with this, you know, what we've been taught is supposed to be this very natural, intuitive, beautiful and critical experience. But I'm curious from your perspective as a primary care provider,

Starting point is 00:04:59 what are the impacts of like these societal expectations around breastfeeding and fear mongering on formula when it comes to mom's physical and mental state, when things are not just going the way they planned? We all have this expectation of this that like, oh, it's my body, so my body knows what to do because it knew how to grow a baby, grow a baby without me telling it to do anything

Starting point is 00:05:20 or working, well, like outside of infertility, but like the act of growing a baby, it seems like it act of growing a baby it seems like it should just be a progressive thing and it's not um because you are trying to bring together two human beings who have never done this before with each other and that's always going to be messy and complex and sometimes it's not and you know, for for some people, it's just as simple as like I put them there and then it went there and then I had milk and they did fine and that was it. And that's wonderful. But that is the exception and not the rule, honestly. And I think we put such an emphasis on

Starting point is 00:06:00 providing breast milk because it is it's this beautiful, wonderful living organism that has incredible benefits. And yes, I wish everyone could provide breast milk, but you know what? It's not my baby, it's not my body, it's not my choice. And that is where I think the message gets frayed is, hey, you need to be doing this thing, but also you have to go back to work at six weeks.

Starting point is 00:06:25 And also we're not gonna provide you with lactation support. And also we're not gonna provide you with parent support because you're gonna be in a diaper and maybe your spouse or you don't have a partner and they have to go back to work, but it takes 12 hands to do this. And oh yeah, you have to go in for all these weight checks. Like there is just this inundation of stress

Starting point is 00:06:52 on one human being who just gave birth. It's just a lot, and it's a lot of this expectation. So then it's almost dug into you as you have failed. Your body has failed. You have not done this right because you couldn't make this work because you should have. And it is just, I mean, this is everything in America, right? We're taking systemic problems and putting them on the individual.

Starting point is 00:07:17 And this is just another example of, hey, we're gonna expect you to do this, but we're gonna provide you zero resources or support. Yep. I mean, I don't know what your breastfeeding experiences were like, but I remember when my first son was born, I had both latch issues and supply issues. And I had an LC come on like the day I got home from the hospital. And I had told her that the night before my first night at home, I

Starting point is 00:07:45 had to supplement with formula because my kid was screaming all night, nonstop. Clearly I had nothing to give him. And she gasped audibly and said, Oh no, like as if I just ruined my child's life forever. Because again, if this notion that a single drop of formula changes baby's microbiome forever, which by the way, to those listening, the microbiome is always changing and we have no good evidence that formula ruins a microbiome for life. But yeah, I just feel like that the interaction really threw me into this all or nothing type a spiral that, you know, ultimately really had resulted in insomnia and postpartum anxiety and really a real handicap in my experience of early motherhood.

Starting point is 00:08:29 It's so hard. Yeah. So my poor feeding experience with my first is why I became an IBCLC and got into breast feeding medicine because I was 26 and I didn't know what I was doing. And I remember in my hospital tour, I was like, I would like to speak with a lactation consultant prenatally because I want to, I've never done this

Starting point is 00:08:51 and I have questions. And I would, they were like, what do you want me to talk to you about? Like there was just so much confusion of like why I would wanna meet with someone before I had a baby. And we have data proving that a prenatal lactation visit helps with longevity of breastfeeding. So that was like, whoa.

Starting point is 00:09:14 And then in the hospital, I had him latched and it was just a, that looks good. And that was the extent of my health. His latch looked good and I didn't have pain so everyone assumed everything was fine. It wasn't until I think I was like 10 or days or two weeks postpartum and I went to a breastfeeding support group and the LC there weighed my baby and was like he's only gained 10 grams since last week. And for those who don't know, our goal for babies is to gain 20 to 30 grams a day. And he'd only gained 10 grams in seven days.

Starting point is 00:09:51 And she was like, I'm gonna go over to the hospital to work with someone directly. And we discovered he wasn't transferring. But no, like, I didn't know that. And I thought he was just a fussy kid. And like, that was it. And so then that led us on the path of triple feeding. And I remember the when I had to give him a bottle of formula, like, I was crying so hard, my husband had to leave the house. He like I was just like, yep, wailing like there had been a death. And it was because I'm a pediatrician.

Starting point is 00:10:29 I should just be able to do this. Like, pregnancy was easy. Like, why can't, and so it was just this intrinsic failure. And why couldn't I do this? And then when we find, then we had, he had a tongue tie and that was really difficult to navigate because I went and saw an LC who said, you have to absolutely release this or he's never going to be able to feed. Then I went to my previous pediatrician who said, he can stick out his tongue, there is no tongue tie and you don't need to do anything. Then I was

Starting point is 00:11:04 like, well, what do I do? She know, give him a bottle and it's like well he can't latch onto a bottle milk pours out like he that's not working and and it felt like I was screaming into a void and Nobody could give me any sort of like actual evidence-based guidance everyone was just giving me opinions and Once I then I finally talked to my husband and we walked we walked through it and we got his tongue tie released and then he could actually eat. And we gasp, went to a chiropractor same and did like craniosacral therapy. And I also like, Oh my god, this is

Starting point is 00:11:40 like this is against what I know. Yep, I know. I did it too. You're so desperate. You're like, I'll do everything. So I made my mom go with me to go into the chiropractor. And I was like, you were gonna have, if she does something, you're gonna have to speak up. Yeah. And then I watched it and I was like, you barely touched him.

Starting point is 00:11:58 Why am I paying for this? But then he could eat. Yep. I was very lucky that I had a great supply and he nursed until I was pregnant with my twins. But it was that struggle and that just like feeling of just like being on an island. Helplessness, yeah. Yes. And like no one could help me. That really was like, no, I'm not standing for this and let do this. Yeah. Yeah. I mean, that's amazing. No, I'm not standing for this and let do this.

Starting point is 00:12:25 Yeah, yeah, I mean, that's amazing. And as you know, you know, breastfeeding is often touted as evidence of the power and magic of womanhood. You know, we can make this perfect food for baby to thrive and grow. And I love that, like it is truly insanely cool. But at the same time, like two things can be true. And for a lot of other women, I often worry that this kind of resolute breast is best movement might also in some ways be reinforcing a lot of these patriarchal narratives that glorify

Starting point is 00:13:12 maternal self-sacrifice as this measure of worth. Do you want to talk about that? Sure. So I think that it looks at the overall issue of people living in a vacuum and expecting that their lived experiences are the same as everyone's lived experiences. And that's just not true. I mean, at the very basic, our anatomy is different, like just at the most basic, basic level. And then you look at like, what is our support system? What are our spouse's thing? Where, what is our job work? What is my actual desire?

Starting point is 00:13:50 What is my experience that I've seen with friends and family members with breastfeeding? What is their support like? What is, what's my work time off? What's my maternity leave? How much money am I making? Can I afford a pump? Do I have insurance?

Starting point is 00:14:01 Like there is just, There's so many factors that to make a ubiquitous claim of breast is best is wrong. I hate that phrase because then I also don't like Fed is best because that implies there's an alternative and Fed is the only option. And so when I look at these things, I tell people, one, the number one rule above everything is feed the baby. The next rule is protect the milk supply. Then it is keep baby at the breast. You can't keep the baby at the breast if you don't have milk and you don't feed the baby. You can't protect the milk supply if you don't feed the baby. Like there's just an order of importance. And I think that this just

Starting point is 00:14:50 expectation that women can do it because we're superheroes and we can do it all. And it's just this expectation of you're tough and you can handle it, but also let the boys speak. Yeah, no, I know. I often feel kind of insane looking back at what I convinced myself I had to do in order to prove my worth as a new mom. I truly believed that if I wasn't pumping every hour on the hour to get my supply up so that I could avoid having to supplement with quote unquote toxic formula again as per my LC's instructions that I was like not doing what real moms do which is just like apparently give up all your body autonomy and desires and needs to put your kids first. 100%! It's we need to break that

Starting point is 00:15:39 assumption that's just so pervasive in our society you know. I mentioned this at the top of the show, but by the time my second son came around, I had a lot more self-confidence just in myself and also in myself as a mom. So I wasn't gonna put up with that shit. And I also like found an LC who was going to support me no matter what ended up happening. But yeah, I just feel like it's a real shame that we are poisoning our own experiences with motherhood of, you know, with all these different pressures.

Starting point is 00:16:10 Well, yeah, I mean, that's and that it goes beyond I mean, breastfeeding, then it's like, are you doing toy rotations? Are you doing wooden toys? Are you allowing plastic? Are you allowing screens? Are you allowing noise at night? What about white noise? Is it too close? Is there too many decibels? Are you gentle parenting enough? Are you providing enough touching support? There's just every problem with our children seems to circumvent back to, well, it must be mom. It must have been something with mom. This is just another one. But you walk down the street, tell me who was formula fed and who was breastfed. Tell me. You don't know. You wouldn't know. You'll never know. The people at the top and the CEOs or running the big businesses or successful doctors and lawyers, whatever, nobody knows or cares. It's not on

Starting point is 00:16:58 anyone's CV. It's not going to make or break the rest of your life. So and we put so much pressure on ourselves thinking it will. Yeah, but it's good. And it's going to, this is going to fade. Just like my mom was telling me when she was pregnant with me, she was considered weird and out there because she wanted to room in and breastfeed. Those were the two weirdest things she could have chosen. And everyone's like, you don't want the nurses to just take her and give her a bottle of formula? And they couldn't believe it. That's only been 30 years. So like, I wish we could

Starting point is 00:17:35 just say, Hey, we know breastfeeding is great. But hey, not everybody can, not everybody wants to. And it feels like that is a dream and not a potential reality. Talk to me about baby-friendly hospitals for men and just kind of the role that they play in all of this. And in case people are not familiar, because I think this is like mainly a US thing, I don't even think we have this here in Canada, but these are basically like healthcare facilities that strongly encourage breastfeeding and avoid giving formula and pacifiers. Do you want to kind of talk a little bit about that and how, you know, what issues you might see coming up with this? So this actually is a global thing was created by the WHO and UNICEF in 91.

Starting point is 00:18:19 This is a very global thing. Like with most things, the original goal was great. It was that you're gonna have breastfeeding, friendly hospitals are gonna have a written breastfeeding protocol. You're gonna train your staff and you're gonna inform pregnant people about breastfeeding during pregnancy. You were going to help them initiate. You were going to show them how, like the nurses in the hospitals are trained on this, not just LC's. Um, you're gonna room in You're gonna breastfeed on demand like you're doing all the things that were like you look at it. You're like, that's great That's wonderful. But one of the other parts of it is that you can give no artificial teats or

Starting point is 00:18:59 pacifiers and if you provide formula or a pacifier, then you have, if you do that too often, you risk losing your baby friendly initiative status. And you have to implement retraining and like reeducation and like protocol changes and stuff, because they can come in and assess and make sure you're following like all of the standards. And so while I

Starting point is 00:19:26 do think it was like, oh, this is a really good thing to like, the idea is great. The actuality with, especially in America with our current healthcare system, where you have such understaffed hospitals, and you have nurses stretched as thin as they can possibly be stretched, and you have all of these expectations of doing these things, but you don't have the staff to actually do it, they're going to make, they are like,

Starting point is 00:19:58 I just got to get you doing this so I can do my job and I can move on, which is not their fault. It is once again, a systemic issue that we are forcing onto an individual. But when that happens, you do things like put a nipple shield on in the delivery room because that baby will latch to a nipple shield. It's like putting a bottle in their mouth. It's going to immediately trigger that suck reflex, they are going to suck, they will. And, and when you have, you have these, you know, glorified recommendations to breastfeed everyone, but your actual practice is a dumpster fire, then like it's, it just doesn't

Starting point is 00:20:37 actually end up being a good thing. Right. And, and I see then a lot of people where they're like, okay, we just did a nipple shield and then we got discharged and then I'm trying to undo it. Or they can't get maybe the latch and now they are struggling with supply or that no one told them to pump or to do any sort of stimulation while using a nipple shield. Or they don't know how to come off of it or they don't have resources to come off of it. Or nobody explains that, hey, you can continue this and then try to come off later

Starting point is 00:21:07 or anything like that. And so while I think this was like a good thought, the implementation is just not correct. Yeah. And I think there's also risk. I mean, obviously when we talk about breast milk, we're talking about all the health benefits to baby. But we also have to take into consideration that, you know, one in like 40 to one in 70, depending on a research, you look at babies are hospitalized due to life threatening complications from inadequate breastfeeding without supplementation. So if you are just kind of like putting the baby, you know, baby on the breast, but not actually like you mentioned your experience

Starting point is 00:21:45 where, you know, baby had, wasn't gaining weight because of again, transfer issues. So that is a huge risk. That's not actually benefiting baby in the long run when they are being underfed and you know, under hydrated. And honestly, I look back at my own experience. If I didn't supplement that first night, I could have easily just ended up back in the pediatric ER. And I think that from what I've read, that is the underlying intentions behind the controversial, you know, Fed is Best movement. They're not denying the benefits of breast milk. They're kind of acknowledging the risk benefit to each individual mom and

Starting point is 00:22:26 you know, for mom and baby, that exclusive breastfeeding might not necessarily be what is best for that combination of mom and baby in that moment. We know that the mental health of the parents has the biggest impact on the mental health of a child. Yes. And that is where it gets super frustrating. And Abby, okay, so you were worried about going to the pediatric ER. Now imagine being worried about going bankrupt.

Starting point is 00:22:53 You have to choose, do I want to drop a couple thousand dollars that I probably don't have and go to the ER? Or do I just want to cross my fingers and stay home? That's the other barrier that you have. I cannot tell you how often I have this conversation with people. I'm like, well, I think they need the ER, but you can't afford it. And that is an actual decision that people in America have to make every day because we do not have universal health care.

Starting point is 00:23:21 Right. Oh my goodness. As a Canadian, I'm so so grateful I've never had to make the call of whether or not take my child to a doctor or the hospital to get something checked out because I'm just like that's an expense and risk I just am gonna have to take because of the what it costs. Speaking of maternal sacrifice there is a lot of misinformation and fear-mongering about what we can and cannot do while breastfeeding, which again, I think just reinforces this idea that if you're not suffering, you're

Starting point is 00:23:49 not mothering, right? So I want to go through some of the big ones. And I want to start with breastfeeding and drinking. Do we need to abstain until we wean? Do we need to pump and dump? Like, what's the dealio? The deal is you, you really can't ethically can do a randomized controlled trial for this. You really can't. So what I do is I go down to the math. Because then I think this is a very simple explanation. One thing that people, I think, misunderstand is the difference in a alcohol content percentage

Starting point is 00:24:28 of a drink and the blood alcohol percentage. If you drink a glass of wine that has 12% alcohol, something like that, your blood is not 12%. You would be dead. You would be dead if your blood was 12% alcohol. That is not conducive with life. And so your blood alcohol level is what you bring in and then it gets diluted, right? So whenever people think about the legal limit, you think of 0.08, right? What that means is it is 0.08

Starting point is 00:25:04 is 0.08% blood alcohol level. That is the legal limit. And when we get to 0.4% for non-severe alcoholics, you are generally comatose. We are likely coding you in an ER. If you were to direct breastfeed your baby on that code table, while you were at 0.4% blood alcohol level, your breast milk would contain as much alcohol as in some orange juices because they ferment.

Starting point is 00:25:32 So yes, there is alcohol. I am not denying that. But what I am saying is it is not at the level we think it is in terms of severity. My biggest fear with with drinking and breastfeeding is the physical harm is like, are you going to be so intoxicated that you drop your baby, that you fall asleep on your baby, that you smother your baby? That is my concern. So the joking phrase is actually true. If you can find the baby, you can beat the baby. If you're, if you're with it enough to like, maybe you feel silly, but you can grab your baby, you can feed the baby. So if you're with it enough to like, maybe you feel silly, but you can grab your baby and you know, like I'm not gonna fall asleep with you.

Starting point is 00:26:11 I don't care. Or if you want to drink while you're feeding, that's not like, it takes a while to get into your blood. So if you drink while you're nursing, then you have like a pretty solid couple hours until your next nursing session for that to filter. Now, the next thing I get is do I need to do the blood alcohol breast milk strips? No, like marketing gimmick. Don't do that. But again, because not everyone has the same lived experiences and the same comfort and the same

Starting point is 00:26:39 risk tolerance if you don't want to, you don't have to. You can mix alcohol milk and not alcohol milk, but to demonize it or to call someone who wants a fucking glass of wine postpartum because they went nine months without it, let them. Yeah. Yeah. I'm not pushing drinking because of course we all know alcohol is not good for anyone, but that first glass of wine postpartum just hits different. It does. Just FYI, your tolerance will be way low. Oh yeah, yeah, yeah. One glass, one glass, critical, at least for me, is coffee. Coffee and breast milk. What's the deal there?

Starting point is 00:27:38 Fine. So this is also going to be an individual thing. Some kids are... So how I explain babies, it's all human babies are on a range of maintenance. You have higher maintenance kids. So you have those like kind of fussy or can't put them down and have to, you know, hold your tongue just right to get them to sleep. And then you have the low maintenance kids who they will just fall asleep while someone's driving cars over them. Like it doesn't matter. I

Starting point is 00:28:04 mean, toy cars, not like an actual car. So you have those, so they're, you're on a ring. Typically, your higher maintenance kids might react more to caffeine. They might, but they also might not. So it is primarily going to be, does your baby care? If your baby acts the same, whether you drink coffee or not, I don't care. It is not the same as pregnancy, which has an increased risk of preterm labor. The baby has exited. There are different risks. So I never once counted caffeine after I had my kids. I drank coffee all day, every day, and it was fine. Yep. Yeah. Yeah. No, the research I've read suggests that, you know, breast milk contains

Starting point is 00:28:46 less than like 1% of caffeine consumed by moms. So as long as your caffeine consumption is kept within the recommended guidelines, for the most part, the amount baby would receive is pretty negligible. But like, again, like, just experiment. I have a double espresso, maybe doesn't app as well, but a single day, great. Exactly. Yeah, 100 percent. I personally, though, cannot imagine getting through early motherhood, sans coffee, but amazed at the number of people that don't do coffee, both with motherhood and in residency blows my mind.

Starting point is 00:29:17 Yeah, it blows my mind, too. OK, smoking, smoking. What's the deal on smoking? Smoke. So now with we getting legalized, now smoking is split into two different categories. So nicotine, cigarette smoking, nicotine. I don't recommend it. Not good. So with nicotine, we know that it is not good for us.

Starting point is 00:29:40 And my first recommendation is going to be to quit. Oftentimes there are tech support lines, all of that stuff that you can do to help you quit. Now, say you can't, it is hard. It is a very hard addiction to kick. You minimize it and you don't, of course you don't smoke near your baby because secondhand smoke increases the risk of sudden death syndrome.

Starting point is 00:30:01 But in terms of breastfeeding, it is completely fine. And actually I encourage my cigarette smoking parents to breastfeed because it helps mitigate those increased SIDS risks that come with secondhand smoke. It helps reduce them. So I strongly encourage and work with my smokers. And then just as a guideline, because then the next question I get is, well, what if dad smokes or grandma smokes or whoever? So obviously you shouldn't smoke in the house, shouldn't smoke in the car. You need to wash your hands, wash your face, brush your teeth, change your clothes. I prefer people wear a hat so it's not in their hair. General guideline is if you can smell it, that is too much for your baby. Now let's talk about weed. THC. So THC is a different ball game and there

Starting point is 00:30:47 are very, very, very, very, very few things that I say no to with breastfeeding. This is one. Because THC is a fat soluble substance, meaning that we get stored in our fat cells. stored in our fat cells. Our breasts are primarily fat cells. And so when we have this storage, and especially if you are a chronic user, meaning you frequently use it, you're gonna have more and more build up. That's why people are like, how come it's in my hair for three months, because it's stored in your body. And so there is some again, you can't ethically do this as a trial. But

Starting point is 00:31:26 there is data showing that it is in breast milk for several days. And it can, can I don't know if it's going to 100% but can cause neurodevelopmental disorders in children. So this is one that like, normally I you know, like I said, I'm like, ah, things are, this is, that is one I would not participate with. Fair. Great, great tips. And here's a new one.

Starting point is 00:31:54 Any thoughts on like Ozempic and other weight loss injectables during breastfeeding? Very common question. This is also where I get like really, really nerdy. Yes, we love it. You want to talk about mass spec? I would love to. Yes, I love mass spectrometry. So when we look at like the likelihood

Starting point is 00:32:14 of something crossing over to breast milk, we are looking at things called like the molecular weight. And the bigger something is, the less likely it can pass through, right? So semaglutide, GLP-1 agonists are in breast milk naturally. Yes, of course. Any food will trigger GLP-1, so yeah, that makes sense. Yep, like I also feel like people don't realize,

Starting point is 00:32:41 I mean, it's just like formaldehyde is also in our butt. Like people don't realize like the things that exist in us. formaldehyde is also in our butt, like people don't realize like the things that exist in us. Anyway, so we all have GLP-1, but the semi-glutide specifically, they could not find the semi-glutide molecule in any human milk tissues in the sample in this one in this study that we use through the ABM. And so it is just the max, so their maximum RID, that sorry, the maximum relative infant dose was 1.26%, which is far below the 10% standard for the RID that we have to consider something breast smoke safe.

Starting point is 00:33:21 I cannot fathom how this would be a problem with breastfeeding. And so I give it a thumbs up. Got it. Got it. And I'll just add that, you know, just, just, I mean, of course, especially if we're, we've got, you know, type two diabetes and these are medications your doctor has prescribed, do work with your doctor. But for folks who are thinking about starting a JLP one, I guess like fresh out the gate, give your body some time to recover. Like it's, you know, those transitions are so hard as is, and you are also feeding another person. So, you know, now is not the time to put yourself onto a very aggressive drug and be throwing up and dealing with diarrhea and all the other side effects that come with it. Just give yourself a little bit, your body some time and then work with your doctor on a plan. And that can make your milk supply drop just FYI.

Starting point is 00:34:15 That too, 100%. Yes. Especially if you're not able to keep in adequate hydration and food. You're losing more than a pound a week. Like that does impact your milk supply. Correct. So everything in life is a risk benefit. So you got to decide. A hundred percent. Now, if baby has colic, because man did, is there any reason for mom to start cutting foods out of her diet? So going back to my maintenance of my maintenance range of babies, all babies are going to have a fussy period. That's why it's so frustrating that people immediately are like, no, you need to cut out dairy or soy or corn or whatever. If I can predict it, how come it's diet affected? And so all babies between two and four weeks wake up

Starting point is 00:35:06 and then they start getting fussy and that starts at about four weeks, peaks about eight weeks, dissipates by about 12 weeks. If your child is just fussy, nothing else is going on. They are growing, they are developing, they are happy during the day, they have these fussy periods, but otherwise are happy.

Starting point is 00:35:23 No, that's just, happy during the day, they have these fussy periods, but otherwise are happy. No. That's just, that is part of like learning how to become a human. I have a whole long spiel on that, but it is not something that I would ever recommend just for a fussy baby cutting out dairy. Now my indications to cut out dairy, you have a kid who is not gaining weight. You have a kid who is screaming at the breast every time they eat. They are miserable. You have a kid pooping blood. Okay. Yes. Let's talk about it because reflux like significant GERD different from physiological reflex. So

Starting point is 00:35:58 angry reflex could be a dairy problem, could be a other food problem or bloody stools could be a dairy problem, could be a other food problem, or bloody stools could be a maternal food problem. But spitting up and an otherwise happy, growing, healthy, developing baby. Yeah, I know. Of course, like, you know, my kiddo had colic and cutting out foods made absolutely no difference. He just kind of grew out of it at four months, right? Yes! difference. He just kind of grew out of it at four months, right? But you know, obviously do what works for you. But from my perspective as a dietitian, I just feel like there are so many benefits of dairy as like a great source of calcium and protein as your caloric needs are higher, your nutrient needs, your protein needs are higher. So I just hate for moms to cut it out

Starting point is 00:36:40 unnecessarily. And especially if that's something that they enjoy like cheese I love me some cheese I don't want to have to. Try my coffee creamer out of my cold dead hands. Yes yes yes 100% so yeah and if you are going to attempt an elimination diet of course I always recommend working with you know your pediatrician and your dietitian on that. And don't do don't cut out 20 foods at once. Uh 100% no. That's not a proper elimination diet. We would have zero indication of what actually is the culprit.

Starting point is 00:37:11 So yes, again, work with a professional. The last thing I want to touch on here is this kind of you know, the anti-formula movement, which unfortunately just continues to grow stronger. And in my episode that I did with Jess Nurick, we talked a lot about why infant formula contains the ingredients that it contains, including sugars and seed oils, which, you know, ultimately is used to match the nutritional composition of breast milk as as as equally as possible. So, you know, I do recommend everyone kind of listen to that episode as well. But the bottom line is we know formula is completely safe and nourishing for a baby.

Starting point is 00:37:48 But what is not safe is homemade formula. Can you talk about that? This was news to me within the last year that this even was a thing. I cannot overstate how worried this makes me. As a dietician, you are the people that I look to whenever I'm like in the NICU or whatever. I'm like how much phosphorus does this kid need? How much potassium does this kid need? Because these are such delicate balances. So when babies are first born, their first six months,

Starting point is 00:38:21 their kidneys don't fully work. They are not able to equalize and maintain homeostasis. They are not capable of it. Babies are born before they are physically ready to handle a lot of things. They just can't fit anymore. But one of the things is the kidneys. Have you ever heard of why we can't do ibuprofen until six months?

Starting point is 00:38:42 That's because their kidneys aren't functioning until six months and ibuprofen goes through kidneys. So that is why, like this is such a known thing. And so when you play with making your own formula, you are risking upsetting that balance. And if you have electrolyte disturbances, you can have heart problems. Your heart can stop.

Starting point is 00:39:02 You can have an arrhythmia. You can have a seizure. You can have all of these things that are so terrifying and did not need to have happen. Right. Yeah. Noah, I feel like a lot of this comes back to something that we talk a lot about here on the podcast, which is this appeal to nature's fallacy. And this assumption that formula is mass produced by big food or big pharma and includes all these highly processed ingredients. So it must be super, super, super bad and toxic. But if you can't or don't want to breastfeed, then homemade formula made in your own kitchen

Starting point is 00:39:37 with your own ingredients, your own quote unquote clean ingredients must be better because it is assumedly less processed. But yet you're using the ingredients from these corporations that have mass produced it and you're trusting that. Right, right. Exactly. And I get it. Like even with the best intentions, just so much can go wrong. So please do not ever make your own formula.

Starting point is 00:40:00 Ever. And also do not give your kids raw milk. That's like, that's just like a whole other wild story. Don't and don't make don't make formula with raw milk. Most important, don't make formulas, raw milk and read the formula shortage a couple years ago. Don't dilute it. No, because that again, messes up the electrolyte balance. And that is such an like, you have such a narrow window for your electrolytes to be

Starting point is 00:40:26 where they need to be. And it's babies do not have reserve if they get dehydrated because they're like, they don't have this. And they can't say, my chest hurts or something like that, if they're having an arrhythmia. Like it 100% Yeah, no, trust science. Science you know, has come incredibly long way and we should be so grateful for the advances that we have not be pushing against them and fearing them and creating more hysteria and fear mongering around them.

Starting point is 00:40:56 One million percent. This was so cathartic for me. I feel like I just unpacked like a lot of early motherhood trauma that I had festering inside me for the past seven seven years because yeah, like, like 95% of my mental health struggles during that time probably came from breastfeeding. So yeah, I swear, people say breastfeeding is a preventative against postpartum anxiety, I 100% think it's a contributory. Oh, my God. No, it was it was everything for me

Starting point is 00:41:21 that caused me insomnia that caused me anxiety. I mean, I'm still like dealing with the repercussions of that. But I am sure this conversation will be so helpful for so many new moms. So thank you again, Lauren, for joining me. I will be leaving links in the show notes to where you can find you. And of course, your pediatric practice as well, Bloom. All right. Thank you. Thank you.

Starting point is 00:41:45 Thank you, it was fun. Thanks. This was such an important conversation to have, not just for moms who are pregnant or actively trying to feed their newborns, but really for anyone who has ever interacted with a new mom or been a new mom in the past like myself. Regardless of the feeding choice you make or made, it is really helpful to exercise

Starting point is 00:42:10 some empathy and neutrality around the choices of others. You know, what may have been a very easy cost-benefit analysis for you to breastfeed might be met with considerable costs for your sister or friend. So I'm really just hoping to shine some light on a wide spectrum of experiences here. And there is no doubt that breastfeeding has amazing advantages both for baby and also for mom. But the steadfast quote-unquote breast is best army often makes women who choose to or need to formula feed their infants feel as

Starting point is 00:42:45 though they are causing irreparable harm. That their kid is destined for a life of disease, obesity and cognitive impairment if you feed them a single drop from the box. But as you all know, I'm a science girly, so I thought I would share a bit of data as it pertains to some of the major breastfeeding benefit claims. Now, keep in mind that when I'm discussing the benefits of breastfeeding versus formula, that it's in reference to kids in developed countries that have access to safe water and safe formula alternatives, rather than in undeveloped countries without clean water where breastfeeding carries significantly greater perks. A quick little shout out to Emily Oster who is the creator of

Starting point is 00:43:29 Parent Data and the author of Cripsheet whose research and analysis served as a jumping-off point for what I'm about to share. I will be leaving some links to her content below if you're looking for more critical analysis of parenting recommendations. But let's talk about some of the early life health benefits of breastfeeding for babe. There is pretty good evidence that breastfeeding may help to reduce rashes, eczema, and gastrointestinal infections like diarrhea

Starting point is 00:43:56 in the first year of life. So for example, one randomized control trial found that breastfeeding reduced rates of eczema from 6% to 3% and reduced diarrhea from 13% to 9%. Other observational studies found that it may also help to reduce the risk of ear infections from 7% to 5%, though the effects do seem to dissipate after you stop breastfeeding. It kills me to see my kids sick, especially when they were little babies, so I absolutely appreciate that this is a big perk. That said, you know, about a diarrhea is not likely going to change the trajectory of your child's whole life or have any kind of long-term repercussions, which I think

Starting point is 00:44:45 is what scares most of us as parents. So let's talk about the impact of breastfeeding on something far more serious and devastating like SIDS. The fear of SIDS as a new mom was paralyzing. And as Lauren mentioned briefly, there is data suggesting that breastfeeding for more than two months is associated with half the risk of SIDS. Which again, is huge. The problem here is that we can't do a randomized control trial with SIDS. So the data may be confounded by the fact that moms who breastfeed may also be less likely to smoke, or may have more

Starting point is 00:45:27 support that would encourage safer sleep setups, or may be more likely to have full term rather than preemie babies. And all of these things may affect SIDS risk. It's really hard to get a comparable control group when SIDS ultimately is still so rare, and in studies when they do do a better job at this, they actually don't see a pronounced protective effect of breastfeeding. Especially when held up against much more important risk factors like smoking and bed

Starting point is 00:45:57 sharing. But what about the longer term risks of choosing bottle over breast? Most notably the concern that feeding your child formula may set them up to be overweight or obese. The fear-mongering around this is often so intense, which really just proves that fat phobia and diaculture messaging starts really early. But yes, we do see good observational studies that strongly suggest that breastfed babes are thinner later on in life.

Starting point is 00:46:27 But again, correlation doesn't equal causation. And I can think of a ton of social and economic confounders at play. So for example, moms who formula feed might have lower paying jobs that require them to head back to work earlier. This might also mean that they have less time and money for leisure activity and nutritious food. And when they look at sibling studies comparing one sibling who was breastfed with the other who was formula-fed, they actually don't see any differences in body weight.

Starting point is 00:47:02 And these same confounders apply to the findings that kids who are breastfed tend to have higher IQs. When confounders are eliminated and actual siblings are compared, meaning they have the same parents and the same social upbringing, they found no difference in IQ between those given formula versus breast milk. And I don't share any of this to discourage breastfeeding. You know, as I said earlier, I think there are real benefits of breastfeeding, many of which may not be so easily captured in the literature. So personally, for example, breastfeeding my son felt so empowering, and I felt a really deep appreciation of my body that I

Starting point is 00:47:45 really had never felt before. So I am eternally grateful that I got gifted with that experience. But I also believe that advocacy for breastfeeding should empower women not pressure them. So promoting informed choice, providing equal support for breastfeeding and formula feeding, and respecting individual circumstances are all crucial to breaking the cycle of maternal guilt and suffering. The goal here should really be to center maternal and infant health and well-being, not uphold a standard that may end up sacrificing one for the other. I don't know, I could probably rant and cry and lament about my own breastfeeding journey all day long, but we're gonna just cap it there and save the rest for another episode.

Starting point is 00:48:35 But I really hope that this episode was helpful, and a big thank you to Dr. Lauren Hughes for helping me to bite back against diet culture. Again, if you can, I would love if you would leave me a 5 star review and subscribe to the podcast. It really does help me out. Signing off with Science and Sass, I'm Abbey Sharp. Thanks for listening.

Bite Back with Abbey Sharp - Breaking Up with “Breast is Best”: Breastmilk vs Formula Myths and Truths with Dr. Lauren Hughes

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