Resource for the Informed Sharing of Human Milk

Human milk is for human babies.

In this document, Eats on Feets utilizes the WHO definition of exclusive breastfeeding which includes wet nursing and donor milk.¹ In support of exclusive breastfeeding, informed milksharing is a safe and viable infant feeding option for families.

Eats on Feets recognizes both the benefits that direct feeding from the breast bestows as well as the value of the milk itself. We may, therefore, use the words breastfeeding, breastmilk, human milk, milk, and donor milk interchangeably. We also recognize and affirm chest feeding as part of the infant feeding spectrum.

Benefits of breast(milk)feeding
In a previous WHO document called ‘The 10 Facts on Breastfeeding,’ the WHO stated that a lack of exclusive breastfeeding during the first six months of life contributes to over a million avoidable child deaths each year. In 2013, it stated that if every child was breastfed within an hour of birth, given only breastmilk for their first six months of life, and continued breastfeeding up to the age of two years, about 220,000 child lives would be saved every year.² ³

Breastfeeding is widely recognized as vital in low and middle-income countries, but health authorities in high-income countries seem to ignore the low breastfeeding rates and the resulting significant short and long-term health issues for mothers and children. With few exceptions, breastfeeding duration is shorter in high-income countries than in resource-poor countries. It is estimated that breastfeeding to a near-universal level could prevent 823 000 annual deaths in children under 5 and 20 000 annual deaths from breast cancer.⁴ Promoting breastfeeding in the United States has the potential to save or delay 720 postneonatal (28 days-1 year) deaths each year.⁵

Private and government insurers spend a minimum of $3.6 billion dollars a year to treat medical conditions and diseases that are preventable by breastfeeding. Since children who are not breastfed have more illnesses, employers incur additional costs for increased health claims, and parents lose more time from work to care for sick children.⁶

Everyone has the right to information about the benefits of breastfeeding and the risks of infant formula. Breastfeeding is the natural and recommended way of feeding all infants, even when infant formula feeding is affordable, clean water is available, and good hygienic conditions for preparing and feeding infant formula exist. Given the compelling evidence for differences in health outcomes, breastfeeding should be acknowledged as the biological norm for infant feeding.⁷

Governments and authorities have a responsibility to provide proper breastfeeding information and make available the resources needed to achieve exclusive breastfeeding for the first 6 months of a baby’s life and partial breastfeeding from 6 to 24 months, especially where inequities prevail. Communities, media, and other channels of communication can play a key role in promoting breastfeeding. The use of donor milk from a milk bank and supporting private-arrangement milksharing as a safe and vital way of achieving this goal is another.⁸

Protective factors of breastmilk
Because of its inherent anti-microbial properties, breastmilk can be stored for 8 hours at room temperature (25ºC/77ºF) and for three days in the fridge (4ºC/39ºF) without any significant increase in the levels of pathogens it contains.⁹

Unlike infant formula, fresh human milk contains thousands of distinct bioactive molecules that protect against infection and inflammation and contribute to immune maturation, organ development, and healthy microbial colonization.¹⁰

Human milk provides protection against many infectious agents through repeated exposure and the total antimicrobial protection provided by human milk appears to be far more than can be explained by examining protective factors individually. The antimicrobial potential of human milk is most likely underestimated and components are still being identified.¹¹ ¹² ¹³

For premature infants, donor milk feedings are associated with a decrease in Necrotizing Enterocolitis (NEC) and this can only be attributed to the unique immunologic properties of breastmilk.¹⁴

While pasteurized human milk is more beneficial than artificial infant formula, a strong case can be made for feeding premature infants fresh, unpasteurized human milk.¹⁵ An older but valuable study on human milk and bacteria documented routine screening of raw breastmilk and donor milk for premature babies and showed that while premature infants fed raw expressed human milk are frequently exposed to large numbers of inherent bacteria, no adverse events directly related to consuming this milk were documented.¹⁶ When comparing babies fed with donor milk, preterm formula, or someone’s own milk, the advantages of an exclusive diet of someone’s own milk for their premature infant include fewer infection-related events and shorter hospital.¹⁷

It can be said that in any part of the world, no single pediatric measure has such widespread and dramatic potential for child health as breastfeeding.¹⁸

Physical benefits of breastfeeding¹⁹
The act of breastfeeding promotes adequate growth and bone and muscle development, ie. proper jaw and facial development which reduces both ear infections and bite issues. It also reinforces the physiological nasal breathing of the newborn during and after sucking breastmilk, avoiding oral breathing. All of this has a preventative effect on the development of malocclusions. The act of breastfeeding is also positively associated with the development of proper dental arches.²⁰ ²¹ ²²

Another important aspect of feeding at the breast is that the baby’s saliva, reacting with the breastmilk, generates hydrogen peroxide and provides growth-promoting nucleotide precursors. In other words, breastmilk produces a combination of stimulatory and inhibitory metabolites that regulate early oral and gut microbiota when mixed with saliva.²³

The skin-to-skin transference of bacteria that breastfeeding provides also helps babies acquire the beneficial bacteria to protect them from diseases and builds their immune system. Approximately ten percent of the bacteria introduced to an infant is from the skin around the areola.²⁴

The specificity of bacteria in the infant’s gut is associated with feeding practices. Some bacteria may be reduced when a baby is not able to feed at the breast. However, there are ways to optimize feeding one’s own milk and/or using donor milk at the breast. With motivation, support, and guidance, combinations of feeding methods are possible to optimize beneficial aspects of both human milk feeding and feeding at the breast. That said, any amount of breastmilk is beneficial – even if only for a short period of time, even if there is no sucking at the breast. ((How can I feed the milk to my baby?)) ((Resources for support)) Physical skin-to-skin contact and bodily proximity with any feeding also provide relaxation for both parent/caretaker and child due to the effects of oxytocin.²⁵

Long-term health benefits
Some long-term benefits that have been studied are lower rates of obesity (10% reduction in the prevalence of overweight or obesity in children exposed to longer durations of breastfeeding), type 1 and type 2 diabetes, hypertension (a small protective effect of breastfeeding against systolic blood pressure), cardiovascular disease, hyperlipidemia (results do not support a long-term programming effect of breastfeeding on blood lipids), and some types of cancer (For every 12 months someone breastfeeds, the risk of breast cancer dropped 4.3 percent.).²⁶ ²⁷ ²⁸

These studies are typically confounded by many factors, including socio-economics and inequities, but the benefits of breastfeeding always need to be evaluated against the risks of not breastfeeding. To say that breastfeeding and/or human milk improve something is a distortion of sorts. Breast(milk)feeding is normative. It is better to acknowledge that not breastfeeding causes harm and that no matter how someone needs to feed their baby for various reasons, human milk can and should be a part of this.

Meta-analysis of studies on cognitive performance suggests that breastfeeding is associated with increased performance in intelligence tests in childhood and adolescence. Breastfeeding promotes brain development, particularly white matter growth.²⁹ Some pathways for the beneficial effect of breastfeeding on cognitive development results from the presence of certain essential long-chain fatty acids in breastmilk, particularly arachidonic acid (AA) and docosahexaenoic acid (DHA). These favor the cerebral cortex and retina and accumulate during the last trimester from the placenta and during the first year of life. Infants can synthesize neither AA nor DHA.³⁰

Economic benefits
The absence of breastfeeding not only affects short and long-term health outcomes. It also has a financial toll on the economy. When evaluating the cost of not breastfeeding, Melissa Bartick, et al, conclude that all costs were significantly lower under optimal breastfeeding conditions, with the exception of pre-menopausal ovarian cancer and acute lymphatic leukemia. These costs were qualified into 4 mutually exclusive categories: direct medical costs, indirect medical costs, indirect non-medical costs, and premature maternal death costs. In the US, the cost of a lack of breastfeeding in 2014 was 3.0 billion dollars for total medical costs, 1.3 billion for non-medical costs, and 14.2 billion for premature maternal deaths.³¹ ³²

Environmental benefits

Coming soon

Medicinal uses of human milk
In addition to its long and short-term biological, physiological, and economic benefits, a growing body of research is showing the amazing disease-killing and healing properties of human milk. Human milk contains multipotent stem cells, stem cells that can be reprogrammed to form many types of human tissues. This is especially important for further regenerative therapies, tissue culture techniques, and gene therapy. The presence of these cells in human milk suggests that milk could be an alternative source of stem cells for a patient’s own stem cell therapy. Isolating stem cells from human milk is a simpler and less invasive technique than extracting them from organs. Colostrum is especially rich in stem cells.³³ ³⁴ ³⁵ ³⁶

Human milk is also being researched in the context of skin warts and cancer. A protein in human milk called alpha-lactalbumin, when processed with oleic acid (simply put) forms a compound called alpha-lactalbumin-oleic acid. When this compound was applied topically to skin warts of people who were not responding to conventional treatment, there was an 82% in wart reduction. With time, all lesions resolved completely in most of the patients who received alpha-lactalbumin–oleic acid (83 percent), and these patients were still free of lesions at the two-year follow-up. This raises hope it might also prove effective against cervical cancer and other lethal diseases caused by the same virus.³⁷

The effect of α-lactalbumin–oleic acid on tumor cells was discovered by chance when researchers were studying the antibacterial properties of human milk. HAMLET, which is the same human protein-derived alpha-lactalbumin but with the addition of ‘made-lethal-to-tumor-cells’ induces apoptosis-like death in tumor cells while leaving healthy cells unaffected. Patients with cancer of the bladder who were treated with the substance excreted dead cancer cells in their urine after each treatment.³⁸ ³⁹ ⁴⁰

Lastly, studies showed that HAMLET also has direct bactericidal activity against some bacteria. The findings suggest that maybe HAMLET can be used where antibiotics fail due to antibiotic resistance. Antibiotic resistance is a growing global health concern and hopefully, further research in this area will contribute to novel treatment options.⁴¹

It has to be noted that HAMLET does not occur in human milk. HAMLET is a lab-altered human milk protein. Drinking human milk may or may not have beneficial properties for adults, but it may also have risks for the immuno-compromised, like CMV.⁴² While breastfeeding a child for six months or longer has been associated with a lower risk for childhood cancer compared to children who had been breastfed for less time or not at all, this is most likely due to the age-appropriate immuno-developing properties of human milk and the metabolic processes in the infant. The adult gut has a higher pH than that of babies. Adults need a much bigger variety of food in order to obtain all the essential nutrients.

The importance of the act of breastfeeding
Finally, the benefits of breastfeeding are beyond its product, the milk. They are beyond providing nutrition to one’s child for optimal health, growth, and development. The time spent between lactating parent and child when breastfeeding is also vital to the development of a bonded relationship. It provides an opportunity to interact and connect – or more accurately, it demands it, in a way that is not a given when bottle feeding. Although breastfeeding duration is only one of many factors associated with maternal abuse and neglect, it does offer a protective effect that is higher than in situations where an infant is not breastfed.⁴³

Newborn humans are born in a helpless state and continue their development after birth. The nurturing embraces of breastfeeding mimic the embrace of the womb that the baby experienced in utero. In light of this, the method a parent or caregiver uses to provide donor milk to a baby is thus also very important.⁴⁴

As Dr. Brian Palmer, DDS said: Breathing well, sleeping well, and breastfeeding infants are three key ingredients to good health, feeling better, and reducing healthcare costs for everyone – including insurance companies and governments.

Next: WHO guidelines for exercising feeding options

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