Now Ye're Talking - to an infant milk scientist

Neyite · 04-11-2016 4:27pm #1

We discovered a poster here on Boards did a very interesting PhD on infant milk that might be of special interest to parents, particularly parents of pre-weaned babies. She very kindly agreed to come along and take part in a AMA for us, focusing on the scientific side of infant feeding.

She can answer any questions on the composition of milk, or on the novel applications of different types of milk. She can answer questions on the similarities (and differences) between human milk and formula milk, and the potential issues that may/may not cause for baby (& why there are so many different formulas on the shelf!). She can talk about milk banks, the process of making infant formula, and even provide an explanation as to why breast milk is a different colour sometimes.

She can talk about the link between the reduction of incidences of breast cancer in women who breast fed (along with the hypothesis behind it), the vaccine for breast cancer, and the changes that milk can undergo as required by baby. She can also try to debunk / confirm any myths that people have heard.

However...
She is unable to answer any questions from a feeding point of view, such as latch issues or stimulating milk production as she had nothing to do with that side of things!

Neyite · 04-11-2016 4:43pm

Ok, I have a couple of questions!

Colostrum: What's in it that makes it so important?

Next question is about milk banks. Do the milk banks screen for things that could be transmitted through breast milk such as drugs /medications or disease?

Thank you!

rainbow kirby · 04-11-2016 4:56pm

Can you tell us more about the links between breastfeeding and reduced incidences of breast cancer?

I'm curious as I'm the daughter of a 2 time breast cancer survivor, have dense glandular tissue which is difficult to examine (higher risk) and have been breastfeeding my son for 7 months.

cyning · 04-11-2016 6:22pm

Where do you stand on the fore milk/hind milk debate? Is it really that big a deal?

What is the safest way to make formula?

Why do formula fed babies have more stomach bugs?

Thanks for doing this!

painauchocolat · 04-11-2016 6:24pm

What a kind offer!

When I moved from breastfeeding to formula, i read somewhere (in a haze of guilt and sleep deprivation) that most studies comparing breastfed babies to bottle fed babies study babies from different families, but a study that compared siblings (where one had been bottle fed, the other breastfed) found relatively little difference in outcomes for the kids, suggesting that factors like genetics, parental income and education etc were more significant.

My question is... Did I hallucinate this in an attempt to ease my guilt, or is it an actual thing?

Many thanks

Ms2011 · 04-11-2016 8:21pm

Is it possible to freeze dry or however the process is done to create a powdered actual breastmilk that can be rehydrated & prepared like formula?

mirrorwall14 · 04-11-2016 10:01pm

Where do you stand on the breast feedings versus bottle fed in circumstances where the Mother needs to take medication that is contraindicated for breastfeeding? I felt so guilty

TheBody · 04-11-2016 10:14pm

When my son was born, he was fed on SMA. After the first week, he became extremly unwell. Constant screaming and crying.

I brought him to 4 different GP's who dismissed it all and said it was just colic. Being a new parent it was difficult to listen to this as I knew in my bones something was wrong.

During one particularly bad screaming session, I brought him to hospital and said I'm not leaving until somebody performs some serious tests/examinations and I was not accepting colic for a diagnosis!!

A wondererful paediatrician in Mullingar hospital listened to us and tested my son for just about everything. She also had all his organs checked on an ultrasound. All clear. In the end she suggested that we try a differnt brand of formula....Aptamil.

We went on our way. Not very hopeful to be honest but we did what we were told. Ther ingredients were virtually the same as SMA just in slightly different quantities. The amazing thing was it worked!! The crying stopped within a few hours of the SMA leaving his system. No more screaming baby!!

So, my question is why do you think SMA formula, which is essentially the same as Aptamil cause such a drastic reaction in my son?

Wesser · 04-11-2016 10:20pm

I see one particular brand which is pushing the protein aspect of its formula milk. Rich in protein etc. Protein is cool and in vogue at the moment for young men building muscle. Protein bars protein ice cream etc etc etc. I find this marketing ploy disgraceful. Babies do not need extra protein. What is your opinion. Thank you.

Happydippy · 04-11-2016 10:36pm

Hi,
I'm breastfeeding my toddler, I was wondering how different is the breastmilk now to when she was a newborn? Does it change much in composition as a baby grows?
And are there still nutritional benefits for a toddler who eats a reasonably balanced diet, most days.
Thanks

jlm29 · 04-11-2016 10:49pm

I wonder about tandem feeding. (Im not tandem feeding myself). If the milk adapts to meet the needs of the child, how does the body know which child to cater for?

jlm29 · 04-11-2016 10:58pm

Regarding the milk bank (particularly the Irish one in Fermanagh, I don't know how any others operate). I have heard that in terms of feeding an infant the order of preference of what to feed them would be
A)breast milk directly from source -I.e. Via nursing

expressed breast milk from the infants own mother
C) expressed milk -age matched
D) expressed milk- not age matched
E) synthetic milk/formula

Firstly-is this accurate? (Obviously I know some of it is!). Secondly, if it is, why does the bank take milk only from mothers whose babies are <7mo? Surely if not-age matched milk is preferable to formula, there would be a place for it?

I'm an infant milk scientist, AMA · 04-11-2016 11:32pm

Thanks Neyite, January and Orion for the invite to discuss the wonder of milk. Hopefully I can share some of the knowledge I learned with you guys.

I see there are a few questions already - fantastic! Thank you.

I have read them all and I will respond fully to them all as soon as I get to my computer. In the meantime feel free to keep asking questions. The more the merrier and there is no such thing as a stupid question!

I'm an infant milk scientist, AMA · 04-11-2016 11:35pm

Before I start - thanks for the opportunity to answer some questions.

Also, if at any stage further clarification on a topic is needed, feel free to ask. And if I'm too sciencey let me know - I'm always interested in explaining things in a way that is accessible to all.

Neyite wrote: »

Ok, I have a couple of questions!

Fire away. The more the merrier.

Neyite wrote: »

Colostrum: What's in it that makes it so important?

Colostrum is the first milk that is produced after baby is born (or sometimes even before baby is born). The idea of colostrum is that it is the babies first feed. There's a huge concentration of things that boost babies immune system - things called antibodies, cytokines and growth factors which can help baby develop his own immune system to guard against infections. It also contains other important proteins including:
- lactoferrin (which has natural antimicrobial activity, it binds iron and transports it around the body, and it boosts epithelial cells which are the cells inside babys tummy).
- lysozyme (another antimicrobial protein - its usually found in tears and prevents eye infections in people).

It also contains lots of vitamins, minerals, sugars and fats - all of which are essential for growth and development.

The combination of all of the above also have a slight laxative effect, encouraging the first poo!

Colostrum is available for use as a food supplement for grown up humans too, however there's very little evidence that it performs any better than regular protein supplements, particularly in healthy individuals. The real benefit of colostrum comes in the early days of feeding - hopefully grown ups will have developed their own immune systems!

(Maybe if colostrum has a tendency to induce poos, weighlifters shouldn't take it if they're going to be straining...)

Neyite wrote: »

Next question is about milk banks. Do the milk banks screen for things that could be transmitted through breast milk such as drugs /medications or disease?

Short answer - yes.

Long answer - as much as is reasonably possible. The donations aren't anonymous, so there is an onus on mum to disclose any medications that may be present in the breast milk. Same for any illness that mum may have that can be transmitted through milk. In terms of bacterial loading, all of the banked milk is pasteurised as soon as it's received. It not only reduces bacteria in the milk, but it extends its shelf life a little :pac: Ah no, it makes it more stable for longer and allows delivery to far away hospitals or batch deliveries when needed.

There's only one human milk bank in Ireland and it's based in Fermanagh. For anyone who would be interested in donating their milk, they can be contacted on tmb.irvinestown@westerntrust.hscni.net - I'm not trying to advertise their services, I'm in no way affiliated with them. I just know the importance of their service - not only in providing milk for potentially very sick babies or babies that have lost mum, but also giving scientists a better understanding of breast milk (which can only serve to improve our knowledge and improve formula milk).

Neyite wrote: »

Thank you!

You're welcome.

I'm an infant milk scientist, AMA · 04-11-2016 11:36pm

rainbow kirby wrote: »

Can you tell us more about the links between breastfeeding and reduced incidences of breast cancer?

I'm curious as I'm the daughter of a 2 time breast cancer survivor, have dense glandular tissue which is difficult to examine (higher risk) and have been breastfeeding my son for 7 months.

Wow - your mum must have really been through the mill with her two battles. I hope she is doing well now.

The general consensus amongst the scientific world is that the longer a woman breast feeds for, the less of a risk she has of developing breast cancer. There is a very in depth study which was published in The Lancet in 2002 (v 360, p 187) which confirms this world-over. (If you would like to access the paper, let me know)

There are several hypotheses for why there is a decrease in breast cancer rates in mothers who breast feed compared to those that don't. I'll try and explain them:
- Stimulation of milk production keeps breast tissue active and makes you less likely to have little patches of dead tissue there
- Breast feeding removes dead cells from the breast (they go into the milk but have no bad effects for baby)
- Hormones. Those beautiful hormones :pac:

Breast feeding does reduce the incidences of breast cancer, however I would still follow any screening procedures recommended to you by your doctors.

Congrats on the baby

lazygal · 04-11-2016 11:44pm

I've been breastfeeding since mid 2012. My younger child shows no signs of weaning, he's over three years old. Have I reduced my risk of breast cancer? If I keep feeding will this reduce the risk further? My grandmother died from breast cancer, and several relatives have had it.

I'm an infant milk scientist, AMA · 04-11-2016 11:46pm

cyning wrote: »

Where do you stand on the fore milk/hind milk debate? Is it really that big a deal?

No. There is very little difference between hind milk and fore milk. It's all still milk. Baby isn't going to be any better or worse off. It's simply just a supply issue. If you imagine you're going shopping and you want to buy shoes and a bag and a coat, you'll go into every shop that sells shoes, bags and coats. You're shopping with a friend who only wants a bag, and she only goes into the shops with bags. She will reach the end of the street before you because even though you travelled the same distance, you were held up more on the way through. That's what happens with breast milk - different parts arrive at different times but they all get there in the end.

cyning wrote: »

What is the safest way to make formula?

The safest way to make formula is the way that is written on the tin, essentially. Infant formula is compounded, pasteurised and spray dried, so it's very unlikely to contain any bugs that could upset baby's tummy. However when you're mixing it, it's important to use boiled water to ensure that no nasties get in through the water. And sterilised bottles if you're going to be storing the bottles. When reheating, if possible do it in a cup of hot water rather than the microwave.

cyning wrote: »

Why do formula fed babies have more stomach bugs?

Now I'm going to need some clarification on what you mean by tummy bugs - do you mean pukey and poos? Or do you mean the healthy bugs (gut microbiota) that we all have?

If you mean the former, it's to do with the immune system and infection control. Mum is unlikely to have any nasty bacteria on her skin, and any that she has baby will likely be immune to. So there's less risk of infection at source (for the want of a better expression - baby bottle teats can harbour bugs!). But also, breast milk can change its composition to meet the nutritional needs of baby. The nipple has sensors that can say "oh, baby has the sniffles, let's produce more lysozyme to kill that nasty bug", and breast milk also has higher concentrations of those bug busting proteins.

If you mean the latter, changes in the prebiotics in milk will impact the gut microbiota.

cyning wrote: »

Thanks for doing this!

You're welcome

I'm an infant milk scientist, AMA · 04-11-2016 11:49pm

lazygal wrote: »

I've been breastfeeding since mid 2012. My younger child shows no signs of weaning, he's over three years old. Have I reduced my risk of breast cancer? If I keep feeding will this reduce the risk further? My grandmother died from breast cancer, and several relatives have had it.

I've answered this just above your question, but if you have further queries let me know

But ultimately, yes. You have reduced your risk of breast cancer. The reduction in risk decreases over time though - extended breast feeding doesn't have a significant impact on risk reduction (beyond the initial reduction).

I'm an infant milk scientist, AMA · 04-11-2016 11:51pm

Ms2011 wrote: »

Is it possible to freeze dry or however the process is done to create a powdered actual breastmilk that can be rehydrated & prepared like formula?

Of course. But the issue is supply - there simply isn't enough spare breast milk to justify making powdered breast milk.

I'm an infant milk scientist, AMA · 04-11-2016 11:52pm

mirrorwall14 wrote: »

Where do you stand on the breast feedings versus bottle fed in circumstances where the Mother needs to take medication that is contraindicated for breastfeeding? I felt so guilty

I am the child of a mother who couldn't breast feed because she was taking medication.

I turned out just fine

The technology has come on leaps and bounds. The difference between formula and breast milk is much smaller now than it was before.

Are there health benefits to baby being breast fed? Sure. Is it worth compromising the health of mum to breast feed baby? No!

Your baby was fed. Ultimately that's the most important thing in all of this. You have zero reason to feel guilty!

I'm an infant milk scientist, AMA · 04-11-2016 11:53pm

TheBody wrote: »

When my son was born, he was fed on SMA. After the first week, he became extremly unwell. Constant screaming and crying.

I brought him to 4 different GP's who dismissed it all and said it was just colic. Being a new parent it was difficult to listen to this as I knew in my bones something was wrong.

During one particularly bad screaming session, I brought him to hospital and said I'm not leaving until somebody performs some serious tests/examinations and I was not accepting colic for a diagnosis!!

A wondererful paediatrician in Mullingar hospital listened to us and tested my son for just about everything. She also had all his organs checked on an ultrasound. All clear. In the end she suggested that we try a differnt brand of formula....Aptamil.

We went on our way. Not very hopeful to be honest but we did what we were told. Ther ingredients were virtually the same as SMA just in slightly different quantities. The amazing thing was it worked!! The crying stopped within a few hours of the SMA leaving his system. No more screaming baby!!

So, my question is why do you think SMA formula, which is essentially the same as Aptamil cause such a drastic reaction in my son?

Sorry to hear that baby was so unwell! I'm glad that the change in formula had such a positive impact on his health!

I know that nutritionally they're the same product. They will provide the same % protein, fats, sugars, vitamins etc, and they'll be made with roughly the same processing. However the composition of the individual proteins in the milk can vary drastically depending on the source of milk proteins used.

I'll try to explain it. Different proteins are different sizes. The bigger proteins are a little bit harder for baby to digest - so his tummy is going to go into overdrive. Some milks have more of the smaller proteins, so they're a little bit easier for baby to digest.

I can go into more detail if you'd like?

I'm an infant milk scientist, AMA · 04-11-2016 11:54pm

Wesser wrote: »

I see one particular brand which is pushing the protein aspect of its formula milk. Rich in protein etc. Protein is cool and in vogue at the moment for young men building muscle. Protein bars protein ice cream etc etc etc. I find this marketing ploy disgraceful. Babies do not need extra protein. What is your opinion. Thank you.

Ah yes. The "in vogue"ness of protein!

You're correct in that babies don't need extra protein, but the quality of the protein in the milk is important.

There are two main families of protein in milk: casein and whey. Casein is what is used to make cheese, and whey was historically a waste product/product of no value. However when they started doing research into whey they discovered that whey is pretty cool! I'm going to throw out some figures now:
Human milk is 60% whey, 40% casein.
Cows milk is 80% casein, 20% whey.

Cows milk is the source of protein for infant formula, so a lot more casein is available. Hence it's more economical to use casein over whey, if you're just looking at it from protein content point of view.

However, whey is the part of the milk that has the more "functional" proteins - the immune boosting proteins.

Now if you're looking to have a milk that's 40% protein, as a milk formula manufacturer it is way cheaper to use the casein to make up the bulk of the protein. However, in terms of the idea of "humanising" infant formula, it's better to use the whey. The ones that advertise the protein aspect of it likely have a higher % of whey in them.

Protein is protein when it comes to nutrition and building blocks. And being honest, it's unlikely that some of the bioactive proteins that are in whey will have full activity in baby, because of the processing of the proteins.

Anne_cordelia · 04-11-2016 11:54pm

painauchocolat wrote: »

What a kind offer!

When I moved from breastfeeding to formula, i read somewhere (in a haze of guilt and sleep deprivation) that most studies comparing breastfed babies to bottle fed babies study babies from different families, but a study that compared siblings (where one had been bottle fed, the other breastfed) found relatively little difference in outcomes for the kids, suggesting that factors like genetics, parental income and education etc were more significant.

My question is... Did I hallucinate this in an attempt to ease my guilt, or is it an actual thing?

Many thanks

Really interested in this. Fascinating topic by the way.

I'm an infant milk scientist, AMA · 04-11-2016 11:56pm

painauchocolat wrote: »

What a kind offer!

When I moved from breastfeeding to formula, i read somewhere (in a haze of guilt and sleep deprivation) that most studies comparing breastfed babies to bottle fed babies study babies from different families, but a study that compared siblings (where one had been bottle fed, the other breastfed) found relatively little difference in outcomes for the kids, suggesting that factors like genetics, parental income and education etc were more significant.

My question is... Did I hallucinate this in an attempt to ease my guilt, or is it an actual thing?

Many thanks

Short answer - no. You didn't hallucinate.

Long answer to follow when I can get the link to the correct study - I don't have my laptop home at the moment.

I'm an infant milk scientist, AMA · 04-11-2016 11:57pm

Happydippy wrote: »

Hi,
I'm breastfeeding my toddler, I was wondering how different is the breastmilk now to when she was a newborn? Does it change much in composition as a baby grows?
And are there still nutritional benefits for a toddler who eats a reasonably balanced diet, most days.
Thanks

Does it change much? Yes.

Have you ever expressed milk? You may have noticed that when baby was born your milk was almost yellow? Well that's because the first milk is very highly concentrated whey proteins (which are the soluble proteins).

Interesting fact. Well, maybe not interesting to non nerds. Milk isn't actually white! It's an optical illusion. It's a colloid system, so you're seeing a suspension of the casein proteins together. The soluble part of milk is actually yellow.

Anyway, yes. Colostrum is full of whey. Hence the yellow. However as the days go on, the compositions changes. More casein is produced, and the composition of the whey changes. The predominant whey protein becomes a protein called alpha lactalbumin rather than the immunoglobulins, and it's less yellow.

(Alpha lactalbumin is the protein I did my PhD on)

So as the months go on, baby starts eating more food so relies less on the nutrients from mum, so the milk becomes pretty dilute.

In terms of nutritional benefits, yeah, there would still be benefits. But I don't think that it should be the driving factor in continuing to BF. Obviously if you're comfortable continuing, go for it, but nutritionally cows milk will be as good, or even a piece of cheese and a glass of water.

I'm an infant milk scientist, AMA · 04-11-2016 11:59pm

jlm29 wrote: »

I wonder about tandem feeding. (Im not tandem feeding myself). If the milk adapts to meet the needs of the child, how does the body know which child to cater for?

The human body is a wonder sometimes!

The short answer is hormones. Mum knows which mouth needs to be fed. So the milk is produced accordingly. I've heard stories of using the left boob for one and the right boob for the other, but the body really can tell the difference. It's fascinating.

jlm29 wrote: »

Regarding the milk bank (particularly the Irish one in Fermanagh, I don't know how any others operate). I have heard that in terms of feeding an infant the order of preference of what to feed them would be
A)breast milk directly from source -I.e. Via nursing
expressed breast milk from the infants own mother
C) expressed milk -age matched
D) expressed milk- not age matched
E) synthetic milk/formula

Firstly-is this accurate? (Obviously I know some of it is!). Secondly, if it is, why does the bank take milk only from mothers whose babies are <7mo? Surely if not-age matched milk is preferable to formula, there would be a place for it?

Yeah, that would be fairly accurate on A, B and C. The lines are a bit blurry then in terms of what nutrients would be best for baby - see previous answers on the protein composition over time. Young babies need more protein than older babies - if the non-age matched milk contains too little protein, then supplementing with IF is needed.

As for the <7mo I don't know that one. I can't remember off the top of my head the exact dates but I had samples of milk from different stages of milk production. It's possible that some were from private donors, but we did get milk from the milk bank on occasion.

And there is, of course, a place for non age matched milk, however it comes down to supply and demand. Very few mums can express and donate and feed baby at the same time, and donations aren't guaranteed on a frequent basis.

jlm29 · 05-11-2016 12:03am

Thank you! It's all very interesting! I know this might be outside of your remit, but as regards the energy requirements required for a lactating mother to feed an infant, word on the street is that it burns approx 500 cals in a day. Presumably this reduces over time, as baby starts solids, etc, but by how much?

brokensoul · 05-11-2016 12:10am

I have 16 week old twins, breastfed to 6 weeks and then formula fed as I developed an abscess.

One twin is flying it but the other has had rashes and reflux and generally is uncomfortable a good bit. She is putting on weight and keeping food down but obviously it would be nice for her to be more comfortable. We have moved her onto aptimil pepti on the advice of our doctor as she may have a cow milk protein allergy and it has made some difference but not an enormous amount.

I am wondering if you can explain why some babies get these allergies and if there is any way to figure out what formula might work best (lactose free, pepti etc) apart from trial and error?

Thanks so much.

teggers5 · 05-11-2016 8:55am

hi... my son is now 6 months old. breastfed for the first week and formula since then. (Aptamil)
my question, should I move him to stage 2 milk now that he's 6 months even though he's only slowly taking to solids... Or should I leave him on stage 1 formula until weaning is more established?

sword1 · 05-11-2016 9:32am

The safest way to make formula is the way that is written on the tin, essentially. Infant formula is compounded, pasteurised and spray dried, so it's very unlikely to contain any bugs that could upset baby's tummy. However when you're mixing it, it's important to use boiled water to ensure that no nasties get in through the water. And sterilised bottles if you're going to be storing the bottles. When reheating, if possible do it in a cup of hot water rather than the microwave.

Why not use the microwave? How. Does it change the milk?

SpatialPlanning · 05-11-2016 9:32am

I'm an infant milk scientist, AMA wrote: »

If you mean the former, it's to do with the immune system and infection control. Mum is unlikely to have any nasty bacteria on her skin, and any that she has baby will likely be immune to. So there's less risk of infection at source (for the want of a better expression - baby bottle teats can harbour bugs!). But also, breast milk can change its composition to meet the nutritional needs of baby. The nipple has sensors that can say "oh, baby has the sniffles, let's produce more lysozyme to kill that nasty bug", and breast milk also has higher concentrations of those bug busting proteins.

If you mean the latter, changes in the prebiotics in milk will impact the gut microbiota.

You're welcome

Hi,

Thank you for such an excellent AMA! I was just reading this with my wife and she had a question about the bolded part above:

If you use a nipple shield when breastfeeding, does that interfere with the process mentioned above whereby the composition of the milk responds to changes in the baby's nutritional needs?

Now Ye're Talking - to an infant milk scientist

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