‘Fed is best’
‘Breast is best’
Go to any article or Facebook post concerning infant feeding and you’ll more than likely see one of these two phrases, and no doubt a lot of arguments about it in the comment section. I hate both terms. Neither is true, and neither is helpful.
Informed choice is best.
The issue with ‘fed is best’
The definition of ‘best’ is ‘that which is the most excellent, outstanding, or desirable’. Feeding your baby is not ‘outstanding’, it’s fundamental to their survival. The term ‘fed is best’ infers that what you feed your baby shouldn’t matter to you at all, and that formula is completely equal to breastmilk. The truth is, most women care very much about what they feed their baby, and there are pros and cons to both breastfeeding and formula feeding which families carefully consider before coming to a decision. ‘fed is best’ is completely dismissive of that. Another big issue with this phrase is that it is often used to undermine a woman’s determination to breastfeed, and to spread misinformation about breastfeeding. Breastmilk and formula are not nutritionally equal.
The issue with ‘breast is best’
Breastfeeding is the biologically normal way for babies to feed. Breastmilk is, of course, the healthiest option for most babies, but that doesn’t mean that it is ‘best’ for everybody, because what is ‘best’ is individual to each of us. For a woman who has undergone a mastectomy, breastfeeding might not be best. For a woman who needs to take medication which is incompatible with breastfeeding, breast might not be best. This term may have come into use with good intentions, to let people know what’s so great about breastfeeding, but nowadays it is often used to pressure women into breastfeeding and to shame them if they choose not to. Thousands of women have spoken out about how this phrase made them feel shamed, because breastfeeding didn’t work out for them despite their best efforts, so why do we still say it? What’s more, ‘breast is best’ was actually coined by the formula industry. Calling something ‘best’ infers that it goes above and beyond the norm. By calling breastfeeding ‘best’, formula companies are telling us that formula is the norm, as well as telling us that their product is as close as possible to breastmilk.
How we feed our babies is often a very emotive subject. Both of these terms have been hurled at other women in arguments and have far too many negative connotations. Neither is true for every woman and baby, and neither is remotely helpful to a woman who is trying to decide how to feed her baby, so isn’t it time we started moving away from such restrictive language?
Informed Choice is Best
What’s ‘best’ is individual to each mother-baby dyad. With so much misinformation out there, it can be really difficult for women to decide how to feed their babies. In an ideal world, every single mother would have all the information and support she needs to make an informed decision. Nobody would choose to breastfeed simply because they’ve been told that formula is basically poison. Nobody would choose to formula feed simply because they’ve been told that formula and breastmilk are identical. Everyone would be able to make an informed choice as to how they feed their babies, and nobody would be judged for it. Informed choice for all women would be ‘excellent, outstanding, and desirable’, but unfortunately that’s still a long way off.
A few wonderful facts about breastmilk
Breastmilk is a complete food for baby humans, containing everything they need for the first 6 months. It’s your baby’s main source of nutrition for the first year, and an important part of their diet for at least 2 years. But it’s not just about nutrition! Breastmilk contains thousands of bio-active components which contribute to your child’s healthy development. Here are just a few of them:
Lactoferrin— This is an Iron binding protein which deprives harmful bacteria of their iron and kills them. It has also been shown to prevent the growth of cancerous cells. Formula milk contains lactoferrin too, but it isn’t absorbed as easily as from breastmilk. The level of Lactoferrin in breastmilk increases during the second year of breastfeeding, to help protect your toddler as they get exploring their environment.
Lysozyme – This is an enzyme which destroys pathogens (harmful bacteria and viruses) by breaking down their cell walls. Like Lactoferrin, the level of lysozyme increases during the second year. It isn’t found in formula milk.
Epidermal growth factor – This promotes the growth and healing of the digestive tract. It is found in higher concentrations in milk produced by women who’s babies are born prematurely, offering them significant protection against Necrotizing Entercolitis (a condition in which parts of the intestine die). It isn’t found in formula milk.
Neurological growth factor – This promotes the growth and healing of the cells in your baby’s brain and nervous system. It isn’t found in formula.
Immunoglobulin – Also known as antibodies, these are an important part of our immune system. When our bodies detect a pathogen we produce antibodies to fight them off. When you’re breastfeeding, these antibodies pass to your baby through your milk, giving them protection against infection. The concentration of immunoglobulin is highest in colostrum, and the level increases when you or your baby are ill. This isn’t found in formula milk. Despite popular belief, antibodies do NOT turn you breastmilk blue. Why your milk may appear blue, and many other colours, is explained here.
Beta-endorphin – This protein binds to opoid receptors in the brain and reduces pain. It is found in the highest concentrations in colostrum, to help babies recover from birth. It isn’t found in formula milk.
Stem cells – In 2012, Prof. Foteini Kakulas (formerly Hassiotou) discovered that the stem cells in breastmilk, like embryonic stem cells, are pluripotent, meaning that they have the potential to differentiate into any type of cell in the human body. This is pretty special, because most of the stem cells we produce once we’re out of the womb are partially-specialised cells. The only times we produce pluripotent stem cells are when we’re growing a foetus, or breastfeeding a baby. Amazingly, further research has shown that these cells survive your baby’s gut and migrate around the body, reaching various organs such as the pancreas, liver, kidneys and even the brain, where they specialise into the cells needed by those specific organs. There are no live cells of any type in formula milk.
Human Milk Oligosaccharides – These carbohydrates act as prebiotics, promoting the growth of good bacteria and reducing the growth of pathogens. Some formula manufacturers have added non-digestible oligosaccharides to their formula, so that they can write about it on the tin and get you to buy their product. However, there’s little evidence that these non-human versions have any benefit to your baby, and the FSA advise that they are pointless additive.
Lipase – This is an enzyme that helps your baby digest fat. Young babies don’t produce enough of it on their own so it is considered quite important, and it is not found in any other mammalian milks (or formula), except human and gorilla milk.
Leptin – This is an appetite control hormone which helps your baby to recognise when they are full and is thought to prevent obesity in later life. There are no human hormones in formula milk.
The health benefits
In comparison to babies who are formula fed, babies who are breastfed have a lower risk of:
- Respiratory, gastrointestinal and ear infections
- Asthma and eczema
- Obesity in later life
- Diabetes in later life
- Sudden Infant Death Syndrome (SIDS)
- breastfed babies get ill less often and recover quicker
Women who breastfeed, in comparison to those who do not, have a lower risk of:
- Breast cancer
- Ovarian cancer
And, the longer you breastfeed for, the lower the risk appears to be!
This doesn’t mean that every baby who is formula fed will succumb to these conditions, and every baby who is breastfed will not. These are statistics, looking at the differences between breastfed and formula fed babies at a population level.
The power of Oxytocin
Back in 1906, a powerful hormone was discovered by Sir Henry Dale. We learned that this hormone was responsible for our contractions during birth, and our let down (milk-ejection) reflex when we feed our babies. He named it ‘oxytocin’.
Oxytocin is known as the hormone of love. It forms the chemical basis of our relationships, creating feelings of relaxation and helping us form strong bonds to those important to us. It is the polar opposite of the hormone ‘adrenaline’, which is responsible for our ‘flight or fight’ response when we perceive danger. Oxytocin induces calm, helps us sleep, helps our bodies heal and grow, reduces anxiety and stress and greatly reduces our perception of pain.
During breastfeeding, oxytocin causes the little sacs of milk in your breasts to contract, pushing milk out through your ducts to feed your baby, and stimulates the release of ‘prolactin’ – the hormone which causes you to make more milk. It also causes the blood vessels on your chest to dilate, which helps to regulate your baby’s temperature. When your baby feeds, their brain releases oxytocin too and you give them some of yours through your milk.
Why did I choose to breastfeed?
Breastfeeding is the biological norm and has all these wonderful benefits, but if I’m perfectly honest, those were not the main reasons I decided to breastfeed. Those facts above were the things that fueled my determination through the difficult days in the very beginning, but in the long run what it really came down to is:
- It helps you to bond with your baby
- Breastmilk is always on tap and at the right temperature
- You can breastfeed in your sleep 🙌
- No extra washing up
- It uses up around 500 calories a day (hello? Extra chocolate!)
- It’s a fantastic parenting tool
How breastfeeding benefits everyone else
The formula industry has a huge impact on the environment. Creating 1kg of formula uses about 4,000L of water, and all the farming, manufacturing, packaging, storing and shipping of formula carries a massive carbon footprint. The International Baby Food Action Network made a really interesting (though rather hard-hitting) document about this which can be found here. Breastfeeding, on the other hand, has a low water impact and produces no waste at all (other than your baby’s poop!).
If breastfeeding rates were increased, it could save the NHS £50 million a year! In addition, parents of breastfed babies miss less days of work due to caring for sick children, which benefits the workforce as well as our bank balance!
Lots of parents worry about how dad or grandma will bond with baby if they’re not giving them a bottle, but that fear is completely unfounded. You don’t need a bottle to bond with your baby. Bonding is about touching, talking, eye-contact, spending time together, and so much more. There are SO many ways that the non-breastfeeding parent can bond with their baby, without using a bottle. Some fantastic ideas here.
What about formula feeding? Or combining the two?
Women choose not to breastfeed for numerous reasons, and you should never have to explain your decision to anybody. However, trying to choose a particular formula or bottle for your baby can be an absolute minefield. There are hundreds of different products out there, each with it’s own (generally completely fabricated) claim about how it’s better than everything else available. The lengths which some formula companies go to to encourage you to buy their product is, in my opinion, despicable. So how do you choose? Whether you’re wanting to combine formula with breastfeeding or to exclusively formula feed, science tells us that no one brand is better for your baby than another. Follow-on milks are an unnecessary marketing ploy, and there is no evidence that ‘special’ milks for colic actually work. Don’t fall for the unethical marketing techniques of multi-billion dollar companies. You can find excellent, non-biased information on formula milks at First Steps Nutrition, and a helpful guide to the different types of milk available on the NHS Choices website.
Catherine J. Field; The Immunological Components of Human Milk and Their Effect on Immune Development in Infants, The Journal of Nutrition, Volume 135, Issue 1, 1 January 2005, Pages 1–4.
Katherine E. Gregory and W. Allan Walker, Immunologic Factors in Human Milk and Disease Prevention in the Preterm Infant, Curr Pediatr Rep. 2013 Dec; 1
Olivia Ballard, JD, PhD and Ardythe L. Morrow, PhD, MSc, Human Milk Composition: Nutrients and Bioactive Factors, Pediatr Clin North Am. 2013 Feb; 60
Hassiotou F, Beltran A, Chetwynd E, Stuebe AM, Twigger AJ, Metzger P, Trengove N, Lai CT, Filgueira L, Blancafort P, Hartmann PE (2012). Breastmilk is a novel source of stem cells with multilineage differentiation potential. Stem Cells 30(10):2164-2174.
Aydin MS, Yiğit EN, Vatandaşlar E, Erdoğan E, Öztürk G (2018). Transfer and integration of breast milk stem cells to the brain of suckling pups. Scientific Reports 8:14289