Breastfeeding: Best Choice in a Polluted World

Breastfeeding remains the best option for feeding human infants even though environmental contaminants have been found in human milk. Breastfeeding offers innumerable benefits for both the baby and the mother. The risks of not breastfeeding are well documented. Fetal exposure to environmental contaminants appears to be the biggest problem and breast milk, while a good indicator of fetal exposure, may help overcome some of the harmful effects.

• Breastfeeding beneficial even with high levels of DDT exposure. Eskenazi, Pediatrics, 2006.
• Perchlorate in human milk: Response by Jane Heinig, PhD, IBCLC, Paula Benedict, MPH, RD, and Thomas Hale, PhD - February 25, 2005.
• Flame Retardants in Pudget Sound Residents
• Fact Sheets: Out of Harm's Way by Greater Boston Physicians for Social Responsibility, in English and Spanish
• Breastfeeding Matters, Flame Retardants: Concern for Mothers, Breastmilk, Infants and the Public

Here is how I explain the issue of prenatal and post-natal exposure to environmental toxins: From Chris Mulford, RN, IBCLC, LLL Leader Reserve, working for WIC in South Jersey (Eastern USA), Co-coordinator, Women & Work Task Force, WABA

When scientists test human milk for persistent organic pollutants (POPs), it's not because they want to see whether the milk is safe for babies to drink. They use milk for testing because it is easy and painless to obtain, and because it is high in fat compared to the other body substances that could be tested (blood, urine, and hair). POPs concentrate in fat. When POPs are found in milk, it shows that they are present in fat throughout the body. When POPs are found in nursing mothers, it shows that they are present throughout the population. Most important, finding POPs in milk is evidence that POPs reach our babies via their mothers' blood from the moment they are concieved. All of our children-no matter how their mothers will decide to feed them-are already carrying a body burden of toxic chemicals the day they are born.

The Environmental Working Group, which announced the recent study of flame retardants in human milk, emphasizes that breastfeeding remains the best way to feed babies. "Even women with very high levels of fire retardants in their breast milk should continue to breastfeed their babies. There are two main reasons why. First, adverse effects on learning and behavior are strongly associated with fetal exposure to persistent pollutants, not with breast milk exposure. And second, breastfeeding appears to overcome some of the harmful effects of high fetal exposure to persistent chemicals." Nothing else that parents can feed their children builds the immune system and aids development the way human milk does. The longer breastfeeding continues, the better are the outcomes for child health and development.

Finding POPs in human milk is a call to action, not a call to abandon breastfeeding.

We need to call on the Environmental Protection Agency to phase out PBDE in U.S. products (as has been done in Europe), and to require labeling so consumers can choose not to buy products that contain PBDE.
We need to tell women how they can limit their exposure to harmful chemicals.
We need to call on the CDC (Centers for Disease Control and Prevention) to monitor body burdens of toxic chemicals.
We need to call on Congress to increase funding for research.
We need to continue protecting, promoting, and supporting breastfeeding. Until the day when POPs can be removed from the environment, breastfeeding is our only way to compensate our babies for inadvertently exposing them in the womb.
Yes, human milk brings us the message that we live in a polluted world. But don't kill the messenger!

Links to news articles:

• USATODAY.com - Breast milk can protect babyy  
• USATODAY.com - Flame retardant found in breast milk
• SF Chronicle - Study finds flame-retardant chemical in U.S. breast milk
• LA Times - Testing people for pollutants

Link to the research group: The study may be found at www.ewg.org.

Position Paper:  "Position on Breastfeeding, Breast Milk, and Environmental Contaminants." from the International Lactation Consultant Association.  Just go to the ILCA website at: http://www.ilca.org/pubs/index.php and scroll down to the Position Papers, which are fully downloadable.

Joint Statement that was issued in 2001 by WABA and IPEN (International POPs Elimination Network). ("POPs" stands for "Persistent Organic Pollutants.") You can see the joint statement on the WABA website at http://www.waba.org.my/RRR/joint.pdf

Press Release: A new LLLI press release on contaminants in human milk is available here: http://www.lalecheleague.org/Release/contaminants.html. This release also lists 10 simple ways a woman can help reduce her body burden of this and other chemicals.

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Professional Responses: Thomas Hale, PhD & Ruth A. Lawrence, MD, US Breastfeeding Committee

Ruth A. Lawrence, M.D.

Headlines are reporting flame retardant chemicals in breast milk because of the published studies. They have highlighted the report by the Environmental Working Group that two studies have shown these chemicals in lactating women. While this headline is alarming, it must be put in a perspective. It was decided by the Environmental Working Group that studying environmental chemicals in lactating women was the most economic and non-invasive way of monitoring environmental chemical levels in the general population in the United States. The reason is that human milk contains fat. It is the only way that a human excretes their fat. In order to measure chemical levels in fat depots in the general population, it would require the very invasive fat biopsy which would be technically difficult and extremely expensive or minimally blood draws.

A third study not referred to shows that newborns have the same level of these chemicals as their mothers. Pregnancy involves the important transmission of any chemical. The chemicals which are being reported are the bromine-based fire retardants that are used in many home and commercial settings. They are used in such things as television sets, automobiles, copy machines, hair dryers. The fire retardants are polybrominated biphenyl ethers or PBDE. They have been studied in small animals in large doses and been associated with nervous system damage and reproductive problems. There are no comparable studies in humans.

In two recent studies, a total of 67 women participated. 100% of the women who were involved had measurable amounts of PBDE's. The levels are much higher levels than those found in European women and in those noted five years ago. The Environmental Protection Agency suggests that PBDE's are doubling in humans every five years. Besides environmental sources, the EPA suspects that humans may be accumulating these chemicals from the animal fat they consume.

In the United States, California and Maine have begun to restrict the use of these chemicals. They are banned in Europe.

What does this mean for our infants? The important thing to recognize is that all women are at risk for having these chemicals in their fat depots. Therefore, all infants are exposed in utero which is a far greater exposure than through human milk. There are no data regarding the levels in cow milk, water, and infant formula. There is no indication that breastfeeding would contribute substantially to the exposure of our infants. It is important to recognize the tremendous benefit of being breastfed. The value of the nutrient constituents of human milk, the constituents which promote brain growth and good development, the constituents which protect against infection, the constituents that offer immuno-protection against chronic disease and allergy cannot be duplicated. The tremendous value of breastfeeding far exceeds the theoretic risk of these recently reported chemicals.

The public can expect to hear about more environmental chemicals being found in human milk, only because human milk has been selected as the environmental modality for monitoring chemicals in the general population.

The Environmental Work Group says even though a woman has a high level of chemical in her milk, she should continue to breastfeed because of the tremendous value of human milk and the effects of the chemicals are related to fetal intrauterine exposure.

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Tom Hale on Flame Retardant Research

There is great interest presently in the new data just being published concerning the transfer of polybrominated diphenyl ether flame retardants.

This family of chemicals is commonly used in soft foam pads, and many many plastics used in the computer industry.

The paper is being published by Arnold Schecter MD, MPH for The UT Health Sciences Center Dallas Texas. Basically this paper shows that in a small population of central Texas women, that levels of Polybrominated diphenyl products were present in milk. If you look at the distribution curve, the vast majority of women were less than 50 ng/g lipid, and only a few 13 of 47 were about this amount.

These products have been around for over 30 years, but due to their ability to bioaccumulate in fat tissues in humans, and some reported neurobehavioral abnormalities in mice and rats, we are becoming more interested in this groups of compounds. This paper suggests that the levels in this Texas subgroup were much higher than in Europe where these compounds are banned.

While it is concerning that they are present in Americans, the data with the rat and mice studies were as you would expect done using extraordinarily high levels. All of the abnormalities occurred in the first trimester in utero, not while breastfeeding or afterward. Secondly the dose was acute, and ranged from 3 to 20 mg/kg.

These studies don't necessarily correlate with what occurs in humans at all (that is slow accumulation). The 50th percentile concentration in human milk was 34 nanograms/gram of lipid in milk. If an infant ingested 150 cc/kg/day, and the milk contained an average of 5% fat...then the infant would ingest about 255 nanograms of PBB per day. This is 1/78,000 that the poor rats received. These levels are so extraordinarily low that I can't imagine they would cause untoward effects in an infant. Some have suggested that the high levels of polyunsaturated oils (arachidonic and docosohexenoic  acids) would more than counteract any problems with these low levels of PBBs.

Nevertheless, this study does suggest why all of us should support better environmental controls of these bioaccumulative compounds, such as the PCBs and PBBs. For those of us who support breastfeeding, environmental pollution is a major risk for future generations of breastfeeding babies.

Tom Hale, Ph.D.