Why is it we cannot talk about health interventions because it might make a population group feel like a 'failure'?

I understand the point you are making - however, I find this line of reasoning to be patronising. That guilt and fear and sense of failure comes from underlying insecurity around choices - so shouldn't parents have access to all the support and information they need, rather than the limited 'oh yes, breastfeed if possible but bottle is just as good'. Why talk about the bottle at all? Why do we have dialogue all the time about women's bodies where we expect them to fail? Why do the corporations who make artificial milk for profit get such standing in our community, while people who want to talk about what our bodies can do for free are always told to stop because they are making women feel bad?

New parents are often quite unaware of the long term benefits of breastfeeding because all they have ever been told is that it is 'best' - and in the moment 'okay' seems quite good, which is completely understandable - after all isn't everyone a 'good enough' parent? But women who are confident they can breastfeed usually can - so when you continuously tell women that they probably won't be able to breastfeed, they probably won't. Interestingly, most women are able to breastfeed their second baby. So while I realise that shaming and guilting people does not generally lead to behavioural change - I also assert that by having positive discussions of breast-feeding, we can create change in our culture.

I see the use of artificial milk as a heath intervention - much like a caesarean. However, the issues that prevent breastfeeding usually relate to socio-cultural and structural barriers, not health reasons. Therefore the social and structural barriers needs to be rectified, as discussed in the article. It is both extremely telling and completely unfair that women with economic security are usually able to breastfeed and yet women with economic insecurity are much more likely to use artificial feeding methods.

I would also like to point out that it is not just the quality of the water which is an issue - the powder itself is not sterile - this is why even clean water needs to be heated wherever you live, despite the claims of artificial feeding companies.

Not everything can be quantified - and this obviously applies to both the use of artificial milk and breastfeeding - but given breastfeeding is the non-oppressive biological norm - why can't we champion it? It doesn't have to be best. It doesn't have to be anything. It just is a pretty nice way to connect with your baby or child, and women shouldn't have to justify why they want to do it.

Finally, not all my friends were able to breastfeed. But they are all smart women and wonderful mothers, and I really don't think they would feel shame or guilt after reading this article - but I am happy to be corrected by a non-breastfeeding parental perspective.

Kate Hegarty asks "Why is it we cannot talk about health interventions because it might make a population group feel like a 'failure'? "

Because, in our society, the benefits to babies' health are marginal (as I've explained above). If breastfeeding made a great difference (as it does where there is no clean water), there would be a stronger case to push for it in all children.

"oh yes, breastfeed if possible but bottle is just as good'. Essentially, the bottle IS just as good. That's what the evidence shows.

"women who are confident they can breastfeed usually can -" - unfortunately, that is not so. There are many examples of women who assumed they would be able to feed and find, for various reasons, that they can't. These women are prone to Post-Postum Depression.

Many women find breastfeeding both easy and rewarding. Others find it difficult, frustrating and painful. Babies have become dehydrated and malnourished by desperate mothers who have been convinced not to supplement with what you call "artificial milk" (a value judgement in itself).

"Interestingly, most women are able to breastfeed their second baby. " I don't know where you get this assertion from. Many women who have problems the first time, conversely, are able to let go of the guilt and happily formula feed their second.

Difficulties with breast-feeding are not a post-modernist indulgence - they have always occurred. In the long past, babies were either wet-nursed, given other milk like goat's milk, or died. Some cultures used water and sugar or rice cereal when mothers couldn't produce milk. This has happened throughout history.

If you are truly interested, I can refer you to information about the perspectives of other wonderful mothers who have skillfully raised formula-fed children, but are tired and frustrated at value judgements and criticisms - either direct or subtle.

Certainly, in my previous message I was speaking anecdotally and narratively, from my own experiences as a mother, and from my own research before motherhood. When I wrote 'confident', I also meant women who had access to resources and coping skills -- social, economic, cultural support as well as knowledge regarding the mechanics of breastfeeding.

So yes, confidence is key - without some self belief how can anyone do anything? Women internalise the failings of their bodies at a young age and I do think that contributes to challenges with breast-feeding so yes I do think it is important to talk about breastfeeding positively - but I also acknowledge that I have no experience of the other side. I feel like these discussions always become a tug of war about personal choices instead of a critical analysis of the structural barriers. I am sorry if you (or those close to you) have felt judged regarding your methods of infant feeding - that is really awful and I do not wish to contribute to that. But it is artificial milk - nothing about it is natural - which is why it should be a health intervention and also why its use should not automatically end the breastfeeding relationship. I happen to live in Indonesia and I see the destruction of breastfeeding culture through the actions of artificial milk manufacturers everywhere I look. These companies should be held accountable for they actions - all mothers, everywhere, deserve better.

Like the concept of resilience, breast milk and breastfeeding cannot be quantified - for example we do not actually know what constitutes breast milk and are making new discoveries all the time. Breastmilk changes in composition in response to your growing child. Breastfeeding promotes teeth and jaw formation. It reduces the risks of SIDS. And actually, breastfeeding through post partum depression can actually help a mother recover. In many cases of PPD, breast-feeding becomes the physical manifestation of emotional stressors such as lack of support, sleep deprivation etc. The answer is not to stop breastfeeding - the answer is to address the other issues (unless of course there needs to be pharmacological intervention etc)

Furthermore, breastfeeding is a feminist issues and raises political questions regarding maternity and paternity leave, the right to breastfeed at work and in public - in general it reflects how poorly our society treats women and children.

But in the end, I don't really care if the studies cannot demonstrate the benefits of breastfeeding - because as I said it doesn't have to be proven. It is a really nice activity if you can manage it.

"In fact, breastfeeding is the physiologic way to feed a human infant. When this physiology is disrupted, health risks increase for mother and child. A systematic review of the evidenced based literature has concluded that infants who are formula-fed face increased risks of ear infections, pneumonia, gastrointestinal infections, allergies , malignancies, obesity and sudden infant death syndrome. Mothers who do not breastfeed are more likely to develop breast cancer, ovarian cancer, type 2 diabetes, hypertension and cardiovascular disease... there are multiple societal barriers to breastfeeding, but the solution is not to downplay the importance of normal human physiology. ...The issues are not one of maternal guilt or life style but rather a basic concern for the well being of mothers and their infants.

Arthur I. Eidelman, MD, President,
Academy of Breastfeeding Medicine"
--http://bfmed.wordpress.com/2012/07/25/abm-responds-to-the-new-york-times-the-milk-wars/

That is just a letter to the editor - but it really sums up what I want to say. I was about to spend a few hours linking to studies but I hope someone with access to a research database does it for me -someone who doesn't have a baby waking up 20 minutes would be good!

Sue I - I value your opinion and understand the values your are promoting, thanks for the comment.
We all know industrialising food has had global ramifications, we have many articles here written around these issues. Looking at the overview any organisation, group or government body claiming that multinational food corporations have the formula for the foundation of human life 'right' is far fetched. We may be approaching singularity with AI, have fantastic advances in genomics, but there is vast difference in applied knowledge and the values of the worlds food corporations.
Before asking mothers to put their child's life in the hands of these entities, we would need to see a serious shift in their corporate value systems. The premiss that breast feeding mothers are not up to challenging multinational food corporations for healthy food and experience is flawed.
Food singularity with hundreds of thousands of years evolution is not that close and but just sales rhetoric.

Thanks, Paul. Just to clarify, I am not presenting my own opinion or values - I am presenting what the research shows.

Until I started lookingin detail at infant outcomes from feeding, I had happily accepted the "breast is best" message - who argues against mother's milk? I was personally surprised to find that the outcomes for our children don't depend much on what type of milk they are fed. That's what the population studies have found.

As I said before, breast feeding difficulties were not invented by the industrialised world - it's just that we now have standardised formula, with appropriate nutrients, available in an easily accessible form. Prior to this, people made up their own "formula" - that's where the term came from.

Cartainly the promotion of formula in the impoverished world is unethical - as I discussed above.

Your comment beginning "Before asking mothers to put their child's life in the hands of these entities..." is highly emotive, but not based on reality. Let's face it - many of the academic authors who are published here will have been nourished on infant formula - we have no way of distinguishing which ones they are.

Those who deny that there are real issues amongst many smart, capable women could do well (apart from reading the actual studies) to look at blogs like Fearless Formula Feeder. You will find the stories of many capable, intelligent women who were made to feel hopeless by the ideological rhetoric that can surround so many issues in parenting.

Thanks Sue for your comment, your values are appreciated.
"Certainly the promotion of formula in the impoverished world is unethical "
On this issue we have a value system divergence, we both know the methods used to target women at our stage of development are very sophisticated, as it is the entire industrialised food chain. "Appropriate Nutrients" are weasel words for corporations making equal product, and a clear demonstration of detached cold corporate view.
The last decades research done on human biota is a case in point. Breast feeding has a direct affect on the make up of the human gut flora, we are only just discovering how this has a lifetimes affect on many disease. Obesity being the most obvious example. Since the flora are delivered to the child's body from the mothers breast and are a unique combination, formula fails to compete. Based just on this relationship, formula can never be classed as equivalent in human health benefits in the developed world e.g. Australia.
I take your point regarding women who do not follow the natural method, social ramifications, feelings of guilt are all real health issues as well.
However getting back to values, how good is a culture that puts women down who do not breast feed? Is promoting the idea formula is this really a sound premiss for promoting the equality of food corporations formula and trust in their values? Yes this is an emotive line of argument, but softly side stepping others feelings misses the real issue.
Change is needed and it is in women who while breast feeding exclude, ostracise or use a win / lose mindset against those that do not. In saying this, naturally their partners are included.
We all do our best, and need to be grateful we can. Acceptance of others and awareness of their worldview demonstrates an evolved set of values and that is the least we can do for anyone.

Paul - you may wish to update your knowledge about infant feeding and gut flora. There is a good article on this very site:
https://theconversation.edu.au/are-people-born-by-caesarean-section-more-likely-to-be-obese-7200

"Although birth is when we first encounter microbes, the process of acquiring a stable gut microbiota takes time. As any parent knows, an infant’s poo will change dramatically in texture, smell and even colour over the first year and introducing anything new to the diet often precedes an interesting experience. A stable microbial community isn’t formed until we have a fully developed immune system and an adult diet pattern – well after age three."

Sue I - thanks for that, I read that the day of publication. But will return the favour
The Application of Ecological Theory Toward an Understanding of the Human Microbiome
www.sciencemag.org/content/336/6086/1255.full 4/11
represent and reveal the fundamental types of assembly relevant to human health.
Postnatal Acquisition and Development of the Human Microbiome
"Exclusive breastfeeding selects for increased abundance of particular Bifidobacterium species whose genome sequences reflect specialized use of human milk oligosaccharides and similar host-derived substrates (36 ), or for other bacteria such as Bacteroides that could compete for the same ecological niche (37 ). Strikingly, during this early phase, microbiota composition is highly dynamic within and between
infants (3 , 23 , 38 –40 ), with temporal variation characterized by periods of relative stability (for varying
lengths of time) punctuated by abrupt shifts in composition and structure. In some cases, these shifts
can be linked with life events that likely impose environmental selection, such as fever, formula
feeding, or antibiotic therapy."

There are many papers recently written on this relatively new field of study. My point being, industrialised formula makers have not even begun to understand or develop strategies to mimic the breast feeding cycle taking the development of microbiota and immune system before it settles into an adult diet pattern.
So we diverge on viewing the unfolding understanding regarding microbiota. As my extensive scans of published data are reason enough, not to place formula on at he same nutritional plane as breast milk for a healthy mother in a developed country.

Hi, Paul. You say " industrialised formula makers have not even begun to understand or develop strategies to mimic the breast feeding cycle taking the development of microbiota and immune system before it settles into an adult diet pattern."

Perhaps your "extensive scans of published data" have missed these papers:

"Galacto-oligosaccharides Are Bifidogenic and Safe at Weaning: A Double-blind Randomized Multicenter Study" Journal of Paediatric Gastroenterology and Nutrition 2009

"Prebiotic supplementation of formula in preterm neonates: A systematic review and meta-analysis of randomised controlled trials" in CLinical Nutrition 2009

"Prebiotic supplementation of formula milk increases stool counts of bifidobacteria and lactobacilli compared with unsupplemented formula milk in full-term neonates" in Evidence-based Nursing 2010

"Prebiotic Supplementation in Full-term Neonates: A Systematic Review of Randomized Controlled Trials" in Archives of Paediatric and Adolescent Medicine 2009.

Your citation above - an article in Science Magazine, is not clinical research. It is important to distinguish process from outcome. The question is not just "is it the same as natural" but "does it make a difference to the clinical outcome".

Many people have studied this area. The answer, in our society, is that the health benefits, both short and long term, are more modest that most people realise, and the confounding influences have a greater influence.

The health benefits of exclusive breast feeding, in our society, are not great enough to make mothers feel guilty or inadequate, or to force them to endure pain and anxiety, or to deprive babies of nutrition, simply on the basis of
avoiding the use of infant formula.

Sue I said " ..... have missed these papers" Some, not all.
Given the many thousands generations of human evolution medicine is trying to unravel, my saying; " not even begun to understand or develop strategies to mimic the breast feeding cycle" I stand by and will explain the line of thought.
Mimicking breast milk is as limited as the broad spectrum of drugs used currently, and we both know medicine is moving down the personalised pathway for their use. Given the implications of microbiota, the same is proving true of this field as well. e.g. we have seen over recent years raised awareness of human microbiota and the implications in ICUs, together with regimes fortifying personal flora. Even care for the ICU patient in this single area is just at the beginning, with science being done currently and great advantages expected for the the critically ill patient.
So without understanding the full microbiota process from natural birth, breast to weaning, how can our community say with absolute certainty formula feeding is equal?
Which circles right back to values and believing multinational food corporations have the values to claim equality.
We do not live in a perfect world, no individual is the same, time and circumstances change. So again, being understanding of parents right to choose is important, it is the parents who generally can say with confidence breast or bottle is best under their circumstances.

Hi Sue
I've done quite a lot of research on breast feeding some years ago. Though I'm not currently working in that area, your comment set off some alarm bells for mr because it sounds a lot like comments made by some researchers who were funded by infant formula companies. So I checked out your first link and it seems you have misunderstood what the authors are saying. They found that complete breast feeding for two months or longer, or partial breast feeding for a longer period, offered "substantial" protection against respiratory infections. Moreover, they controlled for potential confounders - that was the point of the discussion about confounders. I haven't checked all the references you give, but as a general point, reviews look at all the available evidence. Thus the evidence from a review is stronger (not weaker as you seem to imply) than that from single articles. It's not good practice to pick and choose individual articles to support a particular view (although in this case that one you referred to doesn't actually support your view, as discussed)
In later comments you also seem to shift from saying the differences between breastmilk and formula are "minor" to saying there is no difference. This is also similar to trends I observed in the comments from researchers funded by infant formula in earlier research. I'm not saying that is your motivation, but you do seem to be looking for evidence to support your particular views rather than looking carefully at the evidence, and I'm concerned that your comments could mislead people.

COnversely, Tom, iron-fortified formula is great for preventing iron deficiency, which can occur when iron-deficient mothers breast-feed.

"Most women know this truth within their interior or intuitively, so If they do not persist and fail with breast feeding suffer the internal consequences. Always ready with lines of logic and emotional reasons why it was not possible. Down deep inside the pain of missing this crucial mothering experience lasts a life time, raising doubts when issues arise about the child's physical and probably most importantly their psychological health."

This is exactly the type of emotive nonsense that mothers have to contend with. Paul - show us the evidence that formula-fed babies "physical and psychological health" suffers.

Of course it is possible to cover the science - that's what this type of website is for.

FWIW, I completely agree with Paul and Kate. I don't need science to tell me that the most natural process post birth is best. My simple question is why would a scientist hypothesise that baby formula is better than breast milk?

I would also add that there IS a problem in wealthy countries with formula feeding, i.e. fluoride in the water and fluoride in the formula.

Lisa - nobody has hypothesised that baby formula is better. They did what scientists do - they looked for a difference in outcome, and found that (a) feeding method didn't amke much difference to outcomes for babies; and (b) that there are many other more important determinants (as I listed above).

"Natural" human processes are not always better, no matter how much we might like them to be. Breasts are not perfectly functioning organs - just like the rest of the human body.

Fluoride in the water is a real bonus for both mothers' and babies' dental health.

You are free to hold whatever opinions you like, but you are not free to make up the facts.

Sue, can the evidence say anything about the evolutionary benefits of breast feeding over a generation or two? Can you definitively say that science knows everything there is to know about breast feeding and the whole range of physical and psychological benefits it provides both mother and baby? Can you definitively say that infant formulas provide each and every one of those benefits? You place a lot of faith on the *evidence as if it is always the final word. More like a religion than science?

With regards to babies dental health: fluoride in infant formula http://jada.ada.org/content/142/1/79/T1.expansion.html
fluoride in water: "– The estimated risk of enamel fluorosis related to fluoride intake from reconstituted infant formula is associated with the fluoride concentration in the drinking water27" http://jada.ada.org/content/142/1/79.full#ref-27

And we're only talking teeth here, not IQ.

Can you definitively tell me that consuming fluoride for a life time will not effect any part of the human body nor cause any type of disease?

Lisa H - thanks for the link posted.
"Practitioners should be aware that children are exposed to multiple sources of fluoride during the tooth development period. Reducing fluoride intake from reconstituted infant formula alone will not eliminate the risk of fluorosis development...." At the opening of the conclusion. http://jada.ada.org/content/142/1/79.full#ref-27
Awareness is raised, much appreciated.

Lisa - I'm not here to tell you anything definitiely - I'm directing you to what population-based research shows.

Can you definitely say that your understanding of fluoride is better than the overwhelming majority of dentists? Water fluoridation is one of the most successful public health measures - alongside vaccination.

Mother-infant health and bonding are much more complex than just about type and duration of feeding.

Sue, you said "Fluoride in the water is a real bonus for both mothers' and babies' dental health". I provided evidence from the Journal of the American Dental Association that warns against too much F both from formula and water and the problem of fluorosis. You managed to ignore this yet as a clinician this should be something that you are aware of.

You linked to the respiratory disease study. Hardly a blanket health endorsement of infant formula. Hopefully dentists don't rely on the Cochrane Review for their knowledge of the safety effects on anything other than teeth. It is not a reassuring display of science in action.

Hi Paul, you're very welcome. I've already had a bit to say on F on other threads here. Ditto, thanks, I've learned a lot about gut health in the past few days. What you posted added to that new awareness. You might be interested in GAPS theory? http://www.gaps.me/preview/?page_id=20

Yes, Lisa, TOO MUCH fluoride presents a risk for fluorosis, the optimal amount is a highly successful public health measure.

Too much potassium is life-threatening - the right amount is essential to life.

Too much magnesium makes you weak and hypotensive, the right amount is essential to muscle and myocardial function.

Too much glucose makes you pee too much and get hyperosmolar - the right amount gives your cells energy.

Do you see a pattern here?

Do I see a pattern here? Well yes I do Sue. So how much exactly is the right amount of Fluoride? Please specify the perfect dose for infants, the perfect dose for adults, and the perfect dose for crocodiles separately.

And please also state what the length of administration of the perfect dose of F should be to account for a life time of F doses.

Why ask me, Lisa - you can look all that up in the dental and public health literature.

Lisa H - thanks, it is interesting how early theories on microbiota started 1979. [GAPS theory]
With the cost of gene sequencing falling below a thousand dollars US, and projected to be hundred dollars soon we are literally at the very beginning of a new era understanding. Many CAM theory on microbiota can be tested most definitely and there are plenty of theories other than autism.
It is the literal interaction at cellular level that the knowledge will come and understanding of how human microbiota interact with the human digestive system from birth to death. We are at very beginning of this genomic research, will have soon have a definitive answer on microbiota breast to death. It takes a brave person to say human breast formula is ‘almost equal’ in comparing the genomic research era we are entering with previous methodologies and their limited evidence.

Paul - brave people are prepared to say that infant formula is "almost equal" to breast milk on the basis of OUTCOMES. Researchers have compared large populations of children and looked at how their health outcomes are influenced by a range of factors, including feeding.

Of course whatever new knowledge is discovered will add to our understanding of human physiology, but it won;t change the fact that the health outcomes for formula-fed and breast-fed babies, in our society, and all other things beinig equal, are not much different.

Sue I " ......"almost equal" to breast milk on the basis of OUTCOMES."
Projecting into our future about todays generation of formula fed children shows a great confidence.
My scan of our future sees major advances because of human microbiota and a completely different scenario unfolding about breast feedings importance. One again, thank you for your valuable insight into this area.

Sue, Can you please provide some references for your claims? I'm struggling to find any "Researchers have compared large populations of children and looked at how their health outcomes are influenced by a range of factors, including feeding."

What I have found does not support your assertions. E.g. The Risks of Not Breastfeeding for Mothers and Infants. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/

Lisa - I included several references in my original post.

The problem with the paper you linked to is that the language they use exaggerates the magnitude of the benefits. Read the actual papers in the references of that review - you will see that the reductions (in relatively mild infections) may be statistically significant, but the overall numbers are small.

I had always accepted the "breast is best" mantra myself until I started looking at the magnitude of the benefits (in our society). Yes, some benefit is there, but it is relatively modest compared with the effect of factors like smoking in the household, or going to child care.

Hi Sue,

A statistically significant result is just that. Your linked evidence concludes that “Predominant breast feeding for at least six months and partial breast feeding for up to one year may reduce the prevalence and subsequent morbidity of respiratory illness and infection in infancy.”

The longitudinal study is IMHO not worth citing. The authors state “In our study, most infants were exposed to cow’s milk formula in the maternity hospital.” Which I think as a scientist you should agree that the whole sample was compromised?

You didn’t cite the second UK/BMJ study?

Sue you don't like the *language of the *evidence that I linked to. I did take a quick look at some of their reviewed studies. I wonder how it is that you could miss *evidence such as:

“The available evidence suggests that breastfeed- ing may have long-term benefits. Subjects who had been breastfed were found to have a lower mean blood pressure and lower total cholesterol, and showed higher performance in intelligence tests. Furthermore, the prevalence of overweight/ obesity and type-2 diabetes was lower among breastfed subjects. All effects were statistically significant, but for some outcomes their mag- nitude was relatively modest.” http://whqlibdoc.who.int/publications/2007/9789241595230_eng.pdf

or

“Among generally healthy infants in developed nations, more than a tripling in severe respiratory tract illnesses resulting in hospitalizations was noted for infants who were not breastfed compared with those who were exclusively breastfed for 4 months.” http://www.ncbi.nlm.nih.gov/pubmed/12622672

Why is some *evidence ignored in favour of the *evidence that supports your view?

*Lisa*

Your own quote supports what I was saying:

"All effects were statistically significant, but for some outcomes their mag- nitude was relatively modest.”

So, I'll repeat: "Yes, some benefit is there, but it is relatively modest compared with the effect of factors like smoking in the household, or going to child care. "

And to clarify: statistical significance is a numerical value that reflects the odds that two different values differ by chance. It says nothing about the magnitude of the change.

So, a value might be halved, and the difference in the values might be highly statistically significant, but it might just reduce from one two colds or gastro episodes in a year to one.

"breast milk replacements ................. Formula feeding is not a 21st century phenomenon" Sue I said
Certainly, we need to respect all the work done by hundreds of thousands of people over human history, evolution is a long story.
"..Human health and longevity continues to improve.." Sue I said
To quote Dr. Karl Kruszelnicki "In fact, our children may never die. ... We may be the last generation of the mortals."
"What is the basis of your "scan of the future" Sue I said
The cost of gene sequencing is plummeting faster than Moore's Law. Soon small laboratories throughout the world will be able to affordably study the symbiotic relationship we have with human microbiota. Including a focus on breast milk and the role it plays in cultivating genetically unique stomach flora and human development. Competition for knowledge is accelerating at a rate never seen before in human history and gene sequencing is facilitating this. As Dr J Craig Venter said: ‘We are in the digital age of biology’
We have just begun to understand genome of living organisms, the complexity of interaction and symbiotic relationships. This could mean formulae of synthetic breast formula changes faster than at any time in human history. Since we are at the beginning of the 'J curve' on genomics, any paediatrician would need to be very confident in 2012 batch of synthetic breast milk will be seen as better in the future.
A frequently retold story about a little old lady, after hearing a scientific lecture on the solar system, claims that the world is a flat plate resting on the back of a giant tortoise. When asked what the turtle is standing on, she invokes a second turtle. And when the inevitable follow-up question comes, she replies, “You’re very clever, young man, but you can’t fool me. It’s turtles all the way down”.

Sure, Lisa, I'm happy to declare my interests:

I am interested in the general public, and especially new mothers, receiving balanced, realistic information about the real magnitude of the benefits of breast milk for babies short-and long-term health outcomes (in our wealthy urban society).

I'm interested in people facing this situation having realistic information about the relative magnitude of the benefits of BF vs the other confounding influences on baby health.

I'm interested in new parents being able to do their best to nurture their chikdren without being judged or made to feel like failures if they don';t, or can't, exclusively breast feed.

I'm interested in new mothers, who find that they are in severe pain or otherwise suffering but persist with BF becasue they have been bullied or feel guilty if they use formula, understanding that they dont have to suffer and that there is nothing wrong with using forumla.

Your turn, Lisa. What are your interests?

Paul - I'm not sure of the significance of your final anecdote. Are you a flat-earther?

We already have generaltions of formula-fed children who have grown up, had children and grandchildren, aged and died. What do you think advances in genomics will tell us about these people?

Sue, if you are really interested in "balanced" information then you should regard ALL of the *evidence. As you showed above you only care about the *evidence that supports your view. If you are really interested in mothers and babies then you would be providing a balanced view on the pros and cons of breast feeding which includes a statement to the effect the 'we don't really know all there is to know'. New mums might be more inclined to persist and succeed with breast feeding if they are fully aware of the potential implications, rather than being given an unsupported claim that formula is equivalent to human milk, however supportive or reassuring.

My interests are much broader than yours. I'm interested in the biopsychosocial evolution of humanity and all that that entails. I am also interested in an important means to that end - truth.

"Are you a flat-earther?" Sue I said
The old lady was a flat-earther and could only see her idea was the centre of the universe. How little we still know.
Sue I said "What do you think advances in genomics will tell us about these people?"
Good question. 'All things being equal' or using Ockham's Razor the simplest explanation is usually the best, breast feeding clearly fits this model.

" I'm interested in the biopsychosocial evolution of humanity and all that that entails. I am also interested in an important means to that end - truth. "

Wow - a lofty aim.

I guess I'll persist with more achievable ones.

Oh - and thank you for the advice.

No, Tom, not all pregnant women are iron-deficient. But the ones with iron-deficiency are, and their breast milk is low in iron.

I claim no specific knowledge of causes of anaemia in northeast Thailand - I was speaking in generalities.

I do, however, know a bit about thalassaemia and the other haemoglobinopathies - which tend to have a familial and racial distribution, and are not caused by iron deficiency.

Quote: But the ones with iron-deficiency are

Answer: These , very few women , are iron deficient because why ? How could the world have survived for soooo long without the 'discovery' and intervention of iron supplements ?

Is this how one explains all that iron deficiency ?
"The meat diets nor the vegetarian diets fulfilled the estimated daily requirements of absorbed iron in spite of a meat intake of 180 g/d in the meat diets"
RDA set sooo high nobody can even meet the requirements.

Tom - what has made you sooooo obsessed about iron?

"The meat diets nor the vegetarian diets fulfilled the estimated daily requirements of absorbed iron in spite of a meat intake of 180 g/d in the meat diets"

So in theory , according to that studies' findings , most of the people in the world should be dead ? Most people in the developing world don't eat anywhere near that , and quite a few people in the developed countries don't either. So how have we survived over the centuries ?
Does that study prove positive the RDA is a joke , as it seems it is , too , for protein ?
The amount of protein the RDA recommends , IE: demands , is three times higher than what Dr. Hindhede proved is required.
http://en.wikipedia.org/wiki/Mikkel_Hindhede
THAT type of discrepency is inexcusable and is leading to high rates of obesity and disease due to the fact hospitals and everyone associated with them maximise protein due to RDA guidelines , and high protein is very closely linked to kidney disease progression?
What is the recommended protein intake for a child in their formula ?
“No attention was paid to the protein minimum. It was held that this minimum was so low for man that it could not be reached, provided sufficient calories were furnished. While fat was regarded as a very valuable addition to the dietary, it was not considered as being necessary.”