About six months ago, when I was seeking experts to interview for my book, I considered contacting a well-known British researcher by the name of Alan Lucas. Problem was, I couldn’t tell where he stood on things. It’s not that I only wanted to talk to folks who agreed with everything I thought – it was simply that at this particular point in the process, I was attempting to speak with researchers who’d strayed from the party line, to see if they’d essentially been “silenced” by bad press and accusations of being in bed with Big Formula. But I wasn’t sure if Lucas was the right guy to talk to; while I found some of his research really interesting and potentially controversial (for example, he worked on one study that suggested our Western diets may not be well-suited to breastfeeding), he was also one of the first people to support the breastfeeding-leads-to-higher-IQ argument, and his work is cited by a plethora of lactivist literature. (For example, in one article about a study he did on breastfeeding and later heart disease, he said “It is quite possible that hundreds of thousands of deaths in the west are prevented by breastfeeding and many more would be prevented if the uptake of breastfeeding were greater.” Ironically, he also authored a different study warning that prolonged breastfeeding could cause hardening of the arteries. Not sure what the message is here – breastfeed, but not for too long…??) So while a small section of his CV may have been controversial, it seemed that he was still relatively beloved by breastfeeding advocates.
In hindsight, he probably would’ve been a fascinating guy to talk to, for just this reason. Here was someone who managed to ask some potentially damning questions and remain unscathed – perhaps because he’d paid his dues by providing ample research supporting breastfeeding?
Anyway. I was thinking about Lucas a lot today, since his name was on the list of authors for this “Analysis” from the British Medical Journal which has been causing quite a stir. Entitled “Six months of exclusive breastfeeding: how good is the evidence?”, the piece is basically a review of what know, to date, about breastfeeding duration/exclusivity, delayed introduction of solids, and the risk for allergies and celiac disease (obesity is also briefly mentioned). The authors contend that WHO recommendations (6 months exclusive breastfeeding) may not necessarily be appropriate for those in developed countries. Speaking of the adoption of WHO recommendations, they suggest that “…the evidence base supporting a major, population-wide change in public health policy underwent surprisingly little scrutiny” in the first place, and that a “reappraisal of the evidence is timely in view of new data.”
The most interesting point that these authors make is that since delaying solids – especially ones with high risk for allergy- has become common practice, the incidence of food allergies and celiac’s disease have risen. Other than that, there’s really nothing all that controversial in the paper, which is why I find it amusing that it’s pissed so many people off . There was a veritable media shitstorm that occurred in the last 24 hours surrounding this paper, mostly from the breastfeeding advocacy front, who took it as a direct attack on breastfeeding. But the authors actually make a point to say that they are advocating an earlier introduction of solids (4 months versus 6 months), not formula; they are simply questioning if breastmilk alone is the ideal diet for those in developed countries after a certain point. In other words, they are still saying that women should breastfeed rather than formula feed, but that it might be advisable to offer foods along with breastmilk after four months. Not a huge deal, one would think.
One would be wrong, apparently. Within hours of the media coverage surrounding this analysis, not only were the blogs and Twitter were abuzz, reputable organizations like Baby Milk Action were freaking out, accusing the authors of being funded by baby food companies (apparently it’s not just formula makers who are out to undermine breastfeeding, but the makers of blended chicken and carrots, too. Personally, I think there is something inherently evil about blended chicken and carrots, but I doubt it’s the same kind of evil these folks are talking about).
But Lucas, and my new hero, Mary Fewtrell, who seems like the coolest cucumber ever, are taking this all in stride. And their attitudes are what I’m really excited about. Sure, the analysis is cool; I think there’s probably some truth to the assertion that earlier introduction of solids is better for us in the long run, but they aren’t the first to bring this up. It’s what’s between the lines of this analysis – and what its authors have said in the press – which really gets the FFF in me all riled up. Read the BMJ piece for yourself; it’s available for free here. Other than that, I want to submit the following as evidence for why I have good reason to think these authors are, as the kids like to say, “da bomb”:
1. They question WHO’s infant feeding recommendations, which is Simply. Not. Done.
2. They make reference to the fact that studies regarding breastfeeding are inherently flawed: “Apart from two randomised trials in Honduras, the studies were observational, precluding proof of causation for the outcomes examined, since residual or unidentified confounding may remain even after adjusting for potential confounders…”
3. They say this: “It can be argued that, from a biological perspective, the point when breast milk ceases to be an adequate sole source of nutrition would not be expected to be fixed, but to vary according to the infant’s size, activity, growth rate, and sex, and the quality and volume of the breast milk supply,” to which I say YESYESYESYESYES.
4. In interviews regarding the study, Alan Lucas explained that “The WHO recommendation is very sensible for developing countries…But in the UK, it’s important we take a balanced look at the evidence.” Fewtrell told the Guardian that “she supported the WHO recommendation, but… that it needed to be interpreted differently in different countries. Exclusive breastfeeding protects against infections, which is critical in developing countries, but less important in the UK where hygiene and sanitation are better. ‘There’s only one piece of evidence relevant to babies in the UK – a slightly decreased risk of gastroenteritis,’” She also wrote off the criticism the study has received because she and some of the other study authors had worked with commercial baby food companies within the past three years (a conflict openly divulged in BMJ, incidentally), saying “This is not an attempt to promote commercial weaning foods…We are a university and Medical Research Council-funded group”, member of whom had “advised babyfood manufacturers because they were specialists in child nutrition”.
5. Fewtrell also provided my absolute favorite quote of the day, earning her a permanent place in the FFF Hall of Heroes: “Some organisations are all too happy to quote our data when it supports breastfeeding,” she said. “They are choosy in what they will allow.”
Word to your mom. Or actually, word to all moms. The truth is out there; we just need some more kick-ass women like Fewtrell to help us find it.