How important is the virgin gut?

[FeelLikeTweedleDee]

Is it very important to maintain the virgin gut?

Is occassional top-ups of formula bad?

I don't think there is any controversy that the best health outcomes are seen in babies who have been breastfed exclusively for the first months of life - I don't think there is much difference between 4 mths and 6 mths, except to say there is no nutritional benefit in starting with foods other than breastmilk before 6 mths, and in some studies, there seems to be a slightly higher risk of ill health at 4 mths, impossible to predict in an individual child. There's certainly no evidence that 4 mths is better than 6 mths.

Small amounts of infant formula do change the gut. No controversy about that, either. In susceptible babies, this may have a long-term effect - but we don't really know how great, or who it affects. In a tiny number of highly susceptible babies, it might be an obvious effect. For the vast majority, we'll never know!

Having said that, I honestly don't think that small amounts of formula, given when necessary, should cause distress and anxiety in mothers - they need to understand balance of risks, and be supported to return to full breastfeeding whenever that's possible. If it's not possible, then any breastfeeding is better than no breastfeeding - no controversy there, either.

The public health endorsement of exclusive breastfeeding should be seen not so much as an 'instruction' to mothers, but a standard for HCPs and the rest of society to enable. There is no doubt that many, many babies get formula unnecessarily and that this undermines breastfeeding. This bothers me far more than predominantly breastfed babies getting the odd bit of formula, as mother's choice (as long as the mother is informed).

BTW, Jay Gordon is not the same as struck-off, dishonest, unethical 'Dr' Andrew Wakefield!

Tiktok- I don't dispute the evidence that suggests that breastfed babies get the best outcomes and maybe I was a bit harsh on Dr Jay, but there does seem to be some concern that he finds the facts to fit his theories rather than the other way around.

I just think that sometimes, the breastfeeding purists can put people off doing any breastfeeding at all, in that it can make them think "well I used formula once, so I've ruined it now. May as well give up." when actually, mixed feeding is still a net positive. It's a bit like the way in which people who dont do the full year/ 2 years/ 5 years are sometimes made to feel as though they havent quite pulled out all the stops for their children.

The trials on gut appear to compare mixed fed babies with pure bf babies, so I'm not sure there's any reliable survey (sig significant numbers) which shows the impact of a single shot of formula (might be wrong though).

BaggedandTagged, the only breastfeeding purism I have seen ie the notion that one use of formula means it's pointless continuing is among people who for one reason or another don't know much about breastfeeding.

I'm not being critical of them (unless they should know better 'cos they're midwives or HVs) - but I am saying they're misinterpreting what they have heard. Honestly, people who do know about breastfeeding do not think this way. Who 'makes' people feel they should do better if they don't bf for x amount of time? My experience is that people put pressure on themselves - they're certainly not 'made' to feel that way, in a culture that does not value breastfeeding at all beyond the first few weeks, and in a society that actively works against them feeding 'older' babies.

I am not aware of any study that shows the effect of a single shot of formula in the long term - there is no doubt that it does change things, though, but temporarily, and there is no evidence that this has a long-term negative impact except in rare cases.

What you said about Dr Jay Gordon was not just harsh, but actually libellous, BTW, given what we know about AW!

I don't know anyone who honestly believes it's all or nothing re: breastfeeding (but know plenty of people who believe other myths, so nothing would surprise me!)

Ah well, he can sue my ass then, but I think I'll be at the end of a long list of his other detractors.

Also, to sue for libel what I say has to be incorrect. If I am in fact right that he cherry picks the research to support his own theories, then in fact he cant sue me, and that's probably why he hasnt sued any of the other people who say that about him.

I'd love to see his double blind randomised controlled study on the virgin gut and the impact of a single bottle of formula., put it that way, just as I'd love to see the same from ex-Dr W on cause and effect of MMR and ASD.

The problem is that in the UK, libel law dictates you would need to prove what you say is true. Could you prove it? (Saying "He hasn't done a double blind randomised controlled study so it must be true" wouldn't cut it... ) Comparing him to Wakefield could certainly be classed as reputation damaging, too.

/devil's advocate

You cannot do a double blind randomised controlled trial on the 'virgin gut' because it would be unethical. You could single blind it, as the baby would not be conscious of having had a bottle of formula. But the ethical issues remain.

It's the same for many health issues - like smoking, for instance. You could not randomise 2 cohorts and get one to smoke for 20 years and the other one not to. No blinding, either - people know if they are smoking or not :)

Same for diet. Same for many aspects of behaviour.

So all you can do is report what we do know - that the gut undergoes several changes with the introduction of any formula, and that it can take some time of exclusive for it to return to a physiologically normal state. From there, you can theorise a number of health-related possibilities.

I think it's a real shame that from that, women who for one reason or another choose to/have to give formula then worry that they have 'undone all the benefits of breastfeeding' - it is definitely not worth that sort of agony, and anyway it isn't true.

Sounds like rubbish to me. My DS had low blood sugars when he was born and eventually after getting too low they said they would have to top him up with formula otherwise he would need to go on a drip in neo natal care. Anyway - a few formula feeds didnt do him any harm and Ive now been exclusively BFing since he was 5 days old.

Think you need to watch that mixed feeding doesnt compromise your milk supply.