Just a note re "I did x and mine are fine"

[hunkermunker]

If the children to whom you refer aren't 85 (at least), it's not all that bright a statement.

That's all.

I really don't think a single letter to a journal from two researchers is really enough to strike out one of the biggest ever controlled trials about breastfeeding ever, do you? Honestly? There have been plenty more letters picking holes in the WHO breastfeeding advice. There will be letters about just about any study you can mention. And even that huge, reputable study hardly stands alone in casting huge doubt on the hypotheses that breastfeeding (exclusive, non-exclusive, six months or less) has any significant long term affect in preventing asthma or allergies. As my links show. I could post them all night!

How many studies do you want? HOw many editorials in highly reputable peer-reviewed journals? HOw many quotes from the leading figures in paediatric allergy? I am curious. Why have you not applied the same very rigorous standards to people who posted that breastfeeding is protective? Where is your evidence that it IS?

And I didn't make any claim that wasn't made before me by lead researchers in massive clinical studies.
If you think people don't feel guilty about breastfeeding when their children develop allergies, I suggest you trawl the MN archives.

Look, I used to work with expert reviews of medical evidence - not Cochrane but a pretty similar independent organisation. You are making some the sort of mistaken assumptions that people do who come across interesting newspaper reports and look up abstracts online.

It's just not as easy as looking up one study, or two, or three and assuming it says what you think it does and creates a general rule. It's far more complicated than that.

NO, you are twisting my words, just as you are twisting the evidence. Cheap debating trick. I have merely shown how your assertions simply don't bear the weight of your claims.

You mentioned guilt. And pretended that disagreeing with you = making people feel guilty.

www.bmj.com/cgi/content/full/335/7624/782 BMJ editorial on the Belarus study, saying that while the study, like most, is not perfect it is is part of the evidence that breastfeeding does not appear to be protective against allergy]]

"For the moment, promotion of breast feeding should include evidence that it reduces the incidence of a wide range of infectious diseases, including diarrhoeal diseases and lower respiratory tract infections.8 9 Evidence that it reduces the incidence of other conditions including diabetes, obesity, and some cancers is emerging.10 11 12 13 Furthermore, breast feeding has health benefits for the mother. Therefore, there is already ample evidence to promote breast feeding as a public health measure. None the less, the claim that breast feeding reduces the risk of allergy and asthma is not supported by evidence."
Sheila Gahagan, clinical professor of pediatrics and communicable diseases

Center for Human Growth and Development, University of Michigan, Ann Arbor, MI 48109-5406, USA

And if you don't like it, get cross with Sheila. You can email her if you like.
[email protected]

And hard though it clearly is to believe, I do have an interest in mothers who feel misplaced guilt. As the mother of child with numerous problems, I know how easy it is to feel guilty, and have seen it on this board. Yet there is no reason to feel guilty on this issue. The evidence simply does not stand up.

And I also work with medical experts and studies form part of my work.
Here is the link for easy reading.
BMJ editorial on the Belarus study, saying that while the study, like most, is not perfect it is is part of the evidence that breastfeeding does not appear to be protective against allergy

can't get a link that the general public can access but here is The Practitioner, for GPS saying the same thing. Do they not understand the studies either?

even the Unicef Baby Friendly Initiative admits there is no real evidence of long term effects Is Unicef trying cheap debating tricks, as you put it, rather unpleasantly. This is, by the way, the most emphatic commentary I have found making any links between breastfeeding and allergy, as you might expect.

Does maternal diet, breastfeeding and the timing of the introduction of solid diet impact upon the development of atopic disease in infants and children?

"A review by the American Academy of Pediatrics of the evidence about the development of atopic disease (atopic dermatitis, asthma, food allergy) in early life related to the diet of babies, and of mothers during pregnancy and lactation, has been published. As has been previously reported, the benefits of a nutritional intervention that may prevent or delay the onset of atopic disease are largely limited to infants at high risk of developing allergy, i.e. those with a family history. The current evidence does not support a major role for dietary restrictions during pregnancy or lactation. However, there is evidence that breastfeeding for at least four months, compared with feeding infant formula made with intact cow?s milk protein, prevents or delays the occurrence of atopic dermatitis, cow?s milk allergy, and wheezing in early childhood.
For infants at high risk of developing atopic disease, there is evidence that exclusive breastfeeding for at least four months, compared with feeding intact cow?s milk protein formula, decreases the cumulative incidence of atopic dermatitis and cow?s milk allergy in the first two years of life. There is evidence that exclusive breastfeeding for at least three months protects against wheezing in early life. For infants at high risk of atopy who are not exclusively breastfed for four to six months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas, compared with formula made with intact cow?s milk protein, particularly for atopic dermatitis. The report states that there is little evidence that delaying the introduction of complementary foods beyond ?4 to 6 months? is effective at preventing atopic disease but does not examine differences across this age range. It should be noted that the authors reflect that the current body of evidence is lacking and this limits their ability to reach firm conclusions.

Links
Greer et al. (2008) Effects of early nutritional interventions on the development of atopic disease in infants and children. PEDIATRICS; 121

This is what SecondComing posted: "Before 6 months they do not have the enzymes to digest solid foods, and some babies do not have closed guts which relates to a food being seen as a foreign protein, therefore fought off and establishing an allergy. This does happen, you cannot say for sure it's the reason behind your child's allergy but you can be sure it does cause some allergies. Why risk it?"

This is the latest guidance from the American Academy of Paediatrics:
not quite the same

"exclusive breastfeeding beyond 3 to 4 months does not seem to lead to any additional benefit in the incidence of atopic eczema."
"In summary, at the present time, it is not possible to conclude that exclusive breastfeeding protects young infants who are at risk of atopic disease from developing asthma in the long term (>6 years of age), and it may even have a detrimental effect.37,38 On the other hand, breastfeeding seems to decrease the wheezing episodes seen in younger children (

another link

You aren't reading your own links. The Unicef link says:

However, there is evidence that breastfeeding for at least four months, compared with feeding infant formula made with intact cow?s milk protein, prevents or delays the occurrence of atopic dermatitis, cow?s milk allergy, and wheezing in early childhood.

For infants at high risk of developing atopic disease, there is evidence that exclusive breastfeeding for at least four months, compared with feeding intact cow?s milk protein formula, decreases the cumulative incidence of atopic dermatitis and cow?s milk allergy in the first two years of life. There is evidence that exclusive breastfeeding for at least three months protects against wheezing in early life.

So, what one can say is there is evidence to suggest breastfeeding protects against allergies in early childhood, the evidence for longer-term effects is unclear.

Can we agree on that?

(words from 'so what one can say' are mine, btw, not Unicef's.)

scaredoflove, TBH I don't know when I was weaned but I have SO many friends in my generation who have crohn's disease, IBS, bowel disfunctions - whereas my mum knows no-one who has these. My generation (30ish) is not ok in terms of digestive system health and early weaning could be a causal factor - of course we will never know but it's just not helpful to say that you were weaned early and you were ok. It's like saying "I crossed a busy street without looking and I wasn't knocked over" - that would be luck, it wouldn't and shouldn't endorse others to do the same!!

The evidence on infant feeding and atopy is contradictory - there may well be no difference, when the dust settles, between exclusive bf to 4 mths and exclusive bf to 6 mths in this respect. At the moment, research is actually hampered by different definitions of exclusive breastfeeding, and the difficulty of ensuring the exclusivity of it, and the challenges of measuring and defining allergy.

I don't think allergy is the strongest argument in favour of supporting the WHO guidance, personally, because of this contradictory research base.

We don't cover all adverse effects of non-exclusive bf with the term allergy, anyway.

There are many physiological pointers indicating that around 6 mths is about right for most infants, and the debate in WHO when the studies were being examined as a possible policy base was really very little to do with allergy, but rather to do with the question of infant growth and gastro-enteritis.

Gastro infections were pretty clearly less among babies breastfed excl for longer - but, came the question, did this compromise growth in any way? The answer was, broadly, 'no' - babies who continued excl bf beyond 4 mths did not suffer growth-wise, so there was no price to pay for the continued protection against infection. There was also no evidence, broadly speaking, that babies suffered from any sort of iron deficiency if they did not have other foods until after 6 mths.

Sticking to the physiological norm of (about) 6 mths excl bf had no disadvantages and demonstrable advantages, as a public health policy.

In individual babies, individual 'deviations' might apply, of course.

Since this policy, other papers have emerged showing that (for example) earlier weaning/ff increases the risk of later obesity (lots of big studies, controlling for other social and dietary factors). I am not sure if anyone has done anything on conditions like IBS or other chronic gut disorders that tend to emerge in adult life, but it would be interesting to see the results.

Anyone worried that belarus managed to nuke themselves during the study period?

Edam, far from not reading my own links, I quoted exactly those passages in my post of 00.40.13! And I even put in bold the parts that emphasised this only applies to early childhood. Even this evidence is shaky and the conclusions not agreed upon. Nobody can say that breastfeeding has any long terms effects re allergies and asthma, as the studies tend to say the opposite.
I don't believe that scaring people will ever normalise breastfeeding. Especially if the scary stuff is inaccurate.
There are plenty of good reasons to breastfeed which are backed up by evidence, but I personally think the main things that will help raise breastfeeding rates are it being acceptable and welcomed in public, a more matter of fact approach to the human body, more and better support in hospitals and from HVs and better maternity and paternity leave. Not this rather smug and unpleasant suggestion that if you don't breastfeed you will have set up your kids for a lifetime of disease, and even if they seem perfectly fine, they probably aren't. The links between lifelong ill health and lack of exercise and getting plenty of fruit and veg are so much stronger it's not true. But nobody posts stuff about people who can't get their kids to eat five a day harming them, as we tend to accept it is difficult and that most people do their best. Breastfeeding is not the only fruit.

Who's scaring anyone?

I agree with you that public attitudes to b/f, better support from health professionals (appalling that so many of them get no education or training about this at all) etc. will do more to raise rates than anything else.

But I disagree that there's anything smug or unpleasant in giving people the facts (as far as we know them within the limitations of the research that's been done to date) about the health benefits of b/f (or the risks of formula, depending on how you choose to look at it).

There would be something smug and unpleasant about blaming people for not b/f - human behaviour is complex, everyone's situation is different, etc. etc. etc. But hiding information because you assume the truth as far as we know it will hurt someone's feelings is just daft.

I also think we need to define terms here. Yes, there is evidence that 'early weaning' in studies that is linked with harm , but in the studies I've seen that's defined as weaning in the first three months. In the links I've put up, weaning onto solids at 17 weeks or later has not been found to cause any harm.
like this one
Interestingly this study, part of the Avon Longtitudinal study did not find that breastfeeding reduced the risk of obesity at age seven, though it did find that smoking in pregnancy was linked with greater obesity in children aged seven
It seems likely that early weaning (ie before 17weeks) is implicated in higher obesity rates though from the studies I've looked at it is far from the most important factor. Having obese parents, too much telly, too many fizzy drinks etc and not enough exercise and fruit and veg are much more important.
It may be that weaning at six months or, who knows, 10 months, might be more effective at reducing the risk of obesity but I am not sure there is any evidence to back this up.
It is undoubtedly true that breastfeeding reduces the risk of gastro and ear infections.

No, I'm asbsolutely all for giving people the facts. That's what I've been doing here, without even swearing at anyone. There were some quite big assertions re allergies and breastfeeding made without any supporting evidence early on in this thread. And some truly crackers posts which appear to compare the risks of formala feeding with those of heroin.
Actually I'm truly puzzled at why saying this stuff has provoked such anger. Surely this is GOOD news? That if your child has allergies or asthma, and you didn't manage to breastfeed, or mixed fed, or weaned at four months or gave up for any reason before six months, it's OK. It is hugely unlikely that this has anything at all to do with your child's problems. Why would anyone think this is a bad thing to say? Especially as it happens to be true.

Actually it's weaning before 12 weeks that really seems to bump up the risks. But that's never been the advice.

I am actually laughing about the idea that I am trying to suppress facts. Blimey, the links I've put up and the time I've wasted!

I'm not sure that this post, for example, is particularly helpful. I might even suggest it was scaremongering and unpleasant.
"Does it really matter if they are fine? Even at eighty five?
That's like saying 'I got hit by a car/stabbed in the chest/took ten grams of heroin and I'm ok' yeah, you might be, but not everyone is that lucky."
Or this one
"Although it does amaze me (maybe I'm biased from losing a baby) that people don't want the burden of caring for their child."
There is more to caring for a child than breastfeeding, and I say that as someone who breastfed for years and thinks it is pretty small beer in a lifetime of caring.

No, you were suggesting giving people the facts was unkind as it might upset them.

Blimey, I've thrown out a couple of olive branches to you, identifying areas where we agree. Doesn't seem to be much point.

Hmm, if there is no "benefits" (even allowing for Mind Your Language) then what's the point in breastfeeding? After the struggle I had to do it last time, maybe this time we would be better off just skiping it entirely

That's that sorted then.