The Researcher's Perspective Lynn Goldman Interview Transcript Posted October 15, 2009 Views and opinions expressed in these podcasts are those of the interview subjects and do not necessarily reflect the views, opinions, or policies of EHP or of the National Institute of Environmental Health Sciences. Narrator: EHP presents The Researcher's Perspective. Ernie Hood: Welcome once again to The Researcher's Perspective. I'm your host, science writer Ernie Hood. On this episode of The Researcher's Perspective, we welcome Dr. Lynn R. Goldman to the program. Today we are talking with Dr. Goldman about the benefits and risks of nursing newborns, infants and toddlers. Dr. Goldman is principal investigator for the Johns Hopkins University Center for the National Children's Study and is described on the National Library of Medicine's "Changing the Face of Medicine" website as "one of the most influential public health physicians of our time." A number of recent studies have reported on levels of persistent organic pollutants in human milk-chemicals such as the pesticide DDT, PCBs, dioxins and brominated flame retardants. Even though many of these chemicals are linked to adverse health effects in humans, studies consistently conclude that, all things considered, the benefits of breastfeeding still make it the optimal method of infant feeding. In fact, as we head toward flu season in the Northern Hemisphere, the Centers for Disease Control and Prevention is urging women to continue breastfeeding their infants, especially if they or their babies become sick with novel H1N1 flu, because of the immunoprotective effects of human milk.1 Dr. Goldman, welcome to The Researcher's Perspective. Dr. Goldman: Thank you for having me. Ernie Hood: Dr. Goldman, it seems like every time we turn around lately, there's a new report about chemical contaminants being discovered in human milk. This would seem to be a perfect example of a situation where the public must be justifiably confused about the mixed messages they're receiving. What is the science telling us today about the benefits and risks of breastfeeding? Dr. Goldman: Well, generally we know that there are enormous benefits to breastfeeding, and not the least of which is that human milk is the only milk that is actually specifically designed and perfectly designed for the human infant. At the same time, when we look at human milk, and not surprisingly, when we look for the chemicals that tend to persist in our bodies, we see those chemicals in human milk. And, partly, we can see them because human milk happens to be something that is very easy to look at. It's easier to look at human milk than many other tissues. We can obtain it without doing anything invasive. And so if we look for these things, we can find them. And then we need to look at what the risks are. And the good news is that even though we see these environmental chemicals in the human milk, that the risks that are conferred by these chemicals are much, much lower than and very much offset by the benefits of breastfeeding. Ernie Hood: Where do we stand at this point in terms of the science in our knowledge of the benefits of breastfeeding? Dr. Goldman: Here's what we know in terms of the science. One, we know that the first six months of life, that the baby's immune system is still developing. So the baby is not born with a completely mature immune system. And so those immune factors that are in breast milk are important, and they're not present in artificial feedings like infant formula. Second, we know that the baby's digestive system is not fully developed as well, and that the baby can much more effectively absorb the nutrients that it needs from breast milk than it can from non-human milk, from artificial milk or milk from other animals, if you may. And so that's where the science is in terms of the benefits. And then of course, there are other benefits. There are probably emotional benefits and other benefits that may be there as well for both the parents and the baby. And that's the basis of the recommendations, not only by the American Academy of Pediatrics2, but also the World Health Organization3 for exclusive breastfeeding during the first six months of life. Ernie Hood: Dr. Goldman, are you concerned that with all of the publicity about chemical contaminants, as you've discussed, in human milk, that that publicity may be distorting the message and actually discouraging mothers from nursing their babies? Dr. Goldman: I am concerned that sometimes mothers may be getting many mixed messages about breastfeeding, not only in terms of being concerned about the possibility of contaminants in the breast milk, but also that when mothers go back to work, that oftentimes the workplace is not conducive to breastfeeding. Many women live in home environments that are not supportive of breastfeeding because to be able to breastfeed women need to have good nutrition and adequate amounts of rest and fluids, and an opportunity to do that, a place where they can go to do that. And so there are many factors in society that tend to make it more difficult for women to breastfeed. Now would I say that means we shouldn't talk about the pollutants in breast milk? I don't feel that way. I think we need to be honest about that because as a society if we're doing things that are, over time, likely to threaten our health, such as by putting contaminants into breast milk, we need to raise concerns about that. We just need to do that in a way that's appropriate and that prompts what I believe is the right action, which is to stop exposing ourselves to these persistent substances but not something inappropriate, which would be to say don't breastfeed. Ernie Hood: Dr. Goldman, what do you recommend that we do to make human milk even safer than it is today? Are there actions on a macro level that we can take to reduce the presence of these contaminants we've been discussing? Dr. Goldman: Yes, I think so. I think on a macro level, what we need to do is develop policies where we are much more vigilant about avoiding the use of persistent chemicals and pesticides. We do not want to have anything that's persistent and going to build up in the environment or in our bodies in our food supply, in the air we breathe, in the water we drink. Because we've learned over and over and over again that these persistent substances, if they do have adverse health effects, then over time there's very little we can do about them. So, many of the chemicals that are found in human milk are no longer used today. Many of them were banned as much as 20 or 30 years ago and yet we still find them. And yet when these chemicals are persistent we can't simply dial down the exposure levels, because some of them have half-lives that last many, many years. Ernie Hood: Is there anything mothers can do to optimize the purity of their own breast milk? Are there simple actions they can take to reduce their exposures to the type of chemicals that could end up in their milk? Dr. Goldman: Well certainly if women have occupations where they're likely to be highly exposed to industrial chemicals or pesticides, I would certainly advise women in such situations to take steps to protect themselves, whether it's making sure that they're careful about personal protection, making sure that they're very careful to follow all the rules about how you handle these substances, how you protect yourself from them. And there are a lot of women involved in manufacturing and agriculture and so forth who may have these kinds of exposures. The other thing that women can do is to pay attention to fish advisories, because many of these persistent chemicals accumulate in water bodies, and we know that there are certain places where the fish are highly contaminated, and there are warnings that are issued, and to pay attention to those warnings and to avoid eating fish that are contaminated, either locally or we also know certain species of fish, such as the mackerel fish and shark have very high levels of some of these persistent chemicals. These are top predator kinds of fish. Fish are generally good to eat and have a lot of things in it that are beneficial for women and beneficial for their babies but paying attention to what kind of fish you use. There are organizations that have published lists; I happen to know about one that Environmental Defense Fund has published4, that many others have published them as well, that are guides that you can take when you go shopping to help point you to the safer fish and safer seafood. Ernie Hood: What about women who aren't necessarily in that line of potential exposure-just everyday people around their households? Is there a cause for concern or caution about being exposed to things like household pesticides, or paints, or solvents, or things of that nature? Dr. Goldman: You know, there's some commonsense things that people can do. And one thing is, during pregnancy and while breastfeeding a baby, not to have routine pesticide applications. Now sometimes there are pest control situations that just demand an application, but sometimes people have contracts with pest applicators where they're just coming on a routine basis to apply pesticides- probably a good idea, just as a matter of precaution, not to do that during pregnancy and while breastfeeding. Then, if there is a pest control problem, to use softer means of controlling pests, like bait stations and nontoxic pest control alternatives where there's not going to be contact with the mother, or for that matter with the father or other children in the household. The other thing that is probably also a matter of common sense, a lot of times when people are expanding their families, they begin to do things around the house like creating nurseries or remodeling, and it's a really good idea for women who are pregnant or who are breastfeeding to try to avoid exposure or contact with the products that are used in those kinds of processes. You can even be out of the house when these activities are under way. You can make sure that the house is aired out before going back into the house, or even just wait, delay on doing those activities until you've gotten through the pregnancy and breastfeeding. I can't tell you how many times I've seen this nesting behavior that can start toward the end of pregnancy and that can lead to that kind of thing. And some of the products that can be used, like for example some paint strippers and certain kinds of solvents that people might use, are pretty powerful. Ernie Hood: Of course we know that in the real world many, many women, for a variety of reasons, will choose not to breastfeed or will wean their babies to formula quite early. With that reality in mind, the safety of infant formula will also continue to be a cause for concern, especially when we have reports such as the one we got in April from the CDC5 about the presence of perchlorate in powdered infant formulas. Do you have any advice for mothers who, for whatever reason, will give their babies formula? Dr. Goldman: Well, I think that generally infant formula is safe. It's very tightly regulated by the U.S. Food and Drug Administration in the U.S. and by other regulators in other parts of the world. One major concern with infant formula-if you use the kind that is concentrated powder, the water that you use to mix up the formula, to make sure that the water is safe water. And another thing that's very, very important is you use infant formula that you refrigerate, to make sure that it's adequately refrigerated because poor refrigeration of infant formula can actually cause infections, and in fact I have seen such infections here in the United States. This is not just a problem in developing countries. So those are the main things that people need to be careful about. Of course, using U.S. brands; I wouldn't go abroad to get your infant formula; I wouldn't use off brands of infant formula. I think that the important point is that, as they say, breast is best, and that human milk is the best food for an infant and that whenever possible we need to support breastfeeding. Not just women who are the mothers of babies, but really everybody needs to support breastfeeding. Family members need to give women support. Employers need to give women support. We need to do much more as a society to support this activity, including taking steps to make the breast milk safer by preventing persistent chemicals from getting into our bodies. Ernie Hood: Dr. Lynn R. Goldman, thank you so much for joining us. Dr. Goldman: Thank you for having me. Ernie Hood: And thank you for listening to The Researcher's Perspective! Notes 1Centers for Disease Control and Prevention. 2009. Novel H1N1 Flu (Swine Flu) and Feeding Your Baby: What Parents Should Know. Available: http://www.cdc.gov/h1n1flu/infantfeeding.htm [accessed 12 October 2009]. 2American Academy of Pediatrics. 2005. Policy Statement: Breastfeeding and the Use of Human Milk. Available: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496 [accessed 12 October 2009]. 3World Health Organization. 2003. Global Strategy for Infant and Young Child Feeding. Available: http://www.who.int/child_adolescent_health/documents/9241562218/en/ [accessed 12 October 2009]. 4Environmental Defense Fund. 2009. Health Alerts-How Many Meals Are Safe to Eat per Month? Available: http://www.edf.org/page.cfm?tagID=17694 [accessed 12 October 2009]. Also see the Monterey Bay Aquarium Seafood WATCH website at http://www.montereybayaquarium.org/cr/seafoodwatch.aspx. 5Centers for Disease Control and Prevention. 2009. Perchlorate in Baby Formula Fact Sheet. Available: http://cdc.gov/nceh/features/perchlorate_factsheet.htm [accessed 12 October 2009]. For More Information: Mead MN. 2008. Contaminants in human milk: weighing the risks against the benefits of breastfeeding. Environ Health Perspect 116:A426ÐA434. Available: http://www.ehponline.org/members/2008/116- 10/focus.html [accessed 12 October 2009].