 All right welcome everybody. Our next speaker is Dr. Philip Goshensky. Dr. Goshensky is a retired clinical professor of pediatrics and a regular lecture on fitness and health. He's the author of several articles, book chapters and numerous magazine and newspaper articles and he's also the author of the book Health Secrets of the Stone Age. Please welcome Dr. Goshensky. Good afternoon. It's a pleasure to be here talking about one of my favorite subjects and it's important to know that breastfeeding is something that we used to take for granted but we don't anymore because it's too easy, not too. But those of us who are interested in the paleo lifestyle have some things that we should enjoy about. First of all, no grains, no legumes, no cow secretions and it's totally organic. And if you look at some one of the most important statements that applies to to this concept is that milk is a complex fluid that exerts effects far beyond its nutritional value which is a huge under statement. If we look at the unique features of breast milk especially when we compare them with any alternatives that have been offered over the last century or so, we realize that it's number one species specific. And although we depend on cow's milk to feed our babies most of the time, cow's milk is not nearly as adequate as our own species. It's unique to the mother infant dyad. As an example, the milk that a mom produced for her baby last year is different from what she is producing for her baby this year. It is that specific. It can be modified by the gender of the infant because the breast milk that's formed for a boy baby is different from the milk that's formed for a girl baby. We'll talk about that in a little bit. It increases from multiple births. I've always been oppressed by the moms who can breast feed twins for a full six months and I'm really impressed by the ones that can do it for triplets. There is a significant change in breast milk probably more than one when a baby is born prematurely. There are some things that are found only in breast milk. One of them is endorphins, things like lysozyme, secretory IGA, protective oligosaccharides, antioxidants, lactoferrin, cytokines, and protective bacteria. Well, if we look at endorphins, I'm sure many of you are familiar with the concept, it means endogenous morphine. We talk about the runner's high and the good feeling that we get when we exercise, but it's interesting to note that when a mother has undergone labor and a natural delivery, her endorphin levels are higher after that kind of delivery than they would be after a C-section and she puts these endorphins out in her breast milk. It may help to alleviate the birth stress of the infant and it seems to facilitate the bonding between a mother and her infant. There is also a boost that helps to protect the baby after birth because there's a limit to the kind of protective antibodies that cross the placenta that will protect the baby from the kinds of things that the mother has been exposed to during her lifetime. But breast milk adds certain things. One is lysozyme. Lysozyme is one of the most primitive elements of the innate immune system. It's been around for literally tens of millions of years. Breast milk also contains substances called oligosaccharides that block the attachment of harmful bacteria to the lining of the intestinal wall. Also produces secretory IgA, which is another class of antibody. Now, if we look at interferon, this is something that we really don't know a lot about, but we do know that it's produced in cells in response to either infection or to cancerous cell presence. And breast-fed infants, for instance, will produce more interferon if the mom is undergoing an influenza infection because there's something in breast milk that passes to the infant that allows that infant to produce more interferon. The problem is that we don't know much about it at this point. We don't know much to date, but I'll talk about some of the things that we will be finding out over the next generation or so. This is really important. Breast milk contains live cells. And if a can of formula happens to contain live cells, heads will roll in the quality control division. There are no live cells in any can of infant formula, but these are the kinds of cells that we find in breast milk. Now, these have been known, recognized for about a century and a half, observed well in the middle of the 19th century. And they knew by the end of the 19th century that breast milk cells killed bacteria and killed fungal elements. Now, it's important to know something about these cells. They don't just happen to spill over from the blood of the mom. They come from the mother's own immune tissues and not just from her blood. And in fact, although these are proteinaceous products, for some reason, the infant knows not to digest those cells. But those cells pass through the walls of the intestine and they take up residence in the immune tissues of that infant. Something about breast milk cells that we need to consider when we talk about the value of breast milk to protect from infection is that those cells last for years, we know it's at least seven years, could be for a lifetime. And this is an aspect of the immune substances in breast milk that have far reaching consequences for that child. Now, if we look at the differences between breastfeeding now and what it was like back in the Stone Age, those moms had a very diverse source of their nutrients. There was much more nutrition per serving in the foods they had back then. There were some environmental factors that were very different. There was no pollution back then. They got plenty of vitamin D. And the maternal lifestyle was far different than it is today, largely in the case of ingested toxins. If we look at what life was like before the agricultural revolution, following the kind of ideas that have been murdered by Eaton, Shostack, and Connor in their book, the Paleolithic Prescription, they had more than 100 different plant foods to choose from, more than 100 types of wild game, more than 100 species of birds. How many species of birds do you find in the supermarket today? Two, chickens, turkeys, okay, Cornish game hen, maybe an occasional duck, but it's far from the 100 that we had 15, 20,000 years ago. How many kinds of eggs do we find today? One, okay, brown eggs and white eggs. But they all come from chickens. But back then, there were all kinds of eggs including those that came from reptiles and amphibians. If we look at some of the environmental factors back then, all foods were organic. There was no dilution of nutrients because of soil exhaustion. When the first farmer planted his second crop, he was already exhausting the soil. Think of what's happened in the last 15,000 years. There was plenty of vitamin D, which is supposed to child of good health these days, because most humans in that era lived within a few thousand miles of the equator. There was sunshine all year round and they pretty much went without clothing all the time. There was no air pollution and there was no water pollution in those years. If we look at the maternal lifestyle, we find that stone ages didn't drink alcohol. There was no tobacco. There were no drugs in their breast milk. And a nursing infant actually ingested beneficial bacteria about which we'll have more to say in a little bit. One of the things that's also important is that the placenta transferred protective antibodies to the germs, as I mentioned, as the mother had survived. There were also fats in breast milk and in large measure, they consisted of omega-3 fats, which as we know contributed to the evolutionary changes in our brain and nervous system. There was something called the lacustrine leap theory, which says that about 150,000 years ago, humans learned to gather seafood first from the shore, from ordinary things like clams, mussels, oysters, etc. And finally from fish that they were able to net and trap. And that the growth of the human brain occur after we developed the ability to gather large amounts of omega-3 fats. One of the things that we find among breastfed infants is that their brain development and eye development is better than the development of those structures in formula-fed infants. Now, formula manufacturers have tried very hard to imitate breast milk. One of the things that they've done in the last few years is to add omega-3 fats. But as many of you know, fats become rancid. They can become rancid in the can or the bottle. They don't become rancid in the breast. When it comes to something like prematurity, one of the things that we now know is that omega-3 fats tend to cross the placenta during the last eight or so weeks of pregnancy. Well, what happens to the poor kid who happens to arrive about two months early? They won't be shortchanged because it turns out that the milk that is produced by a mother of a preemie has more omega-3 fats than the milk that she would have produced at term. It's as if nature is saying, I am not going to let you be shortchanged on your contribution to the human race by coming a little early. When it comes to protecting preemies, there's something else. Many of you may be aware of something called necrotizing enterocolitis, NEC. Necrotizing enterocolitis is a condition that happens in premature babies and the smaller the baby, the earlier they come, the more likely they are to develop this kind of destruction of a large part of a small intestine, sometimes almost 100% of a small intestine, has a mortality rate which can be as high as 40 or 50%. Turns out that those preemies given breast milk, especially from their own mothers, have a much lower incidence of NEC. And for those babies that are simply too small to nurse like the one pounders that we're saving on a regular basis these days, they're simply tube fed the mother's milk and they're getting the benefit of that as well. Probably one of the biggest take home messages today is that every breastfeeding day is different. Colostrum is the breast milk that comes in the first seven to ten days or so. It's kind of thick, it's somewhat darkly colored because it contains a lot of protein and that protein is mostly in form of antibodies. Transitional milk occurs a little later, it's higher in calories and this is when babies gain the most weight. The moms in the audience, maybe some of the dads do too, know that a baby doubles its birth weight in about three months from seven pounds to about 14 or 15 pounds. But it takes another nine months before it adds another seven pounds. So they're weighing about 20, 21 pounds at the end of a year. This is why that transitional milk is so high in calories because every cell and every organ is undergoing change and growth during that period. Mature milk is very high in fat calories to sustain the infant. There are more than a thousand nutrients that we know of. Probably still more to be be discovered in breast milk. How about this? You talk about fine tuning. The milk that a mother produces at night is different from the milk she produces during the day, which helps the baby sleep better. And so the argument that breastfed babies wake up more frequently and the moms don't get as much sleep simply isn't true because both the moms and the babies sleep better if she's breastfeeding. Ah, how about this one? The breast knows if that baby is a boy or a girl because it turns out that although we only have done studies now in primates and bovines, it turns out that there are, that the babies, that the girl babies get more calcium in their breast milk and the boy babies get more fat. Maybe that's what makes us guys fat heads. And it's a truism that the nutrient composition of cow's milk formula is never changing, but babies need change every day. When dad goes out and the first day the baby comes home to get some formula the milk he buys on day one or day 10 or day 100 is always the same and if it's not the same again it's a quality control issue but breast milk changes every day because the babies are changing every day and it's also a truism that the quality of the breast milk depends on mother's nutrition but a mother has to be really deprived of nutrients before there is a very significant change in the quality of her breast milk. Nature tends to send more nutrients to the breast. Something that's not present in modern breast milk occurs sometimes in vegan mothers they don't have very much vitamin b12, they don't have satisfactory amounts of vitamin d or vitamin k. Dark skin mothers especially in northern climates tend to get less vitamin d and their babies are somewhat at risk for things like rickets for instance. I mentioned vitamin k because there is a movement to avoid vitamin k injections on the day of delivery and one of the problems of babies who don't have enough vitamin k which is a fair amount, a fair number of babies is that they are at increased risk of getting excess bleeding and if it's an intracranial bleed it is 81 times more likely in a child who does not get vitamin d and contrary to what you may see on the internet there was no risk to vitamin k. I meant to say vitamin k not vitamin d. Now how many of you are taking probiotics? That's a fair number and babies get probiotics too and the fact is that there are 10 times as many bacterial cells in our bodies as there are what are called somatic cells and those good bacteria are so essential that when animals are bred in a germ-free environment they don't survive very long and it's also been known that the gut flora, those normal bacteria of breast-fed babies is different from the gut flora of formula-fed babies and something that we've come across very recently is although the original thinking was that the baby's gut flora came from the birth passage which is a pretty messy place to begin with especially coming in close proximity to fecal discharge and the babies might get some bacteria from nursing because it comes from the skin around the breast. The fact is that bacteria are found in the mother's breast even before labor begins. Nature sends those bacteria from her intestine to her breast so with that baby's first nursing movements that baby is getting healthy bacteria so therefore breast milk is not sterile and those transmitted bacteria are necessary for a baby to develop a normal immune system. In addition to the bacteria that are present in breast milk there is something for the bacteria to feed on because there are nutrients in breast milk that the infant doesn't need but those normal flora do and so the babies get both the germs that protect them and the things that the germs need to live on. Now I'll bet there's a mom in the house who has a child who's a picky eater. Anybody? Sure. Well it turns out that picky eaters are less likely if they're breast fed because the flavor of breast milk is determined by what the mother has eaten. When I started practice half a century ago literally I told moms don't eat spicy foods don't eat things like pickles or things that will cause the breast milk to be less flavorful or less irritating although it made it more flavorful because it turns out that when babies experience those different flavors of foods that the mom has eaten then they are exposed to flavors that they will get when they're being weaned and they therefore accept foods more readily when they are weaned if they are breastfed. One of the downsides of breastfeeding is that they're toxins in breast milk and the ones that I have marked with an asterisk are the ones luckily that because the regulation are now declining but we still find some of these like bisphenol A, perchlorate, phthalates, etc in breast milk because they occur in the in the mother's diet. Something to remember that these toxins are present often in even higher amounts in cow's milk and if we look at their proper perspective we find that even though breast milk does have some toxins breastfed infants perform better on neurologic tests than formerly fed infants do. Another example keeping things in perspective even though there may be some toxins in fish that a higher intake of fish and omega 3s in pregnancy outweighs a low intake of fish and when it comes to contaminants in fruits and vegetables a diet high in fruits and vegetables is better than a diet low in fruits and vegetables even though there may be some toxins present there because the benefits outweigh those disadvantages. Now what are some of the early benefits from the infant? Well one thing is that there was a lower risk of sudden infant death syndrome. Another is that those kids have less otitis media, ear infections, than bottle fed babies, certainly well documented especially in third world countries a lower rate of infectious diarrhea and less pyloric stenosis. Pyloric stenosis is a condition in which the the farther end of the stomach has a muscle around it and that muscle becomes large and narrows the outlet of the stomach and it often shows up in about the end of the first week or second week more common in boys and without surgery then the outcome is often very very challenging for the child and breastfed babies have less pyloric stenosis. Breastfed babies have a normal trajectory of weight gain and the infant growth charts that I saw when I was in training in early practice were usually based on the growth rates of bottle fed babies which we now know are not normal. Those babies grow faster than breastfed babies but breastfed babies are the norm something that the World Health Organization only recognized about 15 years ago. One of the long-term benefits is that they are less developed to develop certain things like type 1 diabetes, type 2 diabetes, osteoporosis when they themselves reach middle age, less asthma a condition that has literally doubled since 1970, less eczema and interestingly enough breastfed babies multiple studies show this have less risk of leukemia and lymphoma we don't know why. Now does obesity prevent obesity, breastfeeding prevent obesity later in life? Well we used to say yes. One of the reasons that it ought to is because breastfed babies have lower insulin levels. Insulin drives the multiplication of fat cells adipocytes and so when the baby reaches age of two they've acquired most of their fat cells and therefore if they are breastfed they are less likely to have a lot of them but the fact is that there are so many other factors now that that overwhelms the ability of breastfeeding to modify obesity. There are some maternal benefits that some of you may know about but there's some maybe you may not be aware of. One is that when the infant nurses immediately after delivery causes the uterus to contract. Not so much of a problem now because we have skilled medical facilities at every maternal delivery site but back before modern medicine that was a big deal for the uterus to contract quickly to limit the amount of blood loss by the mom but it turns out that she has other benefits. Breastfeeding moms are less likely to get breast cancer of their premenopausal type, less likely to have ovarian cancer possibly related to the fact that breastfeeding moms have fewer menses during the course of their lifetime. They have less metabolic syndrome, less cardiovascular disease, less type 2 diabetes and less rheumatoid arthritis, less postpartum depression which is a very significant problem and something that makes a lot of moms happy that the return to pre-pregnancy weight is faster in breastfeeding moms. No great surprise because when a mom nurses she's putting out about 500 calories a day that's a lot of calories. For every week it's a pound 7 times 500, 3500 and as you know 3500 calories are what are found in a pound of fat. Now is breastfeeding a method of contraception? Well there is something I refer to as paleo contraception because breastfeeding actually suppresses ovulation. The medical term is lactational amenorrhea. Now there are some caveats. One is that the suckling has to occur around the clock. That the minimum frequency is about every two hours. The optimal frequency is every 15 or 20 minutes and I can hear the groans already. But keep in mind that hunter gather a woman from the time the baby is born during the day they keep that baby in the sling. That baby has access to the to the breast every waking moment of the mom and when she lies down to go to bed with the baby it's not mom in the bed and the baby in the bassinet they sleep together and all night long the baby can suckle whenever it wants to. That's why paleo contraception works. Now if we look at what contraception was like back then it's been observed to occurred hunter gatherer people as you know who live a lifestyle as they did back in the stone age. Their birth frequency was only about every three to four years because that's how long they breastfed that's how long the baby had access to the breast and one of the problems of women in the modern age is they have what's called incessant ovulation and the current theory is that every time an egg pops out of the ovary it causes some inflammation and we heard about inflammation this morning and that inflammation repeated month after month after month year after year after year is one of the reasons why there is a high incidence of ovarian cancer among women in the first world and not among hunter gatherer women and it's not because our moms live longer. There was something also called breast maturity and the fact is that the mammalian breast does not become fully mature until it has undergone pregnancy and lactation and what that means is that if a woman has never lactated or never had an infant then her breast cells are somewhat immature and they're susceptible to carcinogens such as those in tobacco smoke and one of the biggest reasons why adolescents have to be cautioned not to smoke is because if they are smoking for a few years before they have their first pregnancy they are becoming susceptible to the kinds of cancer of the breasts that are induced by tobacco and it's certainly true that there were no immature breasts back in the Stone Age. Now how natural is breastfeeding? Well it's natural for the baby it's not so natural or it's natural but not so instinctive for the mom what I mean is this we know that some women have experienced what is called breastfeeding failure the fact is that even primates have breastfeeding failure if a female private primate is raised in isolation from other females when she becomes pregnant and delivers a baby that baby often does not survive and one of the reasons is the mother hasn't had any observation of other primates and how they nurse their young now female primates as I mentioned often fail to breastfeed and the reason hunter-gatherers never fail to breastfeed is because they had rolled models and ask yourself who are the rolled models of the 21st century well I like to talk about what I call the grandmother effect and what that says is that grandmothers were usually around in prehistoric times and in fact it wasn't until about the last couple of hundred years when daughters went out to different parts of the country different parts of the world didn't have mom available at every moment to answer her questions to show her how to do things where the baby was concerned and in the 20th century as many of you are breastfeeding took a nosedive and as commercial infant formula manufacturers got better at marketing their product there was less and less breastfeeding so in the middle of the 20th century most women didn't breastfeed and they didn't then gather the experience that they needed to pass on to their daughters and the fact is that most of today's grandmothers not only didn't breastfeed they don't even know how to teach their daughters how to breastfeed and today's lactation consultants are the equivalent of yesterday's grandmothers now what can we expect over the next few years well we're going to find out there are more critical nutrients in breast milk we're going to find out why there are stem cells in breast milk we're going to find out why breast milk composition changes whether it's a boy baby or a girl baby there's a whole lot more to that story than more calcium for girls and more fat for boys we're going to find out there probably dozens if not scores of nutrients that differ depending on the gender of the infant i mentioned a couple things about premies one is omega-3 fats the other is protection against NEC i think those are only two examples of the kinds of differences we're going to find in the milk produced by a mother who has a preemie versus milk produced by a mother who has a full term infant we're going to find out why mothers with twins or triplets are able to breastfeed and we're going to find out what the mechanism is for her producing more milk depending on the number of infants that she has so the bottom line is that there are no biological disadvantages to breastfeeding it fits the evolutionary principles that you've heard from cordane and eaten and other people who are promoted to paleo lifestyle there is a learning curve for the mother but not for the infant if you've ever seen an ultrasound of a baby in the womb sometimes they get that cute picture that photo op or the baby sucking its thumb that's not accidental babies are learning to suck they're strengthening the muscles that are involved in suckling and they are facilitating the neurologic pathways that make suckling more easy for them mothers don't get that kind of practice this is where i think breastfeeding is now what we know is what you see at the top what we don't know is what you see below the surface and i am so excited about what's going to be found in the next few years one says the other it doesn't get any better than this and finally thank you very much if you have any further questions i'll be out outside at one of the tents for the book signing be happy to answer any questions you have we actually have five minutes for questions right now go ahead hello um are there any benefits for adults consuming breast milk i've heard some stories of people in new york buying and selling breast milk for mothers have you ever heard of breast milk ice cream no yeah they didn't stay in business very long it just never caught on wonder why are there benefits i don't think so that are meaningful and the reason is when you purchase breast milk let's say you get it at albertsons that is not very specific for you but your mother's breast milk was specific for you and the mother's breast milk that you got is different from what your brothers or sisters got and think of how even greater the disparity is for people who are entirely unrelated to the person who volunteered to market or market for breast milk second question related um colostrum is i think one of the better or i guess more nutritional ingredients in breast milk and now there are people selling colostrum from cows to humans um is there a benefit for that are there good reasons to consume that one of the stock answers i used to give mothers who asked me about about milk especially when the kids were a year too old and and i suggested that they might be getting a little too much milk or they really didn't need milk and i said cow's milk is for baby cows and they say well where will she get her calcium i said where do cows get their calcium they get her from leafy green vegetables a cow that's been weaned never gets milk after that but you never see a cow with osteoporosis can i answer the question is there close enough okay and more specific no no i just what uh oh colostrum yeah consuming colostrum the advantage of colostrum is mainly in antibodies and the colostrum that you buy may have antibodies in that totally unrelated to what you need and it's it's probably going to get digested just like any other protein so i really don't think that colostrum has any great nutritional value unwilling to have people present information to me that's different from that i think there are other nutrients in colostrum that may be helpful but how much can you drink in a day that's fair thank you okay okay so you mentioned a little bit about the differences in the breast milk for preemies and those who were born in a c-section um which both of them i was born that way so i'm i'm now glad to know that i got some nice things out of preemie milk that probably helps some stuff but is it is the milk different and worse if you were born in a c-section or normally the differences in the milk produced by a c-section mom versus a a vaginal delivery mom um are mostly in the form of two things endorphins and normal flora the probiotic bacteria that i mentioned but otherwise the nutritional value is pretty much the same but unfortunately it takes months for a baby's gut flora to catch up if they're forming the fed then if they're breastfed or if they're c-section babies versus natural birth but the differences are not huge so i don't see any huge downside i certainly don't think that we need 50 percent c-sections in this country uh which is close to what it is now it's over my mom had to she wouldn't have if she had pardon my mom had to so oh yeah sure there's no question that c-section saves lives but why has it gone from about five percent 50 years ago to 35 percent today china it's over 50 percent this there's a disconnect there's what i'm saying but yeah i would never question the obstetricians decision to do a c-section never so uh and then i have another question sorry if i'm keeping everyone waiting but so i couldn't suck but my mom managed to get the milk into me anyway uh i have a twin brother and i know you mentioned that there was there are differences in the milk for different genders now what if you have a twin brother i have grand twins a boy and a girl i think about this all the time that somehow there's still a third change in breast milk if one is a boy and one is a girl it's the stuff at the bottom of the iceberg that's what we'll find out someday okay thank you you're welcome hi it's interesting that you mentioned the breast milk ice cream because that was a story a couple of years ago if you remember and actually the woman who gave the breast milk for the ice cream was my wife um in england and she was the swoop of the story if you want to read her story about it she wrote a an article in the garden newspaper so if you visit go.cream.org slash milk it'll forward you to the right place and what was very interesting at the time as part of the question is that westminster council confiscated the milk and said it was a biohazard even though it only pasteurized and tested and what the irony was was that a block down the road there was a cheese shop selling unpasteurized cow's milk cheese um and it was very interesting that people had a repulsion of consuming human breast milk but they were happy to drink the milk of another animal and Lady Gaga because the milk the the ice cream was called Baby Gaga Lady Gaga said it was it was repulsive to her this is a woman who wore the skin of a cow to a premier but she she found it repulsive and so it's very interesting and because my wife is actually a lactation consultant and volunteers and it's part of baby milk action in in Britain part of her doing this was just to try and shake up people's very peculiar attitudes to breast milk which seems to be stymying people's ability to breastfeed in a in a competent and confident way are things as bad in the United States as they appear to be in the United Kingdom in that respect that the kind of and there's a weird prudery as well that we all know about as about to are things going to get better in your well I think there's been a huge awakening of the value of breast milk and that will only increase as more and more studies are found to show what the differences are between breast milk and and a cow's milk formula and I appreciate the fact that some mothers can't breast milk for a variety of reasons that's a whole other issue take us an hour to discuss that and if what your wife did would awaken people to the reasonableness of breastfeeding I commend her for that and applaud her for that there is no there is a phrase called political logic but it's an oxymoron I mean I just look around the newspapers every day things happen that don't make any sense and what you cite is another example of that well talking about this is very last thing talking about political logic and I said this to others I think it's a little bit disappointing that the water being given out to people at this conference is produced by Nestle I'll put it no more strongly than that at a at a paleo conference that's pretty disappointing shall we say again okay I was wondering I've read something about cultures where they have multiple mothers feeding like all the babies in a village or something what do you think about that versus a single mother feeding her infant well obviously there's an advantage if a given mom feeds her own baby because if you have a wet nurse for instance let's get the ultimate example mom has a severe medical problem requires some sort of surgery after delivery cannot breastfeed for days if not for weeks she may receive frozen breast milk from other mother donors or the family may hire a wet nurse which is very common in years past but again the milk produced by a mom who's been nursing for nine months is totally different from the milk that the mom would produce at nine days now there are some benefits to that and is better than some of the alternatives but the the best choice is for the mother's own milk but if the alternative is frozen breast milk for instance or a wet nurse I would accept that mine actually with that same segue is what were your thoughts on breast milk banking and sort of logging the time of breast milk you know pumping because I'm a huge advocate of putting the time on the actual container of breast milk and telling you know mothers that there are different levels of stress hormones and things at different times of day yeah there's some logic to that there are so many other variables I can't make a blanket statement right and I am not a lactation expert okay I never breastfed so how much can I say about it thank you all right let's thank Dr. Groshensky