Thoughts on breastmilk and vitamin contents
by Hilary Butler
First, as a dairy herd-tester, I know full well, that what milk is tested,
determines the constituents. For instance, with cows, we never test the
foremilk. We take a proportionate sample (one-fortieth) of everything,
from the start of the fore milk, to the last of the hind milk. This forms
a composite sample. which is then slightly heated, and thoroughly mixed to
even out the fat and protein etc....
however, as a professional her tester, in order to check this out, I have
also tested foremilk, mid milk, and the last hind milk, separately in order
to look at multiple compenents such as protein fat etc. And we know that
various vitamin have various affinities. You will NOT find the vitamins in
the fore milk.
All three "milks" test like different planets.
Therefore even though I have not read the complete study below, unless the
mothers took proportionate samples (or preferably hind milk samples, since
that is where the vitamins will be) the study is totally meaningless.
So, while there may well be a regulatory mechanism (it would make sense to
have one) we don't know what that is, and what it relates to. Certainly
there are a lot of prescription drugs that go through this regulatory
device and can cause havoc in babies.
Words like "suggest" are just that. Here is a more recent one that
suggests that they haven't gotten to the bottom of the issue yet:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=7991643
Pharmacol Ther. 1994 Apr-May;62(1-2):193-220. Related Articles, Links
Breast milk as a source of vitamins, essential minerals and trace elements.
Bates CJ, Prentice A.
MRC Dunn Nutrition Unit, Cambridge, U.K.
Human breast milk provides all of the vitamins and essential minerals and
trace elements (micronutrients) that are required by the normal term
infant, until weaning. With a few exceptions, excessive micronutrient
supplies to the mother, or a moderate deficiency in her diet, do not
greatly alter the supply to the infant. Thus, the infant is well-protected
by maternal homeostatic processes, although the mechanisms of these are not
yet well understood. Considerable progressive changes in concentration
occur for some of the micronutrients during the course of lactation.
Because the concentration of these nutrients, and of other substances that
modify their absorption by the infant, such as binding proteins, differs
considerably between human milk, animal milk and, hence, commercial milk
formulae, there is great interest in the quantitative significance of
micronutrient supplies, and their variability in breast milk, in the quest
for improvement of commercial formulations. The aim of this review is to
summarize the available information about the factors that determine breast
milk contents of micronutrients.
Publication Types:
* Clinical Trial
* Review
* Review, Academic
PMID: 7991643 [PubMed - indexed for MEDLINE]
It isn't just a case of sampling milk. There are a whole load of
interactions and other factors... including sampling technique.
that is why it would be far more valuable to study what comes OUT of a
baby, and how it is utilised IN a baby, rather than a possibly falacious
technique of what they THINK is IN breastmilk. Here is why:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=6853060
Int J Vitam Nutr Res. 1983;53(1):68-76. Related Articles, Links
The effect of vitamin C supplementation on lactating women in Keneba, a
West African rural community.
Bates CJ, Prentice AM, Prentice A, Lamb WH, Whitehead RG.
A study of vitamin C requirements was undertaken in the village of Keneba,
The Gambia, during the rainy season, when the intake of vitamin C-rich
foods is very low. The effect of four supplementary levels of vitamin C (0,
24, 47 and 60 mg/day), together with a milk and biscuit food supplement
which provided 34 mg vitamin C/day, was studied for a five-week period.
Plasma ascorbate increased from 0.25 to 0.72 mg/dl; buffy coat ascorbate
increased from 14.7 to 24.3 micrograms/10(8) cells and breast milk
ascorbate increased from 3.4 to 5.5 mg/dl as intake increased from 34 to
103 mg/dl. Breast milk ascorbate approached a plateau at the high intakes.
A fasting plasma ascorbate of at least 0.3 mg/dl in 97.5% of the population
of lactating women in Keneba would require a daily vitamin C intake of
about 117 mg. No differences between vitamin C supplementation levels were
observed with respect to changes in plasma iron, total iron-binding
capacity or its percentage saturation. Whole blood histamine levels showed
a slight downward trend as the vitamin C intake increased.
PMID: 6853060 [PubMed - indexed for MEDLINE]
Anyone who knows anything about histidine function would know that it is
crucial, and vitamin C dependant. So that is another measurement that
needs to be taken into account, not just urinary output..
I have to wonder if the mothers just expressed the first milk that came
out, each time, and then got on with the job of feeding their babies.
~~~~~~~~~~~~~~
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=7424809
Am J Clin Nutr. 1980 Oct;33(10):2151-6. Additions mine - Hilary Related
Articles, Links
The effects of vitamin C, vitamin B6, vitamin B12, folic acid, riboflavin,
and thiamin on the breast milk and maternal status of well-nourished women
at 6 months postpartum.
Thomas MR, Sneed SM, Wei C, Nail PA, Wilson M, Sprinkle EE 3rd.
The effects of vitamin supplements and/or diet on the vitamin levels in
milk of women were determined at 6 months postpartum. Six subjects consumed
a daily supplement (Natalins, Mead-Johnson) in addition to a well-balanced
diet--supplemented group, and six subjects consumed only a well-balanced
diet--nonsupplemented group. The subjects expressed milk for 3 days at 4-hr
intervals, 0, 4, 8, and 12 hr after awakening or taking their vitamin
supplement. (What milk was sampled???) A 4-day diet record, fasting blood
sample, and 24-hr urine samples were collected on each subject at 6 months
postpartum. Nutrient intake from diet alone did not differ significantly
between the two groups except for riboflavin intake which was significantly
higher in the supplemented group. (You'd perhaps not be surprised at an
increase of riboflavin in the foremilk, as its water soluble.) The
nutritional status of all women indicated excellent dietary intakes, which
vitamin supplementation did not alter significantly. Milk concentration of
vitamin B6, vitamin B12, folate, thiamin, riboflavin, and vitamin C, did
not differ significntly between groups. Thiamin, vitamin B12, and vitamin
B6 concentration in the milk did appear to plateau during the day. Vitamin
supplementatin at 6 months postpartum did not affect the breast milk
concentration or the nutritional status of well-nourished women.
PMID: 7424809 [PubMed - indexed for MEDLINE]
There are a lot of variables in this study which have not been elucidated,
so I would have to read it. But also bear in mind that a LOT more is now
known about breastmilk, that in 1980 they simply had NO IDEA about...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Again, this next study also suffers from a similar flaw. When was the milk
sampled? In the fore milk, or the hind milk? given that the foremilk has
stable low to not much concentrations of anything, and given that if it was
a foremilk measurement, it is irrelevant, the whole study is irrelevant.
This may "suggest" a regulatory mechanism, but the operative word is
"suggest".
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=3984919
Am J Clin Nutr. 1985 Apr;41(4):665-71. Related Articles, Links
Effects of different levels of vitamin C intake on the vitamin C
concentration in human milk and the vitamin C intakes of breast-fed infants.
Byerley LO, Kirksey A.
The influence of maternal intake of vitamin C on the vitamin C
concentration in human milk and on the vitamin C intakes of breast-fed
infants has not been demonstrated conclusively. This study examined these
influences of diet and supplementation in 25 lactating women administered
90 mg of ascorbic acid for 1 day followed by 250, 500 or 1000 mg/day for 2
days or unsupplemented for 1 day followed by either 0 or 90 mg ascorbic
acid supplement for 2 days. Vitamin C content in milk and urine was
determined by the 2,4-dinitrophenylhydrazine method. Vitamin C intakes of
infants were calculated from milk volume, as determined by the
test-weighing method and from vitamin C levels in milk samples obtained at
each feeding. Total maternal intakes of vitamin C, which exceeded 1000
mg/day or 10-fold the RDA for lactation (100 mg/day), did not significantly
influence the vitamin C content in milk or the vitamin C intakes of
infants. However, maternal vitamin C intake was positively correlated (r =
0.7) with maternal urinary excretion. These differences in milk and urine
response to vitamin C intake suggest a regulatory mechanism for vitamin C
levels in milk.
Publication Types:
* Clinical Trial
* Controlled Clinical Trial
PMID: 3984919 [PubMed - indexed for MEDLINE]
I notice that in Professor Ruth A Lawrence's latest text book on
breastfeeding, she quotes this study which also showed that 6% of well
nourished healthy mothers had low levels of vitamin C, and that in
malnourished women, tissue stores may take time to replenish, which
explained why 35 mg per day failed to increase low plasma levels.
This highlights the fact that the supposed words "healthy" are a misnomer.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=6496385
Am J Clin Nutr. 1984 Nov;40(5):1050-6. Related Articles, Links
Vitamin C nutrition during prolonged lactation: optimal in infants while
marginal in some mothers.
Salmenpera L.
Prolonged breast-feeding is practiced by mothers in the hope of improving
their infants' health and preventing diseases. In this study of the
nutritional adequacy of breast-feeding, 200 mothers with healthy, full term
newborns were encouraged to breast-feed exclusively. At age 6 months 116
infants and at age 9 months 36 infants remained exclusively breast-fed. The
control infants were weaned early and they received vitamin C through a
supplemented milk formula and solid food. The exclusively breast-fed
infants were able to maintain their plasma vitamin C concentration at the
same or a higher concentration than the vitamin C-supplemented controls.
Their plasma concentration was about 2-fold compared with the maternal
concentration. It was relatively independent of maternal nutrition and of
vitamin C concentration in milk. The mother's intake of vitamin C
influenced their plasma and milk concentrations. About 6% of the mothers
had subnormal plasma concentrations without symptoms. The lowest
concentrations occurred 2 months postpartum and during the spring. Thus,
exclusively breast-fed infants are well protected against vitamin C
deficiency, but marginal intake in lactating mothers is more common than
assumed for a well-nourished population.
PMID: 6496385 [PubMed - indexed for MEDLINE]
I think her textbook is a good base line for all mothers to read and
understand...
This study above though, is not proof, given that in 1985, breastfeeding
experts appeared not to understand that much about breastmilk, or its
functions.
for example, if you study the work of Caterina Svanborg, you will instantly
see why the measurement of vitamin C in "breastmilk" is a whole lot more
complicated than this paper below alludes.
A better method of study would have been to compare the babies urinary
output both before and after the study, as per Professor Clemetson's
textbooks.
Again, this study, which suggestive, suffers from patently obvious flaws to
anyone who knows anything about the composition of breastmilk.
We are assuming too, that the audience is all so-called healthy mothers.
This study done in Bagdad between 1998 - 2000 isn't that irrelevant. Given
some of the diets walking around New Zealand, I would say this would apply
here, as well as in America:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=12362586
Food Nutr Bull. 2002 Sep;23(3):244-7. Related Articles, Links
Effect of maternal dietary vitamin C intake on the level of vitamin C in
breastmilk among nursing mothers in Baghdad, Iraq.
Tawfeek HI, Muhyaddin OM, al-Sanwi HI, al-Baety N.
College of Medicine and Public Health Technology, Bab-Al Mudam, Baghdad, Iraq.
The vitamin C content of breastmilk was investigated in a group of nursing
mothers attending maternal and child health centers in Baghdad during
1998-2000. Two hundred healthy, nonsmoking, 28- to 38-year-old lactating
women were studied. Individual samples of breastmilk were obtained for
estimation of vitamin C. Dietary data were collected by using 24-hour food
recalls. The mean intake of vitamin C was far below the Food and
Agriculture Organization/World Health Organization requirement of 26 +/-
2.13 (SD) mg/day). The vitamin C content of breastmilk was significantly
correlated with the maternal intake of vitamin C (r = 0.61, p < .01). The
vitamin C content of breastmilk varied with the season. The level was much
higher in summer (3.9 +/- 1.05 mg/100 ml) than in winter (3.02 +/- 2.01
mg/100 ml; p < .05). This fluctuation indicates the dependence of
breastmilk vitamin C on dietary intake. The results show the need to
increase the consumption of vegetables and fruits and to monitor maternal
ascorbic acid intake.
PMID: 12362586 [PubMed - indexed for MEDLINE]
Though I still think they should be monitorring the babies output etc as
well...
But the issue of how to sample is the key one. And this has only recently
been addressed here:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=12470492
J Toxicol Environ Health A. 2002 Nov 22;65(22):1881-91. Related Articles,
Links
Click here to read
Guidelines for collection of human milk samples for monitoring and research
of environmental chemicals.
Lovelady CA, Dewey KG, Picciano MF, Dermer A; Technical Workshop on Human
Milk Surveillance and Research on Environmental Chemicals in the United
States.
Department of Nutrition, University of North Carolina at Greensboro, 27410,
USA. Cheryl_lovelady@uncg.edu
This article addresses sample collection protocols for monitoring and
research of environmental chemicals in human milk. The process of milk
synthesis and secretion and variations in contents of constituents that may
impact measurement of environmental chemicals are presented. Possible
sources of variation include parity, stage of lactation, method of
sampling, maternal nutritional status, and dietary intake. General
principles regarding how and when to collect milk samples are provided. For
any previously unstudied environmental chemical in milk, all sources of
variance must be assessed before a meaningful sampling protocol can be
devised.
Publication Types:
* Review
* Review, Tutorial
PMID: 12470492 [PubMed - indexed for MEDLINE]
And hopefully a better understanding of WHERE to find nutrients in the milk
samples, will enable more valid research to be done.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=3984919
Am J Clin Nutr. 1985 Apr;41(4):665-71. Related Articles, Links
Effects of different levels of vitamin C intake on the vitamin C
concentration in human milk and the vitamin C intakes of breast-fed infants.
Byerley LO, Kirksey A.
The influence of maternal intake of vitamin C on the vitamin C
concentration in human milk and on the vitamin C intakes of breast-fed
infants has not been demonstrated conclusively. This study examined these
influences of diet and supplementation in 25 lactating women administered
90 mg of ascorbic acid for 1 day followed by 250, 500 or 1000 mg/day for 2
days or unsupplemented for 1 day followed by either 0 or 90 mg ascorbic
acid supplement for 2 days. Vitamin C content in milk and urine was
determined by the 2,4-dinitrophenylhydrazine method. Vitamin C intakes of
infants were calculated from milk volume, as determined by the
test-weighing method and from vitamin C levels in milk samples obtained at
each feeding. Total maternal intakes of vitamin C, which exceeded 1000
mg/day or 10-fold the RDA for lactation (100 mg/day), did not significantly
influence the vitamin C content in milk or the vitamin C intakes of
infants. However, maternal vitamin C intake was positively correlated (r =
0.7) with maternal urinary excretion. These differences in milk and urine
response to vitamin C intake suggest a regulatory mechanism for vitamin C
levels in milk.
Publication Types:
* Clinical Trial
* Controlled Clinical Trial
PMID: 3984919 [PubMed - indexed for MEDLINE]
why did they not check urinary output for the babies too? Mind you,
Clemetson's texts were not yet published, so I guess they have an excuse
there...
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I have not read his book, but I have read this:
at least he admits here his LACK OF KNOWLEDGE:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=12771353
J Nutr. 2003 Jun;133(6):1997S-2002S. Related Articles, Links
Click here to read
Pregnancy and lactation: physiological adjustments, nutritional
requirements and the role of dietary supplements.
Picciano MF.
Office of Dietary Supplements, National Institutes of Health, Bethesda, MD
20892, USA. PiccianM@OD.NIH.GOV
Nutritional needs are increased during pregnancy and lactation for support
of fetal and infant growth and development along with alterations in
maternal tissues and metabolism. Total nutrient needs are not necessarily
the sum of those accumulated in maternal tissues, products of pregnancy and
lactation and those attributable to the maintenance of nonreproducing
women. Maternal metabolism is adjusted through the elaboration of hormones
that serve as mediators, redirecting nutrients to highly specialized
maternal tissues specific to reproduction (i.e., placenta and mammary
gland). It is most unlikely that the heightened nutrient needs for
successful reproduction can always be met from the maternal diet.
Requirements for energy-yielding macronutrients increase modestly compared
with several micronutrients that are unevenly distributed among foods.
Altered nutrient utilization and mobilization of reserves often offset
enhanced needs but sometimes nutrient deficiencies are precipitated by
reproduction. There are only limited data from well-controlled intervention
studies with dietary supplements and with few exceptions (iron during
pregnancy and folate during the periconceptional period), the evidence is
not strong that nutrient supplements confer measurable benefit. More
research is needed and in future studies attention must be given to subject
characteristics that may influence ability to meet maternal and infant
demands (genetic and environmental), nutrient-nutrient interactions,
sensitivity and selectivity of measured outcomes and proper use of proxy
measures. Consideration of these factors in future studies of pregnancy and
lactation are necessary to provide an understanding of the links among
maternal diet; nutritional supplementation; and fetal, infant and maternal
health.
Publication Types:
* Review
* Review, Tutorial
PMID: 12771353 [PubMed - indexed for MEDLINE]
The underlined bits are in my opinion, an unresolved issue.
I am neither satisfied with the collection procedures, or testing protocols
as of right now, and feel that they are using the wrong outcomes. They
should be testing the babies, and also figuring out nutrient-nutrient
outcomes, because if you just take vitamin C, the whole interactions basis
is also dependant on E, Zinc, and A.
Vitamin C cannot be assessed in the absense of the others.
We know this with animals, but it seems to be forgotten with babies.
So this would also be relevant here:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=11786649
Ann Nutr Metab. 2001;45(6):265-72. Related Articles, Links
Click here to read
Fat-soluble vitamins in the maternal diet, influence of cod liver oil
supplementation and impact of the maternal diet on human milk composition.
Olafsdottir AS, Wagner KH, Thorsdottir I, Elmadfa I.
Unit for Nutrition Research, Landspitali-University Hospital, University of
Iceland, IS-101 Reykjavik, Iceland.
BACKGROUND/AIMS: To investigate lactating mothers' intake of fat-soluble
vitamins in free-living subjects and to what extent cod liver oil
supplementation influences the maternal intake in a population with common
intake of cod liver oil. The impact of maternal diet on the concentration
of fat-soluble vitamins in human milk was studied. METHODS: Dietary intake
of 77 lactating women was investigated by 24-hour diet recalls and
breast-milk samples were taken at the same occasions. Breast milk samples
were analyzed for fat-soluble vitamins. RESULTS: The median intakes were
927 microg/day for vitamin A, 5.5 mg/day for vitamin E and 3.3 microg/day
for vitamin D. Maternal vitamin A, E and D intakes were higher when the
diet was supplemented with cod liver oil. Icelandic breast milk was found
to have high contents of vitamin A and E. Only vitamin D was too low in
breast milk to meet the recommended intake for infants. Retinylpalmitate in
relation to lipids correlated with maternal vitamin A intake (r = 0.23, p <
0.05). The group with cod liver oil supplementation had significantly lower
levels of gamma-tocopherol in breast milk (p < 0.01), whereas the
supplementation did not affect other fat-soluble vitamins. CONCLUSION: The
recommended intake of fat-soluble vitamins for lactating women can more
easily be met with a cod liver oil supplementation than diet alone. Only
vitamin D in human milk cannot meet the recommended intakes for infants,
with normal breastfeeding. There is a relationship between the content of
vitamins A and E in human milk and the maternal diet. Copyright 2001 S.
Karger AG, Basel
PMID: 11786649 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=12396161
J Am Diet Assoc. 2002 Oct;102(10):1433-8. Related Articles, Links
Vitamin B-6 content of breast milk and neonatal behavioral functioning.
Ooylan LM, Hart S, Porter KB, Driskell JA.
Department of Education, Nutrition, Restaurant and Hotel Management, Texas
Tech University, Lubbock 79409, USA.
mboylan@hs.ttu.edu
OBJECTIVE: To determine if vitamin B-6 intakes of mothers influence the B-6
vitamer content of transition milk and if correlations exist between the
vitamin B-6 content of the milk and the infants' neurobehavioral
functioning. DESIGN: Transition milk samples were collected from mothers 8
to 11 days after delivery for B-6 vitamer analysis. Neurobehavioral
functioning of the neonates was determined at that time. A 24-hour recall
was used in estimating vitamin B-6 intakes of the mothers. SUBJECTS: A
convenience sample of low-income, lactating women (n = 25) who had normal
pregnancies. MAIN OUTCOME MEASURES: B-6 vitamers were measured in the
mothers' transition milk samples. Neurobehavioral functioning was assessed
using the Brazelton Neonatal Behavioral Assessment Scale (NBAS), and the
Center for Epidemiologic Studies Depression Scale was used to evaluate
maternal depression. STATISTICAL ANALYSES PERFORMED: Pearson correlation
coefficients were used to assess if statistically significant relationships
existed between variables. The Mann-Whitney test was used to determine if
median group values were significantly different. RESULTS: The major B-6
vitamer in transition milk was pyridoxal. Mothers with vitamin B-6 intake
greater than the median value had a significantly higher median pyridoxal
level in their breast milk than did the mothers with intakes below the
median value. All except one mother had a dietary vitamin B-6 intake that
exceeded the Recommended Dietary Allowance. Infant scores on habituation (r
= .94, P < .05) and autonomic stability (r = .34, P < .05) subscales of the
NBAS were positively correlated with milk pyridoxal values.
APPLICATIONS/CONCLUSIONS: Vitamin B-6 is important for normal behavioral
functioning of infants. The mothers' vitamin B-6 intake affects vitamin B-6
levels of breast milk and the need for consuming recommended levels of
vitamin B-6 should be emphasized to all pregnant and lactating mothers.
PMID: 12396161 [PubMed - indexed for MEDLINE]
This also forms a crucial aspect, since uptake of vitamin C is dependant on
folic acid, is dependant on other B's is dependant on some minerals, and is
potentiated by Vitamin A as well.
So even if a baby was getting enough Vitamin C, if it was NOT getting
enough of other nutrients it would not be able to fully utilise what
vitamin C it does get.
We like to think that we live in a healthy society. I guess all mothers of
children who become vaccine damaged after vaccines, or get autism, or other
disntegrative disorders would like to think that their children are healthy.
I think the evidence in front of our eyes today, proves that children today
are not healthy, and many babies who suffer after vaccines, patently did
not have enough vital nutrients either in their formula, in their
breastmilk, or in their diet.
If everything was hunky dory, we wouldn't have the huge problems we are
starting to see now. These babies can only use what they are being fed.
Patently, they are not being feed enough of the right things.
so it would help if key issues could be resolved by accurate science.
Starting with accurate sampling of milk, and looking at nutrient/nutrient
interaction, and baby "output" and utilisation.
Just to measure what goes in, and assume that is adequate, isn't enough.
The regulatory mechanism needs to be properly researched and there needs to
be a lot more work done on why this mechanism is only selective as well..
Anyway, this is more than enough..it is so complicated you could write
several books.