Breastfeeding and its Benefits

by Veronique Murphy

Breast milk – more than just perfectly balanced nutrition for infants; breastfeeding is a source of bonding, security, immunity and comfort. While a cornerstone of optimal growth and development, breastfeeding can also be psychologically and physically challenging. Breastfeeding is not just the job of mothers: supporting breastfeeding is a vital responsibility of our communities, policy-makers and nations.

It is recommended by the World Health Organization (WHO) that infants be exclusively breastfed for the first six months of life. This means that no other liquids or foods are given, except breast milk. From six to 24 months of age, breast milk can be complemented with nutrient dense foods, providing children with the best possible chance to thrive.

According to the WHO, breastfed children are less likely to be overweight, obese or to develop type two diabetes later in life, and perform better in intelligence tests.  Breastfeeding passes on antibodies that help to protect infants from diarrhoea and pneumonia, common causes of global child mortality.

Since November 2009, the WHO also advocates that HIV-positive mothers, where the mother or the infant is taking anti-retroviral medications, breastfeed their babies to 12 months. This means that babies can benefit from breast milk with little risk of becoming infected by HIV. Please see your health care practitioner for more information.

There are hundreds to thousands of bioactive molecules in breast milk that help to protect babies from infection, inflammation, promote immune system maturation, organ development and healthy microbial colonization. Breastfeeding also helps mothers – it has been linked to a reduced risk of breast and ovarian cancer, T2DM, and postpartum depression. And it’s very convenient!

Unfortunately, the age of weaning has fallen. Globally, less than 40% of infants six months and under are exclusively breastfed.  The 2016 South African Demographic and Health Survey reports that 32% of infants are exclusively breastfed for the first 6 months of life; a significant improvement from previous years that reported rates as low as 16%.

Malnutrition remains a major contributing factor to high South African child mortality and morbidity, with only 23% of toddlers aged 6-23 months being fed an adequate diet – not only nutrient poor but at times of questionable safety.

Breast milk is dynamic – its composition changes through the day, and over time. The first milk (right after birth) is colostrum; it’s thick and yellow and is rich in immunological and growth factors. The mature milk contains protein, fat and lactose.

The hind milk (the last milk of the feed) can contain 2-3 times as much fat as the foremilk, helping to satiate the baby. The mother’s diet can influence the fatty acid profile, particularly in relation to long chain polyunsaturated fatty acids – when the mother eats more omega-3 or omega-6, this tends to be reflected in the milk. The vitamin levels of milk also tend to be influenced by the mother’s nutritional status.

Exclusively breast fed babies are in ketosis; this is a normal, natural metabolic state for infants. Ketones are used by the brain to synthesize the cholesterol and fatty acids needed to build the membranes of developing nerve cells. At birth, the baby’s brain weighs about 20% its adult weight – but by two years of age, the brain has grown to 80% its adult weight – a lot of work in done over these first 24 months! Ketone uptake in the babies’ brain is up to 5 times faster than the adult brain.

Optimal nutrition in these first 24 months is therefore critical, and nutrient density for both the mother and the baby must be a priority. It’s essential to focus on foods that will assist the brain to develop. Examples of such nutrient dense foods include eggs, meats, organs, brains, viscera and marrow.  These kinds of foods contain essential nutrients for humans – that is, we need to attain from the diet in order to survive.

Such foods are so important for brain development – and they naturally contain fats (including omega-3, implicated in breast milk’s beneficial effects on intelligence), vitamins (including A, B1, niacin, B6, folate and vitamin K), iron, iodine, copper, zinc and selenium. Such foods are in accordance with the proposed South African Food Based Dietary Guidelines which recommends that complementary foods after six months of age include meat, chicken, fish, or egg every day, or as often as possible.  

Unfortunately, many of the common foods given to babies are very high in carbohydrate which contains no essential nutrients required for human survival. There is also increasing evidence that gluten containing grains (including wheat, barley and rye) can cause a range of health problems including the leaky gut syndrome, which has been implicated in the development of a variety of autoimmune diseases. Sugar sweetened beverages, juices, and excess fruit should also be avoided – these offer little or no nutrients compared to animal products, natural fats, and dark green, leafy vegetables (like kale).

A brief nutritional analysis of some common infant cereals available in South Africa reveals that per serving, infant cereals can have as much as 36g of carbohydrate, 6-16g of sugar; of which 4-6g can be sucrose. These levels of carbohydrate and sugar have the potential to raise blood glucose and insulin concentrations, ultimately contributing to obesity and T2DM. And while these cereals do often have added vitamins, minerals and fats – these are all available in their natural form to babies via a nutrient dense complementary feeding after six months of age.

When babies are weaned onto animal products rather than cereals, they grow without increasing in adiposity and they have a higher rate of head circumference growth (to hold in those big brains!), Babies are perfectly adapted to eating low-carbohydrate diets, which will provide them with nutrient dense, satiating foods, maintain their insulin sensitivity, and reduce their likelihood of developing chronic disease.

Every mother breast feeding their baby and navigating complementary foods for their young children faces huge social, economic, and physical challenges. When should I return to work? Is my baby growing enough? Can I breastfeed, even when I’m not at home? Every mother deserves to take the time today to congratulate herself and to be congratulated for her efforts.

If you or someone you know is having trouble breastfeeding, The Noakes Foundation encourages you to seek support and talk about your concerns with someone you trust. The South African community as a whole benefits from intelligent, healthy and thriving breastfed children – and so the South African community as a whole must support breastfeeding mothers.

At The Noakes Foundation we believe that the very best science should inform our nutrition choices and that as communities, we should be enabled to provide nutrient dense food to our families – including breastfeeding exclusively for six months, and then for as long as possible, preferably two years. Nutrient density must be a priority when introducing complementary foods.  We applaud every mother and every father working towards the brightest possible future for their children.

For more detailed information, please see Real Meal Revolution: Raising Superheroes by Prof Tim Noakes, Jonno Proudfoot and Bridget Surtees.

Veronique is a nurse from Melbourne, Australia, and is busy completing her studies in International Development. She is currently interning at the Foundation and is working on various important projects, proving to be an invaluable member of the team.

References:

1. World Health Organization 2010. “Bulletin of the World Health Organization: Breast if always best, even for HIV-positive mothers,” 88(1). http://www.who.int/bulletin/volumes/88/1/10-030110/en/

2. O Ballard and A Morrow. “Human Milk Composition: Nutrients and Bioactive Factors,” Pediatric Clinics of North America, 60(1): 49-74

3. South African Department of Health. South Africa Demographic and Health Survey 2016: Key Indicators Report http://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00-092016.pdf

4. UNICEF South Africa 2010. “Nutrition.” https://www.unicef.org/southafrica/survival_devlop_755.htm

5. South African Department of Health. South Africa Demographic and Health Survey 2016: Key Indicators Report

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8. CR Gale, et al. “Critical periods of brain growth and cognitive function in children,’ Brain; 2004, 127(2): 321-329

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10. M Tang and NF Krebs. “High protein intake from meat as complimentary food increases growth but not adiposity in breastfed infants: a randomized trail,” The American Journal of Clinical Nutrition; 2014; 100(5): 1322-1328