This is a 4-topic series focused on nutrition for babies and toddlers with eczema. I’m passionate about nutrition and believe that it’s of utmost importance to our health – after all, it’s one of the daily survival activities of breathe, drink, eat and sleep! I’m honored to have Judy Converse, founder of Nutrition Care for Children LLC, to help out in this series. Judy is a licensed nutritionist, a registered dietitian for more than 20 years and authored the first web-interface accredited learning module for health care providers on nutrition and autism.
More on Judy Converse, MPH RD LD – Judy has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She authored 3 books including Special Needs Kids Go Pharm-Free and Special Needs Kids Eat Right: Strategies to Help Kids on the Autism Spectrum Focus, Learn and Thrive. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Judy is available for nutrition consultation at http://www.NutritionCare.net
Breastfeeding – Impact on Eczema and What’s in the Breast Milk?
Last week, Judy has kindly offered her insights into formula milk and today, we’re tackling breastfeeding. No worry for moms who don’t breastfeed or partially rely on formula milk for your infant’s diet: I’m one of those moms so won’t be making you feel guilty, not that it’s something to be guilty of!
MarcieMom: Judy, thank you for joining me today! Now, on breastfeeding’s impact on eczema, it appears to be still a controversial conclusion if it helps prevent eczema (I did a quick online search, and here, here and here already present varying conclusions). Are you aware of any definitive study on whether breastfeeding (i) prevents eczema and (ii) lessens the severity of eczema?
Judy: Okay, this gets technical, so bear with me. One of the papers you’ve mentioned comes from a collaboration with the International Study of Asthma and Allergies in Childhood (ISAAC), which is an ongoing survey across several countries for inflammatory conditions in children. Given the large numbers in the study, the finding of “lack of benefit” from breastfeeding was puzzling. It also puzzled me that other papers from ISAAC have been equally muddled on benefits of breastfeeding relative to asthma.
Sounds impressive – a “study” with over 50,000 subjects? But this was a weakened tool in many ways: It is a survey, not a study; it is retrospective, not prospective; it is uncontrolled (no control subjects to compare who had only formula); it is based on voluntary parent reporting, which may be faulty or biased some of the time; and I did not see that there was a comparison of exclusively breast fed to exclusively formula fed children. It appears that the survey may only have looked at degrees of breastfeeding relative to eczema. How can we measure the impact of a variable (breastfeeding), if nearly all of those surveyed got some of it? You need an exclusively formula fed population as a control to really find the answer.
Also, the abstract doesn’t allow us to see detail for methodology. It mentions that over 50,000 children with asthma and allergies were evaluated somehow, but doesn’t say much about the breastfeeding survey, methodology or numbers, or introducing solids, which is another big factor. It says that the benefit of breastfeeding that was noted disappeared after age four months – which is when many babies are first given some solid foods. The authors state that benefit of breastfeeding for eczema disappeared at that point. There is no mention of introduction of solids here – was this observed in any way?
I think it is over-simple to state that benefits cease at this point. If the survey only looks for “ever” breastfed and “any eczema ever”, it is weakly designed and can’t give very clear information. It also takes a somewhat trivializing tone on the finding that breastfeeding lessened “sleep disturbed” eczema, which is a significant benefit for weary families and babies struggling against inflammation. Having your baby wake in pain or bleed from scratching is pretty unpleasant.
To make this survey powerful, the authors would have needed a control group of over 100,000 matched children (8-12 year olds with asthma or allergy) who were exclusively formula fed ever, that is, never breast fed at all.
When I see information gathered in this way, I am skeptical – Why go to such lengths to collect or evaluate data in a weak fashion? Surveys are useful to point researchers toward next questions. But I think this survey almost does a disservice, by casting doubt on benefits of breastfeeding for eczema, without careful controls. Even with the design flaws in this survey, the authors still found a small benefit to breastfeeding. Breastfeeding is so important for so many reasons.
A further dilemma here, the elephant in the room, is the influence of vaccination, which strongly correlates with more allergy, asthma, and eczema (the authors of that study inexplicably attribute this effect to doctor visit frequency). Earlier vaccination correlates strongly with asthma, another inflammatory condition. There is meanwhile a compelling ongoing survey that shows less allergy, eczema and asthma in unvaccinated children (and better health over all). This too is limited by voluntary parent reporting, no true controls – but the difference in the two groups is so dramatic that a true trend appears to exist. It certainly needs closer study. A prospective study comparing exclusively breast fed babies to exclusively formula fed babies, vaccinated and/or not, would be fabulous. We need robust prospective design to really answer these questions. But there is considerable opposition to work in those areas.
All that said, there are still other studies that show weak or little impact on eczema for breastfed babies. We may simply be looking at the wrong parts of the puzzle, or looking at it in too narrow a way. For example: A baby’s gut biome may be quite predictive of who gets inflammatory conditions like allergies, eczema, and asthma. This well controlled and blinded study found a dramatic reduction in likelihood of eczema for babies who were breastfed by moms supplemented with probiotics. And, breast milk supports a different, healthier gut biome than formula. Bifido species bacteria appear so far to be more useful at lessening eczema for infants than Lactobacillus species, which may play more of a role as the baby grows toward childhood.
MarcieMom: Thank you Judy, your explanation reminds us not to be too quick to jump into certain course of action, after a news release of study. And certainly, probiotics looks promising for improvement of eczema. Eager to check back next week to understand more on breast milk.