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Episode 30: The Magic of Breastmilk

Episode 30: The Magic of Breastmilk

Would you buy a food or supplement that promised to do all of this daily

  • Develop antibodies against pathogens you’d been exposed to
  • Change based on the weather 
  • Alter itself to support your current level of wellness 
  • Provide all of the macro and micronutrients you need to survive and thrive
  • Bolster your immune system - for life
  • Support your microbiome and feed beneficial strains

Eating such a food would be a no brainer, and in fact, it would be heralded as the key to health. It would be celebrated on every magazine cover and likely cost an arm and a leg.   

Now, what if we told you that this magic food IS available and the best part is: it’s produced for free. Of course, we’re talking about breastmilk, the foundation of the infant diet and an all around rockstar when it comes to packing a nutritional punch.   

But it wasn’t always this way. For decades, mothers were told that formula was a superior choice to breastmilk, both nutritionally and for matters of convenience. Now we know, however, that breastmilk is one of the first building blocks of a healthy microbiome and has wide-ranging implications for the adult immune system.   

Joining Andrea on the show to discuss breastfeeding and human milk is Dr. Ann Witt, a board certified family physician, Fellow of the Academy of Breastfeeding Medicine and an international board certified lactation consultant.  

On this show, Dr. Witt talks about how breastmilk shapes the infant microbiome and sets the stage for future gut health. She also dives into how and why breastmilk changes based on the outside world, including whether it’s pumped or frozen, and why it’s so difficult to replicate breastmilk in formula. Dr. Witt also offers tips and resources to make the journey easier for mothers struggling with breastfeeding.   

If you’ve ever shrugged off breastfeeding as an optional choice or questioned the necessity of breastmilk, you absolutely cannot miss this episode.   

To find more breastfeeding resources and connect with Dr. Witt, head to www.bfmedneo.com  

 

 

On this show, you’ll learn: 

  • Why breastmilk is such a miraculous substance and why breastfeeding is so important (2:32)
  • Breastmilk versus formula (4:23)
  • The different factors that make up breast milk (5:35)
  • How breastmilk constantly changes (6:30)
  • Ratios of fat and macro nutrients (7:29)
  • How a baby’s microbiome evolves (8:51)
  • Why the difficulty in creating an infant formula that stands up to breastmilk (10:50)
  • Certain foods that can influence the quality of the breast milk (15:17)
  • Changes when it comes to pumped, refrigerated and frozen breast milk (17:42)
  • Creation of antibodies in the breastmilk (18:58)
  • Moms who are having a tough time, or choose not to breastfeed (22:12)
  • Length of time and age recommendations for breastfeeding (25:25)
  • Available resources for those looking for help (28:21)

 

Transcript:

Andrea Wien: Welcome to The Microbiome Report powered by Total Gut Balance, a new book on the mycobiome, the missing piece of gut health, by our resident researcher, Dr. Ghannoum. I'm your host, Andrea Wien, and today I'm talking with Dr. Ann Witt. Dr. Witt is a board-certified family physician, Fellow of the Academy of Breastfeeding Medicine, and an international board-certified lactation consultant. She has also conducted clinical research on a variety of lactation topics, including postpartum lactation support, engorgement, and therapeutic breast massage.

                        Today, we're talking all about the magic of breast milk. This episode has been on the top of my wish list to record for the past few months following the birth of my son. So, I am so excited Dr. Witt was able to join me and share her knowledge.

                        We talk about how breast milk impacts the development of the infant microbiome, and how it changes in relation to our child's age and environment. Seriously, this stuff is so wild. And we also talk about why it's so difficult to replicate what's going on in breast milk in formula. This episode really puts it into perspective how amazing the human body is. So, I hope you'll enjoy listening to it as much as I enjoyed recording it.

                        Dr. Witt, thank you so much for joining us.

Dr. Ann Witt: Thank you for having me.

Andrea Wien: I am so excited to do this episode. It's been in my mind for quite some time. And, as you know, I have a four-month-old son at home, and he is exclusively breastfed. Just watching his development, and coming from this little eight-pound person into almost 17-pound person now, all from breast milk and something that my body is making, has been just miraculous. And so it's definitely close to home for me, and I'm so excited to have you here.

Dr. Ann Witt: It is truly amazing. It's one of the neat things about breastfeeding, when you think of kind of just a healthy lifestyle. It's our first unprocessed whole food and it's the first food that nourishes us. And it's really the only time in our life that one substance can provide all the nutrients that the body needs.

Andrea Wien: Yeah.

Dr. Ann Witt: It is truly amazing to watch how a little baby can grow, double their birth weight just on the breast milk.

Andrea Wien: It is. It's really wild. By my thirst levels, I can certainly tell that the fluid is leaving.

Dr. Ann Witt: Uh-huh (affirmative).

Andrea Wien: Let's kind of lay the foundation here and the groundwork for what we're going to be talking about. Why is breast milk such a miraculous substance? And why is breastfeeding so important in your opinion?

Dr. Ann Witt: Yeah, so I think it does…One of the things that is so important, so amazing about it, is how it applies so much in just this one substance. And it is all unprocessed and it's geared towards our species specifically.

Dr. Ann Witt: I think one of the things that's really unique or amazing about it is it has the nutrients, it has the fat, the protein, the carbohydrates, everything that we need, but at that same time those same nutrients are providing a lot of immune function, immune teaching, and that's where the microbiome comes in. It is creating a healthy microbiome for the baby. And that gets seen in how we respond to infection, how we respond to allergens, and how the baby's whole immune system develops.

                        In kind of global or epidemiological way, you can look at how breastfeeding decreases the risks of various infections or chronic diseases. For example, it lowers a baby's risk of getting diarrhea or an upper respiratory infections. And it's also been found to lower autoimmune diseases like diabetes, and even sudden infant death syndrome. And a lot of that has to do because of how it's influencing the immune system.

Andrea Wien: When we talk about foods on here, often on this show, we talk about probiotic foods. So, kombucha, kimchi, sauerkraut. These are foods that are alive, right?

Dr. Ann Witt: Yes.

Andrea Wien: These are foods that have these good bacteria. They're pulled in from our environment. But breast milk is really the first food that humans are introduced to, and it's alive.

Dr. Ann Witt: Yes.

Andrea Wien: So, talk about the difference between what makes up breast milk, why we have those alive constituents in it, versus something like a formula which would be more of like a processed sauerkraut, let's say. Those ones that you see in the bag that maybe you had at grandma's house when you were a kid.

Dr. Ann Witt: Right, right. Yeah. The neat thing about breast milk is it has both probiotics and prebiotics in it. So, from the mother's milk you have the probiotics, the lactobacillus, this nice, good, healthy bacteria. And then the prebiotics, in particular these human milk oligosaccharides are what we call, those are the main sugars in the breast milk. And they provide the prebiotics to grow the good, healthy bifidobacteria, which is the main bacteria that you see in breastfed infants because they are growing on these HMO's, these human milk oligosaccharides. So, it's that combination of the prebiotic and probiotic that makes it really special.

                        In addition, it does have a lot of other live immune cells that are being passed on from the moms, such as what we call immunoglobulin secretory A. It's an antibody that's passed on from the mom that gives a lot of immune antibody production. But it's a live cell that is modified by based on what's going on with the mom's immune system at the time.

Andrea Wien: Now, I've heard that there are around 800 different factors that make up breast milk. Is that an exaggerated number? Are we still learning really what it all is?

Dr. Ann Witt: I think we're still learning everything in breast milk. But to put it in context. So, we'll probably come back a lot to these human milk oligosaccharides, that they're the main sugar in the breast milk. But that component alone, there are a hundred different types potentially in the breast milk. Not in necessarily each individual mother's breast milk. Each mom has a different combination of the oligosaccharides. But that component alone has a potential of a hundred different types.

Andrea Wien: And are those changing? Because when we talk about…That's the other thing that I think is so interesting about breast milk is that it literally changes as your baby ages, whether you're introduced you know, the environment outside, whether you have a germ that you're introduced to. Like even myself breastfeeding, I can tell different colors of breast milk. The other day I put some in a bag to send to grandma's house, and they were completely different colors. That's so interesting. So, are those sugars? Is that what we're seeing change?

Dr. Ann Witt: It can be a lot of different things. I mean, it's the sugars, it's the fat, it's the proteins, it's the vitamins. Probably the main thing that changes the most relative to our diet is going to be fats. If you have omega-3 or omega-6 fatty acids, those are kind of reflected in different levels in your breast milk.

                       Protein level changes, not as much based on what we're eating, but if you look at the colostrum, which is that early milk, that is mostly immune cells, antibodies, and high protein content. And then the protein content relatively decreases a little bit on its own over the next four to six weeks. And then as the baby gets older and more mature, you're going to start to see higher fat content. And even there's a recent study that came out when breastfeeding over a year, that there's a higher relative fat content usually in the milk for toddlers.

Andrea Wien: Okay. So, when we're talking about ratios of fat, the macronutrients, do we have general or is it really different for every woman?

Dr. Ann Witt: It is different for every woman. I think probably the macronutrients that changes the most within women is fat content. There's not as much of a variability in protein in terms of the level of the macronutrient. At the sugar level, like with the oligosaccharides and stuff, there's a big variation between moms in terms of what types of combinations of those human milk oligosaccharides you have.

Andrea Wien: Do we have a theory on why the fat content is so variable?

Dr. Ann Witt: I don't know if there's a theory on it, it's more just an observation on it. And partially, it is dependent on your intake, and the types of fats that you're having.

Andrea Wien: Okay.

Dr. Ann Witt: I think there's also a different needs at different times. I can theorize, as a toddler, they're not eating as much volume, they are very active, they'd need a higher calorie content. The colostrum level you're going to theorize that that's going to be more immune components. The baby's immune system is younger and they don't need as much volume, and what they need is more immune protection.

Andrea Wien: Okay, I want to jump back. We mentioned that a lot of the constituents of breast milk are feeding the bacteria, some of the bifidobacterias and things like that. Are these things that infants are born with? Are they picking it up through the birth canal? Are they picking it up on mom's skin? Where are they getting these bacteria to begin with?

Dr. Ann Witt: Yeah. So, the baby's microbiome evolves over time. There is some bacteria that probably come through the amniotic fluid, and then mom's microbiome through birth. Her actually own individual microbiome changes while she is pregnant. And interestingly, it becomes a little... For us, as adults, we'd call it a little dysbiotic and that it lends itself to a little bit more weight gain and insulin resistance. But that's intentional in pregnancy because that's a good thing for us to be retaining a little weight and energy and stuff. And then at the end of pregnancy, the hormone progesterone relativity drops, and that changes the microbiome to support more of that bifidobacteria growth.

                        So, part of the infant's microbiome is dependent on where the mom's microbiome was during pregnancy. And then another big part of it comes through delivery, through the vaginal or a C-section, and then another factor would be breastfeeding. Those are kind of the three main factors that are affecting the development of the infant's microbiome.

Andrea Wien: Now in your own practice, could you tell based on a child's, let's say, five-year health history of the chances of maybe that they were breastfed versus formula fed? Is that something that you can really see in anecdotal?

Dr. Ann Witt: No, I don't think so anecdotally. I think we can look at on a global level people's health levels and the lower incidents of infectious diseases and chronic disease, but there's so many things that factor in there. I don't think you can objectively just look at one kid and their health and say, "Oh, this kid was formula or breastfed."

Andrea Wien: Sure. And why do we feel... I mean, obviously this ... We're talking about, it's so alive, it's so based on all these different factors. It's hard to talk about the formula versus breastfed thing without really getting into some of the politics of the discussion, but...

Dr. Ann Witt: Yeah.

Andrea Wien: …why do we feel like it's so hard to create a product that stands up pretty close?

Dr. Ann Witt: I think there's just too much individualization within breast milk, depending on the baby's genetics and the mom's genetics. And there's just so many live factors going on in immune teaching. I mean, I think we can probably make it comparable on a macronutrient level in terms of making sure there's enough protein, fat, and sugars in there. But when you get into the whole level of immune teaching that happens with breastfeeding, that's something that's changing, and it's dynamic. One of the limitations of formula is you kind of have to make a somewhat standard fits all, at least within that individual formula product. And so there can't be any of that adaption to one kid's individual needs or another's environment.

Andrea Wien: For moms maybe who can't breastfeed or who choose not to, I have some friends who own their own businesses, they're very busy, they're away from home, they don't choose to breastfeed. Are there things that they can do to fortify the breast milk from this microbiome aspect?

Dr. Ann Witt: Not really. I mean, I think there has to be a recognition that there are a lot of things that affect the infant's microbiome and breast milk isn't the only thing. It certainly sets up a very healthy microbiome. But there's not anything you can do from a formula point of view as an infant when they're just feeding. Obviously, when they start getting in solids and stuff like that, you can be mindful of your foods. But in terms of in that first six months, when you're trying to create that ideal microbiome environment, breast milk is a critical thing, but it's not the only thing. I mean, as you look at the baby's developing microbiome, it's also kind of mom's microbiome in pregnancy, it was the delivery, it's other food factors.

                        And I think when you think about the politics or the pressure that maybe some people feel in terms of breastfeeding, there is a lot of things that balance our needs as a family. And I think ultimately you have to look at that whole balance of things any time you're being a parent. If your stress level is lower, if you make a different choice, or if you're one of those moms that just don't make enough breast milk which does happen, recognizing that we have some nice, safe alternatives that do provide the macronutrient is important and recognizing that. It's certainly important to look at the whole family needs when making those decisions.

Andrea Wien: Yeah. And I want to come back probably closer to the end of our discussion about if moms aren't making enough milk or if they feel like they can't breastfeed, and some tools that you have. But I don't want to get too far off topic right now, so we'll come back to that.

                        One thing I have been thinking about as I've been breastfeeding is I have celiac disease. So my gut, it's a constant work in progress, I should say. I can't never not think about it. I have a propensity to lean towards more of a pathogenic dysbiosis.

Dr. Ann Witt: Okay.

Andrea Wien: And so how does that impact my son? I mean, obviously, I'm passing on big parts of my microbiome to him, but is my breast milk almost buffering that pathogenic?

Dr. Ann Witt: Yes, we can theorize that. I don't know that we have complete proof of that, but yes. Basically, what your breast milk is doing is it is encouraging the growth of bifidobacteria factor, which is overall kind of just a healthy, less immune response trigger healthy biome. There's a lot of things that go on with the microbiome and breast milk that is also triggering cell signaling. So, when bacteria are trying to come in, like, let's say the pathogenic bacteria trying to come in and bind, you have the sugars, the oligosaccharide is lining the whole mucosal of the infant's tract. And that's kind of preventing some of those signals that are more inflammatory. And that's one of the reasons kind of tolerance or like there's lower risk of allergens going on when a baby is breastfed. I think in the instance like with your celiac disease, probably your baby having the breastfeeding to kind of teach them tolerance in that first six months and to say, “Oh, these things are okay for me,” is a critical piece to balance the predisposition that your baby does have to celiac.

Andrea Wien: Yeah. And are there certain foods in general that you see that are influencing the breast milk more positively? You mentioned the fat content, for example. So, doing things like taking cod liver oil or making sure you're eating chia seeds or some type of those like more omega-3 fats.

Dr. Ann Witt: Omega-3s, yeah, I would say the omega-3 three fats would be a good thing. There haven't been a lot of studies in terms of specifically how it affects the microbiome, what you're eating, but what we're eating in terms of like fat content and macronutrient content has been studied. A big component really, the microbiome is kind of the mom's individual human milk, oligosaccharides and that balance of that profile in her breast milk.

Andrea Wien: How much of what we are eating is passed through? For example, I read something the other day that if you drink a cup of coffee, like that caffeine could potentially get into the breast milk within, I think it was an hour, 20 or 30 minutes, something like that. How much of what we're taking in is passing through to baby? Do we know?

Dr. Ann Witt: We know individual things, but not everything. So, maternal diet effects some of the variability is in the micronutrients, like vitamin D, your A and B vitamins. Caffeine is one of the things that does pass through, alcohol passes through and is kind of in this equilibrium with your blood alcohol levels, what is in your breast milk. So, when it's out of your blood, it's out of your breast milk. So it's just, it's variable. It's probably more the vitamins.

Andrea Wien: This episode is brought to you by drmicrobiome.com, the website of our resident scientist, Dr. Dr. Mahmoud Ghannoum and his new book, Total Gut Balance: Fix Your Mycobiome Fast for Complete Digestive Wellness. Dr Ghannoum has spent over 40 years studying our microbial communities, and has now condensed his insights into an entertaining book that dives deep into the fungal colonies in your microbiome. Why candida gets a bad rap and his advice for a diet plan, complete with recipes that's happy for your gut based on years of clinical research. He also lays out a handy test to take, so you can find out where on the health meter your microbiome is at today. And then he gives you recommendations on how to better balance your gut in 24 hours with supplements, lifestyle, and diet.

                        Total Gut Balance: Fix Your Mycobiome Fast for Complete Digestive Wellness is now available for pre-order at Amazon and Barnes & Noble. Just simply search Total Gut Balance book to find it. The book will be shipped and released on December 24th.

                       Going back to the breast milk and it's self-changing, are we seeing changes when it's pumped, refrigerated, frozen, or is it carrying through the same factors no matter what?

Dr. Ann Witt: No, there is difference when it's pumped or frozen. One of the interesting things on kind of a microbiome level is, you know, there are various things that affect the milk microbiome. One is the mom's gut. The other is actually the skin factors and oral, the baby's mouth. So, there's been some studies that had shown that when you're getting breast milk from breastfeeding, that it's the highest amount is bifidobacteria is what the baby's microbiome looks like. But when you look at the breast milk after pump, there's actually a lower amount of some of the oral bacteria, suggesting that when the baby is directly breastfeeding, some of the baby's oral mouth bacteria are a source of bacteria in the breast milk. That immediate difference in pumps versus direct breastfeeding.

                        And then even as it sits out at room temperature, there's variations in growth of bacteria. And so that's why the recommendation currently is, it's fine at room temperature for about four hours, but after that, you should put it in the fridge because the bacterial growth might get too high from some of the more pathogenic bacteria. And then when it's frozen, there's going to be some changes in some of the antibody levels, [inaudible] like the secretory IgA, which is one of the immune factors.

Andrea Wien: I think that that antibody piece is so interesting. I read that…And again, I've been doing so much reading, so please feel free to correct me if any of this is off base.

Dr. Ann Witt: You're doing great.

Andrea Wien: But I've read that one of the reasons that moms find their babies so kissable and just want to kiss them all the time is because ... Let's say, they're somewhere else or even just out somewhere where mom is not, and they pick up a germ or a pathogen, a virus, whatever it is by kissing all over them, then we're taking that in and then creating antibodies in the breast milk to fight that. I mean, man, how cool is that?

Dr. Ann Witt: Yeah, it's totally cool. And that's something you can do in a laboratory to personalize it to your environment like that.

Andrea Wien: Absolutely. How quickly are we seeing that happen? I've read that it was like within the 20-minute range, which seems very quick to me, but maybe that's accurate.

Dr. Ann Witt: I think it depends on kind of if you've been exposed to the infection before or not. Like, if it's an existing virus or something that you've been exposed to, then your body's going to amount to quicker immune response. If it's something that you're newly exposed to, then it'll take longer time for your body to create the antibody and then pass it on into the breast milk. But yeah, within the day.

Andrea Wien: Wow, that's really, really incredible.

Dr. Ann Witt: Yeah.

Andrea Wien: In terms of auto-immunity and teaching the immune system. So obviously, someone like me with celiac, is my body more likely to pass on that coating, a piece of it?

Dr. Ann Witt: I mean, well, celiac is a genetic factor. So yes, your body is more likely to pass that on. And the process of breastfeeding is overall telling your body to not be as inflamed. And so it's telling your body to kind of have be more tolerant to what's your environment. So it does matter.

                        You have genetics, but you also have the epigenetics, so when you think about the environment that you're creating, the breastfeeding is helping the baby's immune system and its gut learn that, okay, these things in these first couple of months, I should be tolerant to these things these things are okay.

Andrea Wien: Wow. That's so interesting. And then in terms of the babies, we mentioned the mouth oral microbiome, but in terms of the baby's saliva, is there any evidence that different things are passing back into the mom to send chemical messengers or hormones or anything like that?

Dr. Ann Witt: I'm not familiar with that study. I don't know the details of it other than I do notice what the baby is passing out through their saliva is affecting the mom's microbiome in the milk.

Andrea Wien: All right. Let's shift gears again and talk about moms who feel maybe they are having a hard time breastfeeding, they feel like they can't breastfeed, or they're not making enough milk. And I will say I had a tough time at the beginning and I was very dedicated to being able to breastfeed my son. So, I could see if I didn't have that dedication and I didn't feel very strongly about doing it, that it would have been very easy to give up because it was difficult at the beginning. I didn't know if he was latched properly, it hurt. I was getting up a million times a night. I was tired and sleep deprived and all these things. And so, I totally can understand from the perspective of a woman saying, “You know what? I just…It's too much stress and I'm just going to bottle feed instead.” So, when someone comes to you and says, I'm considering not breastfeeding, or I feel like I can't do it, or any of these other reasons, what's your advice?

Dr. Ann Witt: I think it's individualizing it to your individual situation. I mean, the beginning is, my initial thing is I will support you in whatever your decision is because you know best what is right for your family. So, I think that's the most important foundation. And then the other spectrum is I think identifying what your goals are and trying to figure out what the problem is. I mean, if your goal was initially to breastfeed and initially to exclusively breastfeed, then it's kind of figuring out, okay, why are there trouble right now? If you're sleep deprived, well, what can we do to manage it? If the baby is causing pain, what can we do to fix it? If you're struggling with making milk, is it a temporary thing, or is it a long-term thing?

                        There was a study in the recent past that looked at a cohort of about 100 moms and notice that of those 100, maybe 2% truly were not able to make milk, but probably about 40% had delayed onset of their milk production. And that delayed onset can really vary a lot where you're located around the globe. There are certain communities that don't have very much delayed onset and lactation, and then there are certain area in the United States that do have a higher incidence, more around that 40%. But I think it's a recognition that you're not alone if you're struggling, that it's okay if in the short-term that your baby does need some formula because your baby needs some calories, and then what can we do to kind of maximize your milk production.

                        And also to celebrate that even getting your baby some colostrum is giving some antibodies and immune production, and that there's a spectrum within breastfeeding that any amount of breast milk is beneficial and it's still providing your baby with some probiotics and then some of the prebiotics, and it's still doing some of that benefit, whatever you are capable of within that timeframe, whatever's the right balance for your family.

Andrea Wien: Let's talk about that delayed…So, when you say delayed onset, this is something that I didn't really realize until I was pregnant and having a baby, was that your milk doesn't come in the day that the baby is born. It sometimes takes a couple of days, two, three, four days for your milk to fully come in. And so in that time in the interim, you have colostrum, which can you describe what that is and why that's such a critical piece and why the milk takes a couple of days to come in?

Dr. Ann Witt: Yeah. So, the colostrum is that high antibody, high immune cells, those live cells that are kind of coating the body with a lot of good, healthy antibodies and nutrients. It is higher in protein content, mostly because of all those antibodies. And then milk production on average starts within 72 hours. That is triggered by the drop in progesterone that happens after delivery. And at that same time, you see an increase in the sugar content in the breast milk.

Andrea Wien: And I thought it was so interesting in that timeframe of that 72 hours, there's not a lot of colostrum. It's like maybe a teaspoon that's made. And so that's really the only time a human can go without eating or drinking for three days basically on such a little amount of food, which I thought was really-

Dr. Ann Witt: Yeah. So the baby's stomach is just very small in the first couple of days. It's a few milliliters, and then it gradually increases in size and need over those three days to kind of match when the milk production comes up.

Andrea Wien: Now, when we're talking about length of time for breastfeeding, do we see…I guess the first question is, what's your advice if someone says, I want to exclusively breastfeed for as long as it's beneficial for my baby? What's the age that you would say, okay, that's a good age to stop? And then…Actually, let's answer that question and then we'll get into the next one.

Dr. Ann Witt: Yeah. The current recommendations from the World Health Organization and from American Academy of Pediatrics is six months of exclusive breastfeeding. And that's primarily geared towards kind of that immune development, decreased risk of allergens. That's where a lot of those studies come from.

Andrea Wien: And then do we see benefits for breastfeeding beyond that point?

Dr. Ann Witt: Definitely. It's recommended to continue breastfeeding for at least a year. World Health Organization recommends it for two years and then as mutually desired between mom and baby. Yeah, I mean, there's a continued immune benefits that happen even as the kid gets older.

                        It's interesting when you're talking about the microbiome. The baby's microbiome or the child's microbiome reaches maturity, kind of developing through the first three years of their life, and when they transitioned to more an adult, diverse, stable microbiome is influenced some from when they weaned from breastfeeding. So, for many kids, that stability point will become around three years, but the earlier you wean the earlier that transition to that more adult microbiome of course.

Andrea Wien: Interesting. Okay. So, if you're weaning at two years of age, then that microbiome is more stable at that point than if you continued on until three where maybe they are building a little bit more of those immune factors.

Dr. Ann Witt: Yeah.

Andrea Wien: Okay.

Dr. Ann Witt: And worldwide, weaning is happening closer to three. In the United States, a lot of people talk more about a year. So, there's a big cultural differences with when people are weaning.

Andrea Wien: Do you think that that's based just on women going back to work and being a little busier here? Is it just a society's perception of that?

Dr. Ann Witt: I mean, yeah, I think there's a big cultural influence here. I mean, no doubt about it, returning to work influences how long women breastfeed. But then we also just have a whole generation in the United States, we're catching up in the appreciation for breastfeeding. There was a whole generation that really wasn't breastfed, you know, low point in the ‘70s. And so there's still kind of a mismatch of what people think of the importance of breastfeeding.

Andrea Wien: Yeah, absolutely. Even with my mom, I always thought that I was breastfed. And then through this journey with my son, she said, “Oh, I did it for a couple of weeks, but it was difficult so I stopped.”.

Dr. Ann Witt: Right. Yeah.

Andrea Wien: So I wasn't even expecting that. I thought, you know, oh, for sure I was breastfed for at least a year. And that certainly wasn't the case. So it's interesting to even learn that within your own family.

Dr. Ann Witt: Yeah, definitely.

Andrea Wien: In terms of resources that people can look up or if they want to get more into the science on breastfeeding, learn more about resources in their area, where can they go?

Dr. Ann Witt: Yeah. I really think it's critical to get support in that first week after delivery. There's a lot of focus I think on prenatal breastfeeding education, so that women know the benefits of breastfeeding. I think part of what's actually missing probably is getting that support after delivery. I think overall people know, okay, yeah, breastfeeding is a good thing. But then what happens when you have challenges? What happens when you have pain? What happens when you have low milk supply? And then, how do you navigate that to find the right balance for you and how do you solve those problems?

                        I do think it's getting healthcare provider that's supporting breastfeeding, so they can help tap you into those resources and then finding lactation consultant help. A lot of times the hospitals have that. There can be individual clinics in your neighborhood. I think it's talking to other moms and finding out where do they tap into that support. I think it is important to identify that prenatally so that you know where to go when you have troubles. And I would encourage most moms to get that support in the first couple of days after delivery.

Andrea Wien: Yeah, I would definitely agree. Are there any national organizations that people might be able to look into to find those supports in their neighborhoods?

Dr. Ann Witt: I mean, there's the United States Lactation Consultant Association. Often, like in Ohio, we have a listing of lactation consultants by geographical area that you can look for. The Academy of Breastfeeding Medicine will kind of help identify if there's a breastfeeding medicine physician in your area. Local hospitals, most of them are going to have breastfeeding support groups and prenatal classes on breastfeeding. And then from there, you can kind of find out who in your area can offer that support after delivery.

Andrea Wien: That's great. Yeah, I have noticed that pediatricians don't know much about breastfeeding as conventional doctors don't know much about nutrition. And so really going outside of your pediatric office perhaps and finding some outside resources who are really tapped into the breastfeeding science and everything. That support [crosstalk] can be super helpful.

Dr. Ann Witt: Yeah. I mean, I would say healthcare is catching up like the rest of our culture, that there's a whole generation of physicians that was trained in the ‘70s without a lot of exposure to breastfeeding and how to problem solve it. So, it's kind of connecting and find out, is your physician one that is aware of things and knows about it, or do you need to go into some other directions to get that support?

Andrea Wien: Absolutely. And I will say just from my own experience, if anyone's listening to this, it was difficult in the beginning. I felt like between 12 and 14 weeks, it kind of clicked into place. So, it did take ...

Dr. Ann Witt: Wonderful.

Andrea Wien: It did take some time. Not that we weren't ... I mean, he was gaining weight the whole time, but it was stressful. So, anyone who's listening to this, it gets better.

Dr. Ann Witt: And get your supports lined up. It takes a community.

Andrea Wien: Absolutely.

Dr. Ann Witt: It's important to tap into the community.

Andrea Wien: Absolutely. Dr. Witt, thank you so much for coming on the show. I hope to talk to you soon.

Dr. Ann Witt: Thank you so much. It's a pleasure.

Andrea Wien: Thanks for listening. This episode is powered by Dr. Ghannoum's new book, Total Gut Balance. You can pick up your copy on pre-order for a December 24th release date. Just search, Total Gut Balance book on Amazon or wherever you get your books. As always, I'm your host, Andrea Wien, and I'll catch you next time.

 

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