Good Bacteria

10.22.13

Buy That Breast Milk!

A new study claims breast milk ordered online is teeming with bacteria. Kent Sepkowitz says that’s the whole point—babies need good bacteria.

Breastfeeding still has many detractors, and they can make persuasive arguments. But advocates have been won over by countless studies that have demonstrated benefit to both infant and Mom—fewer infections, less obesity, higher IQ, lower rates of cancer, development of taller, stronger, handsomer kids. For decades it’s been a non-stop celebration of that most (literally) mammalian activity.

But now America’s favorite health habit has run up against America’s health enemy No. 1: bacteria. Maybe even superbacteria. An article just released in the mainstream medical journal Pediatrics has found a problem with a certain type of breast milk, the breast milk that is available on the internet as a sort of mail-order wet-nurse: it appears to be contaminated with bacteria.

Earnest researchers from Columbus, Ohio, ordered breast milk from the various websites that traffic in it (here is one). They sought out about 500 specimens but for many reasons, including not pursuing the specimen any time the donor wanted to speak to the buyer, they ended up with about 100 specimens—probably a set of specimens skewed towards the unruly, given their exclusions. Note that some donors put their milk out there for free; for others, it is a cash and carry business.

They then set about culturing the breast milk for bacteria and for viruses.

The results have grabbed just about every headline available in the webosphere, from the New York Times to Mom.me. Here’s the kicker: about 91 percent of all milk specimens obtained on-line through mom and pop sites had grow-able bacteria, some of it capable of causing human disease. Yikes.

To make people feel a little less uneasy, this result was compared to breast milk obtained through the Human Milk Banking Association of North America, a professional associated established in 1985 to apply some standard of quality to the enterprise. The HMBANA sites accept only donations; they approach processing, storage, and delivery with a consistent and informed approach to health and hygiene. So given these differences in the sample, was the HMBANA milk different? Um, don’t ask: of the 20 specimens collected from their sites, 75 percent had bacteria that could be cultured. Importantly though, the bacteria associated HMBANA sites were less fierce and worrisome. For example, only the mom and pop milk (not that obtained through HMBANA) grew salmonella, a cause of severe and sometimes fatal diarrhea.

It turns out that the first place infants get their needed bacteria is from dear old Ma.

This has sent an unnecessary shudder through the milk banking industry—both the regulated one characterized by HBMANA and the do-gooder/cash-and-carry ones that fly well below standardization. This is a shame, because many more mothers and babies need human breast milk than could possibly be endangered by “contaminated” milk. Indeed there have been only a small handful of transmissions of bacteria sufficient to cause actual disease this way, and those have been from a mother’s own milk directly into an infant. (Virus is a different story altogether—HIV is well-known to be transmitted in this fashion and represents an ongoing risk for babies born of HIV-infected mothers.)

So we have a finding—bacteria in breast milk—without any known relevance. A fact without a home.

The hubbub is particularly disturbing because of this big un-secret that has not been much mentioned in this discussion. Human milk fresh from Mom is loaded with bacteria. In fact, there are at least 600 different species in normal human milk. And not only that, but the bacteria are good for an infant. Probably even crucial.

One of the big discoveries of the last decade or two has been the importance of microbes in not just sickness (that’s 19th century news, Monsieur Pasteur) but in maintenance of health. The notion of “good bacteria” is now familiar, as is the mind-boggling variety of different bacteria we have in and on us. The bacteria in breast milk direct from mom is mostly of the “good bacteria” variety, though a few species swing both ways. (N.B.: The entire division of bacteria into good and bad makes most experts wince, and not a little. Many if not most bacteria are born “good” but in certain odd and usually unexplained circumstances, go rogue and cause trouble. As with people, today’s villainous bacterium is tomorrow’s glorious hero and vice versa.)

Particular scientific interest has been focused on bacterial (and other microbial) diversity in our intestines. It may well be that conditions as wide-ranging as colon cancer, obesity, and diabetes derive from the particular mix of bacteria resident, often in very small quantities, in our large intestine. Sorry Lao Tse, it’s not our character that it is our destiny; it is our native bacteria.

All babies are born clean, without bacteria in their intestines—and it turns out that the first place infants get their needed bacteria is from dear old Ma. Both from the passage through the birth canal and then from breast feeding, infants meet up with wide populations of microbes and begin to populate their own intestines with the bacteria passed down literally from generation to generation. 

The potential role of the wet-nurse, in this context, begins to take on different significance. This approach of a woman providing milk to sustain a baby, not her own, when a mother was unable to provide milk from illness or death or else because upper classes didn’t believe in something that animalistic and unrefined, is eons old. Some religions have felt that this intimacy is itself a type of family relationship and have produced treatises on so-called “milk kinship.” Perhaps the starter dose of the wet-nurse’s thankfully unsterile milk brought together “milk brothers and milk sisters” in ways those in the Middle Ages could not have imagined.

Which takes us back to those 100 specimens bought online for culture and pumped through news outlets for a quick jolt. Mothers (and babies), please ignore the finding. Of course, as with all things, use judgment and don’t obtain milk (or friends or furniture or anything) off the internet from a site that has claims that are too good to be true. Rather, go to the HMBANA.org site, follow their rules for handling and temperature, and rest assured that not only will the milk be full of wonderful antibodies and lipids and proteins to help your child grow, but chock full of that other key ingredient: bacteria.