Intolerant bodies: a history of auto immunity. Anderson W, Mackay IR. (Johns Hopkins Press 2014) A focussed partial review and commentary..
This readable and illuminating text by an historian and an immunologist outlines the historical process of uncovering the workings of the immune system. Finding this book was for me finding a missing piece of the jigsaw puzzle that is understanding allergy and intolerance in families.
And at the same time, the book clearly outlined the shape of the critical piece that immunologists have omitted from research consideration; a piece central to their quest to understand how the body can turn against self and create serious, even fatal damage in what can be a slow suicide mission. That omission is what I shall focus on in this review.
That missing piece is female-breast-shaped. For this book mentions briefly, but fails to explore in depth, the highly evolved role of lactation in the development, programming, and function of the immune system. The role of the gut microbiome created by postnatal nutrition, of the cells and hormones and enzymes in breastmilk, and their complex interactions in the fundamental process of programming metabolome and even genome, are simply overlooked. Yet these factors and their outcomes are very different between exclusively breastfed infants and those exposed early to immunoreactive and antigenic bovine milk products. (Such exposure had become almost universal by the 1960s-70s; and has had intergenerational consequences.)
So, for example,
- the book explores the role of the thymus: but fails to mention the evidence that not being breastfed results in substantially decreased (halved) thymic size.
- It discusses the development of tolerance prenatally, but fails to explore the very different patterns of tolerance created in exclusively breastfed infants, with their unique microbiomes. (Yet allergists generally acknowledge that widening the infant diet while still being breastfed increases the likelihood of tolerance to foods.)
- It considers antibodies and auto-antibodies, but fails to consider the anti-antibodies created prenatally by maternal ingestion of bovine milk proteins, and their transfer to the fetus and neonate.
- It does not explore the now-acknowledged transfer via breastmilk of immune cells, including pluripotent stem cells, increasingly shown to be both present and effective well beyond the infant gut, and probably capable of repair work.
- The variety and patterns of oligosaccharides in women, important for the microbiome and so for immune function, are not discussed.
- The authors see the family links to auto-immune disease, but do not explore the intergenerational transmission of such disease via distorted metabolic processes, microRNAs and changes to parental immune function.
- The persistence of maternal cells within offspring is nowhere outlined, although transplantation success in adult life is greatest if the donor is related to the mother – but only if the recipient had been breastfed by that mother.
And so on, and on…..
In one way, this breast-shaped hole is hardly surprising. Search Google for “organs of the immune system.” None of the many diagrams includes the female breast. Yet that breast is the factory where specific antibodies are made when sensitised cells circulate from the Peyer’s patches in the gut and the respiratory tree: the enteromammary and bronchomammary circulation is the basis for the specific protections that only breastmilk provides to infants, not only while being breastfed, but for some time thereafter, and in some cases, into the next generations. Researchers such as BC Melnik are finally beginning to realise that
The vigorous change from the evolutionarily highly conserved system of breastfeeding to artificial infant feeding during a most sensitive and vulnerable window of metabolic, hypothalamic and immunological programming apparently represents the most serious error of modern medicine, laying the foundation for the worldwide epidemic of diseases of civilisation.
In fact, I believe that the evidence of the last 150 years strongly suggests that the Milk Hypothesis should subsume the hygiene hypothesis.
For accumulating research shows that mothers’ milk is a unique bridge between the womb and the world, modulating the infant response to the environment, programming not only for optimal growth and development, but also for appropriate responses to challenges. The mother’s body screens and samples that unique environment, presenting traces of all she contacts in manageable doses along with complex cellular and metabolic agents assisting the child’s response.
Both the absence of breast milk and the lack of breastfeeding put every child at risk of suboptimal health, and makes the child different from what that child might have become given an initial diet of mother’s milk. And that child will gestate the next generation.
And – let women not be overlooked- suppressing lactation in a body programmed during pregnancy for postpartum breastfeeding puts the mother herself at greater risk of serious harms (such as long term bone deficiency, increased risk of reproductive cancers, and higher rates of inflammatory disease, from diabetes to CVD). It also leaves mothers in an unphysiological hormonal milieu, one associated with greater difficulty in postpartum adjustment. Lactation hormones act powerfully to assist women, not merely their offspring.
There simply is no safe substitute for women’s milk. Population-wide use of infant formula has been and remains responsible for an ongoing cascade of intergenerational damage and vertically communicated disease, mistakenly described as non-communicable simply because they are not transmitted horizontally. And it has affected clinical understanding of what constitutes normal health and behavior in children and adults alike: the deviant results are now usual, and so considered normal.
How has western medicine developed thus far with such a monumental blind spot? Only the historian can explicate the complex process by which artificial feeding has become the norm in WEIRD (western, educated, industrialised, rich and democratic) nations. Those substitutes for breastmilk are not immunologically harmless.
Cancer researchers looking for an explanation for higher rates of childhood cancer in not-breastfed children uncovered the reality of higher rates of DNA damage and chromosomal breaks in such children. And as highly processed heat-treated industrial products, formulas all carry far more of the metabolites formed by heating, such as advanced glycation endproducts (AGEs), trans fatty acids, and the like.
Children are at risk not just from the absence of what only a highly-evolved living tissue, human milk from a living breast, can provide. They are at risk from the presence of unavoidably contaminated unsterile powdered soups, inevitably carrying traces of the manufacture of their multiple globally-sourced ingredients and processing aids. In the case of the fungal and algal oils added in recent decades, those traces included hexane used to extract the oils from vats of biomass.
Then there are the concerns about aflatoxin levels (higher allowable limits apply to US formulas than to those made in Europe), arsenic, lead, phthalates, and so many more, quite apart from the mathematical impossibility of matching human milk’s nutrients and their bioavailability. Or even of precisely matching what the label says is in the can!
The results now that researchers have begun to look with modern imaging techniques? a wide range of biologically-obvious developmental differences – MRI evidence of differences in brain white matter development in the first year of life, ultrasound evidence of differences in reproductive tissue growth (more ovarian tissue, less testicular tissue) by as early as four months of age, for example. The only readily accessible compilation of all such issues is to be found in my book, Milk Matters: infant feeding and immune disorder, or its e-book Infant formula and modern epidemics: the milk hypothesis. https://infantfeedingmatters.com/infant-formula-epidemics-buy/
That book also explains why these biological differences are in fact underestimated as a result of research that defines groups poorly and in ways that favour the null hypothesis (that there will be little difference between breast and formula fed infants).
In fact, so bad has been the research (most of it industry funded) that WEIRD societies are now experiencing a bullying backlash: media shouting that silences many who should be enabling parents to make informed choices about infant feeding. For public health advocates to tell the truth about infant formula results in absurd accusations of a malign intent solely to shame bottle feeding women. Collective denial by the groups that pioneered the use of infant formula is protecting the practice, while any possible problem of breastfeeding is sensationally highlighted in popular media. The media treatment of obesity, itself a by-product of early high-protein infant formulas, make a interesting contrast!
To focus only on what Intolerant Bodies does not cover would be absurd. It is in fact a lucid and entertaining account of a fascinating progress of intellectual concepts as much as clinical medicine.
Now in my 70s, I realise that I have lived through much of this progress from the 1980s, when I first began writing about food allergy and intolerance in breastfed children, and when older allergists were feeling disconcerted by the language and concepts of clinical immunology. As an invited member of the-then Australian College of Allergy in the 1980s, “in recognition of your work educating the lay public about allergy”, I witnessed the College’s transformation into ASCIA, the Australasian Society for Clinical Immunology and Allergy. It was clear to me from that title and conference discussions that the scientifically-oriented younger generation, hospital based and research-oriented, would dominate the field with a new almost gnostic language – though in some ways the wheel has turned full circle these days as hospital-based allergy clinics multiply and adopt and modify older ideas of graded introduction of reactive foods. (It took twenty years for doctors to recognise the truth of what parents had been saying from the 1970s, that food allergy and intolerance was a real and growing problem. NOT one that began to grow from 2000 onwards, though it becomes ever more obvious as it cascades and compounds intergenerationally in families.)
Intolerant Bodies sets out clearly the sometimes confusing changes of ideas and language which both older practising allergists and outsiders like myself found so irritating and sometimes impenetrable over the decades. It is deeply satisfying to any historian or practitioner to see the contours of the research being so clearly mapped.
But Intolerant Bodies makes it clear to me that, just as 1980s parents were not listened to, immunologists are still not listening to the breastfeeding community and to the burgeoning field of lactation researchers, centred on ISRHML, the International Society for Research on Human Milk and Lactation. My evidence for that statement? How about
- The absence of the female breast and the mother from the book itself.
- The unseemly haste with which many breastfeeding women are told in practice to swap to unsterile industrially processed foods.
- The failure of the immunologists to set up independent comparative trials to find the least-worst alternative to breastmilk, whether as a supplement or a replacement for breastmilk, and to publish the results.
- The failure to create a common reporting site or to independently oversee the collection of adverse reports from families that have tried and been failed by the expensive taxpayer–subsidised breastmilk replacements labelled as allergy formulas. The recent Neocate link with rickets shoud flag the need for vigilance and awareness of formula fallibility.
- ASCIA’s willingness to accept industry money and create guidelines that treat breastfed and formula fed children as identical: e.g., the persistent refusal to support the WHO recommendation of around 6 months exclusive breastfeeding and continued breastfeeding into the second year and beyond, with its explicit – but often overlooked – recognition of individual clinical differences guiding the course for the individual child. Together with the failure to advise widening the formula-fed child’s diet and end reliance on a single processed food past the stage when in utero stores are exhausted, around 4 months or even earlier.
The vested interests which shape allergy practice still dictate that no mention shall be made of the unique value of women’s milk, much less the inevitable harms and unavoidable risks of dead (we devoutly hope) substitutes for living tissues. Few medical pronouncements by immunologists are as blunt as the UK RCPCH-approved e-Learning for Health module on infant formula, which begins with:
The only accepted alternative to breast milk for infants up to 6 months of age is infant formula which supports bodily growth along parameters different from those of the breast-fed child, and provides no immunity against disease. Many of the health outcomes of breastfeeding compared to formula feeding are dose-related: that is, better outcomes are associated with longer duration and exclusive breastfeeding, or less exposure to infant formula. For infants, formula will always be an inferior choice to breast milk.
Yet it is immunologists who above all should appreciate the differences.
That Intolerant Bodies was written by those with personal experience in the field is a huge plus. Chapters 5 and 6, on the effects of autoimmune disease on human beings and their sense of self are powerful, albeit painful for any mother whose lack of knowledge allowed her child – now middle-aged – to be damaged by early in-hospital exposure to infant formula, with its subsequent gut damage. My first book, in 1982, had resulted in feedback from grandmothers whose breastfeeding daughters had seen their child transformed by maternal diet changes, and who had themselves lost symptoms not until then understood to be symptoms of food hypersensitivity. The grandmothers said: “As a baby, my daughter was just like my granddaughter, and no one suggested I change my diet. She changed her diet as you suggested, and the baby is so different – and my daughter has lost the symptoms I had when I was younger. Is my now-developing auto-immune disease the result of my unrecognised food sensitivities, as my immune system has been worn out by decades of coping?” As they said, it made sense that creating an egg and gestating a baby in bodies with affected immune systems was likely to result in passing on problems that might get worse over a lifetime and persist between generations. (That was before epigenetics, and the evidence of paternal effects via microRNAs in sperm, relieved grandmothers and mothers of sole responsibility!)
That communication between parents, along with ongoing work with allergic families and educating health professionals, has led to my Milk hypothesis. Intolerant Bodies charts the emergence of autoimmune epidemics, where once were rare cases. The development of immune disorder almost exactly parallels the use of substitutes for breastmilk and the growth of sales from the mid nineteenth century to the present day. In America by 1950 fewer than 20% of infants were ever-breastfed, and by 1972, the global nadir, this was true of many other nations. But in the 1960s to 1980s, even those still being solely breastfed were being affected by perinatal exposure to alien foods and antibiotics. After World War II the American marketing strategy of provision of free infant formulas to hospitals – a practice with a 93% brand loyalty factor- led to exposure of infants across whole populations. This in turn led to changes in gut microbiomes, perhaps even the extirpation of some helpful microbial strains that had evolved with humans since time immemorial. While books such as Missing Microbes by leading figures such as Professor Martin Blaser chart the role of antibiotics and surgical birth, most such medical authors have been reluctant publicly to acknowledge that exclusive breastfeeding can restore normalcy to the microbiome after such challenges – but formula feeding makes recovery impossible. The 700+ species in human milk are only now being charted, decades after their carriers, the breastfeeding mothers, have been affected by perinatal exposures and intergenerational transmission from parents and grandparents so affected. It is astonishing that even so, a few days of truly exclusive breastfeeding can be shown to make a difference to outcomes such as the emergence of diabetes in adolescence among First Nations people.
A recent Guardian article argued that we need to stop infantilising women and tell them the truth that breastfeeding can be painful and difficult at first, but it is immensely rewarding and worth the effort, as the author clearly found. I agree with her. But to tell that truth about breastfeeding without telling the truth about infant formula would be deeply damaging.
So I argue that we need to stop infantilising parents of both sexes, and let them know the truth about infant formula as well.
Then those who have no choice but to use it, or who are willing to take the risks it involves, will do so more carefully.
Those who do not want to use it will put more pressure on to governments to enable, not just promote, breastfeeding. And that means support that ends the present severe financial penalties accruing to women who step out of the workforce.
IIt astonishes me that health professionals can be so immersed in the normative bottle feeding culture that they refuse to talk about this major primary health issue for fear of upsetting women: they are not so sensitive when it comes to any other, much less important, public health issue affecting fewer people. And Grayson’s experience makes it clear that women who bottle-fed their children can deal with reality and deserve truth.
To come back to the book that sparked these thoughts. The bottom line about Intolerant Bodies? It is well worth reading, though not easy going without some grounding in science. Some of the immunological hypotheses and ideas are complex, and it takes concentration to follow some parts of the story.
But the book is a most useful addition to medical libraries. It will be of interest to those in public health and nutrition, as well as clinicians dealing with the many sufferers of auto-immune disease. As a reference text for the future, chronicling the developments of the past, and setting the present into context, it is a priceless legacy from a pioneer in the field.
And I fervently hope that in a decade or so, those reading it will marvel that research for so long overlooked the inevitably malign impact of substitutes for that most important human survival and adaptation mechanism, breastfeeding.
IBCLC 1985-2006. Author: Milk Matters: infant feeding and immune disorder (2015) and numerous other publications over 35 years of learning and teaching.
Milk Matters is available as two inexpensive and searchable e-books, where all statements of fact made in this article are fully referenced, and more importantly, discussed in context.
For more information go to www.infantfeedingmatters.com
- The 1989s saw the massive growth of parent-created and run voluntary groups such as the AAA (Allergy Awareness Association), AIA (Allergy-Induced Autism), HACSAG (Hyperactive Children’s Support and Action Group), AESSRA (Allergy and Environmental Sensitivity and Research Association), FIN (Food Intolerance Network) in every Anglophone country. Their concerns about food intolerance were derided as a “muesli belt syndrome” by doctors who should have recognised that parents were describing real phenomena. The current idea that allergy has increased only since the 1990s or 2000 is clearly wrong: these parents were birthing in the 1970s. And now their grandchildren are more severely affected than their parents had been – unless the grandparents convinced the mothers to do two things: avoid or reduce their intake of food allergens in pregnancy, and insist on exclusive human milk feeding after birth. (In which case the grandchildren were often better than their parents had been.) This was precisely the period when foods were introduced at 4-6 months of age, following major 1970s and the AAP1980 statements. ↑
- Unlatched , whose author Jennifer Grayson clearly was one of those affected buy formula feeding, and recognizes the fact, is bolder in its willingness to consider these possibilities. She and her mother have discussed the reality intelligently without accusations of daughter shaming mother or other such nonsense. And researchers have been good enough to reply by email that infant formula is “a big part of the problem.” Let’s hope that soon becomes a public message from immunologists and mothers alike. ↑