Adverse Health Effects of Not Breastfeeding? A Look at the Historical Record
In the middle of the 20th century, from the post-war years up until the early 1970's, breastfeeding in the U.S. was relatively rare. (1) But breastfeeding rates started to climb rapidly and substantially in about 1972, as seen in these charts, and they continued to increase following a dip during the 1980's.
By now, we have several decades of government health data that enable us to make a "before and after" comparison regarding effects of breastfeeding vs. bottle feeding. It is important to make such a comparison, for the following reasons:
a) Modern environments in developed countries expose people to large and increasing amounts of toxins, including developmental toxins that can have major effects on how infants develop;(2) and several of those toxins are "persistent" and accumulate in fat in the body, including in breast milk.
b) The EPA recognizes that at least one of the especially hazardous toxins, dioxin, is ingested by breastfed infants in doses about 80 times higher than the dose that the EPA has determined to be a safe dose. And exposure to dioxins by breastfed infants is also recognized to be scores of times higher than the exposure received by formula-fed infants.(3)
c) Since the early 1970's there have been major increases in rates of various diseases among children, with the causes of those increases being basically unknown; "epidemics" have been declared in several diseases and conditions among children during this period, including obesity, diabetes, asthma, and possibly also autism. All of those are specific disorders that proponents of breastfeeding allege to be reduced by breastfeeding.(see www.breastfeedingprosandcons.info) So seeing the historical record going in the opposite direction brings up the concern that the widespread promotion of breastfeeding, in the face of known high levels of toxins in breast milk, might be misguided. That is especially true since the precise times of the increases and slow periods in diseases and adverse conditions have correlated well with precise times of increases and slow periods of breastfeeding rates, as will be described in detail below. Highs and lows of disease rates have been observed in specific demographic groups, specific age groups, and specific geographic areas in which breastfeeding rates were correspondingly high or low, as will be related in detail below.
So there appears to be good reason to take a close look at the historical record concerning the variations (touched on just above) that occurred following the transition to higher rates of breastfeeding, and to compare the health outcomes of children born in the high-breastfeeding period with those of the earlier generation.
Doing a web search for "health problems of baby boomers" (that is basically the low-breastfed generation), the problems that one finds are basically obesity and conditions that are known to stem from lack of exercise and the resulting obesity: heart disease, diabetes, joint pain, and reduced mobility. If the health of the baby boom generation has actually declined below that of earlier generations, that possible decline apparently would have resulted mainly from lack of exercise, from the obesity that stems from lack of exercise, and from transitions in the economy and in society. The lack of exercise that underlies much of the above is a logical result of people's occupations' having gone from farm and factory work to sedentary office work, without compensating for the reduction in the physical activity that had been normal in earlier generations. Given the above as well as the scarcity of health and breastfeeding data for generations born before mid-20th-century, little can be learned by trying to compare health statistics of the low-breastfed, mid-century generation with those of earlier generations.
However, the transition during the 1970's to high-breastfeeding rates was rapid, and there is good data for making comparisons of the low-breastfed generation with the later (highly-breastfed) generations. So we will now try to consider such comparisons. When doing so, we need to bear in mind the considerable evidence about concentrations of various toxins in typical human milk in contemporary developed countries (see description and authoritative sources at www.breastfeeding-toxins.info), as well as the probable immunity-suppressing effects of the immune cells transmitted in breast milk, to be presented below.
Immunity Effects: Proponents of breastfeeding point to the presumed benefit to the infant of immune cells that are transmitted in breast milk. As desirable as this may be in areas with poor sanitation, it apparently is not beneficial in developed countries. A web page of the U.S. Food and Drug Administration favorably presents a line of reasoning according to which proper infant development depends on “the necessary exposure to germs required to “educate” the immune system so it can learn to launch its defense responses to infectious organisms…. In the period immediately after birth the child’s own immune system must take over and learn how to fend for itself.” The FDA reports that this “hygiene hypothesis” is supported by epidemiological studies. A prominent doctor uses stronger language, describing the “critical importance of proper immune conditioning by microbes during the earliest periods of life.” By preventing effective microbial exposure that is important to proper development of the immune system, the shielding effect provided by breast milk’s immune cells is apparently actually counter-productive to long-term health. In addition to the above indirect effect of breast milk on development of immunity, there are also known harmful direct effects on the developing immune system resulting from toxins known to be contained in breast milk. (for details and authoritative sources regarding the above, see Section 1.1.a at http://www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm).
It is important to bear in mind that the U.S. Surgeon General inconspicuously acknowledges that the existing evidence for benefits of breastfeeding consists only of inferences (p. 33 of Surgeon General's Call to Action to Support Breastfeeding 2011). Quite justifiably, the Surgeon General is proposing that "scientifically sound and rigorous studies on breastfeeding topics" should be carried out in the future, which would be expected to provide needed improvement over the research that has been carried out in this field thus far. Note that observational studies, the category that includes all of the studies that have so far found benefits in breastfeeding, would find associations between high death rates in Florida and sunshine, from which one could infer that sunshine causes deaths, while overlooking the factor of the old average age of Florida residents. Studies finding benefits of breastfeeding similarly have not properly taken into account the effects of "confounders" including low income and household smoking, which are known to be disproportionately prevalent in bottle-feeding households, and which are known to cause the adverse health effects that the Surgeon General surmises are results of formula feeding. The U.S. Agency for Health Research and Quality points out that findings from such observational studies can be expected to consist of an unknown amount of "error" and "false conclusion."(5)
A document dealing with findings of a research team of the Norwegian University of Science and Technology referred to the PROBIT study in Belarus as "the largest study that has been done on breastfeeding and health." (That study was apparently also the only study on effects of breastfeeding that has minimized effects of confounders by means of randomization of participants.) According to that research team, "This study cuts the legs out from underneath most of the assertions that breastfeeding has health benefits."(6) It is noteworthy that this is a recent statement from the University of Science of Norway, a country that probably has the highest breastfeeding rates in the entire developed world. (See chart in introduction of www.breastfeedingprosandcons.info).
Given the above as well as the fact that the case in favor of breastfeeding is based on a kind of study that is known to the U.S. government's highest authority on healthcare evidence to be subject to false conclusion, it is especially important to examine the historical data that shed light on the question of whether breastfeeding should be recommended.
Section 1: Actual historical developments in disorders that are alleged by the Surgeon General to be reduced by breastfeeding:
A logical starting point for re-examining the "known benefits" of breastfeeding is the list of specific diseases and conditions that are claimed by U.S. Surgeon General Regina Benjamin to be "risks" of not breastfeeding. That list of "risks," with its clear implication of benefits of breastfeeding, is examined in relation to actual government health data for the last four decades, at www.breastfeedingprosandcons.info. As will be seen there, not a single one of the disorders that is claimed to be reduced by breastfeeding has become less prevalent since the transition to many-times higher rates of breastfeeding. In fact, all except one has actually increased among children, four of them substantially enough to have been considered to be new epidemics.
But there have been not only general increases in both breastfeeding and diseases but also specific variations, as follows: (a) plateaus, (b) extraordinarily rapid increases, (c) very minimal increases, and (d) a decline in one world region, all of which variations in diseases have correlated with matching specific earlier variations in breastfeeding rates: plateaus, very rapid increases, minimal increases, and a significant decline, found in the same geographic areas or demographic groups. Those observations are based entirely on authoritative health data (mostly from the U.S. CDC) for the appropriate periods; the sources are cited in the above-linked website.
Certain other disorders have clearly also either arisen or become far more prevalent during the period following the transition to higher rates of breastfeeding. Those other conditions will be dealt with below.
But first, a word from the author:
Q: If authorities are advising mothers to feed infants a food that (in today's developed countries) is known to the EPA to typically contain very high concentrations of developmental toxins,1
while in recent decades there have been close correlations between variations in prevalence of that feeding type and later fluctuations in childhood disease rates, and four continuing epidemics have arisen following long-term increases in that feeding,2
shouldn't those authorities be prepared to answer some specific questions about the evidence on which they base their advice?
A: They obviously ought to respond to questions. But they don't.3
That says a great deal about the quality of their advice.
Why would you feed your infant a food that is known to the EPA to contain high concentrations of developmental toxins, a feeding type that correlates closely with childhood disease rates, when the proponents of that feeding have no answers to pertinent questions about it?
1) dioxins in concentrations that the EPA has found to be over 300 times their estimated safe dose during initial breastfeeding, and in concentrations many times higher than in formula; also containing PCB's, PBDE's and often mercury; see www.breastfeeding-toxins.info.
2) U.S. breastfeeding rates went from low to high during the 1970's, followed by great long-term increases in childhood diabetes, obesity, allergies, asthma and ADHD; breastfeeding declines and plateaus have also correlated well with later disease fluctuations; see www.breastfeedingprosandcons.info. <bring declines/plateaus out in Ps and Cs>>
3) The American Academy of Pediatrics, American Academy of Family Physicians, American Congress of Obstetricians and Gynecologists, and the World Health Organization have all failed to respond to any of two or more letters to each of them from the Director of Pollution Action, challenging the evidence on which they base their position on breastfeeding, as of two and nine months after mailing of the letters.
Any reader is invited to see if you can get a response from those organizations on this subject. A suggested one-page set of points to ask for response to is at www.breastfeeding-subject.info. If they respond to you, please send a copy of it to firstname.lastname@example.org or Pollution Action, 27 McWhirt Loop, Ste. 111, Fredericksburg, VA 22406 USA, since they don't respond to us.
Section 2: ADHD and Serious Psychological Problems
Section 2.a: Origins of ADHD and serious psychological problems:
ADHD (Attention Deficit Hyperactivity Disorder) was first named as a disorder by the American Psychiatric Association in 1980.(1) That provides one clue as to the approximate time of origin of significant incidence of this disorder.
Another indication comes from a U.S. study published in 2004 which pointed out that, as of that time, it was being "increasingly recognized that attention deficit hyperactivity disorder (ADHD) persists into adulthood."(2) So apparently a significant number of people who had recently become adults in the years leading up to 2004 were demonstrating ADHD symptoms that had not previously been observed in adults.
It is worthwhile to try to obtain information about the period when that cohort with the increasingly recognizable adult ADHD had gone through its infancy, since that is the period when by far the greatest amount of neurological development takes place. This chart shows the period of fastest growth of the brain taking place during the first year after birth. It would be reasonable to assume that vulnerability of neurological development to environmental toxins would probably be greatest during that period. To ascertain when that period would have been for the people with the newly-recognized adult ADHD, it would seem to be reasonable to subtract 25-28 years from the year (2004) of the above-mentioned study's publication.
So there are two major indications, separated by 24 years and based on cases in two different age groups, both of which point to the mid-to-late 1970's as the time when children were first being born in substantial numbers who would later come to have ADHD: the 1980 first naming of the disorder, and the 2004 first published recognition of ADHD as a disorder of adults.
That was the time when breastfeeding rates were increasing very rapidly (see Figure 1). It is well established in EPA and other authoritative documents that chemicals concentrated in human milk are known to lead to ADHD-like effects. More on this will follow in Section 2.b.
As shown in the above CDC chart, "serious emotional or behavioral difficulties" in children were apparently not considered significant enough by the CDC to justify reporting on them until 2003, well into the period of increasing breastfeeding. Before reaching the 5% level in the first data provided (at which point they were on a clear upward trend), those emotional or behavioral difficulties rates must have been building for many years. An extensive web search as well as considerable search on the CDC's website for "Serious emotional or behavioral difficulties" brings up a great deal from after the year 2000, but the only result found for earlier years was 1988 CDC data for those words but without the word "serious." That showed 5.1% of 3-to-17-year-old children had received treatment or counseling for "emotional or behavioral problems" within the previous 12 months. (306) That sounds very much like an intermediate step between essentially no problem and the "serious" emotional or behavioral problems found among 5% of children 15 years later. Notice that the year when the problems existed but were less than serious (1988) was the first year in which nearly all of the children reported on would have been born during the period in which breastfeeding rates had been rising from an initial low level. And the later data, indicating substantial serious problems, were for years in which all of the children would have been infants during a period in which breastfeeding had already greatly increased.
Section 2.b: Testosterone and other connections with psychological problems:
Chemicals that are concentrated in human milk, and which are many times lower in bottle feedings, are known (on the basis of high-quality scientific studies) to have anti-androgenic, testosterone-reducing effects — see Sections 1.c.3 and 2.a of www.breastfeeding-vs-formula.info for details and sources, including about specific toxins of relevance: dioxins, PCBs, and PBDEs. According to Web MD, the leading effects of low testosterone in addition to low sex drive are also "diminishing ability to concentrate, as well as irritability and depression." Also, quoting a urology department chairman, "diminished mental clarity, motivation, drive -- all of these things can be related to low testosterone." (301) Scientific literature points out that testosterone has important effects not only on ability to concentrate but also on mood, memory, and "the overall sense of vigor and well being."(302)
The psychological and mental-concentration-related effects of low testosterone have early beginnings. Testosterone levels are typically high in an infant for several months after birth; they have an important role in development of the rapidly-growing infant brain. According to a medical school research team, "Hormones as mediators of gene effects control indirectly the development of human body and brain, with subsequent consequences on behavior and cognitive functions.....A number of published studies documenting the relationship between testosterone and human intellectual performance have indicated that testosterone exerts its effects neuroanatomically by influencing the organization of the developing brain, modifying cognitive pattern ... (Geschwind & Galaburda, 1985; Gouchie & Kimura, 1991; O’Boyle et al., 2002)."(303) (emphasis added) From an academic source, "recent research on animals and humans suggests that sensory perception, cognition, arousal, attention, and affective processes can be influenced by circulating sex hormones ....(Goldstein et al., 2005; Maney, 2006, Protopopescu et al., 2005; Shively & Bethea, 2004) ... Sex hormones (including testosterone) apparently influence the development of some of the same neural circuitry that is implicated in ADHD." (304) (emphasis and parenthetical expression added)
A study with rhesus monkey infants whose mothers had been exposed to small doses of PCBs during gestation and lactation found that the infants showed hyperactivity and retarded learning ability. (45) Note that PCBs are known to typically be concentrated in breast milk, in far higher concentrations than in cow's milk. (see www.breastfeeding-toxins.info)
A 2008 study found (quoting from its abstract), "high levels of circulating testosterone were related to fewer ADHD symptoms in girls." (305) Put another way, lower testosterone levels were related to more ADHD symptoms. Some readers might have thought that observations about effects of low testosterone (quoted earlier) would apply only to boys, but this study found that low testosterone levels apparently also have such effects in girls. (Both genders have testosterone as well as estrogen, just in different proportions.)
Despite the apparent importance of testosterone also to female neurological development, it should be safe to assume that it has greater importance in males than in females. Therefore exposure of infants to the testosterone-lowering chemicals discussed here would be expected to have greater neuro-developmentally-toxic effects on boys than on girls. This should be kept in mind when thinking about the far higher rates of ADHD as well as autism among boys than among girls.
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Given the recognized importance of testosterone levels regarding attention and mental-health conditions, there is special reason to be concerned about any substances being widely ingested by infants that have been found in high-quality scientific studies to have testosterone-lowering effects. Bear in mind that dioxins (which are apparently typically consumed by breastfed infants in contemporary developed areas at levels over 80 times what the EPA considers to be a safe level, and at many times the doses in formula) and PBDEs (apparently 50 times as high in typical mothers' milk as in formula) have de-masculinizing, testosterone-lowering effects. (see Sections 1.2.b.1 and 1.7.1 at www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm and also www.breastfeeding-toxins.info)
Dioxins are recognized to have effects related to this discussion even aside from their effects on testosterone levels. According to the Board on Environmental Studies and Toxicology of the National Academy of Sciences, "Children and animals exposed to dioxin or PCBs in the perinatal period can exhibit various neurological disorders" including learning and memory disorders and hyperactivity. "Yu-Cheng children (whose mothers had been exposed to elevated levels of dioxins) are rated by their parents and teachers to have a higher activity level, more health, habit and behavioral problems, and to have a temperamental clustering closer to that of a "difficult child." Continuing, "These results indicate that a wide variety of developmental events... can be perturbed, thus suggesting that TCDD (dioxin) has the potential to disrupt a large number of critical developmental events at specific developmental stages."(305a) (emphasis added)
Section 2.c: Serious psychological problems, including ADHD:
It should be pointed out that ADHD is a serious problem in many ways. According to the CDC table above, 11½% of American children in the 10-to-17 age group are diagnosed with ADHD, which means far more than 11½% of boys, since boys are diagnosed with it between 2 and 9 times as much as girls. Not only does this condition cause difficulties in their schooling, the schooling of others, and the working lives of teachers, it also typically leads to problems in relations with peers as well as to the affected children being regularly medicated with Ritalin or other substances, long-term effects of which are very much in question. It would also be anticipated to interfere with productivity and success in later work lives. It greatly increases the likelihood of attempted suicide in adulthood (by three to four times, according to one study, with even higher percentages engaging in intentional self-harm(307) ); the research cited here studied females only, but there appears to be no reason to think that the findings would not apply to males as well. A 30-year study of 551 subjects, 72 of whom had ADHD as teenagers, found that, "compared to people without ADHD in their teens and adulthood, those with the disorder had 82 percent higher odds of having impaired physical health. They were also more than twice as likely to have another mental health problem and more than three times as likely to have antisocial personality disorder.... This behavior is often criminal in nature, according to the U.S. National Institutes of Health. Adults with ADHD were also 2.5 times more likely to have problems at work, and more than three times as likely to have high financial stress, the investigators found."(307c)
The CDC chart earlier (Figure 3) showed data for "serious emotional or behavioral difficulties" only for years after 2003, but an NIH source provides information about such disorders for earlier years, showing the same trend of rapid increases, as follows: in the U.S., the estimated number of office-based visits by youth that included antipsychotic treatment increased from approximately 201,000 in 1993 to 1,224,000 in 2002,(317d) an increase of over 600% in just 10 years. A Spanish study for the years 1994-2003 found that the estimated annual number of youth office-based visits with a diagnosis of bipolar disorder increased 40-fold during that period. (317e) In reference to the above increases, it is noteworthy that the U.S. and Spain are among the many countries in which breastfeeding rates increased dramatically in the decades leading up to the 2000's. (Figure 1 and chart below(317f)) (Obviously, there are multiple factors that could underlie the increases in psychological problems; aside from the rapid general breastfeeding increases shown in the charts, increases of exclusive breastfeeding during those periods, not known, may well have been at least as high as the increases in serious psychological problems.)
By contrast to the very large increases in both breastfeeding and serious psychological problems in the U.S. and Spain, it is noteworthy that the increase in use of antipsychotic drugs by youth in the Netherlands during that period was small (127% in 8 years, but mainly attributable to doubling of duration of use rather than increase in number of users),(317g) and in the U.K. it was still smaller (98% increase in prevalence of use over 14 years, again reflecting increased duration of use rather than significant increase in number of new users).(317h) (Those four countries are the only ones for which studies on this subject can be readily found.) The low or effectively-zero increases in new use of antipsychotic drugs by youth in the Netherlands and U.K. should be seen in light of the fact that breastfeeding rates in those two countries were not increasing in the pre-2000 period. (See the white line for the Netherlands and the almost flat blue line for the U.K. in this WHO chart of breastfeeding rates at 6 months.)
Looking more closely at the years of the above-mentioned huge increase in office visits for serious psychological problems by U.S. youth, note that the period studied was 1993-2002. Also note that 18 was the age specifically mentioned with regard to "the peak age for the onset of schizophrenia and psychosis," in a study provided by the NIH.(317b) So it is of interest, when considering the major 1993-2002 increase in serious psychological problems, to look backward 18 years to the time of the infancies of those who later were in the middle of that increase, that is to 1975-1984. Notice that breastfeeding at 6 months increased about 500% between 1973 and 1983. Then remember (from just above) that office visits for serious psychological problems increased 600% during the period when the infants of 1975-1984 were reaching their late teens.
It is relevant that in the cases of both the increase in serious psychological problems and the earlier increase in breastfeeding, the increases of both were (a) very large, after starting from a low level, and (b) rapid. Also, the increase in serious psychological problems followed the increase in breastfeeding after a lag that represented a likely period of latency before the obvious onset of psychosis or schizophrenia.
Bear in mind the EPA figures showing human milk to be scores of times higher in the neuro-developmentally-toxic dioxins than the EPA-determined safe level, and with many times higher concentrations of those toxins than are found in infant formula.(3)
It should be noted that the long-term effects of these psychological disorders are likely to often be substantial. Recent studies examining the life courses of individuals who have experienced childhood psychological problems indicate that lifetime costs in terms of earnings alone could exceed $500,000.(317a) In addition to suspected adverse long-term effects of antipsychotic drugs on these children,(317c) the frequent long-term effects of childhood ADHD mentioned earlier in Section 2.c would probably also apply to their futures: greatly increased rates of attempted suicide, a tripled likelihood of having anti-social personalities (which are often criminal in nature), greatly increased health problems in adulthood, difficulties at work, and financial stress.
The major mechanism suggested here for why ADHD and other mental effects should correlate with breastfeeding is the known testosterone-lowering effects of certain chemicals (mainly dioxins and PBDEs) concentrated in breast milk; but there are other chemicals also present in breast milk (see www.breastfeeding-toxins.info), which could also have unknown harmful effects.
A study published in 2012 on effects of PBDEs related to hyperactivity in human children is of interest. It measured levels of PBDEs in breast milk of 222 mothers and divided them into quartiles according to those levels. Note that the findings showed apparent adverse effects of PBDE exposures in about half of the breastfed children studied: in both the first and second quartiles. The investigators found that children whose mothers had levels of a type of PBDE in the top quartile were "3.3 (95% CI: 1.3, 8.2) times more likely to have activity/impulsivity subscale scores in the top 20% of our sample compared with children whose mothers had milk levels of these BDEs below the median...." The children with mothers in the second quartile, merely above average, had activity/impulsivity scores that showed them to be 2.1 times more likely to be in the top 20% in activity/impulsivity (95% CI: 0.8, 5.4)). (Children who had high activity/impulsivity subscale scores were rated by their parents as very active, fidgety, having trouble sitting still, or having difficulty inhibiting their actions.) The authors predicted that young children with high activity/impulsivity scores would be disproportionately likely to be "later diagnosed with attention deficit/hyperactivity disorder (ADHD)." Continuing, "Our focus on early childhood may underestimate the potential for the association between PBDEs and behavior later in development, as animal toxicology models demonstrate that the neurodevelopmental impact of early-life PBDE exposures may worsen or become more apparent with age. (Viberg)" (304a)
For additional information on adhd and serious psychological problems as related to breastfeeding, see www.breastfeeding-and-adhd.info.
Section 3: Correlations between levels of breastfeeding and incidences of various disorders in children
One detail from a CDC publication (below) is worth special notice: White children were found to have the highest percentages of emotional or behavioral problems: Prevalence was far lower among black children, and Hispanics were in between. In this regard, note that breastfeeding rates are highest among whites, about 50% lower among blacks, and Hispanics are in between. (see Section 1.2.s.3 of www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm) Notice in the chart below that the ratio of white-to-black emotional and behavioral problems was especially high in the 3-5 age group, the group that would have been most directly affected by the neuro-developmental toxins in breast milk.
It should also be noted that the above is yet another example of very same pattern that was noted before related to the correlations between levels of diseases and levels of breastfeeding among various groups, including according to ethnic, economic or social categories. Some of the correlations are worth repeating here:
-- relatively high asthma rates among whites aged 0-4 (whites breastfeed at higher rates than other ethnic groups); there was also a dramatic rise in asthma only in the specific ethnic group in which breastfeeding had previously increased sharply, at a time when most asthma rates and breastfeeding rates were merely increasing slowly (see www.breastfeedinginfo.info/asthma-and-breastfeeding.htm);
-- obesity in the specific birth cohorts in which breastfeeding had risen greatly, at the specific times when increases in breastfeeding could have caused those increases in obesity (see Section 1 of www.breastfeedingprosandcons.info);
-- childhood diabetes having risen remarkably rapidly only in the specific world region that was the one in which breastfeeding rates had been rising extraordinarily rapidly, and having declined only in the specific world region that was the one in which breastfeeding had been declining. There were also many other international and demographic correlations (see www.breastfeeding-and-diabetes.info);
-- leukemia rising only among children, while breastfeeding was increasing rapidly, and while leukemia was not rising in the general population (see http://www.breastfeeding-and-cancer.info);
-- autism high among children of the more highly educated (Section 1.2.s.1.a*), autism high among children of older mothers (Section 1.2.s.1.b*), autism high among children of first-time mothers (Section 1.2.s.1.c*), and autism high among whites (Section 1.2.s.3*); breastfeeding rates are unusually high among all of those specific demographic groups. *Note: the above Section numbers refer to sections in www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm
-- childhood cancer high among those same groups that were mentioned just above (see http://www.breastfeeding-and-cancer.info); and
-- otitis media high among children of more affluent families, and increasing among the specific income group whose breastfeeding rates had risen the most (Section 8 of http://www.breastfeedingprosandcons.info,).
The groups with the greatest exposure to breastfeeding (and therefore to the concentrations of developmental toxins and carcinogens in contemporary human milk) had the highest rates of adverse health conditions, and the least-breastfed groups had the lowest levels of adverse health conditions. In addition to the above associations, there are also many more such correlations according to nations and U.S. states. (see Introductory Summary of www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm)
Autism accurately correlating with numerous variations in breastfeeding levels:
Note that breast milk contains concentrations of neurodevelopmental toxins at levels that the EPA recognizes to be scores of times higher than safe levels (see opening paragraph of www.breastfeeding-toxins.info). Some correlations of interest:
(a) autism is high or low in several different demographic groups in which breastfeeding is correspondingly high or low (see Introductory Summary of www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm) (see just above),
(b) autism is high or low across many nations in which breastfeeding is correspondingly high or low (see link just above), and
(c) one especially relevant quote from a study of all 50 U.S. states and 51 U.S. counties cited at the above-linked site found that "exclusive breast-feeding shows a direct epidemiological relationship to autism" and also, "The longer the duration of exclusive breast-feeding, the greater the correlation with autism."(310a)
Relationship of breastfeeding to growth of infants – including growth of nerve tissue, specifically
Looking at previous studies by other scientists, an international research group noted that "Breast feeding is often associated with slowed postnatal growth.....Breast feeding is thought to confer an advantage for growth during the first few months, but data on continued growth generally suggest that continued breastfeeding has a negative effect." This group's study, carried out in the Faroe Islands, added considerable support to those earlier findings. The breastfeeding mothers and children in this study had elevated mercury exposure due to a high seafood diet, but the researchers pointed out that "levels similar to or in excess of those recorded in the Faroes have been published from other communities with high seafood or freshwater fish intakes." (319) (italics added) And a very high percentage of mothers in developed countries have exposures that are substantial, even though not typically as high as the exposures of these mothers.
The 5% reduced growth of the breastfed children as shown above may seem not to justify major concern, especially since it was found in children of mothers who had elevated levels of methylmercury due to high seafood consumption. But it is worth considering the particular body organ(s) or systems that might be bearing the brunt of any growth reduction (combined with the fact that most mothers in developed countries have some exposure to the same seafood consumption that elevated the mercury in the mothers in this study). By far the greatest effect that has been observed of methylmercury is on neurological development. A reduction of a few percent in body weight could be especially significant if most of that reduction is in neurological tissue, which includes the brain. That might well be what is happening.
This apparent effect of mercury in breast milk should be seen together with the fact that mercury has been increasing in the environment (it originates basically from combustion, especially of coal, and it keeps accumulating in water bodies as well as in air and soil). Also it should be remembered that mercury is only one of various developmental toxins in human milk, including dioxins in especially high concentrations (see www.breastfeeding-toxins.info). The overall significance becomes more serious considering the major increases in breastfeeding rates in recent decades in most of the developed world (see Fig. 1 and www.breastfeeding-rates.info). All of these factors combined could help explain the increases in mental retardation and developmental disabilities described in www.breastfeedingnegatives.info, as well as the increases in autism (see www.breastfeeding-and-autism.net).
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There has been a major increase in the ratio of males to females with mental difficulties in recent decades, which would seem to be best explainable by a major real increase in a kind of mental impairment that affects males very disproportionately, as is the case with autism. (See Footnote 4.) And when noticing the very disproportionate adverse outcomes among males, it should be remembered that
a) two of the developmental toxins that are known to be highly concentrated in human milk (dioxins and PBDEs) are both known to have testosterone-reducing effects, and
b) testosterone, a predominantly-male hormone, is known to be important to neurological development. (See Section 2 above.)
If an infant food is known to contain high concentrations of chemicals recognized to reduce a chemical that is important to male mental development, at a time when male children have been increasingly and disproportionately having neuro-developmental problems, that infant food should be receiving careful scrutiny. That is especially true if a study of all 50 U.S. states and 51 U.S. counties has found consumption of that infant food to correlate closely with incidence of autism. The authorities who are promoting that infant food ought to be prepared to answer some questions about the evidence on which they base that promotion. But they never respond to inquiries that question their positions. More specifically, the American Academy of Pediatrics, American Academy of Family Physicians, American Congress of Obstetricians and Gynecologists, and the World Health Organization have never responded to any of three or more letters to each organization from this author, as of two and more months after the mailings; the U.S. Department of Health and Human Services justifies its position by referring to the positions of the above organizations; none of the above has said anything to criticize the evidence presented by this author that casts doubt on the advisability of breastfeeding in developed countries.
When people promoting a questionable position have nothing to say in defense of their position, what does that say about the validity of their case?
Of the disorders that the Surgeon General alleges to be reduced by breastfeeding, a total of one (1) has not actually increased substantially while breastfeeding rates increased substantially:
And that disorder (SIDS) did not decline at all as breastfeeding increased greatly, as should have happened if there had been merit to the Surgeon General's opinion in this matter. The fact that SIDS deaths did not decline following the major increases in breastfeeding, despite the allegations that not breastfeeding means a 56% excess risk of SIDS, is dealt with in more detail in Section 9 of www.breastfeedingprosandcons.info . That section also explains why the basis for those allegations was so poor in the first place.
To read about general health trends, including upward trends in activity limitations, mental retardation, developmental disabilities, and chronic health conditions, all correlating closely with variations in breastfeeding with its known content of developmental toxins, go to www.breastfeedingnegatives.info. However, that section contains considerable detail, so the reader might want to postpone going there until time is available for concentrated reading. For a 3-page summary of declines in child health that have synchronized closely with increases in breastfeeding, go to www.breastfeeding-effects.info.
Other noteworthy increases in childhood disorders:
(Note that the first four below have been referred to as epidemics among children, although there is debate in that regard concerning autism):
- - Huge increases in child obesity (quadrupling since the early 1970's), according to CDC data; for information about that, go to http://www.child-obesity.us.
- - Increases in asthma and allergies in recent decades; for CDC data about those increases, go to www.breastfeeding-and-asthma.info/.
- - Increases in childhood diabetes in recent decades; to see authoritative data about that, go to www.breastfeeding-and-diabetes.info.
- - Apparently greatly increasing autism in recent decades; to read about that go to www.breastfeeding-and-autism.net
- - Childhood cancer continuing to increase while cancer has been decreasing in the general population; to read about that, go to www.breastfeeding-and-cancer.info.
All of the above increases have come when there have not been similar increases in limitations among adults, and when many risk factors for disabilities among children have been declining.
As has been pointed out in this author's letters to leading U.S. governmental and medical officials who are promoting breastfeeding, their claims of health benefits to infants of breastfeeding are weakly based, given the confounding factors of low income and smoking that are typical characteristics of bottle-feeders, which factors are known causes of all of the adverse outcomes attributed by their agencies to bottle feeding. In all of their polite replies to letters containing this rebuttal of their case for breastfeeding, not one has responded in any way to the above point (or to any of the other points in the rebuttal). As indicated above, there is excellent evidence confirming that (compared with highly-breastfed generations) the least-breastfed generation was apparently much better off with respect to almost all of the adverse conditions alleged to result from not breastfeeding. (See details at www.breastfeedingprosandcons.info.) In the case of the only exception to the normal pattern of better health for the low-breastfed generation (SIDS), at least the low-breastfed generation was no worse off, adding to the confirmation that the allegations of "excess health risks" of not breastfeeding are not valid. There have also been other serious adverse conditions that have greatly increased among U.S. children during the high-breastfeeding period, conditions that were apparently insignificant or minor during the period of low breastfeeding: ADHD, serious emotional and behavioral problems, type 1 diabetes, and (probably) autism.
Also, a whole generation of young Japanese men has grown up who were born after breastfeeding rates went from low to high in that country, a new generation of males whose conspicuous traits should make one think seriously: lack of interest in sex, effeminate interests, greater attachment to their mothers than to female contemporaries, with all of that not surprisingly leading to plummeting birth rates. National alarm has arisen in Japan over these developments, and explanations offered appear to be merely conjectures that are devoid of scientific basis. (See Section 1.2.b.2 of www.pollutionaction.org/breastfeeding-and-autism-and-cancer.htm) Nobody seems to be making the connection that high-quality scientific studies have found de-masculinizing, testosterone-lowering effects in laboratory animals to result from certain chemicals that are known to be concentrated in breast milk; breastfeeding increased greatly in the years during which this new generation of young men were infants. Highly-industrialized, densely-populated, polluted Japan would have especially high levels of these environmental chemicals bio-accumulated into breast milk in that country. Other developed countries would have the same or similar chemicals in their breast milks, but normally at lower levels; below-replacement-level birth rates and widepread resorting to expensive, possibly hazardous assisted reproductive technologies have become normal in developed countries in recent decades, following increases in breastfeeding in those countries. (The U.S. birth rate, which has recently been 1.1 birth per native-born, married woman, has been spared from far-below-replacement level only by births to immigrant women and unmarried women.)
So the establishment opinion (acknowledged by the Surgeon General to be based only on inferences) is that breastfeeding is protective against certain diseases and conditions; yet, during the period of greatly increased breastfeeding, all except one of those conditions have actually increased substantially, in comparison with levels prevalent for the low-breastfed mid-century generation.. Those are in addition to rapid increases in ADHD, serious emotional and behavioral difficulties among U.S. children, and unusually high rates of childhood cancer and type 1 diabetes in high-breastfeeding countries and U.S. states, all of which came about after breastfeeding became the norm, replacing the low-breastfeeding pattern of the mid-century. (Notice in Figure 1 that the U.S. breastfeeding percentage at 6 months increased by about 600% between 1974 and 2007.)
All of those diseases and conditions could reasonably be assumed to be likely results of either or both of the following:
(a) the concentrations of various developmental toxins and carcinogens (especially dioxins, in over 80 times the dosage that the EPA considers to be safe) that would have been increasingly transmitted to infants via the greatly increased breastfeeding, and/or
(b) excessive shielding of infants from microbes, as a result of the infants' ingesting immune cells from an external source (breast milk), leading to inadequately-developed immune systems. (see "Immunity Effects" earlier)
One final note: Note that (quoting from the NIH's website, as found in www.breastfeeding-toxins.info), "Endocrine disruptors (which include dioxins)... may pose the greatest risk during prenatal and early postnatal development when organ and neural systems are developing.” (The brain is the central part of the neural system.) And according to the National Academy of Sciences, ”Agents that interact with one or more of these receptors and are known to produce abnormal development include dioxin (TCDD)." Explaining how dioxin affects the developing body, the NAS committee points out that it "... alters the expression of several dozen genes, one or more of which might result in an adverse developmental outcome." There was a relevant comment by the authors of the 2012 study that found a doubling and tripling of activity/impulsivity scores in young children whose mothers had above-average levels of PBDEs in their breast milk: "Animal toxicology models demonstrate that the neurodevelopmental impact of early-life PBDE exposures may worsen or become more apparent with age." Remember from earlier in this article the quotation from the summary of a 30-year study finding that, compared to people without ADHD in their teens and adulthood, those with the disorder were more than three times as likely to have antisocial personality disorder.
Readers whose memories go back a few decades to when the low-breastfed generation was young (1950-1985) should try to think of how many cases there were in those days of teenagers and young men who would take guns to schools or other public places and start shooting, vs. how many such cases there have been in the U.S. in recent years. Then remember that since the early 1970's there has been a dramatic increase in breastfeeding rates, causing infants (whose brains are rapidly developing and vulnerable to toxins) to ingest dioxin in doses over 80 times the level that the EPA considers to be a safe level for that recognized neuro-developmental toxin. Also remember that the United States government has since about 1990 been strongly promoting that infant feeding. And that promotion provides no hint that there could be any drawbacks to that type of feeding. Moreover, the average parent never sees the inconspicuous acknowledgement by the Surgeon General that the evidence in favor of that feeding is based entirely on inference, nor do they see the highest-level official recognition that such evidence is subject to error and false conclusion. And when all of this is presented to the officials who are responsible for this promotion, they say nothing that contradicts it.
A question that should be addressed to those who are recommending breastfeeding, but which they probably won't want to answer:
Given (a) the inconclusiveness of the studies that support breastfeeding,** (b) the known concentrations of environmental toxins in recent human milk,** and (c) the many close correlations between variations in breastfeeding levels and similar variations in levels of serious childhood diseases (seen in national health data**): How do we know that breastfeeding is more beneficial than harmful?
** Supporting information and references to authoritative sources regarding matters raised in this question are included in a one-page printable version of this question, to be found at www.pollutionaction.org/Q.pdf .
We have good reason to say that those who recommend breastfeeding probably will not have an answer to the above question. A slightly different version of essentially this same question was mailed to four different high officials at the U.S. Department of Health and Human Services, who are heads of divisions that are involved in promoting breastfeeding. As of a year after mailing those letters, no reply has been received. Several months earlier, each of those officials had sent one polite response to an earlier letter that brought up the matters above, and none of their responses said anything in criticism of any of those points. Those points are all well substantiated. So the question that now comes at the end, above, is a logical question to ask. But the promoters of breastfeeding appear to be unwilling or unable to respond to it. If they won't (or, more likely, can't) answer that question as part of an informed debate on this matter (therefore to email@example.com, as well as to you), should anybody pay attention to their advice?
Message to health professionals and scientists reading this paper: This author cordially invites you to indicate your reactions to the contents presented here. As of now, new parents almost never hear anything but completely one-sided promotion of breastfeeding, with no mention of possible drawbacks except in cases of serious problems on the part of the mother. If you feel that parents should be informed about both sides of this question and thereby enabled to make an educated decision in this important matter, please write to the author of this paper. Also, if you find anything here that you feel isn't accurately drawn from trustworthy sources or based on sound reasoning, please by all means send your comments, to firstname.lastname@example.org.
Comments or questions are invited. At the next link are comments and questions from readers, including a number of doctors. Some of the doctors have been critical but at least four have been in agreement with us, including two with children of their own with health problems and one who says she has delivered thousands of babies; they put into briefer, everyday language and personal terms some important points that tend to be immersed in detail when presented in our own publications. Also, we have responded to many readers’ questions and comments, including about having breast milk tested for toxins and about means of trying to achieve milk that is relatively free of toxins, including the “pump and dump” option. To read the above, with a link for sending your own comments or questions, go to www.pollutionaction.org/comments.htm If you have criticisms, please be specific about any apparent inaccuracies, rather than merely saying you don’t like what is said here. Note that we don’t feel obligated to present the favorable side of the breastfeeding debate, since that is already very amply (and one-sidedly) presented in many other, widely-distributed publications as well as in person by numerous enthusiastic promoters.
To return to the page you were at before coming to this one, click on the "back" arrow on your browser. The home page for Pollution Action, with a listing of our various articles, is at www.pollutionaction.org .
* About Pollution Action and the author of this article: Please visit www.pollutionaction.org
1) Breastfeeding, Family Physicians Supporting (Position Paper) -- AAFP Policies -- in American Academy of Family Physicians web site.
3) U.S. EPA. "Estimating Exposure To Dioxin-Like Compounds - Volume I": U.S. Environmental Protection Agency, Washington, D.C., EPA/600/8-88/005Ca., 2002, revised 2005 – http://cfpub.epa.gov/si/si_public_record_Report.cfm?dirEntryID=43870, Section II.6, "Highly Exposed Populations" (nursing infants are considered to be one of the highly-exposed populations), 4/94 (p. 39): "Using these procedures and assuming that an infant breast feeds for one year, has an average weight during this period of 10 kg, ingests 0.8 kg/d of breast milk and that the dioxin concentration in milk fat is 20 ppt of TEQ, the average daily dose to the infant over this period is predicted to be about 60 pg of TEQ/kg-d."
In its most recent dioxin assessment, issued February, 2012, the EPA set the threshold for safe dioxin exposure at a toxicity equivalence (TEQ) of 0.7 picograms per kilogram of body weight per day. http://www.epa.gov/iris/supdocs/dioxinv1sup.pdf in section 4.3.5, at end of that section: "...the resulting RfD in standard units is 7 × 10−10 mg/kg-day." (that equals 0.7 pg) In the EPA’s “Glossary of Health Effects”, RfD is defined as follows: “RfD (oral reference dose): An estimate (with uncertainty spanning perhaps an order of magnitude) of a daily oral exposure of a chemical to the human population (including sensitive subpopulations) that is likely to be without risk of deleterious noncancer effects during a lifetime.”
Concerning infant exposure via breast milk vs. via formula: Infant Exposure to Dioxin-like Compounds in Breast Milk, Lorber and Phillips Volume 110 | Number 6 | June 2002 • Environmental Health Perspectives at http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=54708#Download Also EPA Home/Research/Environmental Assessment: An Evaluation of Infant Exposure to Dioxin-Like Compounds in Breast Milk, Matthew Lorber (National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency) et al. Also other sources available on request regarding dioxins in formula.
(4) As reported to the U.S. Census Bureau, data for recent decades shows a very disproportionate number of male children with disabilities, especially mental impairment, with the gender ratio becoming more uneven among more recent births. This is evident in a National Academies Press publication (TABLE 3-1 of The Future of Disability in America, Institute of Medicine (US) Committee on Disability in America; Field MJ, Jette AM, editors. National Academies Press (US); 2007, found at http://www.ncbi.nlm.nih.gov/books/NBK11437/table/a2001315cttt00007/?report=objectonly) The U.S. Census Bureau’s question that was apparently used for obtaining this data asks, "Because of a physical, mental or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions?” The percentage of males said to have such mental difficulties who were born since the early 1990’s is twice as high as the percentage of females in the same age group (that is, 5.2% for male children nationwide, which includes many of those with autism, vs. 2.6% of females); this is in sharp contrast with the apparently gender-equal numbers that apply to those born in the half-century leading up to the mid-1970’s. And those born in the period between the mid-1970’s and the early 1990’s had an intermediate male-female disproportion of impairments. (This data is from U.S. Census Bureau Table B18104: SEX BY AGE BY COGNITIVE DISABILITY Universe: Civilian non-institutionalized population 5 years and over. Data Set: 2008-2010 American Community Survey 3-Year Estimates (accessed Jan. 2012 at http://factfinder2.census.gov , using their search process) The even ratio of mental disability among people born up to the mid-1970's, becoming very uneven later, is compatible with various studies.(Leonard et al. 2002; Gissler et al. 1999, as reported in Maulik PK, Harbour CK, 2011: Epidemiology of Intellectual Disability. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/en/article/144/ )
-- According to U.S. Dept. of Education IDEA data (Table 1-12: Children and students served under IDEA, Part B, in the U.S. and outlying areas, by gender and age group: Fall 1999 through fall 2008 at https://www.ideadata.org/arc_toc10.asp#partbCC), the ratio of male to female children age 6-21 with disabilities in recent years has been 2 to 1, but among children 3 to 5 the ratio has been 7 to 3; this implies a ratio of impaired male to female children that has been becoming still more uneven than the 2 to 1 ratio; remember that the 2-to-1 ratio was itself a dramatic change from gender equality a few decades earlier. The above widens the scope of the uneven gender ratio of impairment beyond what is seen in the major increases in diagnosed cases of autism in recent decades.
(5) Agency for Healthcare Research and Quality, U.S. DHHS, Systems to Rate the Strength of Scientific Evidence, Evidence Report/Technology Assessment: Number 47 http://archive.ahrq.gov/clinic/epcsums/strengthsum.pdf
(6) "Breastfeeding is not as beneficial as once thought" (06.01.2010) published by the Norwegian University of Science and Technology, at http://www.ntnu.edu/news/breastfeeding Quoting especially Professor Sven M. Carlsen, Manager of Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU.
(45) Ahlborg UG, Hanberg A, Kenne K. Risk Assessment of Polychlorinated Biphenyls (PCBs). Environmental Report in the Nord Series. Nord 26. Copenhagen: Nordic Council of Ministers, 1992.
(300) Health of Generations, Jeanne Faulkner, RN Article provided by Regence BlueCross BlueShield of Oregon, at https://www.myasuris.com/content/articles/personal_health/aging/Article_HealthofGenerations.htm (Asuris Northwest Health)
(300a) Diagnostic controversies in adult attention deficit hyperactivity disorder. McGough JJ, et al., Am J Psychiatry. 2004 Nov;161(11):1948-56.
(302) Management of the Cardinal Features of Andropause, Arshag D. Mooradian and Stanley G. Korenman American Journal of Therapeutics 13, 145–160 (2006)
(303) Intelligence and salivary testosterone levels in prepubertal children Ostatnıkova et al., Institute of Physiology, School of Medicine, Comenius University, Bratislava, Slovak Republic Neuropsychologia 45 (2007) 1378–1385 Elsevier at https://www.yumpu.com/en/document/view/28653030/intelligence-and-salivary-testosterone-levels-in-prepubertal-children/3
(304) see #305 below
(304a) Lactational Exposure to Polybrominated Diphenyl Ethers and Its Relation to Social and Emotional Development among Toddlers
Kate Hoffman, et al., Environ Health Perspect. 2012 October; 120(10): 1438–1442. Published online 2012 July 19. doi: 10.1289/ehp.1205100 PMCID: PMC3491946 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491946/
(305) Hormonal associations with childhood ADHD and associated trait and neuropsychological mechanisms by Martel, Michelle M., Ph.D., Michigan State University, 2008; AAT 3348153 Quotation taken from abstract at http://proquest.umi.com/pqdwebRQT=305&attempt=1&skip=1&SQ=STYPE(dissertation)+AND+ISBN(9781109036756)&cfc=1
(305a) Board on Environmental Studies and Toxicology, National Academy of Sciences, National Academies Press: Health Risks from Dioxin and Related Compounds: Evaluation of the EPA Reassessment (2006) p. 323
(306b) Better Economic Status Tied to Peanut Allergy in Kids: Study For children aged 1 to 9, living in affluent household may raise risk, researchers say By Robert Preidt HealthDay, Medline Plus, U.S. National Library of Medicine, NIH Friday, November 9, 2012 http://www.nlm.nih.gov/medlineplus/news/fullstory_131177.html
(307) Allergies are mysteriously on the rise in U.S. http://www.msnbc.msn.com/id/36060765/ns/health-allergies_and_asthma/t/allergies-are-mysteriously-rise-us/ Also Research needs in allergy: an EAACI position paper, in collaboration with EFA, Papadopoulos et al. Clinical and Translational Allergy 2012, 2:21 at http://www.ctajournal.com/content/2/1/21
(307a) Girls With ADHD At Risk for Self-Injury, Suicide Attempts As Young Adults, Says New Research American Psychological Assn. August 14, 2012 reported in Medline Plus Weekly Digest Bulletin, 11/25/2012
(307b) Data table for Figure 37, Death rates for leading causes of death among young adults 18-29 years of age, by sex: United States, 1980-2005 in CDC's Health United States, 2008 At http://www.cdc.gov/nchs/data/hus/hus08.pdf That data table can be found at www.pollutionaction.org/HUS_08data2.jpg
(307c) "ADHD Can Cause Lifelong Problems, Study Finds." In HealthDay News of NIH, in Medline Plus Weekly Digest Bulletin of 12/23/12 at http://www.nlm.nih.gov/medlineplus/news/fullstory_132091.html
(307c1) Vanderbilt University study cited at http://www.psychmedaware.org/statement.html
(307c2) Table 4 of Fariz Rani et al., Epidemiologic Features of Antipsychotic Prescribing to Children and Adolescents in Primary Care in the United Kingdom, online at http://pediatrics.aappublications.org/content/121/5/1002.full
(309) Why are allergies increasing? April 13, 2010 http://phys.org/news190391661.html
Provided by University of Montreal. Dr. Delespesse is also director of the Laboratory for Allergy Research at the Centre hospitalier de l'Université de Montréal.
(309a) Diabetes in Children and Teens, Medline Plus, U.S. National Library of Medicine, NIH at http://www.nlm.nih.gov/medlineplus/diabetesinchildrenandteens.html Second quote from Medline Plus Weekly Digest Bulletin, 11/25/2012 at http://www.nlm.nih.gov/medlineplus/news/fullstory_131557.html
(309aa) Type 2 Diabetes in Children and Young Adults: A “New Epidemic” Francine Ratner Kaufman, MD CLINICAL DIABETES • Volume 20, Number 4, 2002 at http://clinical.diabetesjournals.org/content/20/4/217.full.pdf+html
(309a2) "The Effects of Perceiving "Weak Health" in Russia: the Case of Breastfeeding," Cynthia Gabriel, Anthropology of East Europe Review. Vol. 17. No. I 2003, Page: 91ff at http://www.scholarworks.iu.edu/journals/index.php/aeer/article/view/368
(309a3) The ‘hygiene hypothesis’ for autoimmune and allergic diseases: an update H Okada, et al., Clinical and Experimental Immunology, 2010 April; 160(1): 1–9. doi: 10.1111/j.1365-2249.2010.04139.x PMCID: PMC2841828 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841828/
(309a4) Cold Spring Harb Perspect Med 2012. 2: 2012 Cold Spring Harbor Laboratory Press; all rights reserved The Pathogenesis and Natural History of Type 1 Diabetes Mark A. Atkinson
(309b) CDC's "Pertussis Frequently Asked Questions" at http://www.cdc.gov/pertussis/about/faqs.html
(309c) Friday, November 30, 2012 Why is whooping cough on the rise, and what can you do about it? Kristen A. Feemster, M.D.,M.P.H., assistant professor of pediatrics at Children's Hospital of Philadelphia, http://www.philly.com/philly/blogs/public_health/Why-is-whooping-cough-back-and-what-can-you-do-about-it.html
(309h) Prevention and treatment of respiratory syncytial virus bronchiolitis and postbronchiolitic wheezing Jan LL Kimpen Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands Respiratory Research 2002, 3 (Suppl 1):S40-S45 doi:10.1186/rr183 online at: http://respiratory-research.com/content/3/S1/S40
(309i) Bronchiolitis-associated hospitalizations among US children, 1980-1996. Shay DK et al., JAMA.
1999 Oct 20; 282(15):1440-6. At http://www.ncbi.nlm.nih.gov/pubmed/10535434
(309k) Summary of Trends in Breastfeeding (National) 2011 Pediatric Nutrition Surveillance (CDC) Table 13D Children Aged < 5 Years Page 34 at http:/www.cdc.gov/pednss/pednss_tables/pdf/national_table13.pdf
(309l) http://www.nal.usda.gov/wicworks/Learning_Center/research_brief.pdf p. 12
(309m) Shay DK,et al., JAMA. 1999 Oct 20;282(15):1440-6. Bronchiolitis-associated hospitalizations among US children, 1980-1996.
(309o) J Pediatr. 1990 Aug;117(2 Pt 2):S101-9. Impact of the Special Supplemental Food Program on infants. Batten S et al. http://www.ncbi.nlm.nih.gov/pubmed/2380844
(309p) in Food allergy: Riding the second wave of the allergy epidemic Susan Prescott http://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2011.01145.x/pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079317/
(310) The causes of the increasing prevalence of allergy: Is atopy a microbial deprivation disorder? Review Article Allergy 56 (2), 91-102, 2001 O. Strannegård and I-L. Strannegård quoted at http://docnovak.com/novak%20articles/Article_32-01.%20The%20Causes%20of%20the%20Increasing%20Prevalence%20of%20Allergy.%20Is%20Atopy%20a%20Microbial%20Deprivation%20Disorder.strannegard.pdf1
(310a) Autism rates associated with nutrition and the WIC program. Shamberger R.J., Phd, FACN, King James Medical Laboratory, Cleveland, OH J Am Coll Nutr. 2011 Oct;30(5):348-53. Abstract at www.ncbi.nlm.nih.gov/pubmed/22081621
(311) at http://ec.europa.eu/food/food/biosafety/salmonella/13_gastrointestinal_infections_2001.pdf
(311a) at http://ageconsearch.umn.edu/bitstream/20050/1/sp04ad01.pdf
(311b) (Increases from 66.7% to 69.7%, 41.1% to 45.8%, and 34.8% to 41.1% average out to growth from 47.5% to 52.2%, constituting a 10% overall growth for the period.) Trends in otitis media among children in the United States. Auinger P et al., Pediatrics. 2003 Sep;112 (3 Pt 1):514-20. at http://www.ncbi.nlm.nih.gov/pubmed/12949276
(312) American Academy of Pediatrics Policy Statement on Sudden Infant Death Syndrome at http://pediatrics.aappublications.org/content/116/5/1245.full.pdf+html
(313a) A summary of the available surveys of disabilities during the recent decades, showing their spotty, inconsistent nature that isn't helpful in showing long-term trends, see The Internet Journal of Pediatrics and Neonatology ISSN: 1528-8374 A Review On The Prevalence Of Disabilities In Children, Joav Merrick MD, DMSc et al., at http://archive.ispub.com/journal/the-internet-journal-of-pediatrics-and-neonatology/volume-3-number-1/a-review-on-the-prevalence-of-disabilities-in-children.html#sthash.HVVV345a.dpbs
(313b) at http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201303_11.pdf, Data table for Figure 11.2
(314) AAP publication at http://pediatrics.aappublications.org/content/127/6/1034.full.pdf. TheCDC chart shown was found at http://www.cdc.gov/nchs/ppt/nchs2012/SS-22_BLUMBERG.pdf
(315) CDC document found at http://wonder.cdc.gov/wonder/help/populations/bridged-race/NationalVitalStatisticsReportsVol50Number05.pdf
(316) From website http://www.ndss.org/Down-Syndrome/Down-Syndrome-Facts/ "All people with Down syndrome experience cognitive delays, but the effect is usually mild to moderate and is not indicative of the many strengths and talents that each individual possesses.
(316a) Federal Interagency Forum on Child and Family Statistics. America’s Children: Key National Indicators of Well-Being, 2005, p. 43. Federal Interagency Forum on Child and Family Statistics, Washington, DC: U.S. Government Printing Office
(316b) Childhood Health: Trends and Consequences over the Life-course, Liam Delaney et al., Future Child. 2012 Spring; 22(1): 43–63. PMCID: PMC3652568 NIHMSID: NIHMS461654
(317a) Smith James P., Smith Gillian C. Long-term Economic Costs of Psychological Problems during Childhood. Social Science and Medicine. 2010;71(no. 1):110–15. Also Goodman Alissa, Joyce Robert, Smith James P. The Long Shadow Cast by Physical and Mental Problems on Adult Life. PNAS; Proceedings of National Academy of Sciences. 2011;108(no. 15):6032–37
(317b) First- and Second-Generation Antipsychotics for Children and Young Adults (Internet); NIH publication found at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0040944/
(317c) Increasing Off-Label Use Of Antipsychotic Medications In The United States, 1995-2008 G. Caleb Alexander, MD, MS, et al., found at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3069498/ Pharmacoepidemiol Drug Saf. 2011 February; 20(2): 177–184. Published online 2011 January 6. doi: 10.1002/pds.2082 PMCID: PMC3069498 NIHMSID: NIHMS275845
(317d) National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Olfson M, et al., Arch Gen Psychiatry. 2006 Jun;63(6):679-85. http://www.ncbi.nlm.nih.gov/pubmed/16754841
(317e) National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Moreno C, et al., Arch Gen Psychiatry. 2007 Sep;64(9):1032-9.
(317f) WHO/Europe, European HFA database, Jan. 2012
(317g) Use of antipsychotic drugs among Dutch youths between 1997 and 2005. Kalverdijk LJ, et al., Psychiatr 2008 May;59(5):554-60. doi: 10.1176/appi.ps.59.5.554.http://www.ncbi.nlm.nih.gov/pubmed/18451016
(317h) Fariz Rani et al., Epidemiologic Features of Antipsychotic Prescribing to Children and Adolescents in Primary Care in the United Kingdom, online at http://pediatrics.aappublications.org/content/121/5/1002.full
(319) Attenuated growth of breast-fed children exposed to increased concentrations of methylmercury and polychlorinated biphenyls, P. Grandjean et al., FASEB J. (February 5, 2003) 10.1096/fj.02– 0661fje at http://www.fasebj.org/content/17/6/699.full.pdf
* For information about Pollution Action and the author of this article, go to www.pollutionaction.org