Breast Milk: A Comprehensive Guide PDF

-Breast milk -Mother's milk By Dr.Ghada Tajelsir Abdoun Breast milk (sometimes spelled as breastmilk) or is milk produced by mammary glands located in the breast of a human female. Breast milk is the primary source of nutrition for newborns, containing fat, protein, carbohydrates...

-Breast milk -Mother's milk By Dr.Ghada Tajelsir Abdoun Breast milk (sometimes spelled as breastmilk) or is milk produced by mammary glands located in the breast of a human female. Breast milk is the primary source of nutrition for newborns, containing fat, protein, carbohydrates (lactose and human milk oligosaccharides) and variable minerals and vitamins. Breast milk also contains substances that help protect an infant against infection and inflammation, whilst also contributing to healthy development of the immune system and gut microbiome  Contents 1 Uses and methods of consumption 2 Benefits 3 Production 4 Composition 5 Storage of expressed breast milk 6 Comparison to other milks 7 Effects of medications and other substances on milk content 8 Market 9 Older consumption 9.1 Restaurants and recipes 9.2 Bodybuilders 10 See also 11 References  Uses and methods of consumption The World Health Organization recommends exclusive breastfeeding for the first six months of life, with solids gradually being introduced around this age when signs of readiness are shown-Supplemented breastfeeding is recommended until at least age two and then for as long as the mother and child wish Breast milk can also be pumped from the mother using a breast pump and fed by baby bottle, cup and/or spoon, supplementation drip system, or nasogastric tube.  For infants who are born early (preterm birth) and do not have the ability to suck right away, the use of cups to feed expressed milk and other supplements is reported to result in better breastfeeding extent and duration compared with bottles and tube feeding For women who do not produce sufficient amounts of breast milk, donor human breast milk that is pasteurized may be effective If pasteurized donor breast milk is not available, commercial formula is suggested as a second alternative Breast milk supplied by a woman other than the baby's mother that is not pasteurized and informal breast milk sharing is associated with a risk of transmitting bacteria and viruses from the donor mother to the baby and is not considered a safe alternative  Benefits Breastfeeding offers health benefits to mother and child even after infancy These benefits include proper increased intelligence decreased likelihood of contracting middle ear infections cold and flu resistance a tiny decrease in the risk of childhood leukemia lower risk of childhood onset diabetes decreased risk of asthma and eczema decreased dental problems, decreased risk of obesity later in life and a decreased risk of developing psychological disorders, including in adopted children.  In addition, feeding an infant breast milk is associated with lower insulin levels and higher leptin levels compared feeding an infant via powdered- formula. Breastfeeding also provides health benefits for the mother. It assists the uterus in returning to its pre-pregnancy size and reduces post-partum bleeding, through the production of Oxytocin Breastfeeding can also reduce the risk of breast cancer later in lifeLactation may also reduce the risk for both mother and infant from both types of diabetes Lactation may protect the infant from specifically developing Type 2 diabetes, as studies have shown that bioactive ingredients in human breast milk could prevent excess weight gain during childhood via contributing to a feeling of energy and satiety. A lower risk of child-onset diabetes may be more applicable to infants who were born from diabetic mothers  The reason is that while breastfeeding for at least the first six months of life minimizes the risk of Type 1 diabetes from occurring in the infant, inadequate breastfeeding in an infant prenatally exposed to diabetes was associated with a higher risk of the child developing diabetes later However, it can be argued that human breastfeeding may contribute to protective effects against the development of Type 1 diabetes because the alternative of bottle-feeding may expose infants to unhygienic feeding conditions.  in some countries, use of infant formula was considered superior to breast milk However, it is now universally recognized that there is no commercial formula that can substitute breast milk. In addition to the appropriate amounts of carbohydrate, protein, and fat, breast milk provides vitamins, minerals, digestive enzymes and hormones Breast milk also contains antibodies and lymphocytes from the mother that help the baby resist infections The immune function of breast milk is individualized, as the mother, through her touching and taking care of the baby, comes into contact with pathogens that colonize the baby, and, as a consequence, her body makes the appropriate antibodies and immune cells.  At around four months of age, the internal iron supplies of the infant, held in the hepatic cells of the liver, are exhausted. Breast milk contains less iron than formula, because it is more bioavailable as lactoferrin, which carries more safety for mothers and children than ferrous sulphate. and the NHS recommend vitamin D supplementation for breastfed infants Vitamin D can be synthesised by the infant via exposure to sunlight, however, many infants are deficient due to being kept indoors or living in areas with insufficient sunlight. Formula is supplemented with vitamin D for this reason  Production Under the influence of the hormones prolactin and oxytocin, women produce milk after childbirth to feed the baby The initial milk produced is referred to as colostrum, which is high in the immunoglobulin IgA, which coats the gastrointestinal tract. This helps to protect the newborn until its own immune system is functioning properly. It also creates a mild laxative effect, expelling meconium and helping to prevent the build-up of bilirubin (a contributory factor in jaundice studies showing that mothers from malnourished regions still produce amounts of milk of similar quality to that of mothers in developed countries  There are many reasons a mother may not produce enough breast milk Some of the most common reasons are an improper latch (i.e., the baby does not connect efficiently with the nipple), not nursing or pumping enough to meet supply, certain medications (including estrogen-containing hormonal contraceptives), illness, and dehydration. A rarer reason is Sheehan's syndrome, also known as postpartum hypopituitarism, which is associated with prolactin deficiency and may require hormone replacement.  The amount of milk produced depends on how often the mother is nursing and/or pumping: the more the mother nurses her baby or pumps, the more milk is produced mother starts pumping milk sooner, even if the infant is unable to breastfeed Sodium concentration is higher in hand-expressed milk, when compared with the use of manual and electric pumps, and fat content is higher when the breast has been massaged, in conjunction with listening to relaxing audio. This may be important for low birthweight infants.[ If pumping, it is helpful to have an electric, high-grade pump so that all of the milk ducts are stimulated. Galactagogues increase milk supply, although even herbal variants[ carry risks. Non-pharmaceutical methods should be tried first, such as pumping out the mother's breast milk supply often, warming or massaging the breast, as well as starting milk pumping earlier after the child is born if they cannot drink milk at the breast.  Colostrum vs breastmilk During the first few days after delivery, the mother produces colostrum. This is a thin yellowish fluid that is the same fluid that sometimes leaks from the breasts during pregnancy. It is rich in protein and antibodies that provide passive immunity to the baby (the baby's immune system is not fully developed at birth).[ Colostrum will gradually change to become mature milk. In the first 3–4 days it will appear thin and watery and will taste very sweet; later, the milk will be thicker and creamier..  Human milk composition quenches the baby's thirst and hunger and provides the proteins, sugar, minerals, and antibodies that the baby needs The level of Immunoglobulin A (IgA) in breast milk remains high from day 10 until at least 7.5 months post- partum. milk contains 0.8% to 0.9% protein, 4.5% fat, 7.1% carbohydrates, and 0.2% ash (minerals Carbohydrates are mainly lactose; several lactose-based oligosaccharides have been identified as minor components The fat fraction contains specific triglycerides of palmitic and oleic acid (O-P- O triglycerides), and also lipids with trans bonds (see: trans fat). The lipids are vaccenic acid, and Conjugated linoleic acid (CLA) accounting for up to 6% of the human milk fat The principal proteins are alpha-lactalbumin, lactoferrin (apo-lactoferrin), IgA, lysozyme, and serum albumin  In an acidic environment such as the stomach, alpha-lactalbumin unfolds into a different form and binds oleic acid to form a complex called HAMLET that kills tumor cells. This is thought to contribute to the protection of breastfed babies against cancer. Non-protein nitrogen-containing compounds, making up 25% of the milk's nitrogen, include urea, uric acid, creatine, creatinine, amino acids, and nucleotides. Breast milk has circadian variations; some of the nucleotides are more commonly produced during the night, others during the day  Mother's milk has been shown to supply endocannabinoids (the natural neurotransmitters that cannabis simulates) -Arachidonoyl glycerolanandamide oleoylethanolamide Palmitoylethanolamide N-arachidonoyl glycine eicosapentaenoyl ethanolamide docosahexaenoyl ethanolamide, N-palmitoleoyl-ethanolamine dihomo-γ-linolenoylethanolamine,  N-stearoylethanolamine prostaglandin F2alpha ethanolamides and prostaglandin F2 ethanolamides Palmitic acid esters of hydroxy-stearic acids (PAHSAs They may act as an appetite stimulant, but they also regulate appetite so infants don't eat too much. That may be why formula-fed babies have a higher caloric intake than breastfed babies.  Breast milk is not sterile , but contains as many as 600 different species of various bacteria, including beneficial Bifidobacterium breve, B. adolescentis, B. longum, B. bifidum, and B. dentium, which contribute to colonization of the infant gut As a result, it can be defined as a probiotic food, depending on how one defines "probiotic". Breast milk also contains a variety of somatic cells and stem cells and the proportion of each cell type differs from individual to individual The somatic cells are mainly lactocytes and myoepithelial cells derived from the mother's mammary glands  The stem cells found in human breast milk have been shown to be able to differentiate into a variety of other cells involved in the production of bodily tissues and a small proportion of these cross over the nursing infant's intestinal tract into the bloodstream to reach certain organs and transform into fully functional cells.[ Because of its diverse population of cells and multifarious functions, researchers have argued that breast milk should be considered a living tissue Breast milk contains a unique type of sugars, human milk oligosaccharides (HMOs), which are not present in infant formula. HMOs are not digested by the infant but help to make up the intestinal flora They act as decoy receptors that block the attachment of disease causing pathogens, which may help to prevent infectious diseases. They also alter immune cell responses, which may benefit the infant. To date (2015) more than a hundred different HMOs have been identified; both the number and composition vary between women and each HMO may have a distinct functionality  The breast milk of diabetic mothers has been shown to have a different composition from that of non- diabetic mothers. It may contain elevated levels of glucose and insulin and decreased polyunsaturated fatty acids. A dose-dependent effect of diabetic breast milk on increasing language delays in infants has also been noted, although doctors recommend that diabetic mothers breastfeed despite this potential risk.[ Women breastfeeding should consult with their physician regarding substances that can be unwittingly passed to the infant via breast milk, such as alcohol, viruses (HIV or HTLV-1) or medications. Even though most infants infected with HIV contract the disease from breastfeeding, most infants that are breastfed by their HIV positive mothers never contract the disease risk of HIV transmission between an HIV positive mother and her child via breastfeeding is small Composition of human breast milk[] Fat (g/100 ml) 4.2 total fatty acids – length 8C 0.6 polyunsaturated fatty acids 0.016cholesterol Protein (g/100 ml) 1.1 total 0.4 casein 0.3 a-lactalbumin 0.2 lactoferrin (apo-lactoferrin) 0.1 IgA 0.001 IgG 0.05 lysozyme 0.05 serum albumin – β-lactoglobulin Carbohydrate (g/100 ml) 7 lactose 0.5 oligosaccharides Minerals (g/100 ml) 0.03 calcium 0.014 phosphorus 0.015 sodium 0.055 potassium chlorine 0.043  Fat (g/100 ml)total 4.2fatty acids – length 8Cpolyunsaturated fatty acids 0.6cholesterol 0.01  Protein (g/100 ml)total 1.1casein 0.4a-lactalbumin 0.3lactoferrin (apo-lactoferrin) 0.2IgA 0.1IgG 0.001lysozyme 0.05serum albumin 0.05β-lactoglobulin  Carbohydrate (g/100 ml)lactose 7oligosaccharides 0.5  Minerals (g/100 ml)calcium 0.03phosphorus 0.014sodium 0.015potassium 0.055chlorine 0.043  Storage of expressed breast milk[ Bottle of pumped breast milk Expressed breast milk can be stored. Lipase may cause thawed milk to taste soapy or rancid due to milk fat breakdown. It is still safe to use, and most babies will drink it. Scalding it will prevent rancid taste at the expense of antibodies It should be stored with airtight seals. Some plastic bags are designed for storage periods of less than 72 hours. Others can be used for up to 12 months if frozen. This table describes safe storage time limits  Comparison to other milks All mammalian species produce milk, but the composition of milk for each species varies widely and other kinds of milk are often very different from human breast milk. As a rule, the milk of mammals that nurse frequently (including human babies) is less rich, or more watery, than the milk of mammals whose young nurse less often. Human milk is noticeably thinner and sweeter than cow's milk.Whole cow's milk contains too little iron, retinol, vitamin E, vitamin C, vitamin D, unsaturated fats or essential fatty acids for human babies Whole cow's milk also contains too much protein, sodium, potassium, phosphorus and chloride which may put a strain on an infant's immature kidneys. In addition, the proteins, fats and calcium in whole cow's milk are more difficult for an infant to digest and absorb than the ones in breast milk The composition of marsupial and monotreme milk contains essential nutrients, growth factors and immunological properties to support the development of joeys and puggles.  Effects of medications and other substances on milk]Almost all medicines pass into breastmilk in small amounts by a concentration gradient The amount of drug bound by maternal plasma proteins, the size of the drug molecule, the pH of the drug, and the lipophilicity of the drug determine whether the medication will pass into breastmilk Medications that are non-protein bound, low in molecular weight, or highly lipid-soluble are more likely to enter the breast milk in larger quantities. Some have no effect on the baby and can be used while breastfeeding, while other medications may be harmful to the infant Some generally safe medications that the mother can use while breastfeeding include  Furthermore, drugs of abuse, such as cocaine, amphetamines, heroin, and marijuana cause adverse effects on the infant during breastfeeding. Adverse effects include seizures, tremors, restlessness, and diarrhea. To reduce infant exposure to medications used by the mother, use topical therapy or avoid taking the medication during breastfeeding times when possible. Hormonal products and combined oral contraceptives should be avoided during the early postpartum period as they can interfere with lactation There are some medications that may stimulate the production of breast milk. These medications may be beneficial in cases where women with hypothyroidism may be unable to produce milk. Alcohol use during pregnancy carries a significant risk of serious birth defects, but consuming alcohol after the birth of the infant is considered safe.[ High caffeine intake by breastfeeding mothers may cause their infants to become irritable or have trouble sleeping breastfeeding mothers who smoke expose their infants to nicotine, which may cause respiratory illnesses, including otitis media in the nursing infant.[ Pesticides and other toxic substances  Market-human milk bank a commercial market for human breast milk, both in the form of a wet nurse service and as a milk product.As a product, breast milk is exchanged by human milk banks, as well as directly between milk donors and customers as mediated by websites on the internet. Human milk banks generally have standardized measures for screening donors and storing the milk, sometimes even offering pasteurization, while milk donors on websites vary in regard to these measures. A study in 2013 came to the conclusion that 74% of breast milk samples from providers found from websites were colonized with gram-negative bacteria  Human milk is considered to be healthier than cow's milk and infant formula when it comes to feeding an infant in the first six months of life, but only under extreme situations do international health organizations support feeding an infant breast milk from a healthy wet nurse rather than that of its biological motherOne reason is that the unregulated breast milk market is fraught with risks, such as drugs of abuse and prescription medications being present in donated breast milk. The transmission of these substances through breast milk can do more harm than good when it comes to the health outcomes of the infant recipient  Comparing milks (per cup) Nutrient Human Milk Cow's Milk (3.25% fat) Goat's Milk Calories (Kcal) 172 146 168 Water (g) 215 215 212 Protein (g) 2.5 7.9 8.7 Fat (g) 10.8 7.9 10.1 Saturated fat (g) 4.9 4.6 6.5 Monounsaturated fat (g) 4.1 2.0 2.7 Polyunsaturated fat (g) 1.2 0.5 0.4 Omega-3 fatty acids (mg) 128 183 97.6 Omega-6 fatty acids (mg) 920 293 266  Cholesterol (mg) 34.4 24.4 26.8 Carbohydrate (g) 17.0 11.0 10.9 Sugars (g) 17.0 11.0 10.9 Vitamin A (IU) 522 249 483 Vitamin C (mg) 12.3 0 3.2 Vitamin D (IU) * 9.8 97.6 29.3 Vitamin E (mg) 0.2 0.1 0.2 Vitamin K (mcg) 0.7 0.5 0.7 Thiamin (mg) 0.0 0.1 0.1 Riboflavin (mg) 0.1 0.4 0.3  Niacin (mg) 0.4 0.3 0.7 Vitamin B6 (mg) 0.0 0.1 0.1 Folate (mcg) 12 12 2 Vitamin B12 (mcg) 0.1 1.1 0.2 Pantothenic acid (mg) 0.5 0.9 0.8 Choline (mg) 39.4 34.9 39.0 Calcium (mg) 79 276 327 Iron (mg) 0.07 0.07 0.12 Magnesium (mg) 7.4 24.4 34.2 Phosphorus (mg) 34.4 222 271 Potassium (mg) 125 349 498 Sodium (mg) 42 98 122 Zinc (mg) 0.4 1.0 0.7 Copper