Breaking Up with “Breast is Best”: Breastmilk vs Formula Myths and Truths with Dr. Lauren Hughes

In today’s episode of Bite Back with Abbey Sharp, I am chatting breastfeeding with Dr Lauren Hughes, a board certified pediatrician, lactation consultant, mom and founder of Bloom pediatrics. I will start by sharing my own personal story about breastfeeding struggles and Lauren and I will vent over the enormous pressures women feel by “breast is best” messaging. We will also talk about the potential dangers to baby and mom of insisting on breastfeeding at any and all costs. Lauren will chat about the *actual* risks of various activities and substances while breastfeeding (alcohol, caffeine, ozempic, smoking, CBD and THC) and discuss whether or not you should change your diet while breastfeeding if baby is fussy. And I will break down the data on the benefits of breastfeeding over formula for baby’s health, and future risk of obesity and low IQ when we rule out socioeconomic confounders (spoiler: the benefits might not be as profound as you might think). Note the purpose of this episode is not to downplay the benefits of breastfeeding for mom or baby, but to help empower women to feel confident in the feeding choices they make. Check in with today’s amazing guest: Dr. Lauren Hughes, MD, IBCLC Instagram: @bloomdpc Website: drlaurenhughes.com References: Cribsheet by Emily Oster https://pubmed.ncbi.nlm.nih.gov/29191700/ https://pubmed.ncbi.nlm.nih.gov/6691042/ https://pubmed.ncbi.nlm.nih.gov/37881498/ https://onlinelibrary.wiley.com/doi/abs/10.1111/cea.12228 https://jamanetwork.com/journals/jama/fullarticle/193490 https://www.sciencedirect.com/science/article/abs/pii/0196070994901341#:~:text=Results%3A%20The%20risk%20of%20AOM,who%20were%20never%20breast%2Dfed. https://www.pure.fo/en/publications/risk-factors-of-early-otitis-media-in-the-danish-national-birth-c#:~:text=When%20a%20Bonferroni%20correction%20was,a%20risk%20of%20early%20OM. https://pubmed.ncbi.nlm.nih.gov/29084835/ https://pubmed.ncbi.nlm.nih.gov/8696193/ https://pubmed.ncbi.nlm.nih.gov/28398851/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4077166/#:~:text=Results%20from%20standard%20multiple%20regression,of%20the%2011%20outcomes%20studied. https://pmc.ncbi.nlm.nih.gov/articles/PMC1633786/ https://pmc.ncbi.nlm.nih.gov/articles/PMC1633819/ Disclaimer: The content in this episode is for educational and entertainment purposes only and is never a substitute for medical advice. If you’re struggling with with your mental or physical health, please work one on one with a health care provider. If you have heard yourself in our discussion today, and are looking for support, contact the free NEDIC helpline at 1-866-NEDIC-20 or go to eatingdisorderhope.com. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✨ Reach Your Weight & Health Goals — Without Dieting! Pre-order The Hunger Crushing Combo Method, Abbey’s revolutionary additive approach to eating well. Learn how to boost satiety, stabilize blood sugars, reduce disease risk, and improve your relationship with food — all while getting the best nutrient bang for your caloric buck. With 400+ research citations, cheat sheets, evidence-based actionable tips, meal plans, and adaptable recipes, The Hunger Crushing Combo Method is the only nutrition bible you’ll ever need. 👉 Pre-order today! 🛒 Where to Purchase: Amazon Barnes & Noble Amazon Kindle Apple Books Google Play Kobo Apple Books (Audiobook) Audible abbeyskitchen.com/hunger-crushing-combo • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✉️ Subscribe to My Newsletters: Abbey’s Kitchen Newsletter 📘 Check out my FREE E-Books: Hunger Crushing Combo™ E-Book Protein 101 E-Book 👋 Follow me! Instagram: @abbeyskitchen TikTok: @abbeyskitchen YouTube: @AbbeysKitchen Blog: abbeyskitchen.com Book: The Mindful Glow Cookbook • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 🎧 Don’t forget to subscribe on Apple Podcasts, Spotify, or wherever you listen — and leave us a review! It really helps support the show ❤️ 💬 If you liked this podcast, please like, follow, and leave a review — and let me know who you’d love to hear about next! ⭐ ⭐ ⭐⭐ ⭐ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Now streaming on Paramount Plus.

• 0:02Speaker 01

  I'm Dexter Morgan. I've been killing killers for half my life. It gets to you. You're having a midlife crisis. I'm not ready for this.

• 0:11Speaker 00

  He's back.

• 0:12Speaker 01

  I'm older. I'm wiser.

• 0:15Speaker 00

  And sharper than ever.

• 0:17Speaker 01

  Things are gonna get messy. But if I can't believe in myself, I can't believe in anything.

• 0:24Speaker 00

  Dexter Resurrection. New season now streaming on the Paramount Plus Premium Plan.

• 0:30Speaker 02

  Every problem with our children seems to circumvent back to, well, it must be mom. I think we put such an emphasis on providing breast milk. But I'm like, you walk down the street, tell me who is formula fed and who is breast fed. Tell me. You don't know.

• 0:50Abbey Sharp?

  Welcome to another episode of Bite Back with Abbey Sharp, where I dismantle die culture rules, call out the charlatans spinning this pseudoscience, and help you achieve food freedom for good.

• 1:03Abbey Sharp?

  Today's episode is something I really could have used like seven years ago when my first son was born and I was driving myself into the ground trying to breastfeed a colicky, severely tongue-tied baby. Before I gave birth, I had read all of the LaLash Group blogs about the benefits of breastfeeding and about what a magical and natural and critical act of motherhood it was. So when things weren't going well, I flat out refused to give up. I spent thousands of dollars on private lactation consulting visits, physio, OT, dentistry,

• 1:45Abbey Sharp?

  all the things, just trying to get that kid to latch. After weeks of tears, I admitted defeat on breastfeeding and then spent the next 13 months attached to a pump. Yes, I felt accomplished being able to exclusively pump breast milk for the first year of life and fill my freezer with another 35 liters for year two. But I also felt like I had sacrificed. Precious time with my son and my own experience of motherhood just to calm my own guilt around not being able to breastfeed. So when I was pregnant with my second, I promised myself that if breastfeeding didn't work out, that I would formula feed without second thought.

• 2:28Abbey Sharp?

  And luckily, it just happened to be a much easier ride and a truly enjoyable experience for all. But I wanted to shed light on the dangers of rigid breastfeeding pressure and help you feel confident in your own infant feeding journey, whatever that looks like. My guest today is Dr. Lauren Hughes, a board certified pediatrician, lactation consultant, mom, and founder of Bloom Pediatrics. If you like my sassy, no BS approach to nutrition, you are going to really appreciate Dr. Hughes's approach to childhood health. Today, we're going to be going over the risks of various activities and substances while breastfeeding, debunking common breastfeeding myths,

• 3:12Abbey Sharp?

  and I will be discussing what the data actually says about the benefits of breastfeeding over formula. A quick note here that even though I breastfed and pumped for my two kids, I unequivocally believe that fed is best. So I want to make sure that what I'm sharing is not misinterpreted as me like pushing formula or dismissing the benefits of breastfeeding. But rather, I want moms to feel empowered to make the best decisions for themselves, weighing all of the potential costs and risks to their own physical and mental health, rather than relying on fear mongering anti-formula rhetoric. Also, I will be using exclusive women centered language for simplicity,

• 3:54Abbey Sharp?

  even though I fully acknowledge that this doesn't capture everyone's motherhood identities. Finally, a quick reminder that the information in this episode is for educational and entertainment purposes only, and it's never a replacement for one-on-one healthcare advice. And I would love if you would please give Bite Back a five star review and leave me a comment. It really, really does make my day. All right, friends, let's get into it.

• 4:27Abbey Sharp?

  Lauren, thank you so much for joining me. I am like obsessed with your TikTok series on social media. I just find it so helpful for new moms who are like drowning in misinformation and conflicting information. So I'm sure my listeners are going to really appreciate our conversation today.

• 4:45Speaker 02

  TikTok was not intentional. I just happened to say, we're gonna do a little TikTok and then now it's a thing.

• 4:55Abbey Sharp?

  But let's talk about tits. I mean, when it comes to milk and tits, but you are a pediatrician and a lactation consultant. So obviously, you can appreciate that breast milk has benefits. Like, it's kind of amazing, crazy, cool stuff. I am also sure that you probably see a lot of stressed out, you know, over tired moms every single day who, you know, many of which are probably struggling with this, you know, what we've been taught is supposed to be this very natural, intuitive, beautiful, and critical experience. But I'm curious, from your perspective as a primary care provider, what are the impacts of like these societal expectations around breastfeeding and fear mongering on formula when it comes to moms' physical

• 5:37Abbey Sharp?

  and mental state when things are not just going the way they planned?

• 5:41Speaker 02

  We all have this expectation of this that like, oh, it's my body. So my body knows what to do because it knew how to grow a baby, grow a baby without me telling it to do anything or working, well, like outside of infertility, but like the act of growing a baby. It seems like it should just be a progressive thing. And it's not. Because you are trying to bring together two human beings who have never done this before with each other. And that's always going to be messy and complex. And sometimes it's not. And, you know, for, for some people, it's just as simple as like, I put them there and then it went there and then I had milk and they did fine. And that was it. And that's

• 6:22Speaker 02

  wonderful. But that is the exception and not the rule, honestly. And I think we put such an emphasis on providing breast milk because it is, it's this beautiful, wonderful, living organism that has incredible benefits. And yes, I wish everyone could provide breast milk, but you know what? It's not my baby. It's not my body. It's not my choice. And That is where I think the message gets frayed is, hey, you need to be doing this thing, but also you have to go back to work at six weeks and also we're not going to provide you with lactation support and also we're not going to provide you with parent support because you're not, you're going to be in a diaper and maybe your spouse or you don't have a partner and they have to go back to

• 7:05Speaker 02

  work, but it takes 12 hands to do this and oh yeah, you have to go in for all these weight checks. Like there is just this, this inundation of stress on one human being who just gave birth.

• 7:20Speaker 02

  Having just, it's just a lot and it's a lot of this expectation. And so then it's almost dug into you as you have failed. Your body has failed. You have not done this right because you couldn't make this work because you should have. And it is just, it's, I mean, this is everything in America, right? We're taking systemic problems and putting them on the individual.

• 7:46Abbey Sharp?

  Right.

• 7:47Speaker 02

  And it, this is just another example of, of, hey, we're going to expect you to do this, but we're going to provide you zero resources or support.

• 7:55Abbey Sharp?

  Yep. I, I mean, I, I don't know how, what your breastfeeding experiences were like, but I remember when my first son was born, I had both latch issues and supply issues and I had an LC come on like the, the day I got home from the hospital. And I had told her that the night before, my first night at home, I had to supplement with formula because my kid was screaming all night, nonstop. Clearly I had nothing to give him. And she gasped audibly and said, oh no, like as if I just ruined my child's life forever because of, again, of this notion that a single drop of formula changes baby's microbiome forever. Which by the way, to those listening,

• 8:35Abbey Sharp?

  the microbiome is always changing and we have no good evidence that formula ruins a microbiome for life. But yeah, I just feel like that, that interaction really threw me into this all or nothing type A spiral that, you know, ultimately really had resulted in insomnia and postpartum anxiety and really a real hand. In my experience of early motherhood. Um, it's so hard.

• 9:00Speaker 02

  It's, yeah. Uh, so my poor feeding experience with my first is why I became an I B C L C and got into breastfeeding medicine. Um, because I was twenty six and I didn't know what I was doing. And I remember in my hospital tour, I was like, I would like to speak with a lactation consultant prenatally because I want to. I've never done this and I have questions and.

• 9:24Speaker 02

  I was, they were like, what do you want, what do you want me to talk to you about? Like, there was just so much confusion. Of like, why I would want to meet with someone before I had a baby. And, and we have data proving that a prenatal lactation visit. Helps with longevity of breastfeeding. So that was like, whoa. Um, and then in the hospital, I had him latch and it was just a, that looks good. And that was the extent of my help. Um, I, his latch looked good and I didn't have pain. So everyone assumed everything was fine. Um, and it wasn't until, I think it was, I think I was like ten or days or two weeks postpartum.

• 10:05Speaker 02

  And I went to a breastfeeding support group and the L C there weighed my baby and was like, he's only gained ten grams since last week. And, um, for those who don't know, our goal for babies is to gain twenty to thirty grams a day. Um, and he'd only gained ten grams in seven days. And she was like, I'm going to speak over to the hospital to work with someone directly. And we discovered he wasn't transferring, but no, like, I didn't know that. And I thought he was just a fussy kid and like, that was it. And so then that led us on the path of triple feeding. And I remember the, when I had to give him a bottle, um, of formula. Like, I was crying so hard. My husband had to leave the house.

• 10:49Speaker 02

  He like, I, I was just like wailing like there had been a death. And it was because I.

• 10:58Speaker 02

  I'm a pediatrician. This, I should just be able to do this. Like, pregnancy was easy. Like, why can't, and so it was just this intrinsic failure. Um, and why couldn't I do this? And then we, when we find, then we had, he had a tongue tie. And that was really difficult to navigate because I went and saw an LC who said, you have to absolutely release this, um, or he's never going to be able to feed. And then I went to my previous pediatrician who said, he can stick out his tongue. There is no tongue tie and I, and you don't need to do anything. And so then I was like, well, what do I do? And she was, you know, give him a bottle. And it's like, well, he can't latch onto a bottle. Milk pours out like he, that's not working.

• 11:41Speaker 02

  And, and it felt like I was screaming into a void. And, and nobody could give me any sort of like actual evidence-based guidance. Everyone was just giving me opinions. And once I, then I finally talked to my husband and we walked, we walked through it and we got his tongue tie released and then he could actually eat. And we gasped, went to a chiropractor.

• 12:05Abbey Sharp?

  Same.

• 12:06Speaker 02

  And did like craniosacral therapy. And I also like, oh my God, this is like, this is against what I know.

• 12:12Abbey Sharp?

  Yep, I know. I did it too. You're so desperate. You're like, I'll do everything.

• 12:17Speaker 02

  So I made my mom go with me to go into the chiropractor. And I was like, you were gonna, if she does something, you're gonna have to speak up.

• 12:24Abbey Sharp?

  Yeah.

• 12:24Speaker 02

  And then I watched it and I was like, you, you barely touched him. Why am I paying for this? But then he could eat.

• 12:30Abbey Sharp?

  Yep.

• 12:31Speaker 02

  I was very lucky that I had a great supply and he nursed until I was pregnant with my twins. But it was that struggle and that just like feeling of just like being on an island.

• 12:43Abbey Sharp?

  Helplessness, yeah.

• 12:45Speaker 02

  Yes. And like, no one could help me.

• 12:48Abbey Sharp?

  Yep.

• 12:48Speaker 02

  That really was like, no, I, I'm not, I'm not standing for this and let do this.

• 12:55Abbey Sharp?

  Yeah, yeah. I mean, that's amazing.

• 13:13Abbey Sharp?

  And as you know, breastfeeding is often touted as evidence of the power and magic of womanhood. We can make this perfect food for baby to thrive and grow. And I love that. It is truly insanely cool. But at the same time, two things can be true. And for a lot of other women, I often worry that this kind of breast is best movement might also in some ways be reinforcing a lot of these patriarchal narratives that glorify maternal self-sacrifice as this measure of worth. Do you want to talk about that?

• 13:48Speaker 02

  Sure. So I think that it looks at the overall issue of people living in a vacuum and expecting that their lived experiences are the same as everyone's lived experiences. And that's just not true. I mean, at the very basic, our anatomy is different. Like, just at the most basic, basic level. And then you look at like, what is our support system? What do our spouses think? What is our job work? What is my actual desire? What is my experience that I've seen with friends and family members with breastfeeding? What is their support like? What's my work time off? What's my maternity leave? How much money am I making? Can I afford a pump? Do I have interns? Like, there is just, there's

• 14:33Speaker 02

  so many factors that to make a ubiquitous claim of breast is best is wrong. And so I hate that phrase because, and then I also don't like fed is best, because that implies there's an alternative. And fed is the only option. And so when I look at these things, I tell people, one, The number one rule above everything is feed the baby. The next rule is protect the milk supply. Then it is keep baby at the breast. Like you can't keep the baby at the breast if you don't have milk and you don't feed the baby. You can't protect the milk supply if you don't feed the baby. Like there's just an order of importance.

• 15:18Speaker 02

  And I think that this just expectation that women can do it because we're superheroes and we can do it all. And it's just this expectation of you're tough and you can handle it, but also shh, shh, shh, let the boys speak.

• 15:33Abbey Sharp?

  Yeah, no, I know. I often feel kind of insane looking back at what I convinced myself I had to do in order to prove my worth as a new mom. Like I truly believed that if I wasn't pumping every hour on the hour to get my supply up so that I could avoid having to supplement with quote unquote, toxic formula, again, as per my LC's instructions, that I was like not doing what real moms do, which is just like apparently give up all your body autonomy and desires and needs to put your kids first.

• 16:03Speaker 02

  A hundred percent.

• 16:04Abbey Sharp?

  It's, we need to break that, that, that, that, that assumption that's just so pervasive in our society, you know? I, I mentioned this at the top of the show, but by the time my second son came around, I, I had a lot more self-confidence just in myself.

• 16:21Speaker 02

  Yeah.

• 16:21Abbey Sharp?

  And also in myself as a mom, so I wasn't going to put up with that shit. And I also like found an LC who was going to support me no matter what end up happening. But yeah, I just feel like it's a real shame that we are poisoning our own experiences with motherhood of, you know, with all these different pressures.

• 16:40Speaker 02

  Well, yeah, I mean, that's, and that it goes beyond, I mean breastfeeding, then it's like, are you doing toy rotations? Are you doing wooden toys? Are you allowing plastic? Are you allowing screens? Are you allowing noise at night? What about white noise? Is it too close? Is there too many decibels? Are you gentle parenting enough? Are you providing enough touching support? Are you like, there's just every problem.

• 17:00Abbey Sharp?

  Yep.

• 17:00Speaker 02

  With our children seems to circumvent back to, well, it must be mom. It must have been something with mom. And this is just another one, but I'm you walk down the street, tell me who is formula fed and who is breastfed. Tell me, you don't know.

• 17:14Abbey Sharp?

  You wouldn't know, you'll never know the people, the people at the top and the, you know, CEOs or, you know, running the big businesses or successful doctors and lawyers, like whatever, nobody knows or cares. It's not on anyone's CV. It's just, it's not going to make or break the rest of your life. So, and, and we put so much pressure on ourselves thinking it will.

• 17:37Speaker 02

  We, yeah, but it's good. And it's gonna, this is going to fade. Just like my mom was telling me when she was pregnant with me, she was considered weird and out there because she wanted to room in and breastfeed. Those were the two weirdest things she could have chosen. And everyone's like, you don't want the nurses to just take her and give her a bottle of formula? And they couldn't believe it. That's only been 30 years. So like, I wish we could just say, hey, we know breastfeeding is great, but hey, not everybody can, not everybody wants to. And it feels like that is a dream and not a potential reality.

• 18:18Abbey Sharp?

  Talk to me about baby friendly hospitals for men and just kind of the role that they play in all of this. And in case people are not familiar, because I think this is like mainly a US thing. I don't even think we have this here in Canada, but these are basically like healthcare facilities that strongly encourage breastfeeding and avoid giving formula and pacifiers. Do you want to kind of talk a little bit about that and, and how, you know, what issues you might see coming up with this?

• 18:44Speaker 02

  So this actually is a global thing. It was created by the WHO and UNICEF in 91. This is a very global thing. Like with most things, the original goal was great. It was that you're going to have breastfeeding at friendly hospitals are going to have a written breastfeeding protocol. You're going to train your staff and you're going to inform pregnant people about breastfeeding during pregnancy. You were going to help them initiate. You were going to show them how, like the nurses in the hospitals are trained on this, not just the LCs. You're going to room in. Um, you're gonna breastfeed on demand, like you're doing all the things that were like, you look at it, you're like, that's great, that's wonderful.

• 19:23Speaker 02

  But one of the other parts of it is that you can give no artificial teats or pacifiers. And if you provide formula or a pacifier, then you have, if you do that too often, you risk losing your great baby friendly initiative status. And you have to implement retraining and like reeducation and like protocol changes and stuff because they can come in and assess and make sure you're following like all of the standards. And so while I do think it was like, oh, this is a really good thing to like, the, the idea is great.

• 20:02Speaker 02

  The actuality with, especially in America, with our, our current healthcare system, where you have such understaffed hospitals and you have nurses stretched as thin as they can possibly be stretched. And you have all of these expectations that of doing these things, but you don't have the staff to actually do it. They're going to make, they're like, I just got to get you doing this so I can do my job and I can move on, which is not their fault. It is once again a systemic issue that we are forcing onto an individual. But when that happens, you do things like put a nipple shield on in the delivery room because that baby will latch to a nipple shield.

• 20:47Speaker 02

  It's like putting a bottle in their mouth. It's gonna immediately trigger that suck reflex. They are going to suck, they will. And, and when you have, you have these, you know, glorified recommendations to breastfeed everyone, but your actual practice is a dumpster fire. Then like it's, it just doesn't actually end up being a good thing. Right. And, and I see then a lot of people where they're like, okay, we just did a nipple shield and then we got discharge and then I'm trying to undo it. Or they can't get baby to latch and now they are struggling with supply or that no one told them to pump or to do any sort of stimulation while using a nipple shield. Or they don't know how to come off of it, or they don't have resources to come off of

• 21:30Speaker 02

  it, or nobody explains that, hey, uh, you can like continue this and then try to come off later, or anything like that. And so while I think this was like a, a good thought, the implementation is just not correct.

• 21:46Abbey Sharp?

  Yeah. And I, I, I think there's also risk. I mean, obviously when we talk about breast milk, we're talking about all the health benefits to, to baby, but we also have to take into consideration that, you know, one in like 40 to one in 70, depending on a research you look at, babies are hospitalized due to life-threatening complications from inadequate breastfeeding without supplementation. So if you are just kind of like putting the ba-, you know, baby on the breast, but not actually, like you, you mentioned your experience where, you know, baby had, wasn't, wasn't gaining weight because of, again, transfer issues.

• 22:20Speaker 02

  Yeah.

• 22:20Abbey Sharp?

  So that is a huge risk. That's not actually benefiting baby in the long run when they are being underfed and, you know, underhydrated. And honestly, I, I look back at my own experience. If I didn't supplement that first night, I could have easily just ended up back in the pediatric ER. And, you know, I, I think that from what I've read, that is the underlying, you know, the underlying intentions behind the controversial, you know, fed is best movement. They're not denying the benefits of breast milk.

• 22:51Speaker 02

  Right.

• 22:52Abbey Sharp?

  They're kind of acknowledging the risk benefit to each individual mom and, you know, for mom and baby, that exclusive breastfeeding might not necessarily be what is best for that combination of mom and baby in that moment.

• 23:06Speaker 02

  No. We know that the mental health of the parents has the biggest impact on the mental health of a child.

• 23:13Abbey Sharp?

  Yes.

• 23:14Speaker 02

  And that is where it gets super frustrating. And Abbey, okay, so you were worried about going to the pediatric ER. Now imagine we're being worried about going bankrupt. You have to choose, do I want to drop a couple thousand dollars that I probably don't have and go to the ER, or do I just want to cross my fingers and stay home? That's the other barrier that you have of like. You have, I cannot tell you how often I have this conversation with people. I'm like, well, I think they need the ER, but like, you can't afford it. And that is an actual decision that people in America have to make every day. Because we do not have universal healthcare.

• 23:51Abbey Sharp?

  Right. Oh, my goodness. As a Canadian, I'm, I'm so grateful. I've never had to make the call of whether or not to take my child to a doctor or the, or the hospital to get something checked out because I'm just like, that's an expense I, and a risk I just am gonna have to take because of the, what it costs. Speaking of maternal sacrifice, um, there is a lot of misinformation and fear mongering about what we can and cannot do while breastfeeding, which again, I think just reinforces this idea that if you're not suffering, you're not mothering, right? So I want to go through some of the big ones. Um, and I want to start with breastfeeding and drinking. Do we need to abstain until we wean? Do we need to pump and dump? Like, what's the dealio?

• 24:32Speaker 02

  The deal is you, you really can't ethically can do a randomized controlled trial for this. You really can't. So what I do is I go down to the math. Um, and because that, then I think this is a very simple explanation.

• 24:51Speaker 02

  One thing that people I think misunderstand is the difference in a alcohol content percentage of a drink and the blood alcohol percentage. If you drink a glass of wine that has 12% alcohol, something like that, your blood is not 12%, you would be dead. Like, you, you would be dead if your blood was 12% alcohol. That is not conducive with life. Um, and so your blood alcohol level is what you bring in and then it gets diluted, right? So we, whenever people think about the legal limit, you think of point oh eight, right? What that means is it is point oh eight percent blood alcohol level. That is the legal limit.

• 25:36Speaker 02

  And when we get to point four percent for non severe alcoholics, you are generally comatose.

• 25:46Speaker 02

  Likely coding you in an ER. If you were to direct breastfeed your baby on that code table, while you were at 0.4% blood alcohol level, your breastmilk would contain as much alcohol as in some orange juices because they ferment.

• 26:01Abbey Sharp?

  Right.

• 26:02Speaker 02

  So, yes, there is alcohol. I am not denying that. But what I am saying is it is not at the level we think it is in terms of severity. My biggest fear with with drinking and breastfeeding is the physical harm. Is like, are you going to be so intoxicated that you drop your baby? That you fall asleep on your baby, that you smother your baby? That is my concern. So, the joking phrase is actually true. If you can find the baby, you can feed the baby. If you're if you're with it enough to like, maybe you feel silly, but you can grab your baby and you know, like, I'm not gonna fall asleep with you. I don't care. Or if you want to drink while you're feeding,

• 26:46Speaker 02

  that's not, that's not like, it takes a while to get into your blood. So if you drink while you're nursing, then you have like a pretty solid couple hours until your next nursing session for that to filter out. Now, the next thing I get is do I need to do the blood alcohol breastmilk strips? Oh, like, marketing gimmick. Don't do that. If you, but again, because not everyone has the same lived experiences and the same comfort and the same risk tolerance. If you don't want to, you don't have to. You can. You can mix alcohol milk and not alcohol milk. But to demonize it or to call someone who wants a fucking glass of wine, what, postpartum, because they went nine months without it? Let them.

• 27:28Abbey Sharp?

  Yeah, yeah, yeah. I'm not pushing drinking because of course, we all know alcohol is necessarily, it's not good for anyone. But that first glass of wine, postpartum, just hits different.

• 27:38Speaker 02

  It does. Just FYI, your tolerance will be way low.

• 27:41Abbey Sharp?

  Oh, yeah, yeah, yeah. One glass, one glass, all you need. Yeah, yeah, yeah.

• 28:00Abbey Sharp?

  Okay, let's talk about something that may be more critical, at least for me, was is coffee. Coffee and breast milk. What's the deal there?

• 28:08Speaker 02

  Fine. So this is also going to be an individual thing. Some kids are, so how I explain babies, it's all human babies are on a range of maintenance. You have higher maintenance kids, so you have those like kind of fussy or can't put them down and have to, you know, hold your tongue just right to get them to sleep. And then you have the low maintenance kids who they will just fall asleep while someone's driving cars over them. Like, it doesn't matter. I mean, toy cars, not like an actual car.

• 28:37Speaker 02

  So you have the, so you're on a range. Typically, your higher maintenance kids might react more to caffeine. They might, but they also might not. So it is primarily going to be, does your baby care? If your baby acts the same, whether you drink coffee or not, I don't care. It is not the same as pregnancy, which has an increased risk of preterm labor. It is a, we are, the baby has exited.

• 29:03Abbey Sharp?

  Yep.

• 29:03Speaker 02

  There are different risks. So I never once counted caffeine after I had my kids. I drank coffee all day, every day, and it was fine.

• 29:12Abbey Sharp?

  Yep. Yeah, yeah. No, the research I've read suggests that, you know, breast milk contains less than like 1% of caffeine consumed by mom. So as long as your caffeine consumption is kept within the recommended guidelines, for the most part, the amount baby would receive is pretty negligible. But like, again, like, just experiment.

• 29:30Speaker 02

  I have a double espresso, baby doesn't app as well, but a single, great.

• 29:34Abbey Sharp?

  Exactly. Yeah, 100%. I personally, though, cannot imagine getting through early motherhood sans coffee, but.

• 29:41Speaker 02

  Amazed at the number of people that don't do coffee, both with motherhood and in residency. Blows my mind.

• 29:47Abbey Sharp?

  Yeah, blows my mind, too. Okay, smoking, smoking. What's the deal on smoking?

• 29:51Speaker 02

  Smoke. So now with weed getting legalized, now smoking is split into two different categories. So nicotine, cigarette smoking, nicotine. I don't recommend it.

• 30:04Abbey Sharp?

  Not good.

• 30:05Speaker 02

  So with nicotine, we know that it is not good for us. And my first recommendation is going to be to quit. Oftentimes, there are tech support lines, all of that stuff that you can do to help you quit. Now, say you can't. It is hard. It is a very hard addiction to kick. You minimize it, and you don't, of course, you don't smoke near your baby because secondhand smoke increases the risk of sudden death syndrome. But in terms of breastfeeding, it is completely fine. And actually, I encourage my cigarette-smoking parents to breastfeed because it helps mitigate those increased SIDS risks that come with secondhand smoke. It helps reduce them. So, I strongly encourage and work with my smokers.

• 30:51Speaker 02

  Um, and then, just as a guideline, because then the next question I get is, well, what if dad smokes or grandma smokes, or whoever? So, obviously, you shouldn't smoke in the house, shouldn't smoke in the car. Um, you need to wash your hands, wash your face, brush your teeth, change your clothes. Um, I prefer people wear a hat, so it's not in their hair. General guideline is if you can smell it, that is too much for your baby. Now, let's talk about weed, THC. So THC is a different ballgame. And there are very, very, very, very, very few things that I say no to with breastfeeding. This is one. Um, because THC is a fat soluble substance, meaning that it gets stored in our fat cells. Our breasts are primarily fat cells.

• 31:37Speaker 02

  And so, when we have this storage, and especially if you are a chronic user, meaning you frequently use it, you're gonna have more and more buildup. That's why people are like, how come it's in my hair for three months? Because it's stored in your body. And so, there is some, again, you can't ethically do this as a trial. Um, but there is data showing that it is in breastmilk for several days. And it can, can, I don't know if it's going to a hundred percent, but can cause neurodevelopmental disorders in children. So, this is one that like, normally, I, you know, like I said, I'm like, ah, things are this is, that is one I would not participate with.

• 32:19Abbey Sharp?

  Fair. Great, great tips. And here's a new one. Any thoughts on like Ozempic and other weight loss injectables during breastfeeding?

• 32:28Speaker 02

  Very common question. This is also where I get like really, really nerdy.

• 32:32Abbey Sharp?

  Yes, we love it.

• 32:34Speaker 02

  You want to talk about mass spec? I would love to.

• 32:36Abbey Sharp?

  Yes.

• 32:37Speaker 02

  I love mass spectrometry. So when we look at like the likelihood of something crossing over to breast milk, we are looking at things called like the molecular weight. And the bigger something is, the less likely it can pass through, right? So semaglutide, GLP-1 agonists, are in breast milk naturally.

• 33:01Abbey Sharp?

  Yes, of course. Any food will trigger GLP-1. So yeah, it makes sense.

• 33:06Speaker 02

  Yep. Like I also feel like people don't realize, I mean, it's just like formaldehyde is also in our blood. Like, people don't realize like the things that exist in us. Anyway, so we all have GLP-1, but the semaglutide specifically, they could not find the semaglutide molecule in any human milk tissues in the sample in this one, in this study that we use through the ABM. And so it is just the max, so their maximum RID, the, sorry, the maximum relative infant dose was 1.26%, which is far below the 10% standard for the RID

• 33:48Speaker 02

  that we have to consider something breast milk safe. I cannot fathom how this would be a problem with breastfeeding. And so I give it a thumbs up.

• 33:59Abbey Sharp?

  Got it, got it. And I'll just add that, you know, just, just, I mean, of course, especially if we're, we've got, you know, type 2 diabetes and these are medications your doctor has prescribed, do work with your doctor. But for folks who are thinking about starting a GLP-1 agonist, like fresh out the gate, give your body some time to recover. Like it's, you know, those transitions are so hard as is, and you are also feeding another person. So, you know, now is not the time to put yourself onto a very aggressive drug and be throwing up and dealing with diarrhea and all, all the other side effects that come with it. Just, just give yourself a little bit, your, your body some time and, and then, you know, work with your doctor on a plan.

• 34:42Speaker 02

  And that can make your milk supply drop, just FYI.

• 34:45Abbey Sharp?

  That too, a hundred percent, yes. Especially if you can't, if you're not able to keep in adequate hydration and food.

• 34:51Speaker 02

  You're losing more than a pound a week, like that does impact your milk supply.

• 34:56Abbey Sharp?

  Correct.

• 34:57Speaker 02

  So you, everything in life is a risk benefit, so you gotta decide.

• 35:02Abbey Sharp?

  A hundred percent. Now, if baby has colic, because man did, is there any reason for mom to start cutting foods out of her diet?

• 35:11Speaker 02

  So, going back to my maintenance of, of my maintenance range of babies. All babies are going to have a fussy period. That's why the, it's so frustrating that people immediately are like, no, you need to cut out dairy, or soy, or corn, or whatever, when, if I can predict it, how come it's diet affected? Um, and so all babies between two and four weeks, wake up. And then they start getting fussy, and that starts at about four weeks, peaks about eight weeks, dissipates by about 12 weeks. If your child is just fussy, nothing else is going on. They are growing, they are developing, they are happy during the day, they have these fussy periods, but otherwise are happy. No.

• 35:55Speaker 02

  There, that's just, that is part of like, learning how to become a human. Um, I have a whole long spiel on that, but it is not something that I would ever recommend just for a fussy baby, cutting out dairy. Now, my indications to cut out dairy, you have a kid who is not gaining weight. You have a kid who is screaming at the breast, every time they eat, they are miserable. You have a kid pooping blood. Okay, yes, let's talk about it, because reflux, like significant GERD, different from physiological reflux. So angry reflux could be a dairy problem, could be a other food problem. Or bloody stools could be a, a maternal food problem.

• 36:38Speaker 02

  But spitting up, and then otherwise happy, growing, healthy, developing baby.

• 36:42Abbey Sharp?

  Yeah, I, I know, I, of course, like, you know, yeah, my, my, my kiddo had colic and cutting out foods made absolutely no difference. He just kinda grew, grew out of it. Four months, right?

• 36:53Speaker 02

  Yes.

• 36:53Abbey Sharp?

  But you know, obviously do what works for you. But from my perspective as a dietitian, I just feel like there are so many benefits for dairy as like a great source of calcium and protein as your, you know, your caloric needs are higher, your nutrient needs, your protein needs are higher. So I just hate for moms to cut it out unnecessarily. And especially if that's something that they enjoy like cheese. I love me some cheese. I don't want to have to.

• 37:17Speaker 02

  Fry my coffee creamer out of my cold dead hands.

• 37:20Abbey Sharp?

  Yes, yes, yes, a hundred percent. So yeah, and if you are going to attempt an elimination diet, of course, I always recommend working with, you know, your pediatrician and your dietitian on that.

• 37:31Speaker 02

  And don't do, don't cut out 20 foods at once.

• 37:34Abbey Sharp?

  A hundred percent, no, that's not a proper elimination diet. We would have zero indication of what actually is the culprit. So yes, again, work with a professional.

• 37:43Speaker 02

  Yep.

• 37:44Abbey Sharp?

  The last thing I want to touch on here is this kind of, you know, the anti-formula movement, which unfortunately just continues to grow stronger. And in my episode that I did with Jess Nurek, we talked a lot about why infant formula contains the ingredients that it contains, including sugars and seed oils, which, you know, ultimately is used to match the nutritional composition of breast milk as equally as possible. So, you know, I do recommend everyone kind of listen to that episode as well. But the bottom line is we know formula is completely safe and nourishing for a baby. But what is not safe is homemade formula. Can you talk about that?

• 38:23Speaker 02

  This was news to me within the last year that this even was a thing. Um, I cannot overstate how worried this makes me. Um, as a dietitian, you are the people that I look to whenever I'm like in the NICU or whatever. I'm like, how much phosphorus does this kid need? How much potassium does this kid need? Because these are such. Delicate balances. So when babies are first born, their first six months, their kidneys don't fully work. They, they are not able to equalize and maintain homeostasis. They are not capable of it. Babies are born before they are physically ready to handle a lot

• 39:05Speaker 02

  of things. They just can't fit anymore. But one of the things is the kidneys. Have you ever heard of why we can't do ibuprofen until six months? That's because their kidneys aren't functioning until six months and ibuprofen goes through kidneys. So that is why, like, this is such a known thing. And so when you play with making your own formula, you are risking upsetting that balance. And if you have electrolyte disturbances, you can have heart problems. Your heart can stop. You can have an arrhythmia. You can have a seizure. You can have all of these things that are so terrifying and did not need to have happen.

• 39:41Abbey Sharp?

  Right. Yeah. No, I feel like a lot of this comes back to something that we talk a lot about here on the podcast, which is this appeal to nature's fallacy. And you know, this assumption that, you know, formula is mass produced by big food or, you know, big pharma and includes all these highly processed ingredients. So it must be super, super, super bad and toxic. But if you can't or don't want to breastfeed, then homemade formula made in your own kitchen with your own ingredients, your own quote, quote, clean ingredients must be better because it is assumedly less processed.

• 40:14Speaker 02

  But yet you're using the ingredients from these corporations that have mass produced it and you are trusting that.

• 40:20Abbey Sharp?

  Right, right. Exactly. And I get it. Like even with the best intentions, just so much can go wrong. So please do not ever make your own formula.

• 40:30Speaker 02

  Ever.

• 40:30Abbey Sharp?

  And also do not give your kids raw milk. That's like, that's just like a whole other wild story. Don't, and don't make, don't make formula with raw milk, most importantly.

• 40:39Speaker 02

  Don't make formulas with raw milk and breathe the formula shortage a couple of years ago. Don't dilute it.

• 40:45Abbey Sharp?

  No.

• 40:46Speaker 02

  Because that again, messes up the electrolyte balance. And that is such an like.

• 40:53Speaker 02

  You have such a narrow window for your electrolytes to be where they need to be. And it's babies do not have reserve if they get dehydrated because they're like, they don't have this and they can't say, my chest hurts or something like that if they're having an arrhythmia like it.

• 41:10Abbey Sharp?

  A hundred percent. Yeah, no, trust science. Science, you know, has come incredibly long way and we should be so grateful for the advances that we have, not be pushing against them and fearing them and creating more hysteria and fear mongering around them.

• 41:26Speaker 02

  One million percent.

• 41:27Abbey Sharp?

  This was so cathartic for me. I feel like I just unpacked like a lot of early motherhood trauma that I had festering inside me for the past seven, seven years because yeah, like, like 95% of my mental health struggles during that time probably came from breastfeeding. So yeah.

• 41:43Speaker 02

  I swear, people say breastfeeding is a preventative against postpartum anxiety. I a hundred percent think it's a contributory.

• 41:49Abbey Sharp?

  Oh my God, no, it was, it was everything for me. That caused me insomnia, that caused me anxiety. I mean, I'm still like dealing with the repercussions of that, but I am sure this conversation will be so helpful for so many new moms. So thank you again, Lauren, for joining me. Um, I will be leaving links in the show notes to where you can find you and, and of course your pediatric practice as well, Bloom.

• 42:13Speaker 02

  All right.

• 42:14Abbey Sharp?

  Thank you.

• 42:15Speaker 02

  Thank you. It was fun. Thanks.

• 42:18Abbey Sharp?

  This was such an important conversation to have, not just for moms who are pregnant or actively trying to feed their newborns, but really for anyone who has ever interacted with a new mom or been a new mom in the past, like myself. Regardless of the feeding choice you make or made, it is really helpful to exercise some empathy and neutrality around the choices of others. You know, what may have been a very easy cost benefit analysis for you to breastfeed might be met with considerable costs for your sister or friend. So I'm really just hoping to shine some light on a wide spectrum of experiences here. And there is no doubt that breastfeeding.

• 43:02Abbey Sharp?

  Breastfeeding has amazing advantages, both for baby and also for mom. But the steadfast "breast is best" army often makes women who choose to or need to formula-feed their infants feel as though they are causing irreparable harm. That their kid is destined for a life of disease, obesity, and cognitive impairment if you feed them a single drop from the box. But as you all know, I'm a science girly, so I thought I would share a bit of data as it pertains to some of the major breastfeeding benefit claims. Now, keep in mind that when I'm discussing the benefits of breastfeeding versus formula, that it's in reference to kids in developed countries that have access to safe water

• 43:45Abbey Sharp?

  and safe formula alternatives, rather than in undeveloped countries without clean water, where breastfeeding carries significantly greater perks. A quick little shout out to Emily Oster, who is the creator of Parent Data and the author of Crib Sheet, whose research and analysis served as a jumping off point for what I'm about to share. I will be leaving some links to her content below if you're looking for more critical analysis of parenting recommendations. But let's talk about some of the early life health benefits of breastfeeding for babe. There is pretty good evidence that breastfeeding may help to reduce rashes, eczema, and gastrointestinal infections like diarrhea in the first year of life.

• 44:29Abbey Sharp?

  So for example, one randomized control trial found that breastfeeding reduced rates of eczema from 6% to 3% and reduced diarrhea from 13% to 9%. Other observational studies found that it may also help to reduce the risk of urine infections from 7% to 5%, though the effects do seem to dissipate after you stop breastfeeding. It kills me to see my kids sick, especially when they were little babies, so I absolutely appreciate that this is a big perk. That said, you know, about a diarrhea is not likely going to change the trajectory

• 45:09Abbey Sharp?

  of your child's whole life or have any kind of long-term repercussions, which I think is what scares most of us as parents. So let's talk about the impact of breastfeeding on something far more serious and devastating like SIDS.

• 45:27Abbey Sharp?

  The fear of SIDS as a new mom was paralyzing. And as Lauren mentioned briefly, there is data suggesting that breastfeeding for more than two months is associated with half the risk of SIDS, which again is huge. The problem here is that we can't do a randomized control trial with SIDS. So the data may be confounded by the fact that moms who breastfeed may also be less likely to smoke, or may have more support that would encourage safer sleep setups, or may be more likely to have full-term rather than preemie babies. And all of these things may affect SIDS risk.

• 46:09Abbey Sharp?

  It's really, really hard to get a comparable control group when SIDS ultimately is still so rare. And in studies when they do do a better job at this, they actually don't see a pronounced protective effect of breastfeeding, especially when held up against much more important risk factors like smoking and bed sharing. But what about the longer-term risks of choosing bottle over breast? Most notably, the concern that feeding your child formula may set them up to be overweight or obese. The fear mongering around this is often so intense, which really just proves that fat phobia and diet culture messaging starts really, really early.

• 46:48Abbey Sharp?

  But yes, we do see good observational studies that strongly suggest that breastfed babes are thinner later on in life. But again, correlation doesn't equal causation. And I can think of a ton of social and economic confounders at play. So for example, moms who formula feed might have lower-paying jobs that require them to head back to work earlier. This might also mean that they have less time and money for leisure activity and nutritious food. And when they look at sibling studies comparing one sibling who was breastfed with the other who was formula-fed, they actually don't see any differences in body weight.

• 47:32Abbey Sharp?

  And these same confounders apply to the findings that kids who are breastfed tend to have higher IQs. When confounders are eliminated and actual siblings are compared, meaning they have the same parents and the same social upbringing, they found no difference in IQ between those given formula versus breast milk. And I don't share any of this to discourage breastfeeding. You know, as I said earlier, I think there are real benefits of breastfeeding, many of which may not be so easily captured in the literature. So personally, for example, breastfeeding my son felt so empowering and I felt a really deep appreciation of my body that I really had never felt before.

• 48:17Abbey Sharp?

  So I am eternally grateful that I got gifted with that experience. But I also believe that advocacy for breastfeeding should empower women, not pressure them. So promoting informed choice, providing equal support for breastfeeding and formula feeding, and respecting individual circumstances are all crucial to breaking the cycle of maternal guilt and suffering. The goal here should really be to center maternal and infant health and wellbeing, not uphold a standard that may end up sacrificing one for the other. I don't know, I could probably rant and cry and lament about my own breastfeeding

• 48:59Abbey Sharp?

  journey all day long, but we're gonna just cap it there and save the rest for another episode. But I really hope that this episode was helpful and a big thank you to Dr. Lauren Hughes for helping me to bite back against diet culture. Again, if you can, I would love if you would leave me a five star review and subscribe to the podcast. It really does help me out. Signing off with Science and SASS, I'm Abbey Sharp. Thanks for listening.

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