Is Breast Best? View from a Doctor’s Desk – Dr Lisa Surman

Public health officials around the globe were stunned when the American delegation attending the World Health Assembly in Geneva sought to soften the resolution to encourage breast feeding, after decades of research has demonstrated that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes. It is believed that the US delegation was influenced by the interests of infant formula manufacturers, seeking to remove language that called for governments to ” protect, promote and support breastfeeding” and for policy makers to restrict the promotion of inappropriate food products to infants and children. When Equador tried to save the proposal, the US threatened trade sanctions and diminished military aid. In the end Russia introduced the measures which were introduced with most of the original wording

Breast feeding is the optimal way to feed neonates and infants. Breast milk provides complete nutrition, is readily available, helps prevent infection and has long term benefits such as improved cognitive and neurological development and reduced likelihood of obesity. Benefits to mothers include weight loss, reduced risk of osteoporosis, ovarian cancer and breast cancer.

A study published in the Lancet in 2016 announced that “breastmilk makes the world healthier, smarter and more equal” and predicted that 800 000 child deaths a year across the world could be prevented and $300 billion in savings from reduced health care costs and improved economic outcomes for those reared on breast milk.

There is some nuance to the evidence for the benefits of breastfeeding as the benefits are not possible to disentangle from socioeconomic factors in observational studies. Scientists are not ethically able to conduct double-blind studies providing one group of infants with breast milk and the other breast milk substitute.

A small number of women are unable to breastfeed their baby and breast feeding can be difficult for many reasons. Support for breast feeding is critical, including institutional provisions, emotional support, reassurance, practical help and information. Importantly parents need support, advice, practical assistance and no judgement from professionals, community and peers.

Resources, an online forum and links to social media or a local group for breast feeding women are available at breastfeeding.asn.au

More fact sheets are also available at https://www.thewomens.org.au/health-information/breastfeeding/breastfeeding-overview

Reliable sources of information about medicine use in breastfeeding are LactMed http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT and Infant Risk Centre at http://www.infantrisk.com/categories/breastfeeding

For those who are unable or who chose not to breastfeed the online group at  fearlessformulafeeder.com is dedicated to providing non-judgemental support for all new parents at #ISupportYou

 

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

“Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites

Dry July. View from a Doctor’s Desk – Dr Lisa Surman

A month of sobriety every year does not reduce your lifetime risk of harm from alcohol, but does act as a circuit-breaker to help reassess your relationship with regular drinking. You may get to assess the effects it may be having on productivity, relationships and review the amount and circumstances you are drinking under (for example the automatic pouring of a larger glass of wine while cooking dinner, or sitting down to watch the television).  Research has repeatedly demonstrated that we underestimate how much we drink. A break may also highlight the social pressures we are under to consume alcohol. There has been little research into whether campaigns such as Dry July have any effect on long-lasting change in alcohol consumption, but there is some evidence from the UK of reduced consumption in the 1-2 months following participating in these campaigns.

The short-term benefits from a month alcohol-free for regular drinkers include a more refreshing sleep. Although alcohol acts as a sedative, it is associated with increased snoring, sleep apnoea and wakening after the effect wears off at 4-6 hours. Alcohol acts as a diuretic and this effect may also interrupt sleep.

Alcohol contains significant calories and a break can be associated with weight loss and reduced restaurant bills. Although often without physical symptoms, your liver function also improves when not processing regular alcohol.

In Australia, almost 6000 deaths a year can be attributed to alcohol, with approximately 400 hospitalisations per day. Many people remain unaware that the long-term health risks associated with regular alcohol intake are not only confined to very heavy drinkers. There is a growing list of alcohol-related diseases: bowel cancer, mouth and oesophageal cancer, breast cancer, heart disease, respiratory infections, mental health problems and perhaps prostate cancer. There is also the foetal alcohol spectrum disorders occurring as a result of exposure to alcohol in the womb. Alcohol affects judgement and affects risk-taking, with injuries, vehicle accidents, drownings and violence associated.

Individual vulnerability and the context in which you drink are relevant, but in general low-risk drinking to avoid alcohol-related death is two standard drinks or less per day and a single occasion low-risk drinking is four standard drinks or less. The safest option for those thinking about pregnancy, who are pregnant and for those under 18 years old is not to drink.

The National Alcohol and Other Drug Hotline offers professional, confidential and free advice to connect you to the most appropriate services locally at 1800 250 0115 (anytime and anywhere) should you be concerned about your level of alcohol use.

Daybreak is a helpful, free App designed around a Drink Less Support Community created by the Hello Sunday Morning team, see hellosundaymorning.org for more information about the App and Facebook group promoting hang-over free Sundays, for those interested in a longer term approach to changing their relationship with alcohol.

Funds raised though Dry July are donated to cancer support organisations across Australia, with $30 million being raised for more than 75 cancer organisations since the first Dry July in 2008.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

“Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites”.