Antiviral Factors in Breastmilk That Protect from Severe Respiratory Illness
by Anne Eglash MD, IBCLC, FABM
I find it hard to turn my attention away from breastfeeding and COVID-19 right now, in the midst of this pandemic.
Many of us are pushing hard within our hospitals and outpatient medical systems to provide optimal support for breastfeeding families. With the rising numbers of COVID-19 infections, patients with non-urgent needs are being kept out of the office, some with the option of telehealth care. Patients with urgent needs, such as abdominal pain, infections and heart failure are being seen at sites where they don’t have exposure to patients with respiratory symptoms. Unfortunately, some breastfeeding dyads are finding themselves on the list of patients who can be deferred.
In addition, the US Center for Disease Control guidelines are often used to develop policies requiring separation of mother and infant both in the hospital and at home if the mother has symptoms of a respiratory infection.
Because of these challenges, many breastfeeding medicine specialists and lactation consultants find it difficult to see breastfeeding dyads for face-face visits, despite knowing that mothers are more likely to prematurely wean if they don’t receive adequate help. How do we emphasize to the decision makers within our healthcare teams that breastfeeding is vitally important for infants all the time, that breastfeeding problems should be put into the ‘urgent’ category, especially now?
We are not doing ourselves a favor by only highlighting antibodies as the reason for the superiority of breastmilk over formula. I have heard people say ‘oh, it’s just antibodies,’ as a means of downplaying the importance of breastmilk. Perhaps rephrasing the conversation by sharing the role of other bioactive factors in breastmilk will help the undereducated realize that there is a science and biologic plausibility to the claim that breastfed infants are healthier and at less risk for respiratory infection.
OK, truthfully, a search of coronavirus and breastfeeding turned up zilch, likely because the typical coronavirus is not on steroids like COVID-19. Coronaviruses typically cause the common cold.
Today’s article is a summary of bioactive factors that protect infants from infection, reduce inflammation when illness occurs, and mature multiple organs including the infant’s immune system. Adding in bits and pieces from other sources, let’s review the classic biofactors beyond antibodies that we should be bragging about, in the form of today’s CQW.
- Cytokines are abundant in breastmilk and the majority are anti-inflammatory, playing a variety of roles including reducing tissue damage that occurs during infection.
- Antioxidants in breastmilk, such as beta-carotene and other carotenoids, help to prevent tissue damage, such as necrotizing enterocolitis, due to the rise in oxygen exposure that newborns experience.
- Growth factors such as epidermal growth factor in breastmilk play a role in development of the newborn gut. The gut harbors the infant’s largest immune system.
- Lysozyme plays a crucial role in decreasing gastroesophageal reflux symptoms in breastfed infants.
- Lactoferrin is an abundant protein in breastmilk. It starves bacteria of iron, and it releases lactoferricin, which has powerful antibacterial, antiviral, and antitumor activity.
- White cells in breastmilk survive the infant gut and not only help the infant fight infection, but transfer information to the infant for future immunity.
- Oligosaccharides provide fuel for healthy bacteria in the infant’s gut, and also prevent infection by preventing germs from adhering to the lining of the gut.
See the Answer
Breastfeeding is considered the gold standard for infants’ nutrition, as mother’s own milk (MOM) provides nutritional and bioactive factors functional to optimal development. Early life microbiome is one of the main contributors to short and long-term infant health status, with the gut microbiota (GM) being the most studied ecosystem. Some human milk (HM) bioactive factors, such as HM prebiotic carbohydrates that select for beneficial bacteria, and the specific human milk microbiota (HMM) are emerging as early mediators in the relationship between the development of GM in early life and clinical outcomes. The beneficial role of HM becomes even more crucial for preterm infants, who are exposed to significant risks of severe infection in early life as well as to adverse short and long-term outcomes. When MOM is unavailable or insufficient, donor human milk (DHM) constitutes the optimal nutritional choice. However, little is known about the specific effect of DHM on preterm GM and its potential functional implication on HMM. The purpose of this narrative review is to summarize recent findings on HMM origin and composition and discuss the role of HMM on infant health and development, with a specific focus on preterm infants.
None of the bioactive factors protect from gastroesophageal reflux. One theory is that infant reflux serves to propel immune factors in breastmilk into the mouth, nose, lungs and Eustachian tubes, to protect those areas from infection and mature the tissues.
Lysozyme is an enzyme made by white cells in breastmilk, and it destroys germs.
So there you have it, we covered just a snippet of the large amount of emerging information on the role of breastmilk in protecting, supporting and maturing the infant’s immune and neurologic system.
When someone asks you, 'isn't it just antibodies,' here is a one-liner:
'Of course it is not just antibodies, haven't you ever heard of ACE CHOICE? (Antibodies, Cytokines, Epidermal growth factor, Carotenoids, Hormones, Oligosaccharides, Interleukin-10, Cells that fight infection, and Essential fatty acids for neuro development?'
If you have a favorite acronym or elevator speech to explain the amazing powers of breastmilk, please share.