Deconstructing Gerber: Why Industry Should Not be Giving Health Advice

I was recently interviewed by a reporter from WebMD. She was knowledgeable and pleasant to talk with, and wrote a nice article about a new research study on how the SSRI-class of antidepressants influenced a breastfeeding woman’s milk supply. Since only 8 women in the study were actually taking the medication, the findings were not something that particularly worried me. And the resulting article was well-written and reflected that.

Imagine my surprise when I actually received the link to the article and found a slide-show imbedded right in the middle. It was entitled “Breastfeeding Hints and Hurdles.” I thought “what a good idea. I’ll take a look.” What I found was an attractive slide show, with some accurate information. The problem was that there was enough inaccurate information to cause breastfeeding failure. And on the very last page, just in case failure occurred, there was an ad for formula. Did I mention that the slide was funded by Gerber? (I posted the entire slide show on my previous post.)

In recent years, there has been a move throughout the health care industry to free health care from relationships with commercial companies. It is an idea I have always supported. But it is sometimes challenging for health care centers to implement having become accustomed to everything from free pens to continuing education to hospital equipment. But the Gerber slideshow is a great example of why these policies must be implemented. It does not make sense for a company to provide health information, in this case breastfeeding advice, when it is in their economic interest for breastfeeding to fail. It’s a bit like cigarette companies funding anti-smoking campaigns.


Let me show you what I mean. The photographs are copyrighted, so I can’t show them here. But I will do my best to describe them. Because of limited space, I can only share a couple. But you can read the analysis of all of the slides on my Web site.

Soothing Sore Nipples
(Picture of a rolled white terrycloth towel)
To soothe sore nipples, use warm moist compresses, rub a bit of fresh breast milk on your nipples and then let it dry, or dab on a bit of lanolin made for breastfeeding. A little pain and tenderness is normal at first. Pain usually goes away once you find a good breastfeeding position and baby latches on comfortably. Be sure to see your doctor if soreness increases or lasts several weeks.

Here's My Take
Warm compresses for sore nipples? Really? Lanolin is OK, as long as there's not an infection and the reason for soreness is addressed. But here’s where it gets bad. First, nipple pain as normal. At least they only said “a little.” But “be sure to see you doctor if soreness increases or lasts several weeks.[emphasis added] How many mothers would still be breastfeeding?

Ready for another one?

How Often Do Babies Nurse?
Photo of a jaundiced breastfeeding baby

Newborns should nurse every two to three hours, according to the American Academy of Pediatrics. That’s eight to 12 times in 24 hours.
Baby may feed from both breasts during one nursing session. And you can switch from side to side to avoid exhaustion. Baby is full when sucking has slowed or he turns away. After the first month, feedings may start decreasing to seven to nine times a day.

Here's My Take
OK, they’ve got the 8-12 times/day right. But every 2-3 hours? What about when babies cluster feed, such as in the evening?

Switch from side to side to “avoid exhaustion”? Whose exhaustion and how does that help avoid it?
“Baby is full when sucking has slowed”? Is that true for the jaundiced baby in the photo or is he simply falling asleep because he is jaundiced?
And decreasing feedings to 7-9 times a day after the first month? Says who? What if a mother has a small storage capacity and her baby needs to be fed more often? Unfortunately, mothers who follow this advice wonder why their supply has suddenly dropped. Good thing there is a coupon for formula!

At the end of this slide show purportedly about breastfeeding is an ad with coupons for Gerber infant formula, information on bottle-feeding, and link so readers can forward this “health information” to others. To me, the tactics of the formula companies are nothing new. Lactation consultants encounter them all the time.

But I’ll tell what I did find concerning: finding this slide show on WebMD. Consumers come to this site expecting to see evidence-based, impartial information--and this is anything but. True, they did clearly post that this was slide show was funded by Gerber. But new parents, the very ones most susceptible to this campaign of misinformation, may not realize the significance of that, and may take as gospel the advice that may very well derail their efforts to breastfeed their babies. And that, to me, is the real shame.

Breastfeeding Hints

Breastfeeding Hints

Why Would Breastfed Children Be Less Depressed?

I had an interesting call this week from a reporter. A new study is being released showing that children who were breastfed for 6 months or longer were significantly less likely be depressed several years later. Did I have any ideas about why they might have found that?

Actually, I did. It all comes back to the human stress response.

We know from a number of different studies that women who breastfeed past six months are doing a lot of things differently than women who stop in the first few weeks. For example, women who are still breastfeeding at six months are more likely to sleep near their babies, increasing the ease of nighttime breastfeeding while also sustaining their milk supply. These mothers are more likely to practice babywearing, or carrying their babies on their bodies rather than in a carseat or stroller. Finally, they are more likely to breastfeed their babies on cue rather than according to a schedule.

It's this total constellation of behaviors that sustains breastfeeding past the first few days and weeks, and I believe it accounts for the lower rates of depression among breastfed children. This pattern of behavior increases mothers' responsiveness to their babies, which lowers babies' stress levels. That is the key to understanding their lower risk.

When babies are ignored, or left to cry it out, their stress levels rise. If this only happens from time to time, babies adapt. But when this pattern becomes the norm, it has a fundamental effect on babies' developing brains. When their brains are bathed in stress hormones on a regular basis, they become more vulnerable to stress. Further, their bodies become hyper-responsive to stressful stimuli. That increases their vulnerability to depression not only in childhood, but throughout their lives.

By breastfeeding, and parenting in a responsive way, mothers are ensuring that their babies are not chronically stressed--and that shows up years later as decreased rates of depression and myriad other health problems.

Can a non-breastfeeding mother get the same effect? Yes, of course. But she will consciously need to be responsive to her baby's cues. From a practical standpoint, the beauty of breastfeeding is that this responsiveness is built into the system.

I think the takeaway message from this study is that responsive parenting does make a difference in how children fare throughout their lives. So it's something important for parents to consider next time someone advises them to let their babies cry it out.

St. John’s Wort for Depression

The herbal antidepressant St. John’s wort is the most widely prescribed antidepressant in the world, and it is highly effective in treating depression. The botanical name is Hypericum perforatum. Its standard uses are for mild-to-moderate depression, but St. John's wort has been used for major depression as well. When researchers have compared St. John’s wort to Zoloft and Paxil, St. John’s wort was as effective as medications and patients reported fewer side effects. One of its constituients, hyperforin, has also been shown to be highly anti-inflammatory, and this likely contributes to its effectiveness in treating depression.


Used by itself, St. John’s wort has an excellent safety record. But there are two important cautions. First, it does interact with several classes of medications, so should not be combined with antidepressants, birth control pills, cyclosporins, and several other classes of medications. If you decide to take St. John’s wort, be sure to tell your doctor or other health care provider. Second, brands of herbal products vary widely in quality, and it’s not always possible to tell which product is good quality. Seek the advice of a naturopath or licensed herbalist to find a good product. Or for a small fee, ConsumerLabs.com provides information on specific brands. Below are some resources and recommendations regarding use of St. John's wort.

Dosage: 300 mg, three times a day

Standardized to 0.3% hypericin or 2% to 4% hyperforin

The Complete German Commission E Monographs available online and for purchase from the American Botanical Council, www.herbalgram.org

Exercise Can Treat Major Depression

Health care providers often believe that alternative treatments for depression are only appropriate for mild depression. For more serious depressions, the patient needs DRUGS. But is that true? As I mentioned in a previous post, there are a number of non-drug treatments for depression. For this posting, I’d like to focus on exercise.

Two recent studies at the Duke University Medical Center tested exercise as a treatment for depression by putting it head-to-head with Zoloft in two randomized clinical trials. The patients were older adults with major depression. In both studies, exercise was as effective Zoloft.

Other studies have found that exercise prevents or treats depression with a wide range of people. The strongest effects are for aerobic exercise, but weight lifting and stretching/yoga are also helpful. If you exercise at a moderate level, exercise is safe during pregnancy or breastfeeding. The guidelines for treating mild-to-moderate and major depression with exercise are listed below.

The recommended exercise regimen for treating major depression requires more effort than the regimen for mild-to-moderate depression. But it is a viable alternative to medications and many women find that it is worth the effort. In the second Duke study, the researchers found that the group that came to the lab to exercise had a lower rate of depression than the group that followed a home-exercise program. The fact that they needed to come to the laboratory probably meant that they also received social support from study staff and fellow participants in addition to benefits of exercise. The participants were also probably more likely to exercise regularly when they knew that they were expected to show up some place. You might find that exercise in a group setting works well for you too.

How much exercise do you need to do? Here are some guidelines summarized from several recent studies.

For mild-to-moderate depression
• Frequency: 2 to 3 times a week
• Intensity: moderate
• Duration: 20 to 30 minutes

For major depression
• Frequency: 3 to 5 times a week
• Intensity: 60% to 85% maximum capacity
• Duration: 45 to 60 minutes

Exercise is another thing you can do for yourself to increase your physical and mental well-being. Get off that couch and just do it! You’ll be happy you did.

Can Fats Make You Happy?: Omega-3 Fatty Acids and Depression

Is all the discussion about Omega-3 fatty acids in health just a bunch of hype? The short answer is “no.”

Our best evidence on the effectiveness of Omega-3s is in the prevention of heart disease. They are particularly good at lowering triglycerides. And as I described in a previous blog, heart disease and depression and not only related, but likely share a similar underlying mechanism.So the fact that Omega-3s are helpful for both makes sense.

The long-chain Omega-3 fatty acids, EPA and DHA, have been used successfully to both prevent and treat depression. Both of these are found in fatty fish. EPA is the Omega-3 that actually treats depression because it specifically lowers inflammation and lowers the stress response. It has been used by itself or has been combined with medications. When it is used with medications, it makes medications work more effectively. The American Psychiatric Association recently recognized EPA as a promising treatment for mood disorders.

DHA helps prevent depression, but does not treat it by itself. It is usually combined with EPA. There is a vegetarian source of DHA, but no vegetarian source of EPA; fish oil is still the best source. Sources and dosages are listed on the side bar. Even in relatively large doses, EPA and DHA are safe for children, pregnant and breastfeeding women, and other populations. In addition, they provide a number of other health benefits for men and women, including lower their risk of heart disease and making them less vulnerable to stress.

For vegetarians, the bad news is that ALA, the Omega-3 in flax seed and other plant sources, such as walnuts and canola oil, does not prevent or treat depression. ALA is not harmful and can be helpful in other ways. But it is metabolically too far removed from EPA to aid in lessening depression.

What I like is that there really is no downside to using Omega-3s. And there is considerable upside. Even if they doesn’t lessen depression by themselves, they increase overall health. And that is a good thing.

Alternative Treatments for Depression in Pregnant Women

There has recently been a lot of discussion in the news about the potential hazards of taking antidepressants while pregnant. Some are concerned that they increase the risk of birth defects. Proponents of antidepressants point out, correctly, that depression during pregnancy is also risky and can lead to premature delivery and other complications.

Health care providers often make treatment decisions by balancing the risks and benefits of a medication. Is the risk of using the medication less than the risk of the mother getting depressed again? In most cases, the risk of using the medication is less than the risk of possible depression, so clinicians will prescribe it. But are antidepressants the only choice?

Curiously, while people debate about antidepressant use in both research studies and the popular media, non-drug treatments for depression are largely absent from the discussion. Fortunately, antidepressants are not the only choice for treating depression and may offer a safe “third choice” for treating depression during pregnancy. Physicians and other health care providers may not consider these non-drug treatments, assuming that they cannot address more severe depression.

But recent research paints a very different picture. There are a number of non-drug treatments that are effective for even major depression. Non-drug treatments include Omega-3s, exercise, bright light therapy, psychotherapy, and St. John’s wort. Many of these can be combined with each other, and are sometimes used in addition to antidepressants (only St. John’s wort cannot be combined with medications). What all these treatments have in common is that they are all specifically anti-inflammatory. In the next few installments, I’ll explain that in more detail. But it’s important to know that there are alternatives, and these are especially important to consider during vulnerable times, like pregnancy.

Depression and Inflammation: The Surprising Link

Depression is risk factor for depression. Researchers have known that for many years but couldn't really explain why—until now.

In the past 10 years, researchers have firmly established that a lot of common diseases--such as diabetes, cancer, Alzheimer’s, and yes, even heart disease--are due to inflammation. For example, physicians have noted that elevated levels of an inflammatory marked called C-reactive protein is an early harbinger of heart disease.

But here’s where the plot really thickens. Depression is also caused by inflammation, and specifically by elevated levels of molecules called proinflammatory cytokines. In fact, by specifically treating people with cytokines, as they do for conditions such as MS, doctors have actually caused depression. The more cytokines patients received, the more depressed they got. When the patients started to taper off of the cytokines, the depression got better too.

Depressed people have significantly higher levels of the cytokines in their plasma than non-depressed people. And this is where the disease-depression link comes from. High levels of proinflammatory cytokines damage blood vessels, and elevate other factors in the blood that increases the risk of clots.

And in another interesting twist, we now know that most of the effective treatments for depression have one thing in common: they are also anti-inflammatory. In fact, that knowledge has fueled some very interesting discoveries. For example, antidepressants lower inflammation levels in cardiac patients. And they’ve been added to steroids for treating asthma, leading to the use of fewer steroids in these patients.

This discovery has also led to some novel ways of treating depression. For example, anti-inflammatory medications, such as ibuprofen, which is not an antidepressant, have been added to antidepressants to make them more effective. Adding Omega-3 fatty acids to a treatment regimen helps with depression for the same reason.

Knowing about the anti-inflammatory connection also gives us a framework for understanding why non-medication treatments for depression would also work.

Inflammation: The Key to the Link between Stress and Disease

Human beings are wired to respond to physical threat in some predetermined ways. This is our body’s way of preserving our lives. The problem is that our normal stress response is meant to be acute, not chronic. But the types of stressors modern humans encounter are often chronic, and so our stress response is out of sync with the realities of our world. When stressors are chronic, our stress response malfunctions and actually increases our risk of disease.

There are three main components of the stress response. When you understand these, you will understand the basic concepts underlying mind-body medicine.

Simply put, the human stress response has three basic components.

The first is the catecholamine, or fight-or-flight response, and it kicks in as soon as we are threatened.

The second is the response of the HPA axis. HPA stands for hypothalamic-pituitary-adrenal axis. When faced with a threat, the HPA axis responds with a cascade of chemicals, the final one being the stress hormone cortisol.

The third component is the immune system’s response. When faced with danger, the immune system increases inflammation by releasing molecules known as proinflammatory cytokines. Cytokines are basically messenger molecules of the immune system. Inflammation has a very important role in protecting your health. These molecules protect you against infection and heal wounds. But when levels of these cytokines continue to be high, they can actually damage your body.

A key finding in mind-body research is that psychological stress can trigger the inflammatory response.

You’ll notice that I’ve drawn this three-component response with arrows connecting each component. In a normally functioning system, these three components serve as checks and balances to each other. When one part gets too high, the others activate to lower it. The problem is that when this system is overloaded, as it is in stress and depression, the components no longer serve as checks and balances. Instead, they start actually enhancing the negative effects.

Fortunately, there are some steps you can take to lower your response to stress. And that is what we will talk about in the next few posts.

What’s Stress Got to Do With It?: The Many Ways That Stress Impacts Our Health

Health care providers often tell me that they came to my lectures to learn about something for their patients, but they ended up finding something useful for themselves. They could be suffering from chronic pain, or heart disease, or metabolic syndrome. But they didn’t know that psychological stress was often a key part of why they were sick--and could even kill them.

In one of the first major studies in this field, researchers noted that people who were taking care of spouses with Alzheimer’s were dying at higher than rates than their non-caregiving peers. They were developing heart disease and cancer and other fatal diseases. I often think of Christopher Reeves' wife. Had caring for her severely disabled husband contributed to her own early death?

Researchers have also studied the link between depression and heart disease. Did you know that depression is a well-known risk factor for heart disease? Or that depression, hostility and other negative mental states increases your risk of developing diabetes?

Along these same lines, researchers have discovered that depression, stress or anxiety during pregnancy dramatically increases the risk of preterm birth. We are now beginning to understand why that would be so.

Sleep problems are another fascinating area of study. A lot of people know that sleep problems increase this risk of heart disease and diabetes. But what you might not realize is why they do.

The answer to these questions has to do with how humans respond to stress. And that is the focus of our installment. Stay tuned!

Mind-Body Connection: What You Don’t Know Can Kill You

Have you ever heard something so profound that it completely changes the way you look at things? That’s what happened to me when I first learned about the mind-body connection in health. I remember it vividly. I was attending grand rounds at my local hospital. The speaker mentioned something, almost in passing, about child maltreatment increasing the risk of irritable bowel syndrome in adults.

That sentence hit me like a thunder bolt. I had studied the effects of child maltreatment on adults for many years. But like most of my colleagues, I had only studied the mental health consequences of childhood events. That speaker’s comment raised such an interesting question. Could childhood events impact both body and mind? These questions started my journey through the fields of health psychology and behavioral medicine, and I learned much about the miraculous connection between our bodies and our minds. That is what I would like to tell you about.

Please allow me to introduce myself. I am a health psychologist, researcher, medical school professor, author and educator. I teach health care professionals all over the world about what I have learned. Health care providers often tell me that it is the first time that they have heard of this research. That’s a real shame—and something I’d like to change.

Mind-Body Connection is a way for me to let people know what is going on in this field--and to write about it in plain English. In the process, I hope to make this amazing field more accessible to both health care providers and regular folk.

As we journey together, I believe you will also be convinced of the importance of this work. And I hope that you will realize that what you don’t know about the link between your body and mind can indeed kill you. But what you find out can save your life.