Breastfeeding as Related to Autism and Childhood Cancer in Developed Countries
by Donald P. Meulenberg *
The greatly increasing numbers of those diagnosed with Autism Spectrum Disorder (ASD, often referred to simply as autism) are well known. There has also been a significant increase in childhood cancer in recent decades in the U.S. and Europe, while overall cancer incidence has been declining in both regions. Both of these developments appear to be very much related to toxins that have become widespread in the environment in recent decades, which become concentrated in breast milk.
There are certain neurological toxins that have been high or increasing rapidly in the environment in recent decades that are known to cause harm to mental development: principal ones are dioxins, PCBs, PBDEs, certain pesticides, mercury, and diesel emissions. (see www.breastfeeding-toxins.info) Diesel emissions, dioxins and PCBs are also classified variously either as known or probable carcinogens. Apparently most or all of those chemicals reach the developing fetus and breastfeeding infant mainly as a result of their long-term build-up in the body of the future mother, and they affect an infant at critical stages of neurological development. There is ample evidence (and no apparent disagreement) that some of these chemicals are ingested in many-times greater quantities by breastfed infants than by formula-fed infants. Average daily exposure of a breastfed infant to dioxin toxicity over the period of a year, as estimated by the EPA, is over 80 times higher than the reasonably-safe upper threshold of dioxin exposure estimated by the EPA. (see www.breastfeeding-toxins.info)
Two generations ago the case in favor of extended, exclusive breastfeeding was valid. But the world has changed since then. This paper will present considerable evidence showing that, in fact, the medium- and long-term physical health effects of extended breastfeeding by most women in developed countries are currently unfavorable. This is in addition to the apparent relationship between breastfeeding of infants and subsequent rates of autism and cancer.
Evidence will be presented in this paper showing the following:
Very strong correlations between high rates of breastfeeding and high rates of autism and childhood cancer in many specific instances: in many countries, in U.S. states and counties, among various demographic groups, with various parental characteristics, and with variations in birth order:
a) In every advanced country in which breastfeeding is known to be high, autism has also been found to be high (the Scandinavian countries, Germany, Switzerland, Austria, Australia, New Zealand, Japan, and South Korea) (Section 1.2.s.5); in the European countries with low breastfeeding rates, autism rates have been found to be less than half as high (Ireland, France, Belgium, and U.K.) (Section 1.2.s.4; childhood cancer rates, also, show a close correlation with breastfeeding rates (see www.breastfeeding-and-cancer.info);
b) The four U.S. states that are highest in autism (MN, OR, ME and UT) are also high in breastfeeding rates (Sections 1.2.s.7, 1.2.x.1); of the seven U.S. states that have the lowest rates of breastfeeding, every one of these seven also has an unusually low rate of autism (KY, WV, SC, AR, AL, LA, MS) (Section 1.2.x.5); a U.S. study of all 50 U.S. states and 51 U.S. counties, carried out by a PhD and Fellow of the American College of Nutrition, found that "exclusive breast-feeding shows a direct epidemiological relationship to autism" and also, "the longer the duration of exclusive breast-feeding, the greater the correlation with autism."(110b) Two other studies, one in the U.S. and one in the U.K., have come to similar conclusions. All of these studies support a finding that, the greater the exposure to breast milk, the greater the level of autism among the breastfed infants. (See Appendix 2.a)
c) There is a 50% higher rate of breastfeeding among U.S. whites than among blacks, corresponding with a roughly 50% higher rate of autism among whites than among blacks, and Hispanics are in between in both respects; however, blacks who breastfeed at about the same rate as whites apparently have autism at about the same rate as whites (Section 1.2.s.3); childhood cancer rates show an extremely similar pattern -- high among (high-breastfeeding) whites, low among (low-breastfeeding) blacks, and Hispanics are in between in both respects (see http://www.breastfeeding-and-cancer.info); childhood diabetes rates show the same pattern. (see www.breastfeedingprosandcons.info)
e) Autism rates have generally been found to be increasing in recent decades, while breastfeeding rates have also been increasing. Autism rates have apparently been found to be not increasing in only one study, in only one country; that specific country was unusual in having had a stable, non-increasing rate of breastfeeding in the period during which the studied groups of children were born. (Section 1.2.s.6) Increasing breastfeeding -- increasing autism (most countries). Stable breastfeeding -- stable autism (U.K. during the applicable period.).
The above are only some of many associations that have been found. Many more will be presented later in this paper.
Alert readers will notice that the above are only associations, and that they don’t prove that breastfeeding is the cause of the autism or cancer. That is true, but the associations should make one think carefully about (a) what could be causal connections, and (2) what else could be causes of the highs and lows in autism and childhood cancer, aside from the known highs and lows in breastfeeding and/or concentrations of toxins in breast milk in those same locations and social groups. For a causal connection, there are many randomized, controlled, high-quality studies that verify the neuro-developmentally-toxic and carcinogenic effects of specific chemicals of kinds that are known to be contained in typical breast milk. (see www.breastfeeding-toxins.info)
In addition, responsible U.S. government agencies acknowledge that the chemicals mentioned above are concentrated in breast milk and are ingested by breastfed infants in many-times higher quantities than by bottle-fed infants (see www.breastfeeding-toxins.info). This author invites and will publish here any thoughts submitted by readers as to what else, besides toxins in breast milk, could be causes of the associations noted above as well as those to follow. (Please write to firstname.lastname@example.org)
Proponents of breastfeeding point to the presumed benefit to the infant of immune cells that are transmitted in breast milk. As desirable as this may be in areas with poor sanitation, it apparently is not beneficial in developed countries. A web page of the U.S. Food and Drug Administration favorably presents a line of reasoning according to which proper infant development depends on “the necessary exposure to germs required to “educate” the immune system so it can learn to launch its defense responses to infectious organisms…. In the period immediately after birth the child’s own immune system must take over and learn how to fend for itself.” The FDA reports that this “hygiene hypothesis” is supported by epidemiological studies. A prominent doctor uses stronger language, describing the “critical importance of proper immune conditioning by microbes during the earliest periods of life.” By preventing effective microbial exposure that is important to proper development of the immune system, the shielding effect provided by breast milk’s immune cells is apparently actually counter-productive to long-term health. (more in Section 1.1.a) In addition to the above indirect effect of breast milk on development of immunity, there are also known harmful direct effects on the developing immune system resulting from toxins known to be contained in breast milk (see Section 1.1.a).
Given the above, the following should not be surprising:
-- Compared with people over age 15 in higher-breastfeeding countries, 8% fewer over-age-15 residents in low-breastfeeding European countries report a long-standing illness or health problem (Section 1.2.p.2);
-- Pertussis (whooping cough) and salmonellosis are diseases that cause many tens of thousands of deaths worldwide annually, principally among children under five years of age; in data reported for the EU, EEA and EFTA, the European countries with the highest rates of breastfeeding had an average rate of those diseases fifty times as high and over twice as high, respectively, as the countries with the lowest rates of breastfeeding; type 1 diabetes, another serious, sometimes fatal disease, is 2.6 times as high among children in the highest-breastfeeding countries of Europe as in the lowest-breastfeeding countries (Section 1.2.p.2).
-- Childhood cancer is substantially lower in the low-breastfeeding European countries than in the higher-breastfeeding countries, with only one high-breastfeeding country overlapping slightly into the low-cancer range that all of the low-breastfeeding countries fall within. (see www.breastfeeding-and-cancer.info)
The U.S. Surgeon General has pointed out that "research on the health outcomes of different modes of infant feeding is limited to observational studies, the results of which can only provide inferences on the association between feeding type and outcomes." (p. 33 at (3)) The dictionary definition of "inference" that applies here is "conclusion that, though it is not logically derivable from the assumed premises, possesses some degree of probability."(270b)
Given this recognition at the highest level of U.S. medical authority of the weakness of the evidence in favor of breastfeeding, the question must be asked whether "some degree of probability" of benefits of breastfeeding is sufficient grounds for what is being carried out: multi-million dollar government programs that promote a practice that subjects infants to officially-recognized extraordinarily high concentrations of developmental toxins and carcinogens. Bear in mind that, as will be presented along with authoritative sources later, (1) the EPA estimates that the average breastfed infant in its first year is exposed to neuro-developmentally toxic dioxins at 86 times the EPA's estimated safe exposure, and (2) the EPA estimates that the average dioxin toxicity exposure of an infant breastfed for one year is six times that of an infant that had been bottle fed. Also note that considerable crucial neurological development must take place during infancy if it will ever take place. (Section 1.2.b.1) In addition, note the very considerable evidence connecting higher and lower rates of breastfeeding with higher and lower levels of autism and childhood cancer. (More evidence to follow.)
Regarding this map of PCB exposure in the western U.S., bear in mind that (1) dioxins and PCBs from the environment become concentrated in breast milk (see www.breastfeeding-toxins.info) (PCBs are normally considered a variation of dioxins, and both are neuro-developmental toxins); and (2) Oregon (the western part of which is shown in red) has one of the very highest rates of breastfeeding in the U.S. See the text below the map for what appears to be the outcome of the high rate of breastfeeding in combination with high levels of PCBs in an area. For more on the subject shown in this map, and for the complete map, see Section 1.2.x.1.
1/800,000th of an ounce: The amount of a PCB-containing product administered per day to pregnant or lactating female monkeys that was found to cause the offspring to be hyperactive and retarded in learning ability. (see www.breastfeeding-toxins.info)
600,000 tons: The amount of PCBs produced in the U.S. between 1930 and 1977, which became part of considerable electrical equipment and appliances that are still in use (often leaking) and that are heavily present in landfills, from where the toxins can be released to the atmosphere or water supplies.
150 times higher: the intake of PCBs by an average breastfed infant per kg of body weight compared with the intake of an average adult, according to the German Federal Environmental Office. (same link as above)
20 times higher: The average effective daily intake of PBDEs (similar in toxicity to PCBs) by a breastfeeding infant from mother's milk alone as compared with the average total daily intake of adults, according to the EPA. Typical breast milk appears to be over 50 times as high in PBDEs as infant formula. (see www.breastfeeding-toxins.info) A major study found that children who had consumed breast milk that was merely above the median in PBDEs were over twice as likely (compared with those below median) to have unusually high scores in activity/impulsivity behavior, of a kind that indicated likelihood of developing into Attention Deficit/Hyperactivity Disorder. (see www.breastfeeding-health-effects.info)
7 to 1000 times higher: Intake by infants of BaP (a carcinogen) in breast milk of urban smokers, as compared with intake by babies whose mothers were rural non-smokers, in an Italian study. That is also up to 1000 times higher than the Acceptable Daily Intake determined for BaP in drinking water. This highly concentrated toxic exposure of breastfeeding infants apparently occurs mainly as a result of the mothers' inhalation of toxins through fairly common environmental and smoking exposures. (see link below for source)
4½ times higher: The average PCB levels in children who had been breastfed for at least 6 weeks, compared with those of children who had been formula-fed, at 3½ years of age, according to a study in the Netherlands. For breastfed vs. formula-fed levels of PBDEs at 4 years, the ratio was nearly at the above level. (see www.breastfeeding-toxins.info)
100 times greater: The average effective exposure of a breastfed infant, as compared with that of the mother, to persistent lipophilic substances (which include dioxins, PCBs, and PBDEs). (see link above for authoritative source)
10 times lower: The toxicity-equivalent concentrations of dioxins in formula-fed infants at 11 months of age, compared with infants that had been breast-fed for six to seven months, according to a German study. Note that the first year or so of life includes the “window” during which critical development of the brain takes place, if it will ever take place. (Section 1.2.b.1)
1 conclusion that can reasonably be drawn from the above and other evidence: Lactation is an effective means of taking in mild doses of toxins through being in developed areas in recent years, and then concentrating those toxins in breast milk. For details and sources, see www.breastfeeding-toxins.info . Also note that these are environmental pollutants to which human mothers and not cows are especially exposed: diesel emissions and other urban combustion emissions, household or office dust released by electronics, tobacco smoke, residential wood-burning smoke, and toxins bio-accumulated into meat, fish and dairy products consumed. It is not surprising that several sources of unquestioned authority have found breast milk to be many times higher in toxins than was the case for alternative feedings. (Request: If any reader can point to a scientific study that has found levels of any known toxins in cow's milk or infant formula to be even one-quarter as high as those in human milk, please submit it to email@example.com to be inserted here, and/or post it with your chat group, etc.)
70% decrease in a mother’s body burden of dioxins over a two-year period while she was breastfeeding twins, as found in a U.S. study. Another study praised the "decontamination" of the mother resulting from breastfeeding (see Section 1.1.e), BUT
?? increase in neuro-developmentally toxic, carcinogenic dioxins and other toxins in her infants as a result of this transfer of contaminants, during the neurologically most vulnerable periods of the infants' lives, while their brains are rapidly growing, and at the beginning of a 3-year period when childhood cancer rates are especially high.(www.breastfeeding-and-cancer.info ) To get some idea of quantities and toxicity that are relevant here, remember some of the numbers shown in bold above, starting with 1/800,000th of an ounce, and also see below.
Half as high: A fourth child’s risk of autism, as compared with that of a firstborn, on average. And the odds of being diagnosed with autism continuously decrease from first to later children. Infants later in birth order are less likely to be breastfed, they are breastfed for shorter periods on average, and the milk they receive has toxin levels that have been reduced as a result of excretion to earlier-born infants during previous breastfeeding. (Section 1.2.s.1.c) What a surprise that later infants have progressively lower rates of autism than firstborns, given the known extraordinarily high levels of neuro-developmental toxins in breast milk.
6 times higher: Accumulated dioxin toxic equivalency exposure in infants that had been breastfed for one year, compared with infants that had not been breastfed, in an EPA study (83)
86 times higher: Average daily exposure of an infant to dioxin toxicity during a year of breastfeeding, as estimated by the EPA, compared with the reasonably-safe upper threshold of dioxin exposure estimated by the EPA in 2012. (60 pg of TEQ/kg bw/day vs. 0.7 pg of TEQ/kg bw/day) (see www.breastfeeding-toxins.info)
65% vs. 28%: 65% of children diagnosed with autism had received substantial breastfeeding, in one of only three studies published with such data as of June, 2014 (the other two studies are summarized below); by contrast, only 28% of the children in the general population as a whole had received that much breastfeeding. (Comparing on basis of exclusive breastfeeding for at least four weeks or not, in UK and Northern Ireland.) A smaller U.S. study found similar results, but with a higher ratio of autistic breastfed children to the general population, when comparing on the basis of a greater exposure to breastfeeding. (See Appendix 2.a regarding the above.) These studies are very compatible with the study cited earlier, of all 50 U.S. states and 51 counties, finding "a direct correlation (of increased autism) with the increasing percentage of women exclusively breast-feeding." (110b)
4½ to 1: The ratio of males to females among the autistic, which is compatible with the facts that (a) neurological development depends heavily on presence of testosterone, and (b) the dioxins and PBDEs that are hazardously high in (the increasingly-ingested) human milk are known on the basis of animal tests to reduce levels of testosterone. (see Section 1.2.b.1) By contrast,
1 to 1: the apparent ratio of males to females among the mentally impaired in earlier decades,(1) before breastfeeding rates increased greatly.
Disproportionately high among children of the less-educated: General intellectual disability.(1a) No surprise.
Disproportionately high among children of the more-educated: The recently increasing autism. This is surprising, until one considers the fact that breastfeeding, increasing greatly in recent decades and imparting neuro-developmentally toxic dioxins to infants in doses scores of times higher than the EPA-estimated safe dose, is twice as frequent among college graduates as among high school graduates. (see Section 1.2.s.1.a)
Additional surprising findings about autism (that is, surprising until one understands what probably underlies the paradoxes) can be found at www.pollutionaction.org/surprises.htm . Those include the finding that autism is unusually low among children of unmarried women, even though general intellectual disability is over twice as high among children of unmarried women. Data from studies finding these surprising relationships, as well as good explanations for why these outcomes should be as they are, are found at the above link.
The EPA tries hard, with very limited success, to assess cancer risk, as indicated in the maps on the left. For instance, look at Utah on both maps, showing low EPA-determined risk but exceptionally high cancer rate in Utah, as compared with its neighboring states. After huge amounts of research, the EPA's ability to assess cancer risk has a long way to go.
Then look at the maps on the lower right, which take breastfeeding data for 2001-2003 from the CDC and childhood cancer data for 2005-2009 from the cancer.gov map below left (converting colored gradations to grayscale steps). Observe how much better breastfeeding rates are at predicting which states will be higher and which lower in childhood cancer incidence, as compared with the best efforts of the EPA.
When looking at these maps, bear in mind (1) the EPA estimate that the average breastfed infant receives extended exposure to dioxin toxicity at an average of 86 times the EPA's estimated safe level, and (2) the EPA's estimate that the average accumulated dioxin toxicity exposure of an infant breastfed for one year is six times that of an infant that had been bottle fed. (see www.breastfeeding-toxins.info)
The generally low levels of toxins in the western U.S. mean that that is the best region for observing effects of a single source of toxins, but the Northeast coastal region is also useful to look at for such a purpose because of its relative uniformity of pollution (details and sources at www.breastfeeding-and-cancer.info)
Vermont clearly stands out in its relatively low cancer incidence, which is to be expected judging by its pollution levels that are far lower than those of any other state on this map; it isn't even part of the coastal region, where pollution is above average. But one other state shown (Rhode Island) has still lower cancer incidence, despite having pollution levels similar to those of the other coastal states. Obviously there is something still more important in determining childhood cancer incidence than pollution levels.
Q: Which state has breastfeeding rates well below those of every other state in the region?
A: Just look for the blue color indicating unusually low childhood cancer incidence, in Rhode Island. What seems to matter most is the percentage of infants consuming a food in which toxins from the environment become highly concentrated. Pollution in this region, although above average, is nevertheless so mild that instruments are normally required to detect it. And, judging by the case of Rhode Island, it appears that (at least in a region such as this) the effects of pollution on childhood cancer rates only become major when the toxins become concentrated in a food that is substantially consumed by infants. (See above about lactation as a highly-effective means of concentrating toxins from the environment.) (We are informed of the unusually-low consumption of that high-toxin infant food in Rhode Island by the U.S. CDC, and the states' cancer incidence data come from the National Cancer Institute of the U.S. government. (see details and sources at www.breastfeeding-and-cancer.info)
Notice that New Hampshire's cancer risk (as determined by the EPA) is not high for the region, yet it has the highest childhood cancer rate in the region.
Q: How does New Hampshire's breastfeeding rate rank in the northeast coastal region, according to the CDC (2001-2004)?
A: Number 1.
Should we pay some attention to the fact that merely moderate levels of toxins appear to have a large effect in the states in which breastfeeding rates are high, and apparently far less effect in the states in which breastfeeding rates are unusually low?
The remainder of the U.S. contiguous states, when grouped according to childhood cancer levels and the groups' breastfeeding rates are averaged, show this same kind of close correlation between higher and lower childhood cancer rates and higher or lower breastfeeding rates in earlier years. For much more on this topic, go to www.breastfeeding-and-cancer.info.
Invitation to researchers, amateur or professional: Look for any apparently-close relationship between a pollutant in the environment and any disease, to make a comparison that draws on trustworthy major data sources and that can be pictured as in the maps above. If you can point out any such relationship that is anywhere near as close as the relationship between breastfeeding and childhood cancer shown here, please submit it to firstname.lastname@example.org and it will be posted in this paper.
An entire generation of Americans was mostly deprived of the benefits of breastfeeding, so it's worth looking into how much they suffered from that.
(The following is a summary of www.breastfeeding-health-effects.info .) According to the American Academy of Family Physicians, there was an entire generation born at a time when breastfeeding was rare: that was basically the post-World-War-II "baby boom" generation, plus several years of those born up until 1971. A careful web search for health problems of that generation brings up several thoughts as to what might be health problems of that generation, but there appears to be no certainty about anything other than obesity, lack of exercise, and conditions expected to arise from those two; in any case, that generation's life expectancy has risen and their disability rates have fallen in relation to those of earlier generations.
However, there are excellent, well-documented reasons to see this low-breastfed generation's health to be much better than that of the highly-breastfed generations that came later: The more-breastfed generations of children and young adults have
-- three and four times the obesity at a given age compared with the low-breastfed generation,
-- dramatically increased levels of asthma and other allergies, ADHD, serious emotional and behavioral difficulties, and (probably) autism,
-- greatly increased diabetes and other important diseases during childhood, and
-- increased childhood cancer, while adult cancer has declined.
The CDC's data show that, among those born during the period before the increase in breastfeeding, these disorders were either not increasing or any increases were minor and/or explainable by the decrease in exercise following the transition from farm and factory work to sedentary work. It was only among those born after the increase in breastfeeding started that extraordinarily large, surprising increases in these diseases and conditions occurred. The term "epidemic" has been applied to the increases that have occurred in obesity, diabetes, allergies, and autism following the transition from low to high breastfeeding. ADHD, now widespread, had not even been classified as a condition until eight years into the period of higher breastfeeding.
In some cases, there are high-quality scientific studies that provide excellent evidence that specific toxins that are known to be highly concentrated in breast milk (and low in infant formula or cow's milk) are causes of these increasing adverse health conditions: notably dioxins, PCBs, and PBDEs. In other cases, the connection appears to be reduced development of the individual's immune system as a result of (a) anti-microbial effects of externally-sourced immune cells (in breast milk) acting indirectly by removing the previously-normal stimulation for the immune system to develop, or (b) harm caused directly by toxins known to affect the developing immune system.
Looking at the diseases and health conditions that the Surgeon General alleges are "health risks" of not breastfeeding, all but one of them actually increased substantially during the years of greatly increased breastfeeding. If the Surgeon General's allegations about risks of not breastfeeding had been valid, most of those diseases and conditions would instead have declined. In the case of the only one that did not increase, at least it did not decline. For many details and sources related to the above points and about the extremely close correlations between breastfeeding and diabetes and obesity, see http://www.breastfeedingprosandcons.info .
To summarize: If breastfeeding were significantly beneficial to infants, one would expect to see evidence in historical health records that those born during periods of high breastfeeding are in better health than those born in a period of low breastfeeding. But, looking at the best-available U.S. evidence, the opposite turns out to be true. That is in addition to the data from other sources of unquestioned authority showing that (compared with people over age 15 in higher-breastfeeding countries) 8% fewer over-age-15 residents in low-breastfeeding European countries report a long-standing illness or health problem.
The officials who promote breastfeeding say that they haven't seen reason to feel that the undeniably high levels of toxins in typical contemporary breast milk are sufficient reason to question the overall desirability of feeding it to infants. This is despite the facts that (1) the benefits they claim for breastfeeding are based on very questionable evidence (see below), and (2) their claims are strongly contradicted by over three decades of health data covering the period since major increases in breastfeeding rates. Thus far, those officials even feel that information such as what is presented above should not so much as be shown to parents, along with the government-sponsored promotion of breastfeeding. And that is despite the fact that they don't (or can't) say anything to contradict the above. (see below)
The Surgeon General of the United States and the U.S. Department of Health and Human Services have said nothing to contradict the accuracy of the contents of this paper, in their several responses to letters from the author of this website. The American Academies of Pediatricians and Family Physicians, the American Congress of Obstetrician and Gynecologists, and the World Health Organization also have said nothing to contradict the contents of this website, in response to multiple letters to them. They were all informed that this website, giving reasons to oppose their promotion of breastfeeding, is being widely read; and they have been given ample opportunity to respond in defense of their position. But none of them has offered one word of criticism of the contents of this website, as of several months after receiving letters from the author. One very logical possible reason for their failure to respond or to criticize anything written here is that they can't find anything wrong with it.
The "Surgeon General's Call to Action to Support Breastfeeding 2011" (pp. 1-2) contains many statements and bold headings that are based on questionable assumptions and not on good evidence; but there is only very inconspicuous acknowledgement of the weakness of the evidence provided to support the alleged "risks" of formula feeding. The Surgeon General does admit (p. 33) that the evidence for benefits of breastfeeding consists merely of inferences, from observational studies -- the kind that would find high death rates in Florida to be associated with sunshine, while overlooking effects of old average age in Florida. Three letters from this author pointed out to the Surgeon General, citing considerable authoritative evidence, the following: Low incomes and smoking are unusually prevalent in bottle-feeding households, and many adverse health outcomes are known to go along with low incomes and smoking (See Section D of www.breastfeeding-benefits.net); those are at least as likely as bottle feeding to be the real basis for the "associations" of formula feeding with negative health outcomes. The Surgeon General and her colleagues said nothing to contradict this alternative explanation for the supposed "risks" of bottle feeding. They also said nothing in response to the well-documented point that several important childhood diseases (diseases that they never mention when promoting breastfeeding) are much less prevalent in low-breastfeeding countries than in high-breastfeeding countries. But they continue to let all of their many unqualified assertions of "health risks of formula feeding" stand, without proper indication of the speculative nature of those assertions. They also do not provide so much as a hint that there is another side to this important issue that parents should consider while they are being told the completely pro-breastfeeding position. (For a fuller rebuttal of the position of the U.S. Surgeon General on this matter, see Section 1.1.cwww.breastfeeding-benefits.net)
Much worse than that, on the basis of their very questionable assumptions, the Surgeon General and other federal offices have embarked on major governmental programs promoting breastfeeding, when it is known (with no disagreement) that the infant food they recommend contains very high concentrations of developmental toxins and carcinogens, in far higher concentrations than in alternative infant foods. (see http://www.babyfeeding.info/toxins-in-breastmilk-and-formula.htm ). And they continue promoting this high-toxin diet after very good evidence has been provided to them (with no rebuttal provided by them or by anyone) that breastfeeding is closely associated with unusually high levels of autism and childhood cancer and unusually high levels of important childhood diseases. (see earlier part of this Introductory Summary)
This author, like the Surgeon General in one respect, relies on associations to support his position. But there are major differences in how this is done.
1) There are many high-quality studies (randomized, controlled trials) verifying that chemicals that are highly concentrated in breast milk cause both cancer and endocrine disruption of the kind that harms neurological development. To mention only one such toxin among several contained in typical breast milk, dioxins are known carcinogens and known endocrine disruptors (therefore neuro-developmental toxins), and are present in breast milk in average quantities 86 times the EPA's estimated safe dose, for the period of a year. (see http://www.babyfeeding.info/toxins-in-breastmilk-and-formula.htm ) There is high-quality evidence showing the "mechanisms of action" by which the toxins contained in breast milk can cause harm, when looking at the associations referred to by this author. By contrast, the associations referred to by the Surgeon General have no such support from high-quality studies. There is no evidence about known toxicity of any substance in infant formula in the quantities known to be present; and there are no high-quality studies verifying harmful effects of lack of any substance contained in breast milk that isn't present in formula. The "associations" referred to by the Surgeon General remain at the level of merely something that should stimulate thought and further research. They are far below the level that could be a rational basis for a national program that would expose infants to known high concentrations of carcinogens and developmental toxins.
2) There are very authoritative sources (cited in this paper) that provide full explanation for why specific other factors could well be the real causes of all of the adverse health conditions that the Surgeon General alleges to be "risks" of formula feeding. (see Section D of www.breastfeeding-benefits.net) However, regarding the many associations presented in this paper between breastfeeding and adverse health outcomes, an invitation has long been open here soliciting thoughts that could contradict the contents of this website, including its major points regarding the well-documented higher autism and disease rates in high-breastfeeding countries and U.S. states. Nobody has written to offer any suggestions for any other possible causes for these associations, other than harm caused by components of breast milk. The invitation is still open.
3) The author of this paper, unlike the Surgeon General, is not using questionable evidence (inferences, supported only by studies recognized to be subject to false conclusion) as a basis for promoting massive feeding to infants of a substance that is known to contain high concentrations of carcinogens and developmental toxins. The Surgeon General is engaging in exactly that kind of misuse of associations from observational studies.
Message to health professionals, scientists, and others reading this paper: This author cordially invites you to indicate your reactions to the contents presented here. As of now, new parents almost never hear anything but completely one-sided promotion of breastfeeding, with no mention of possible drawbacks except in cases of serious problems on the part of the mother. If you feel that parents should be informed about both sides of this question and thereby enabled to make an educated decision in this important matter, please write to the author of this paper. Also, if you find anything here that you feel isn't accurately drawn from trustworthy sources or based on sound reasoning, please by all means send your comments, to email@example.com. Comments, and a response to a doctor's request for high-quality evidence comparing toxins in breast milk vs. those in formula or cow's milk, are posted at www.pollutionaction.org/comments.htm.
Aside from ingestion via breast milk, there are other probable avenues by which infants can ingest or absorb toxins that could result in abnormal mental developments. Those include (1) ingestion of typical soil or dust, containing concentrations of dioxins and other toxins (Section 2.4.a), (2) absorption of certain widespread chemicals through the skin (Sections 1.2.b.1, 1.6.b), and (3) breathing of air containing recently-prevalent toxins (Section 1.4). All of these can interfere with activity of testosterone, which is known to be important to neurological development (Section 1.2.b.1).
The following should be pointed out regarding the seriousness of some of the problems being discussed here: According to years-old data from the CDC, over 35,000 children are born in the U.S. every year who will probably eventually be diagnosed with Autism Spectrum Disorder alone (the rate has risen substantially since then). Estimates of the average total lifetime cost of caring for a mentally-impaired person with ASD have varied between $3.2 million and $4.7 million. (2) Those impaired by autism are less than half of the children currently reported by the Census Bureau to have “serious difficulty” concentrating and remembering (1), and many or most within that much larger and increasing impaired group will also end up being burdens on their parents and on society for their entire lives. A high percentage of those children who are not judged to be impaired have probably nevertheless been developing to a level well below their genetic potentials, as a result of exposure to these same toxins at levels lower than had been ingested by those who became seriously impaired. Childhood cancer: 34,500 deaths from childhood cancer were reported in the U.S. during 1990-2004 (per CDC); in 2012, almost 12,000 U.S. children will be diagnosed with cancer; (2a) incalculable suffering to children and expenses for their families and for all who bear the expenses of care and treatment (including taxpayers and all payers of insurance premiums) are also incurred. Even more numerous than those who die are those who survive and face a problematic or at least uncertain future.(2b)
Proposed Remedial Actions: Mothers should be extremely wary of the likely effects of breastfeeding if they have been receiving typical exposure to the environments in developed countries, especially if they have been eating a typical, omnivorous diet. For parents-to-be who can plan well ahead, the ideal action might be for the woman (years before pregnancy) to adopt a diet that mainly avoids the meat, dairy products, fish, and snack foods that are high in animal fats, which are the main sources of dioxins, mercury and other developmental toxins into her body, as well as avoiding close proximity to electronic devices and to areas of high vehicular traffic, so that there could be a better chance of her being able to feed her future infant good-quality breast milk, and also to minimize effects of toxins on the fetus during gestation. Other ways to protect future nursing mothers and developing infants from neurological toxins include keeping them away from known sources of toxins (including downwind from wildfires), aggressive publicity discouraging eating by infants of foods known to contain high levels of dioxins and/or mercury (especially ground beef and foods high in animal fats), thorough air filtration and frequent removal of dust (especially in areas where infants could be kept most of the time during critical stages of their brains' developments), refraining from enclosing the infant male scrotum in (possibly dioxin-contaminated) bleached disposable diapers, separation of infants from tobacco smoke, and minimizing exposure of infants to possible ingestion or absorption of soil and of DEHPs contained in soft plastics. Keeping infants away from PVC flooring appears to be a good idea. (Section 1.6.b) Practicality of unusually good air filtration during periods of bad air could be improved by focusing more research on "critical windows of sensitivity" during which the developing brain has been found by scientific research to be especially vulnerable to effects of toxins. Many more suggestions for remedial actions will be presented elsewhere in the paper.
This author's personal bias, of a kind that many people object to: I believe that, where there is reasonable doubt about the safety of a substance to which people are exposed in the environment, the benefit of the doubt should be on the side of trying to minimize human exposure to that substance. In presenting my concerns to various people, some have pointed out that there isn't conclusive proof that the substances in question cause the harm that I am concerned about. They are likely to recommend that high standards of evidence should first be met (involving research that could take place only over many years, requiring funding, personnel and/or equipment that may or may not ever be available) before attempts should be made to discourage a usage or activity that is seriously in question. In line with that kind of orientation, at least two pesticides, endosulfan and dicofol, had been in use in the U.S. since the 1950's before a study by researchers with the state of California found autism to be several times higher than average among infants residing in areas where it was used. Not long after that, following a half-century of widespread use (and unknown numbers of lives harmed), the EPA disallowed the registrations for those two pesticides. Also bear in mind that the causal association between smoking and lung cancer was merely suspected for decades before evidence was finally provided that conclusively proved the connection, following unknown thousands of avoidable lung cancer deaths in the intervening years. In the case of Thalidomide, identification of that particular chemical’s harmful effects was made relatively easy by various factors including the facts that the effects were quickly very conspicuous and also were traceable to one single chemical. But even then, it still took over two years and about 10,000 malformed babies before general sale of Thalidomide was stopped. With the environmental toxins that have apparently been causing mental impairment in recent decades, verifying them as causes of harm is greatly complicated by the years of delay between the exposure and the subsequent observability of the effects, by the large numbers of the various chemicals that have become new in the environment in recent decades without any kind of testing for safety, and by the relatively small percentage of all children who have been conspicuously impaired. This author’s position, based on the above: We should not wait for a conclusive breakthrough discovery before taking constructive steps; if we see things in the environment that appear to be probable sources of serious problems, and if something can reasonably be done about them, we should do something. And if we see a kind of infant feeding taking place that takes in toxins from the environment and greatly concentrates them before then causing them to be ingested by infants at the most vulnerable times of their lives (breastfeeding), we should look at that process with very serious skepticism. Especially if
a) authoritative sources have determined that infants ingesting that feeding are in most cases also unavoidably ingesting developmental toxins in doses scores or even hundreds of times higher than established safe levels,
b) authoritative sources have determined that levels of developmental toxins are scores of times higher in that promoted feeding than in an alternative feeding that was quite satisfactory for an entire generation of Americans (see www.breastfeeding-toxins.info); and
c) there are many examples in the world of high levels of serious adverse effects in the very same places and social groups where that process takes place at high rates, as well as low levels of those adverse effects in every place where breastfeeding rates are low.
Aside from what seems to be effectively an acknowledgement by the leading advocate of breastfeeding that the contents of this paper are accurate, anybody can verify that this consists of correctly-summarized information gleaned from trustworthy sources; just go to the sources indicated and find the original data or other basis for what is presented. Or do that just for one or two statements contained here that seem to you to be hard to believe. If any reader considers any statement made here to be questionable and/or has difficulty accessing the original, authoritative source of that information, or considers the source (EPA, CDC, NIH, university-affiliated researcher, etc.) not to be trustworthy, please notify this paper's author at firstname.lastname@example.org . Many people hold views contrary to the basic position of this website, and this site (with its invitation of criticism) has been receiving considerable traffic since early 2012, but only one inaccuracy has been pointed out as of January 27, 2014, and that is noted in www.pollutionaction.org/comments.htm.
A question that should be addressed to those who are recommending breastfeeding, but which they probably won't want to answer:
Given (a) the inconclusiveness of the studies that support breastfeeding,** (b) the known concentrations of environmental toxins in recent human milk,** and (c) the many close correlations between variations in breastfeeding levels and similar variations in levels of several important childhood diseases (as seen in national health data**): How do we know that breastfeeding is more beneficial than harmful?
** Supporting information and references to authoritative sources regarding matters raised in this question are included in a one-page printable version of this question, to be found at www.pollutionaction.org/Q.pdf .
We have good reason to say that those who recommend breastfeeding probably will not have an answer to the above question. A slightly different version of essentially this same question was mailed to four different high officials at the U.S. Department of Health and Human Services, who are heads of divisions that are involved in promoting breastfeeding. As of 9 and more weeks after mailing those letters, no reply has been received. Several months earlier, each of those officials had sent one response to an earlier letter that brought up the matters above, and none of their responses said anything in criticism of any of those points. Those points are all well substantiated. So the above question is a logical one to ask. But the promoters of breastfeeding appear to be unwilling or unable to respond to it. If they can't or won't answer that question as part of an informed debate on this matter (therefore to email@example.com, as well as to you), should anybody pay attention to their advice?
Direct Effects of Toxins in Breast Milk on the Developing Immune System:
According to an extensive study on environmental toxicants and the developing immune system, published in 2011 (Winans et al.), toxins including dioxins, PCBs, PAHs, BPA, and phthalates can harm development of the immune system.(23a1) Note that all of these have been found in breast milk, with dioxins in doses known to be especially high in relation to the EPA-determined safe level - - see Section 1.6.b and www.breastfeeding-toxins.info. According to the Winans study, which draws on a vast body of research on the subject, "...Epidemiological data have demonstrated that early life exposure to AhR ligands, including dioxins and PCBs, leads to altered immune function in children [24–31]." Research for over 30 years, including studies of developmental exposure of rodents to dioxin, has demonstrated that "early life exposure to TCDD (dioxin) alters the functional capacity of the offspring’s immune system." In Section 2.2 of that study: "Increased incidences of respiratory and ear infections, cough, and sore throat were observed in children with higher early life exposure to dioxins, PCBs and PAHs [25–31]. Further, studies in the Faroe Islands and the Netherlands demonstrated that increased developmental PCB exposure correlated with reduced antibody response to vaccination [24, 30], ... These studies clearly demonstrate the ability of dioxins and related persistent organic compounds to have a long-lasting and deleterious impact on immune function." Section 6.3: "...epidemiological studies investigating phthalate exposure in children found increased risk of respiratory symptoms such as wheeze and allergic indications ." "...there are several animal studies to support the idea that exposure to BPA alters immune function.... Early-life exposure to BPA has been suggested to...enhance the development of an asthmatic phenotype [135, 136]." "In the example of dioxin-like compounds, epidemiological data show that children with developmental exposure have increased susceptibility to infections." (23a1)
Another toxin known to typically be highly concentrated in breast milk, PBDEs, is also known to harm the developing immune system. PBDEs have been found to displace thyroid hormones that otherwise would be acting as modulators of the immune response. They also decrease levels of T4 following developmental exposure (T4 regulates the body's immune responses). In addition, PBDEs may be converted to polybrominated dibenzo-p-dioxins (PBDDs) and dibenzofurans (See Section 1.7.1.), which (as indicated in their names) are structurally similar to polychlorinated dioxins and furans, with their demonstrated tendency of leading to altered immune function in children (see previous paragraph).
Bear in mind that not only are all of the above toxins present in breast milk, but dioxins, PCBs and PBDEs have been found to be present in breast milk in many times higher concentrations than in alternative feedings. Data about concentrations of PAHs in breast milk compared directly with those in alternative feedings have not been found by this author; however, widely-varying concentrations of PAHs in milk from different women have been found, varying up to 1000-fold according to how directly exposed the women were to urban traffic and tobacco smoke. (see www.breastfeeding-toxins.info) It should be safe to assume that milk from cows would normally be close to the low end of the 1000-to-1 ratio, given the normal lack of exposure of cows to urban traffic and tobacco smoke; that is compatible with the fact that the only human females found to have breast milk at the low end of that ratio were rural non-smokers.
Indirect Effect of Breast Milk on the Developing Immune System -- The Hygiene Hypothesis / Microbial-Deprivation Hypothesis:
As promoters of extended breastfeeding point out, breastfeeding transmits immune cells/antibodies from the mother to the baby, which help protect the infant from microbes. But there is an important reverse side to that coin, related to the major recent reduction in stimuli needed for a child’s own immune system to develop properly. It is well established, in the underlying principle of most vaccinations, that the immune system develops its own capacities in response to challenges. It has recently been learned that some microbial challenges need to occur very soon after birth in order to properly promote development of the child’s immune system (see below). As mentioned in the introduction, with more detail below and in www.breastfeeding-health-effects.info, in Section 1.2.p.2 of this paper, there is considerable evidence indicating worse long-term health outcomes among people who have had the most exposure to breastfeeding.
When Homo Sapiens was evolving, sanitation did not exist, and our forebears until late in the 19th Century knew nothing about protecting infants from bacteria. For well over 99% of our evolutionary history, before modern sanitation, clean water, pasteurized milk, food inspection, vaccinations, and refrigeration came into existence, transmission of immune cells via breastfeeding promoted survival and increase of our species. It is safe to summarize that most infants’ exposures to microbes in developed countries have already been reduced to extremely low levels in relation to what our species adapted to over almost all of our evolutionary history. Given what has been observed about harm that may result from too little exposure to microbes (see below for specific evidence), the time has come to re-consider the desirability of a kind of infant feeding that further combats microbes.
Of great relevance here is the “hygiene hypothesis” described in a web page of the U.S. Food and Drug Administration, according to which proper infant development depends on “the necessary exposure to germs required to “educate” the immune system so it can learn to launch its defense responses to infectious organisms…. In the period immediately after birth the child’s own immune system must take over and learn how to fend for itself.” (emphasis added) The reader should try to figure out where activity of microbe-destroying cells from outside the infant’s body, via breast milk beginning right after birth, fits into this picture of necessary exposure of the infant to germs right after birth. The FDA continues, “The “hygiene hypothesis” is supported by epidemiologic studies….” (20) A study found on the NIH’s website discusses “the microbial exposure which may be critical for immune priming” and suggests it would be helpful to re-name the “hygiene hypothesis” as “microbial deprivation hypothesis.” (21) "Just as a baby's brain needs stimulation, input, and interaction to develop normally, the young immune system is strengthened by exposure to everyday germs so that it can learn, adapt, and regulate itself," according to the director of the Laboratory for Human Biology Research at Northwestern University. A recent study found that children who were exposed to more animal feces and had more cases of diarrhea before age 2 had less incidence of inflammation in the body as they grew into adulthood. (Inflammation has been linked to many chronic adulthood illnesses, such as heart disease, diabetes, and Alzheimer's.)(21b) A 2009 study “suggests that exposure to infectious microbes early in life may actually protect individuals from cardiovascular diseases that can lead to death as an adult.”(21a) Another study (in the website of the National Center for Biotechnology Information, U.S. National Library of Medicine, NIH) also refers to studies that help verify the long-term beneficial effects of early exposure to microorganisms; specifically applicable studies found apparent benefits of infant exposure to microbes on farms (with animals) and benefits to younger children of exposure to microbes from older siblings. “A key question with regard to the hygiene hypothesis, which remains to be addressed, is how big the critical microbial exposure needs to be…..”(22). The question that remains open appears to be not whether development of the immune system depends on exposure to microbes, but "Does further reduction in exposure to microbes (below the already historically low levels) by means of externally-provided immune cells do anything other than harm an infant’s long-term health?"
Various studies have recently added to the evidence along the above lines. "These studies show the critical importance of proper immune conditioning by microbes during the earliest periods of life" (emphasis added), according to Richard Blumberg, MD, chief of the Brigham and Women’s Hospital’s Division of Gastroenterology, Hepatology and Endoscopy. (23). It appears that the hygiene hypothesis (or microbial deprivation hypothesis) is advancing past the stage of being merely supported by epidemiological evidence, if a highly-placed medical official flatly declares that early conditioning by microbes is of “critical importance.” By implication, the apparently logical next step is to look with serious skepticism at the notion that it is beneficial in developed countries to recommend infant feeding that contains externally-created microbe-destroying components; that is especially the case if that infant feeding is recognized by the EPA to include very hazardous concentrations of developmental toxins and carcinogens, in many-times higher amounts than alternative feedings.
In many ways, living organisms become healthier as a result of being subjected to challenges. Muscles of all kinds are only the most conspicuous of many verifications of this principle. Lung capacity is known to increase among people who require major exertion of their pulmonary systems through exercise. Bones become stronger in response to mechanical stress. (23a) The circulatory system functions better in response to strenuous challenges. It is well established that challenges to the brain strengthen mental powers, most notably in older people but also in children. Immunities of all kinds are produced by vaccinations that subject the immune system to moderate challenges, thereby activating the person's own immune system, not by pumping in externally-sourced immune cells and alleviating the need for a person's own immune system to develop.
In addition to the apparent importance of not shielding people in general from challenges, there is good reason to actually encourage the exposure of children to microbial challenges. In earlier generations, measles and mumps were normal childhood illnesses, illnesses that could be described as temporary discomforts for the child, which were important to go through as a child because that exposure built immunity against what would be a serious disease if incurred during adulthood. A child's body is apparently better able to tolerate at least some, if not most, illnesses than an adult's body. And childhood is probably a better time to have those illnesses than adulthood, considering the relative costs of time spent in an incapacitated state, and especially considering the sometimes very serious consequences of incurring that disease as an adult. A mature reproductive system as well as actual reproduction are aspects of adulthood that are very much subject to serious harm by certain diseases (e.g. German measles); development of immunity to those diseases as a result of going through them while still a child (as opposed to being shielded from them at that stage) is clearly beneficial. Before the days of the MMR vaccination, no knowledgeable person would have recommended that children be protected from mumps and measles viruses. Yet that kind of thing is being done every day when infants are breastfed and thereby are shielded from microbes by an external substance that essentially prevents the child's own immune system from being stimulated to develop.
Obviously, excessive bacterial exposure is bad, just as excessive amounts of many ordinary things (dietary fat, iron, Vitamin A, salt, sunshine, stress, etc.) are bad. But too little of each of these exposures is also unhealthy. Warding off most of the remaining relatively small amount of microbial exposure in today's developed countries, by means of externally-provided immune cells, is equivalent to always carrying a toddler wherever he wants to go, or providing him with a motorized cart as soon as he can operate it; development of his own capacities will suffer.
Some real-world verification of the importance of avoiding excessive shielding of an infant from microbes can be seen in the facts that
(a) compared with people over age 15 in higher-breastfeeding countries, 8% more over-age-15 residents in high-breastfeeding European countries report a long-standing illness or health problem than do those in low-breastfeeding European countries (Section 1.2.p.2); and
(b) childhood cancer and many other often-fatal childhood diseases are 23% to 5000% more prevalent in Europe's highest-breastfeeding countries than in the low-breastfeeding countries (Section1.2.p.2 and www.breastfeeding-and-cancer.info); and
(c) other serious disorders including asthma and allergies, although reduced by breastfeeding in early childhood, become much higher among the more-breastfed after the years of early childhood. (see.www.breastfeeding-and-asthma.info).
The above may seem hard to believe, considering how popularly-held the idea is that breastfeeding is beneficial. But the above points were presented to the U.S. Surgeon General, to high officials in the U.S. Department of Health and Human Services (including the CDC), and to high officials of the American Academy of Pediatrics in letters in May, June, September and mid-October of 2012, pointing out that this content is being widely publicized (in opposition to their promotion of breastfeeding) but is open to criticism; and the only responses received as of the following May said absolutely nothing to contradict these points. Moreover, anybody can go to the sources indicated for anything presented in this paper and see that the contents presented here are accurately drawn from major, trustworthy sources.
To summarize: It is entirely open to question whether, considering lifetime health, there is validity to the idea that infants in developed countries benefit by receiving maternal immune cells in breast milk. There are excellent grounds to believe that, in the hygienic modern conditions in developed countries, and given the typically-high concentrations of dioxins, PCBs, PBDEs, and other toxins in breast milk in those countries, the child's development is likely to be harmed by breastfeeding. The reader should remember from above (with more detail in www.breastfeeding-health-effects.info and in this paper at Sections 1.2.p.1 -1.2.p.2) the considerable data indicating worse long-term outcomes among those who are most likely to have been breastfed.
It is now recognized that drinking untreated water from local streams or ponds can be harmful, even though that was a ”natural” source of drinking water for most of our species’ history. In the case of breast milk, its current lack of suitability despite being natural is much less obvious, because adverse effects of the toxins that have been increasingly present in it in recent decades aren’t quickly observable in the form of diseases that are traceable to specific pathogens.
However, thousands of new chemicals have become widespread in the environment in the last half century or so, several of which have been found to be both highly concentrated in breast milk and also neuro-developmentally toxic and carcinogenic. One example can be seen in the 6-times-higher accumulated dose of dioxin toxic equivalency in infants that had been breastfed for one year, compared with infants that had not been breastfed, as found in an EPA study. And the average daily exposure of a breastfed infant to dioxin toxicity, as estimated by the EPA, is 86 times higher than the reasonably-safe upper threshold of dioxin exposure estimated by the EPA in 2012. (More detail, other examples, and sources can be found in www.breastfeeding-toxins.info)) Dioxins are known human carcinogens, and other toxins concentrated in breast milk are also known to cause cancer in animals. There is ample evidence based on animal tests that these chemicals cause adverse effects on neurological development. And there are many correlations between higher and lower amounts of breastfeeding and higher and lower levels of childhood cancer and autism. (See the Introductory Summary) Just one of several illustrations of the breastfeeding-autism connection can be seen in the fact that the odds of a child’s being diagnosed with autism continuously and substantially decrease from first to later children; the connection is that infants later in birth order are breastfed less than earlier infants on average, and the milk they receive has toxin levels that have been considerably reduced as a result of excretion to earlier-born infants during previous breastfeeding. (Section 1.2.s.1.c)
Human infants aren’t used in laboratory experiments, which precludes conclusive proof that the dosages of these chemicals that are present in breast milk are causes of neuro-developmental harm and substantially increased rates of cancer. But there is sufficient strong evidence that people should think carefully about what is probably happening, and act accordingly.
For more information about specific developmental toxins and carcinogens that are new or greatly increased in the environment and in breast milk in recent decades, see Section 1.9.6 and www.breastfeeding-toxins.info)
It is generally reported that the causes of autism are basically still unknown. However, well-researched suggestions as to ten specific environmental chemicals that are said to justify further research as possible causes of autism have recently been presented by very authoritative authors: Philip Landrigan, MD, MSc, Director of the Children's Environmental Health Center at Mount Sinai School of Medicine, Luca Lambertini, PhD, MPH, MSc, Assistant Professor of Preventive Medicine at Mount Sinai, and Linda Birnbaum, Director of the National Institute of Environmental Health Sciences (23b) Most of those ten chemicals have been found to be present in breast milk, some of them in high concentrations: lead, mercury, PCBs, certain classes of pesticides, endocrine disruptors (which include dioxins), PAHs, perfluorinated compounds, and PBDEs (brominated flame retardants); considering how many different chemicals are found in breast milk, it is very likely that all ten of the suspected contributors to autism are often present in breast milk, even though two or three of them may not have been reported as such. (see www.breastfeeding-toxins.info) “One property of breast milk is that its high-fat and -protein content attracts heavy metals and other contaminants,” according to a New York Times article and also as stated by the NIH.(24)
Breastfeeding is a factor to be looked at with particular interest as a means of transmission of these toxins to developing infants, for various reasons. It has been greatly increasing in recent decades as a means of infant ingestion of toxins, during the same period when reported autism has been greatly increasing; childhood cancer has also been increasing, while cancer prevalence among adults has been decreasing. Many chemicals have been increasing in the environment in recent decades, but breastfeeding stands out from the other sources of toxins in that it is a source of exposure with all four of the important impairment-related characteristics listed below, while probably no other source of environmental toxins has more than one of these traits:
1) It is a food. The EPA reports that normally, of the human absorption of dioxins (PCBs are a variation of dioxins), about 90% of absorption of those toxins results from food consumed; in addition, lactation greatly concentrates toxins ingested by the mother into the milk before those toxins are excreted to the infant; the average effective intake of dioxin by a breastfeeding infant from mother's milk alone is twenty times the average total intake of adults (see www.breastfeeding-toxins.info);
2) It is a means of ingestion that contains most or all of the toxins linked with autism in the research by the above high-level team, with some of these toxins being in confirmed high concentrations in breast milk; an EPA document indicates daily dosage to breastfeeding infants of 60 pg of dioxin toxic equivalency per kg of body weight for a year of breastfeeding, compared with the safe dose (quoted by the EPA in 2012) of 0.7;
3) It is a source of toxins that is normally ingested extraordinarily heavily at the specific time of maximum vulnerability, while the infants’ brains are going through a critical period for proper development, the crucial early period of infancy during which considerable neurological development has to take place in the infant if it will ever take place; (Section 1.2.b.1)
4) It has been found in three separate scientific studies to have been a very disproportionate exposure of children who were later diagnosed as autistic, as compared with children in the general population. (See Appendix 2.a). That isn't even to mention the fact that it is unusually high in the particular countries, U.S. states and demographic groups that have high autism rates, and far lower in the locations and groups that have autism rates half that high or less.
What other means or source of toxin ingestion by infants, aside from breastfeeding, could qualify in more than one of the above four important regards, much less in all four? (Remember from earlier that accumulated dioxin toxic equivalency exposure in infants that had been breastfed for one year was found to be six times higher than that of with infants that had not been breastfed, in an EPA study.(83))
There are two additional important characteristics of breastfeeding as a source of toxins strongly suspected to lead to autism:
1) It is also an important source of known and likely carcinogens, and a source of carcinogens that correlates extremely well with rates of childhood cancer in many different respects (see www.breastfeeding-and-cancer.info );
2) It is a major source of multiple strongly-suspected causes of autism as well as known carcinogens that could be shut off almost overnight, if people just decided to do so.
Section 1.1.b.2 Pre-natal and other Risk Factors for Autism
It was noteworthy in a major study on risk factors for autism that, in its summary of the "strongest" prenatal risk factors, advanced parental age was first on the list; and early place in birth order was fourth.(24a) In that regard, remember the following from our earlier listings of factors that were closely linked to autism: advanced parental age and early place in birth order are both closely associated with higher rates of breastfeeding (see the "Correlations" and "Numbers" sections in the Introductory Summary). So it is of interest to observe that, of the few strong risk factors for autism identified by fairly exhaustive research, two of them have a common characteristic: breastfeeding is unusually prevalent in infancies characterized by both of those risk factors. That is in addition to the risk factors listed previously, showing strong associations of unusually high autism rates among countries, U.S. states, and demographic groups that have high rates of breastfeeding; in addition to correlations at the high end, autism rates are half as high or less among the countries, states, and demographic groups in which breastfeeding rates are lower. (See more on this subject, with links to details and authoritative sources, at the above links.)
Other risk factors: A major study (investigating over 5700 cases) published in 2013 found "clearly indicated" differences between risk factors for intellectual disability and risk factors for autism. The authors found that autism had "weak or no associations with pre or perinatal factors," whereas intellectual disability was "strongly associated" with such risk factors. For example, the likelihood of severe intellectual disability was over six times higher among infants with a low "percentage of optimal birth weight," a below-optimal head circumference increased the risk of severe intellectual disability 3½ times, and complicated pre-term delivery was associated with a five-fold increase of intellectual disability; but such risks were not found with regard to autism.(24b)
So there appears to be good reason to see that origins of autism are of a distinctly different character as compared with origins of the separate category of general intellectual disability. In the case of intellectual disability, there are obvious physical differences (weight and head size), birth problems (complicated pre-term delivery, etc.), or biomedical causes (Down syndrome, Rett syndrome) that are linked with improper development of the brain and that are typically obvious at birth. In the case of autism, such factors observable at birth are weak or non-existent. That strongly implies predominant influence of post-natal, environmental risk factors in the case of autism, as opposed to genetic influences.
There are clearly many chemicals that have been either new or greatly increased in our environment in recent decades. But there has been only one means of exposure to those toxins that has been found to greatly concentrate an infant's ingestion of many or most of those toxins: human milk. Lactation results in the mother's ingestions of those chemicals being attracted to and collecting in the fat in her milk. Just one of those chemicals, dioxin, is known to be ingested by breastfed infants for a year in concentrations over 80 times as high as what the EPA has determined to be a safe dose, and in accumulations over the course of a year that an EPA study found to be six times higher than those of infants that had not been breastfed.
So on the one hand there are pre-natal, genetic and birth-problem-related factors that seem to be the major influences related to general intellectual disability, all of which are very understandably related to reduced mental capacities; and on the other hand there are risk factors that apply to autism, most of which are not logically related to mental handicap: higher autism in children of more-educated women and married women, and children in countries, U.S. states, and ethnic or religious groups that are of above-average prosperity. (see surprises). Moreover (based on information from the U.S., where the best detail is available about low-autism groups), the lowest rates of autism are found in the states with the lowest per-capita income and in an ethnic group with below-average per capita income. All of these surprising correlations have one thing in common: in every case, the children in the groups or locations with the highest rates of autism have high rates of breastfeeding, and the children in the locations or group with the lowest rates of autism have low rates of breastfeeding.
1.1.b.3 What should be done?
One obvious recommendation is to do further research on these matters. Keep in mind that, once such research starts (after considerable time is spent getting approval and funding for the research, then soliciting and processing proposals from potential researchers, selecting the grantee, and getting the project started), the studies may then go on for years. And then it’s very uncertain if any actionable conclusions will be reached, given the limitation that human infants can’t be used as guinea pigs. So after many years, we might know better which chemicals we should start trying to reduce in the environment. That would then be the beginning of another snail’s-pace process, especially as regards how soon a possible reduction of toxins in the environment could have an impact on infants’ ingestions of those chemicals, which comes mainly from the mother’s lifetime buildup of the toxins in her body.
As a far faster-acting alternative remedial measure, there is something we could easily do now that would quickly and greatly reduce infants’ ingestions of all or almost all of these same strongly-suspected developmental toxins and known carcinogens. That measure would be as follows: to enable parents to make up their own minds about breastfeeding on the basis of at least moderately complete, non-misleading information about the matter. As of now, parents have been receiving essentially nothing but one-sided views on the subject of breastfeeding, including impressive-sounding figures about health benefits without proper acknowledgment of the weakness of the evidence for those claims. These presentations are so distorted as to be basically inaccurate. Parents are told almost nothing about the well-recognized (but unpublicized) toxic exposures brought on by breastfeeding (see Introductory Summary, with links). A moderately valid presentation of the subject matter to parents would conspicuously make the point (acknowledged only inconspicuously by the Surgeon General) that there is no proof that bottle feeding leads to adverse health conditions in children in developed countries; and it would also present the points that, following the transition from a very low-breastfed generation of children to highly-breastfed generations, almost every one of the illnesses that are said to result from not breastfeeding actually increased, several of them very substantially. The only one that didn't increase at least did not decline, as should have been expected if there had been validity in the claims of benefits of breastfeeding. It should also be clarified to prospective nursing mothers that the possible health benefits to the mother are mainly achieved by excreting toxins out of the mother which are then ingested by the infant, during the most vulnerable period of the infant's life. (see Section 1.2.s.1.c)
In addition to correcting the false impression that is presently being given that there are known health risks of bottle feeding, parents should also be informed about the several associations between breastfeeding and autism rates and cancer rates. Data indicating differences between high-breastfeeding and low-breastfeeding countries in reported long-standing illnesses and childhood diseases of all kinds would help complete the picture. (See the Introductory Summary of this paper for specifics, with links to details and sources.) Officials holding a favorable view about breastfeeding would of course make sure that their point of view is fully represented. But, without hearing both sides on this issue, and especially when hearing only statements about “risks” which are actually only fairly meaningless associations, parents are unable to make intelligent decisions on this very important matter.
There is a great deal that can be said in rebuttal of the evidence presented in the above-mentioned Call to Action. A summarized rebuttal is presented just below, but the more complete statement on that matter can be found at www.breastfeeding-benefits.net.
Here follows a very brief summation of the critique of “The Surgeon General’s Call to Action to Support Breastfeeding 2011”:
(1) “Natural” doesn’t necessarily mean healthful, if one recognizes that drinking water from local streams isn’t likely to be healthful in modern developed areas. There is no dispute about the fact that typical breast milk in major parts of present-day developed countries contains high concentrations of multiple developmental toxins and carcinogens, many times more concentrated than in alternative infant feeding materials; that is well established from reputable sources, and apparently no authoritative source disagrees with that, including breastfeeding promoters at high levels in the U.S. government who have been queried several times on the subject.
(2) The Surgeon General inconspicuously points out that most of the studies on which her case depends are observational studies (in which the comparison groups are not randomized or properly controlled) and she acknowledges that the evidence consists only of inferences, and that there is no proof that formula-feeding is a cause of the illnesses that are indicated. But those very inconspicuous acknowledgements are vastly overshadowed by bold headings and many statements of “health risks” that are presented as results of failure to breastfeed, giving the false impression that there is good scientific evidence that the associations mentioned represent causal connections.
(3) Low-income conditions and/or tobacco smoking are very well established as factors that lead to essentially all of the adverse health outcomes that the Surgeon General alleges to be results of formula-feeding; bottle feeding is also conclusively recognized to be very disproportionately prevalent among low income women and among mothers who smoke. It is entirely likely that the “health risks” alleged by the Surgeon General are not at all results of formula feeding, but are instead results of an infant’s being in a low-income household or in a home in which parents smoke, where bottle feeding also happens to be far more likely.
(4) Observational studies, such as are being relied on by the Surgeon General, are recognized to be subject to false conclusions, and proper use of such studies does not include basing major public initiatives on them. That is especially true if the comparison groups are known to be dissimilar, as was the case in the studies cited by the Surgeon General. And that is most especially true if the comparison groups are dissimilar due to underlying factors (low income conditions and parental smoking in these cases), which factors are well known to lead to the same adverse health outcomes that the Surgeon General blames on lack of breastfeeding. Examination of historical health data for the decades following the major transition in breastfeeding rates shows how wrong the beliefs about health benefits of breastfeeding actually were and are. (see www.breastfeedingprosandcons.info ) The evidence provided is not suitable to be a proper basis for a call to action by the Surgeon General of the United States that, in effect, promotes heavy exposure of infants to concentrations of known developmental toxins. Especially if there is good evidence of widespread, seriously negative effects from precisely such exposure (see , indented sections). The reader is encouraged to go to www.breastfeeding-benefits.net for more detail.
Probably not. The Surgeon General makes no attempt to address the many effects that are occurring in the world that can very plausibly be traced back to toxins that are known to be high in breast milk, as presented in this paper. In comparison with the weak evidence (merely "inferences," as acknowledged by the Surgeon General) for benefits of breastfeeding, there is excellent evidence based on historical facts provided by major national and international organizations for the following:
a) Rapidly growing mental impairment among male children following great increases in breastfeeding rates (see Sections 1.2.s ff),
b) childhood cancer increasing while adult cancer is decreasing (www.breastfeeding-and-cancer.info ),
c) rapidly increasing obesity, allergies, ADHD and diabetes, as well as increases in almost all of the diseases that should have been declining (given increases in breastfeeding in recent decades) if there had been validity to the allegations about "health risks" of not breastfeeding (see www.breastfeeding-health-effects.info),
d) several life-threatening diseases not mentioned by the Surgeon General being far less prevalent in low-breastfeeding countries than in high-breastfeeding countries, as found by this author with very little effort, (see Section 1.2.p.2.)
e) lower rates of long-standing illnesses and much lower rates of autism in low-breastfeeding countries than in high-breastfeeding countries. (See Introductory Summary for more on these points, with links to details and sources.)
Unlike the presumed benefits to the infant claimed to result from breastfeeding, the benefits to the mother are somewhat more likely to be real, for the following reason: As related earlier, some important environmental toxins collect in fat within the body, therefore they become concentrated in the breast. In a Japanese study of breast cancer risk, the authors pointed out regarding certain widely-used pesticides, “Organochlorines, which are poorly metabolized, accumulate in the human body via food intake, leaving breastfeeding as the primary means of excretion.” (26) It is very possible that accomplishing that excretion is beneficial to a mother’s long-term health (although the above study of breast cancer risk did not find any such benefit). A U.S. study found especially high benefits accruing to a mother who breastfed twins for two years, finding a decrease of about 70% in the mother’s body burden of dioxins over the two-year period. (27) That may be beneficial to the health of the mother, but one needs to consider that this resulted in high levels of neuro-developmental toxins’ being ingested by the infants while they are going through a period of rapid development of their brains. One study of dioxin concentrations in infants of various birth orders found that, the closer the infant had been to first in birth order, the higher the dioxin concentrations in the deceased infants’ tissues, “thus showing that the mothers can decontaminate themselves by breast feeding.” (more details in Section 1.2.s.1.c) Obviously there’s no need to think about the effect those excreted developmental toxins are having on the vulnerable, developing infant, who is ingesting them while passing through his or her only possible period for potentially normal neurological growth, or whose rapid tissue growth could be sent into a cancerous direction by one or more of the carcinogens known to typically be in breast milk. See www.breastfeeding-toxins.info for more detail concerning the high levels of various developmental toxins that are absorbed by infants who have been breastfed, in amounts many times higher than in infants who have been bottle fed.
As beneficial as this excretion of toxins is to the mother, how many mothers want to accomplish this by means of feeding carcinogens and developmental toxins to their infants, at the developmentally most vulnerable times of the infants’ lives?
The last sentence should be carefully re-read if the reader hasn’t already stopped to think about it.
It is possible to excrete breast milk and the toxins contained in breast milk without feeding them to an infant.
It should also be borne in mind that only some of the toxins in breast milk decline during the course of lactation - - those toxins that have built up over many years. Others, including the PBDEs that are rapidly increasing in the environment and in breast milk, apparently continue to be added to the mother's breast milk about as rapidly as they are excreted. (27b)
Another benefit claimed for breastfeeding is that it builds a mother-child bond. But, as nice as that sounds, one should consider the long term effect, especially for male infants. The reader is encouraged to read in Sections 1.2.b.2-3 about the mostly-effeminate (or at minimum mostly non-masculine) generation of young Japanese men that became conspicuous during the 2000's following Japan’s changeover during the 1980’s to a very high level of breastfeeding. Be sure to notice what is quoted about the typical attachments of these young men to their mothers, as opposed to female contemporaries, in a nation that is extremely worried about its recently-far-below-replacement level birthrate. Also, for some mothers, nursing is difficult, stressful and/or even painful, and feeling pressured to breastfeed is probably not conducive to the mother's having a mental state of a kind that is beneficial for the child.
Message to health professionals, scientists, and others reading this paper: This author cordially invites you to indicate your reactions to the contents presented here. As of now, new parents almost never hear anything but completely one-sided promotion of breastfeeding, with no mention of possible drawbacks except in cases of serious problems on the part of the mother. If you feel that parents should be informed about both sides of this question and thereby enabled to make an educated decision in this important matter, please write to the author of this paper. Also, if you find anything here that you feel isn't accurately drawn from trustworthy sources or based on sound reasoning, please by all means send your comments, to firstname.lastname@example.org. Comments, and a response to a doctor's request for high-quality evidence comparing toxins in breast milk vs. those in formula or cow's milk, are posted at www.pollutionaction.org/comments.htm.
Section 1.1.f Childhood cancer, and carcinogens in breast milk: This entire section has been placed on a separate web page, at www.breastfeeding-and-cancer.info . Please find it there.
Sections 1.2.a and 1.2.d have been transferred to www.breastfeeding-toxins.info , except for what remains below:
Effects of Dioxins and PCBs: Testosterone reduction and toxic effects on males specifically
Before reading what follows, remember that the hormone testosterone (produced mainly by the male reproductive system) is important to infant neurological development. From a study published in the scientific journal, Environmental Health Perspectives: Referring to the "considerable" literature documenting the toxic effects of dioxins on the male reproductive system, "... lactational exposure of male rats to TCDD (dioxin) profoundly disturbed the developing male reproductive organs…. spermatogenesis was inhibited, sexual behavior was feminized and demasculinized…. The effects were elicited by a single maternal oral dose of TCDD on day 15 of pregnancy [ED50 approximately 0.16 pg/kg; at this dose, TCDD had no discernible effect on the mother." Adding significance to the recently-high exposure of infants to developmental toxins that affect the male reproductive system, “All of the best evidence available points with some certainty to a rising tide in Europe and many other countries of human male reproductive disorders involving sperm counts (and probably sperm quality)….” (p. 764) “The most fundamental change has been the striking decline in sperm counts in the ejaculate of normal men; recent evidence from Paris indicates that this decrease amounts to about 2% per year over the last two decades.” (p. 768) (Emphases added) (33) PCBs have also been strongly linked to reduced testosterone levels in men. (33a) Just 1/800,000th of an ounce of a PCB-containing product administered per day to pregnant or lactating female monkeys was found to cause the offspring to be hyperactive and retarded in learning ability.
Section 1.2.b.1 The Special Significance of Testosterone/Androgens in Development of the Brain, and Window(s) of Sensitivity
It is important to look into the specific hormones that, when subject to the effects of endocrine disruptors, can fail to perform important functions in neurological development. According to one expert, "Sex steroid hormones (testosterone in males, estradiol and progesterone in females) play a role early in brain development in the "organization" of neural circuits… A wide variety of neural processes are influenced by sex steroid hormones, including neurogenesis, …growth of the neuronal cell body, dendritic growth, differentiation and synapse formation….and neuronal excitability. "(47) (italics added)
According to another specialist, B.S. McEwen, ”Gonadal, adrenal, and thyroid hormones affect the brain directly, and the sensitivity to hormones begins in embryonic life…. ….any agent that disrupts normal hormone secretion can upset normal brain development. Likewise, exogenous substances that mimic the actions of natural hormones can also play havoc with CNS (central nervous system) development and differentiation." (48) It may be noteworthy that gonadal hormones are the first of the various types mentioned by the author regarding their importance to the developing brain.
Other authors (S.B. Klein and B.M. Thorne) (49) point specifically to testosterone for the way it "clearly affects brain development." They refer to the "critical period for the testosterone organizational effect" which apparently can take place only within a limited window of time while the brain is developing. They cite observations of male rats that are castrated after birth to remove their normal principal source of testosterone, followed by injections of testosterone at various later times. Injections of testosterone during the first two days after birth were effective in leading to some specifically male rat behavior when adulthood was reached. But the effectiveness of the replacement hormones in promoting normal male brain development rapidly declined to "little effect" when not administered until 13-14 days after birth. Other researchers have said that "Androgens are thought to organize the male brain" (50) (testosterone is one of the androgens). (It should be pointed out here that, although testosterone is a predominantly male hormone, females also have some testosterone in their bodies, and it is important to development of the female brain also; just less so than in males.)
The validity of the concept of "critical windows of sensitivity" during neurological development is also accepted by the National Research Council of the National Academy of Sciences (51), and by authors writing for the EPA (52). Wigle et al. refer to bimolecular research showing the dependence of fetal and child development on a complex orchestration of genes in specific cell types at different times.(53)
Winter and colleagues plotted hormone levels in boys during normal postnatal development, showing relatively high levels of male hormones during part of infancy, before the hormones decline to the prepubertal range.(17) This should receive very special attention, since those high levels at this stage are apparently not for purposes of stimulating reproductive development. But as explained earlier in this section, male hormones do promote proper development of the male brain during infancy. And that crucial activity (binding to receptors in the brain to stimulate proper neurological development) is extremely vulnerable to interference by environmental toxins.
Remember from above that lactational exposure of male rats to dioxin profoundly disturbed the developing male reproductive organs, even at a dose mild enough to have no discernible effect on the mother. As noted (with sources) in Section 2.a of www.breastfeeding-vs-formula.info, an infant breastfed for one year would receive an average daily dose of about 60 pg of TEQ/kg bw/day, compared with 0.7 estimated safe dose according to the EPA. And note in Sections 1.7.1 and 1.7.3 about the anti-androgenic properties of PBDEs, which have been rapidly increasingly present in human milk, reaching especially high levels in the U.S.
In an article by a CDC author, it was pointed out that some recent studies have identified male-to-female ratios of autism as being double the four-to-one ratio often indicated in older studies.(55). That provides reason for added focus on toxins (such as dioxins, BPA and PBDEs, concentrated in human milk) that can specifically affect male infants more than females. Aside from their role as endocrine disruptors in general, dioxins are known to affect male endocrine glands specifically, that is to say affecting the source of the testosterone that is essential to normal infant male brain development. According to another CDC report, dioxins have been demonstrated in animal studies to have effects including neurotoxicity, altered transcription of genes, altered thyroid function, and testicular atrophy.(58) According to researchers for the EPA, "In tests by at least two different research teams, dioxins were found to have effects on the male reproductive systems in rats tested, as follows: impaired testosterone synthesis, and possibly central nervous system sexual differentiation, feminization of male sexual behavior. (59) Scientists at the University of Wisconsin, on the basis of testing of rats, found that "if TCDD (dioxin) interferes with any of (various) processes during late gestation and/or early neonatal life, it could irreversibly demasculinize and feminize sexual behavior…in male rats in adulthood.” (60) "In mammals, postnatal functional alterations involving learning behavior and the developing male reproductive system appear to be the developmental events most sensitive to prenatal dioxin exposure." (61)
When reading (above) about dioxin's role in causing testicular atrophy and impaired testosterone synthesis, remember from earlier in this section about the importance of testosterone's "organizational effect" in brain development and its influence in growth of the neuronal cell body.
Most of the research cited above was based on testing of laboratory animals, but there has also been research that found de-masculinization of human males resulting from infant exposure to similar toxins. (Section 1.6.b)
There are good reasons for special concern about the above-mentioned effects that have been demonstrated in tests with animals, quite aside from what first comes to mind. The de-masculinizing effects observed in test animals are almost certainly a sign that testosterone levels had declined. As indicated in Section 1.2.b.1, testosterone is an essential ingredient for normal brain development, and it would be especially important for development of the male brain. When we see that mental impairment in children has gone from gender-equal to twice as high for males during recent decades (1), and also that academic performance of young males has deteriorated (see Section 1.2.b.4-5), we should see special reason to look into anything that could be affecting neurological development in males specifically.
The above declines in young human males are what one would expect from the scientifically-observed de-masculinizing effects of recently-widespread toxins, combined with knowledge of the importance of testosterone in mental development. But the probable effects on males go well beyond development of mental abilities, as will be explained.
Japan (with a long-term breastfeeding rate that is among the very highest in the world – see Section 1.2.p.1) would be a logical country to look at for an especially sensitive demonstration of effects of toxins that are widespread in modern developed regions, since that country is both densely populated (ten times the density of the U.S.) and industrial. According to a 2010 article in The Atlantic, “Japan is in a national panic over the rise of the “herbivores,” the cohort of young men who are… gardening, organizing dessert parties, acting cartoonishly feminine, and declining to have sex.” (62) The literal translation applied to the Japanese word for the young men who fit this description is “grass-eating boys,” and lack of interest in sex is a consistent theme in descriptions applied to them. (63) Multiple surveys suggest that about 60 percent of young Japanese men — in their 20s and early 30s — identify themselves as herbivores. The lead character in a popular television show has secret passions that include sewing, baking and crocheting clothes for his stuffed animals. (64) These men are also described as “often close to their mothers.” “They're more likely to buy gifts for their mothers than for their significant others." (65) “Men are now leading purchasers (in Japan) of hair products, make-up, fashion accessories and manicures.” (66) As part of the considerable national discussion about this development (with special concern due to Japan’s current very low birth rate and shrinking population), there is much speculation about possible causes: “poor communication skills,” or result of “efforts to make the workplace more egalitarian,” among others.(67)
The trends are as noteworthy as the basic figures. According to a study conducted in September, 2010 and published by the Japan Family Planning Association (a government agency), 36% of males aged 16 to 19 surveyed described themselves as “indifferent or averse” towards having sex, and that figure was twice as high as the result of the same survey conducted only two years earlier. And that 36% figure compared with only 6% of 30-to-34-year-old men being disinterested in sex. (63) The head of the agency conducting the survey, speaking on Japan’s national public radio station, provided his own explanation: “The findings seem to reflect the increasing shallowness of human relations in today’s busy society.”
Yes, that must be the reason; plummeting sexual desire in young males must be attributable to a reduced search for deep meaning in human relations. Or could it be the “poor communication skills”? Then again, it might be the egalitarian workplace. Other observers’ suggestions include the effect of a lagging economy, or rebellion against the ways of the previous generation. (After all, isn’t it obvious that a soft economy or rebellion against the preceding generation would be expected to overcome an instinct that has been basic to the entire animal kingdom since its beginnings?) Why not think about the fact that certain chemicals widespread in a densely-populated, industrial environment (and concentrated in breast milk that had recently begun to be widely consumed when these young men were infants) have been found in tests with laboratory animals to cause de-masculinization? (see Section 1.2.b.1, near end of section) This should be especially of interest to the country that may have had the highest rate of extended breastfeeding of any developed country in the world in recent decades (see Section 1.2.p). There is nothing else on a par with laboratory tests with animals as a means of predicting effects of chemicals on humans. The animals have basically the same organs that humans have, and such testing is recognized to be good (though not perfect) at predicting the effects that specific chemicals will have on humans. Is there any reason to think that the scientifically-observed effects of these chemicals are not presently showing up in humans, given that these chemicals have been increasing in the environment and are concentrated in the increasingly-consumed human milk?
After World War II, breastfeeding in Japan became rare. In 1974-75, the Japanese government in cooperation with the World Health Organization began promoting breastfeeding, and Japanese doctors soon joined in the promotion.67a By 2001, Japan’s long-term-exclusive breastfeeding rate had become one of the highest in the world (see Section 1.2.p.1) Deference to authority is very deeply engrained in Japanese culture, so unusually great compliance with the government’s promotion of breastfeeding should not have been surprising. In trying to estimate what the curve of the transition from low- to high-breastfeeding looked like (in absence of actual historical data), we can consider the following: An observer writing in 2003 pointed out (regarding the grandmothers visiting with the new Japanese mothers who were breastfeeding in 2003) that “now most grandmothers (in Japan) have no breastfeeding experience” (68) ; looking back a generation from 2003, this implies that breastfeeding was still relatively rare through most of the 1970’s and probably not widespread even into the early 1980’s. But it should be safe to assume that Japan’s transition to a high rate of breastfeeding was well underway by the mid-to-late1980’s, since it had reached a very high level by 2001.
So it is probably safe to assume that, by the mid-to-late 1980’s, breastfeeding rates were greatly increasing, on their way to becoming among the very highest in the developed world. And it is almost certain that typical breast milk in Japan at that time would have included high levels of the neuro-developmental toxins that are normally in breast milk in developed countries, including toxins that are known to cause de-masculinization of males. (These would have been toxins of the same types that became concentrated in breast milk in most developed economies during recent decades, just in higher quantities in Japan -- see Sections 1.2.b.1 and 1.9 and www.breastfeeding-toxins.info,). And then, 20+ years later, a generation of young Japanese men has grown up who are mostly effeminate. Should that be a surprising outcome? Do people really have to grasp for implausible, non-biological explanations for the decline in masculinity such as “increasing shallowness of human relations in today’s busy society,” or “poor communication skills”?
In assessing the likely effects of breastfeeding, environmental factors might be as important as actual rates of breastfeeding, in that they determine the levels of toxins that are built up in a woman’s body by the time she excretes those toxins in breast milk (see Sections 1.2.u, 1.2.w). Japan, smaller than the state of California but second in the world in use of fossil fuels (as of the 1980’s), is both very industrial and congested, meaning high levels of environmental toxins are emitted close to a high percentage of the population. And Japan’s atmosphere suffers not only from what is domestically generated but also from pollution drifting over from China. In 1984 it was reported that Japan had more than 85,000 recognized victims of environmental pollution, with an estimated rate of increase of 6 percent a year. So Japan’s atmospheric pollution is almost certainly greater than that of most countries, but probably not significantly different in character compared with that of most other developed countries.
Japan’s fertility rate declined from 2.1 per woman in 1970 to 1.3 per woman in 2007, during the same decades during which breastfeeding rates rose dramatically. (UNICEF: The State of the World’s Children 2009, Table 10, p. 154)
As mentioned, testosterone levels have been found to be lowered in laboratory animals by exposure as pups to certain toxins that are concentrated in breast milk and that have been increasing in the environment in developed countries. (see Sections 1.2.b.1, 1.9 and (see www.breastfeeding-toxins.info) Testosterone is also known to be important in development of the brain, especially the male brain. (Section 1.2.b.1) In the United Kingdom, a considerable national discussion started in the mid-1990’s about the “genuine problem of under-achievement among boys,” quoting the then Secretary of State for Education. “Her Majesty’s Chief Inspector (said) that the failure of boys was ‘one of the most disturbing problems we face in the whole educational system’ ” (70) Data regarding a “science reasoning test” that has been given over a 30-year period to 11- and 12-year-olds in the U.K. is of interest. On one question, boys showed a 69% decline in correct answers over those years, while girls showed only a 37% decline. The author relating this pointed out that, although the drop in correct answers to this particular question was especially dramatic, “the overall pattern as between results at the beginning and the end of the study, and between boys and girls is similar for the other questions in the test.” (71) This is very much in line with reports about development among boys in the U.S. In a 2003 Business Week cover story (72), a professor of psychiatry at Harvard Medical School is quoted as saying, “It's not just that boys are falling behind girls, it's that boys themselves are… doing worse than they did before." As explained earlier, the effects of neuro-developmental toxins that have been increasing in the environment in recent decades affect infants in general, but (by especially affecting testosterone levels and the mental development that depends on testosterone) they affect males more than females.
Performance in school is clearly related not only to intelligence but also to ability of a child to concentrate and pay attention to his work. Spending on ADHD medications for use by children under age 5 increased 349% between 2001 and 2004, and use of those medications among all children was increasing at the rate of 23% per year. (73) Summing up the situation, Gurian and Stevens (who may have studied the matter more than any others) state, “Overall, it’s clear that something is going on among our children, especially our sons, in the areas of brain disorders…. Over two thirds of children labeled learning-disabled and 90 percent of children labeled behaviorally disabled are boys. As the learning or behavioral disability becomes more severe, boys constitute an increasingly higher statistical number.” (74) Those same authors suggest that about a third of all boys in contemporary U.S. schools have a learning or brain disorder. (judging from the statement in Gurian and Stevens that just under one-quarter of students are considered to be in those categories, about 68% of whom are boys, which would mean that .68 x .24 = 16.3% of all students would be boys with the problems, or about one third of boys).
Other international data point in the same direction. According to the Programme for International Student Assessment, 2009, the differences between 15-year-old boys and girls have become especially high in Norway, Sweden and Finland, reaching an average 50.2-point difference in favor of girls (on a test with average scores of about 500) in reading, interpretation and evaluation tests, compared with an average difference of only 33 points among students in France, Belgium and Northern Ireland (information for Ireland was not provided, so data for Northern Ireland is used here in its place). Note that the first group, with the higher gap between boys and girls, is in the highest-breastfeeding group of western European countries (see Figure 1.9), and the second group, with the smaller gap, is a low-breastfeeding group of countries. In math and science in the high-breastfeeding Western European countries, the former average advantage that boys had in aptitudes in those subjects has given way to a 2.8-point average advantage in favor of girls. Boys in the equivalent low-breastfeeding countries have held onto an 11.5-point average advantage over girls. (75)
In most countries of the OECD, women have caught up with and far surpassed men in enrollment in higher education since the 1990s. (76) OECD member countries were ranked in order of how far women exceeded men in their countries’ enrollments in higher education. The group of four European countries that are lowest in breastfeeding (Ireland, France, UK and Belgium) had an average position of fifteenth from the top in this ranking (indicating smaller male-female differences in enrollment), whereas the three highest-breastfeeding countries (see Figure 1.9) had an average rank of fourth from the highest. Norway, the country with the top-of-the-chart breastfeeding rate, also had the very highest ratio by which women in any country exceeded men in higher education enrollment.(78)
But the male-female differences in enrollment in higher education may well understate the actual differences between the two sexes in present-day mental abilities. In an American study published in 2006 of the growing female advantage in college completion, the authors observed that “the female advantage over males is largely attributable to the superior performance of women in college…” The authors point out that this performance advantage starts in middle school and high school, but only becomes especially conspicuous in college via ”the higher dropout rate from 4-year colleges for males.” Tracing the history of male-female mental differences, they point out, “Using data from six U.S. national probability samples spanning 1960 through 1992, Hedges and Nowell (1995) found … a gradual reduction of the male advantage in math and science tests and no reduction in the female advantage in tests of reading and writing ability.” Given recent trends, college admissions officers “are considering affirmative action for male applicants.” (79) That sort of thing may have been contributing to keeping the female-male enrollment ratios from becoming even more imbalanced than they already are, in most countries, at the expense of admitting a significant number of males who aren’t able to succeed at university-level work.
Section 1.2.d, on the subject of specific toxins contained in breast milk, their original sources in the environment, their known effects on human development+, and their concentrations in breast milk vs. in infant formula or cow’s milk, has been transferred to www.breastfeeding-toxins.info , except for what remains below:
Cases in which a mother's milk would be less likely to contain substantial toxins:
Parents should bear in mind two important characteristics that almost certainly apply to the studies that found infant exposures to toxins to be so much higher in breastfed infants than in bottle fed: The infants being studied were generally (a) located in areas with typical levels of environmental toxins, and were also (b) born to mothers who ate typical diets. Note in www.breastfeeding-and-cancer.info that, if the general area is unusually low in environmental toxins, childhood cancer rates can be merely medium (as in Vermont) despite a high breastfeeding rate. And remember the general consensus that the major route of dioxins into the mother is via a long-standing diet that includes meat, dairy and fish. Therefore if a woman has had a mainly vegetarian diet for many years before breastfeeding, the levels of dioxins in her breast milk would probably be low. (But PBDE concentrations in her milk would probably vary mainly according to how much time the mother spends breathing air around electronic devices, especially devices that are in use.) For those women who live or work in locations with average or high levels of pollution (including pollution from residential wood burning and backyard burning), or whose diets have been typical, the most helpful example to look at would be Rhode Island (with low childhood cancer despite being in a relatively-high-pollution zone) in the childhood-cancer map of the Northeast U.S. coast, in www.breastfeeding-and-cancer.info
Mothers should not necessarily feel safe about their breast milk if they are rural non-smokers. Whereas PAH's are apparently mainly taken in by inhalation, dioxins are mainly taken in by way of food; unless one lives in an unusually low-pollution food-source region, the only way to avoid typical concentrations of dioxins in breast milk is to adopt a basically vegetarian diet many years before breastfeeding starts. Also, residential wood-burning emissions are a major source of BaP(26b) and particulate matter, and a significant source of lead, typically emitted in the immediate air supply of both lactating mothers and infants. (See Section 2.1 about toxicity of wood burning). Breast milk in rural Italian mothers was probably uniformly within acceptable limits of BaP at least partly because there is relatively little residential wood burning in sunny Italy, with minimal forests. It is also important to bear in mind that backyard burning, often done in rural areas, has become the largest single source of releases of dioxins to the atmosphere in recent years, according to the EPA. In addition, high levels of PBDEs in breast milk apparently result mainly from exposure of mothers to air around electronic devices. (See earlier in this section.)
For more on how most or all of these toxins have been continuing to increase in the environment, see Section 1.9.1 through 1.9.11.
Message to health professionals, scientists, and others reading this paper: This author cordially invites you to indicate your reactions to the contents presented here. As of now, new parents almost never hear anything but completely one-sided promotion of breastfeeding, with no mention of possible drawbacks except in cases of serious problems on the part of the mother. If you feel that parents should be informed about both sides of this question and thereby enabled to make an educated decision in this important matter, please write to the author of this paper. Also, if you find anything here that you feel isn't accurately drawn from trustworthy sources or based on sound reasoning, please by all means send your comments, to email@example.com. Comments, and a response to a doctor's request for high-quality evidence comparing toxins in breast milk vs. those in formula or cow's milk, are posted at www.pollutionaction.org/comments.htm.
Sections 1.2.e through 1.2.o have been incorporated into other sections.
Section 1.2.p Possible Effects of Variations in Breastfeeding Levels, viewed Internationally:
Section 1.2.p.1 Varying rates of breastfeeding among nations:
Irish breastfeeding rates are by far the lowest in Western Europe and North America. French and Belgian rates are second and third from the lowest in this measure of "ever breastfed." The United Kingdom rounds out the group of four European countries with the lowest rates of breastfeeding. (95) See farther down in this section how long-lived the Irish, French, Belgians and citizens of other low-breastfeeding countries are in relation to the countries that are high in breastfeeding rates.
This chart from the World Health Organization’s website shows long-term data indicating Norway and Sweden as European countries with very high breastfeeding rates. Finland’s data on this chart appear below the very top levels, but an “expert study” carried out in 1984 found Finland’s breastfeeding rates to be the highest in Europe at that time. Germany’s rates aren’t shown in this chart, but data from one German study show that country’s 3-month breastfeeding rate to look like very much like a smoothed-out version of Finland’s for the years 1985-2005(96) and another study indicates very high figures of 90% initial breastfeeding and 61% at four months, in one of Germany's largest states. (96a) Separate WHO data indicate that, for the stricter standard of exclusive breastfeeding for six months, Germany and Japan have what may be the developed world’s highest known breastfeeding rates by that standard (both considerably exceeding Finland’s rate; such data not available for Norway or Sweden).(97) Japan’s 2005 “ever-breastfed” rate of about 97%, as shown in Figure 1.8, should also be noted. Switzerland’s rates also aren’t shown on this chart, but a 1994 study showed that 92% of Swiss mothers initiated breastfeeding and by four months 48% were exclusively breastfeeding, both of which figures place that country in the higher breastfeeding category.(98) New Zealand: Their government's data show that country's breastfeeding rate to be unusually high. (98a)
Denmark, Portugal, Spain, and Austria, are all (at least until recently) a step below the highest level, which we will call “medium high.” Italy appears to have gone through a transition from medium low to medium high. Note that, by the early 1990’s, Denmark appears to be on its way, with much uncertainty, to reaching the high-level group by this particular measurement; and a WHO/UNICEF report of 2001 shows Denmark with a 99% breastfeeding rate (99)
France, Ireland, Belgium and the UK are shown in Figure 9 as having low rates, as was also shown in Figure 1.8. There is obviously not much data in Figure 1.9 for France and Ireland, but the LaLeche League’s website’s data shows Ireland’s breastfeeding rates to be by far the lowest of any European country for which they provide data, and it shows France, Scotland, Belgium and U.K. as being far lower than the other European countries for breastfeeding percentage at initiation.
There is less data available about Poland, but what data is available shows that country to be in the low-breastfeeding category. (99a)
The Netherlands are quite centered in Figure 1.8, and very close to center among the range of rates shown in Figure 1.9. Luxembourg appears to be below the center here, but other data (from the LaLeche League) show Luxembourg to be well above average, so that country will be considered indeterminate.
Since practices like breast feeding are part of culture, passed down through the generations, we will be looking at data such as these and considering it to be reasonable to think that, when considering a large number of countries, breastfeeding rates for high-breastfeeding and low-breastfeeding countries were on average also either relatively higher or lower for several decades before the currently-available data. The rationale is summed up in the principal conclusion of a study with 909 participants in France (researchers were seeking ways to encourage breastfeeding in France but were finding resistance resulting from deeply-ingrained cultural feelings): "The results of this study showed a strong impact of society and cultural norms on feeding choice." (100)
The period of major increases in breastfeeding rates in western countries began in the 1970’s. (101) A rapid upward trend in breastfeeding prevalence in Europe continued during the 1980’s and 1990’s, as shown in Figure 1.9. The pattern was somewhat different in the U.S. as is seen in Figure 1b, in that there was a dip in the 1980’s, before strong growth resumed in the ‘90’s. Norway’s rate doesn’t appear to have increased in Figure1.9, but that is only because the data on this chart don’t go back far enough in the case of Norway; a separate WHO document states that Norway’s rate in 1969 was only 25%-30%, rising to 80% by 1985. (102)
Only Three or four other Advanced Countries appear to Compete with Norway, Sweden, and Finland for having the Highest Long-term Breastfeeding Rates in the Developed World:
Before leaving this section and Figure 1.8, we should focus on which countries hold the very top ranks in breastfeeding rates in the developed world: As of this writing, data equivalent to that of Figure 1.8 is not available for Japan, but Figure 1.8 shows Japan close to the top with about 97% “ever breastfeeding”, and 2001 WHO data related to a far stricter standard (“exclusively breastfed for the first six months of life”) is available, according to which Japan has a 21% rate, much higher than the equivalent 15% rate for high-breastfeeding Finland; no “exclusively-breastfed for six months” data is available for Norway or Sweden. (103) In the absence of comparable data for those other countries, note that Japan could be essentially tied for the highest position in the “exclusively breastfed for 1st six months” rate among the developed countries for which this data is available. And that is combined with an almost-at-the-top position at initiation. This is especially significant in that Japan is probably unusually polluted, meaning that exposure of women to Japan’s environment will almost certainly cause breast milk in that country to have unusually high concentrations of neuro-developmental toxins. See Section 1.2.b.2 regarding what many people consider to be a very undesirable kind of maturation on the parts of most young Japanese men, chronologically following Japan’s transition from low breastfeeding to high breastfeeding.
As indicated early in this section, Germany also holds a very top-level position according to the 6-month exclusive breastfeeding standard (22%); but there are no data available that are directly comparable with that used for the above charts, so it is somewhat uncertain as to how Germany compares with the other European countries. The ethnically-German country of Austria seems also be in the highest-breastfeeding category, although based on relatively minimal data (see the chart in Section 1.2.s.4)
One study indicates a very high rate for South Korea as of 1979: “Of these countries (including South Korea) the percentage of ever-married women who had breastfed in the last closed interval was between 94-99%... South Korea also has the highest level of breastfeeding.” (104) Another study, published in 2007, estimated 20% exclusive breastfeeding after six months, which is very high for that type and duration. (105)
Given the relative scarcity of data for Denmark compared with that available for the other European countries, Denmark can be placed in the "high" breastfeeding category but probably not in the "highest" category.
Section 1.2.p.2 Some Additional Examples that Shed Light on Breastfeeding’s Alleged Health Benefits to the Infant
This chart is of special interest because it highlights the kind of thing that is omitted from the Surgeon General’s listing of conditions that are associated with bottle feeding. The Surgeon General alleges that type 2 diabetes is higher among bottle-fed children. As mentioned, she failed to acknowledge that low-income conditions in the bottle-feeding group could well be the underlying, real cause of that elevated level of diabetes type 2. Another logical question that comes up is, what about type 1 diabetes? This chart shows the answer to that question. The high-breastfeeding Scandinavian countries can’t be missed, bunched at the high end of the type 1 diabetes rates, in this data set that is omitted from the Surgeon General’s presentation. The average incidence for the higher-breastfeeding countries is 25.1 (no data for Switzerland and Austria), and if it’s restricted to the three known highest-breastfeeding European countries (Norway, Sweden and Finland), the incidence is 42.1. The average incidence for the lower-breastfeeding countries (France, Poland, UK, Ireland, no data for Belgium) is 16.5. Notice that this chart applies to diabetes among children aged 0-14, those whose health would be most closely related to effects of breastfeeding. Does this give a clue about how evidence is selected or excluded on the basis of whether or not it leads to the pre-determined conclusions of the proponents of maximum breastfeeding?
For more about diabetes in Europe in relation to breastfeeding, see http://www.breastfeeding-health-effects.info.
Pertussis (also known as whooping cough) is estimated to cause 295,000 deaths per year worldwide.(106) The CDC’s web page on pertussis shows that by far the greatest incidence of pertussis (far more than in all other age groups combined, in most years) is among infants less than one year old;(106b3) that is the group that clearly includes those most closely affected by breastfeeding. And that age group includes those “who are at greatest risk for severe disease and death” from this disease, according to the CDC. The average rate of reported cases of pertussis for the higher-breastfeeding countries (except Germany and Switzerland, for which no rates are given, and Austria, which is conspicuously out of step in confirmation of cases) is 17.03, and the average for the three highest-breastfeeding countries (Norway, Sweden and Finland) is 43.9. By contrast, the average for the four lowest-breastfeeding countries (Ireland, Belgium, U.K. and France) is 0.83. (data from European Centre for Disease Prevention and Control, Surveillance Report for Pertussis, 2007, Table 3.5.7) (106a)
This example is worth special note. A disease that causes hundreds of thousands of deaths per year, especially affecting those who are under one year old, with a reported incidence in the highest-breastfeeding European countries fifty times higher than in the lowest-breastfeeding countries. Although this is an extreme example, it is just one of many associations of breastfeeding with negative outcomes. Many more can be seen at www.breastfeedingprosandcons.info .
The CDC’s web page on salmonellosis points out that “the rate of diagnosed infections in children less than five years old is about five times higher than the rate in all other persons,” and also that about 400 people die every year in the U.S. alone from this illness.(106b4) So it is clearly a serious disease, and it is another disease that affects those who are most closely affected by breastfeeding or formula feeding. The higher-breastfeeding countries (except for Switzerland and Spain, for which no data are given) had an average salmonellosis rate of 35.39 per 100,000, and the four highest-breastfeeding countries (Sweden, Norway, Finland and Germany) had an average rate of 49.25. The four lowest-breastfeeding countries had an average rate of 22.85. (data from European Centre for Disease Prevention and Control, Surveillance Report for Salmonellosis, 2007, Table 3.3.12)
Continuing with a few other diseases, including other data that didn’t make it into the Surgeon General’s list of “risks” of not breastfeeding: (The following draws on data from the Surveillance Reports of the European Centre for Disease Prevention and Control, using averages for the years 2008 and 2009, reported cases per 100,000):
High-Breastfeeding Countries Low-Breastfeeding Countries
Hepatitis C* (Table 2.2.4) 23.7 12.8
Campylobacteriosis** (2.3.3) 72.1 48.8
Yersiniosis*** (Table 2.3.20) 5.6 0.7
*(mostly affects younger people)
**(a gastro-intestinal disease that especially affects children 0-4)
***(a bacterial disease, sometimes mimicking appendicitis, mainly affecting children 0-4))
Another illustration of selectivity shown by proponents of breastfeeding is the claim of lower rates of leukemia among breast-fed children. Aside from the fact that different leukemia rates could result entirely from the adverse health effects of low income conditions and smoking that are very disproportionately present among bottle-feeding parents (see Section D at www.breastfeeding-benefits.net), it is clear that overall childhood cancer rates are about 23% higher in the highest-breastfeeding European countries than in the lowest-breastfeeding European countries. (see www.breastfeeding-and-cancer.info )
It should be apparent that the above examples only include diseases that provide especially major illustrations that are contrary to claims of benefits of breastfeeding. A look at other diseases could probably find more examples, both major and minor, but the above should be sufficient to convince a rational person that breastfeeding should not be promoted on the basis of presumed health benefits for the infant regarding rates of various individual diseases. Such promotion is especially dubious when done without reporting what happens in regard to the many other diseases that are not mentioned.
In the chart below/left, adults in the low-breastfeeding countries (Ireland, UK, Belgium, France) reported “good or very good health” in a slightly higher overall average percentage than adults in the high-breastfeeding countries of Sweden, Norway and Finland. Although the difference was rather insignificant, at least it should help lay to rest the idea that breastfeeding is beneficial to the child overall. Also, using a standard that is more specific than that first one, and better suited to accurate reporting, the average percentage reporting “Long-standing illness or health problem” in the low-breastfeeding countries was 29.75, compared with 32.3 for the high-breastfeeding countries. That difference (which is 8%) is very significant, especially in that the data represent a large number of countries and are drawn from information provided by major international organizations.
These illustrations show that the alleged health benefits of breastfeeding are extremely dubious at best. Also bear in mind that (a) the Surgeon General inconspicuously acknowledges that essentially all of the “risks” that she relates to formula-feeding are in question, given that there could be causes other than breastfeeding for the “associations” she lists, and (b) there are other factors (low income conditions and parental smoking) that are known to lead to all of the diseases in question, which factors are known to be very disproportionately prevalent among the people who are less likely to breastfeed. (See www.breastfeeding-benefits.net )
Section 1.2.p.3 Possible Effects of Variation in Breastfeeding on Health in the United States:
According to the American Academy of Family Physicians, "Throughout the middle part of the 20th century, most physicians did not advocate breastfeeding, and most women did not choose to breastfeed." (106b2) Despite the immense benefits claimed by many for breastfeeding, and the supposed negative effects of bottle feeding, that low-breastfed generation actually has far better health statistics than those of the highly-breastfed generations that followed. (See www.breastfeeding-health-effects.info for details.)
Many women probably tend to think that, since their foremothers may have breastfed for long periods and their children turned out well, and since breastfeeding is widely encouraged, then that must mean that breast feeding is risk-free. But high levels of dioxins, mercury, and PBDEs in the environment, and therefore in breast milk, are a relatively recent development. Researchers cite various studies suggesting that rates of dioxin deposition in the environment increased more than 10-fold between the 1930's and the 1960's.(107) Bear in mind that dioxins are essentially a product of many typical forms of combustion, requiring presence of a source of chlorine as part of the burning, such as is included in the plastics waste that skyrocketed in the U.S. environment in the mid- and late-twentieth century. Mercury is released by combustion of mercury-containing materials, especially ones such as in coal, which has been increasing rapidly with growing populations and industrialization in various parts of the world; since airborne mercury drifts around the globe, considerable emissions from Asia's rapidly-expanding, polluting industries, and from ships going back and forth, are in the U.S. air supply and in the water habitat of fish. PBDE's are something new in recent decades. All of the above mean that breast milk today is very different from that of earlier periods. New releases of dioxins by U.S. industry have declined recently, but other sources that closely affect humans (especially diesel emissions) have increased greatly at the same time. Dioxin-containing soil is often ingested by infants, and is partly ingested by farm animals after which the dioxins become part of meat and dairy products; dioxins are almost certainly continuing to increase in a major part of the environment due to the extremely long lives of dioxins in soil, even though they are increasing less rapidly than in earlier decades. A long-term, mostly-vegetarian diet is apparently the only way for a woman to avoid major buildup of dioxins and mercury within her body. Minimizing breathing of air in the vicinity of electronic devices (especially where ventilation isn't good) might be the only way to avoid buildup of PBDEs.
Dioxins, which accumulate in the body over the years, are very much associated with usually-adult diseases (especially cancer) (108). So present day breastfeeding, by mothers with body burdens of dioxins that are typical in modern industrial countries, would be getting infants off to a major start in accumulation of toxins that could lead to disease decades later. (Remember from www.breastfeeding-toxins.info the quote from the National Academy of Sciences about a contemporary breastfed baby during its first year effectively receiving 87 times the average adult dosage of dioxins.) It would only be prudent to assume that the current increased level of toxins, when combined with additional, accumulating exposures to toxins later in life, would have long-term effects of kinds that scientific studies have found to be caused by those toxins. Additional apparent neurological effects of breastfeeding (greatly increased autism, lowered fertility, lowered mental capacities especially among young males, and unusually large numbers of people with non-traditional sexual preferences) have already been presented.
Section 1.2.s.1.a Higher socio-economic status (SES) in the U.S. and U.K. is related to both far higher rates of breastfeeding and substantially higher rates of autism.
Education and income are associated with autism in the U.S. and the U.K.: An in-depth study of autism in California "…showed autism clusters to be highly associated with the education of the parent population" (meaning higher autism in areas with higher educational levels). The research team looked at many other environmental factors that could have been associated with formation of the clusters, but found that "…none of the effects approach the magnitude of parental education." The authors pointed out that services for the autistic were available regardless of income, so ability to pay was not seen as something to reduce use of autism-treatment services by less-educated families. The authors also pointed out that the association of higher parental education with autism had also been found in two other studies in the U.S. and in one study in the U.K. (109) In a U.S. study published in 2007 (Bhasin and Schendel), it was found that median family income was positively and significantly associated with autism prevalence. (110) In a U.S. study, looking at the correlation between autism and WIC participation (WIC participants receive government assistance based on their low incomes, and they are known to have low average rates of breastfeeding(110a)), observation of all 50 states as well as 51 counties revealed that those "with the highest WIC participation were found to have significantly lower autism rates....(110b) (parenthetical expressions added). A CDC publication provides data showing that children of mothers with less than high school education have 40% of the autism rate found among children of college graduates.(110c)
But there are apparently no such associations in Denmark or Sweden: The authors of the above California study pointed out that, whereas their study and other studies in the U.S. and the U.K. found a positive association of high parental education with autism, that same relationship was researched but not found in two studies carried out in Denmark.(111) Another study since then has researched the same topic and also not found a positive association of socio-economic status with autism in Sweden, according to a study published in 2012; in fact, in this study of about 5000 cases of autism in Stockholm County, the researchers concluded that lower socio-economic status seemed to be associated with a risk of autism in offspring. (112)
Why should the above observed differences exist? In the U.S., mothers of low socio-economic status (SES) are far less likely to breastfeed than college graduates, by differences of nearly 2 to 1. (see CDC chart on left and (113) (114)) The same kind of difference applies in the U.K., as evidenced by data showing 60% vs. 28% difference in breastfeeding rates according to socio-economic status breakdown.(115). An Australian study found a 75% vs. 33% difference to be typical.(116). Therefore it is obvious that fewer infants of low-SES parents in the U.S., U.K. and Australia would receive the high concentrations of neuro-developmental toxins that are contained in breast milk. By contrast, in the Scandinavian countries (Norway, Sweden, Denmark and Finland), almost every mother breastfeeds, at least initially (see Section 1.2.p.1); and their rates of breastfeeding are still very unusually high after three and more months. There seems to be no data indicating lower rates of breastfeeding among mothers of low SES than among high-SES mothers in the Nordic countries. It appears that, when (after the early period) breastfeeding becomes less universal, the decline may not be among the same groups as in the U.S. and U.K.; whereas in the U.S. and U.K. later children are likely to be breastfed for shorter periods (see below), the opposite was found to be the case in a Norwegian study (117). Apparently infants from all sectors of society in the Nordic countries receive about the same exposure to the developmental toxins in breast milk at least at first, and probably later also. It should not be surprising that it has been found that autism rates in those countries are:
(a) uniform across socio-economic strata, and
(b) very high, since (unlike the norms in countries with lower breastfeeding rates) there are no sectors of their societies in which infants have reduced exposure to the developmental toxins in breast milk. See later (Section 1.2.s.4) concerning the very high autism rates in Scandinavian countries. An autism rate for children in the U.S., at about half the rate that appears to be prevalent in the Scandinavian countries, has been well publicized. In the historically relatively low-breastfeeding U.K., autism among children is reported to be about 1% (118), which is even less than half that of the high-breastfeeding countries.
It would seem to be only logical that, as has been the case in some countries, autism rates would be no higher among high-SES mothers than among low-SES mothers, and should if anything be expected to be lower. After all, parents with higher SES are likely to have reached those levels to a great extent (in a modern market economy) through above-average mental and/or social abilities; genetically, children of higher-status parents should be expected to have at least the same freedom from mental and social impairment as children of lower-status parents. And that appears to be exactly the way it is in countries (such as Denmark and Sweden) in which there are no differences in breastfeeding rates according to SES levels.
The seemingly-contradictory outcome of lower autism rates among children of lower-SES parents has apparently been found ONLY in those countries in which breastfeeding rates are unusually low among low-SES mothers. As mentioned, it is established and not disputed that breastfed infants receive far higher dosages of certain known developmental toxins than bottle-fed infants receive. This is a perfectly logical explanation for a phenomenon that appears to have no other good explanation. However, there are widespread and very strongly-held views that “breast is best,” so it is understandable that scientists have not ventured into what this author considers to be the correct explanation for a serious problem.
It should be noted that the generally higher rate of breastfeeding among American women of higher social strata applies to whites but not to African-American women, among whom breastfeeding apparently has a serious image problem. (118a)
Section 1.2.s.1.b Parental age and breastfeeding: In a U.K. study, finding the same relationship that had been found in previous surveys, it was found that an average of only 58% of mothers under age 20 breastfed, compared with 87% over age 30 (119). In an Australian study, it was found that breastfeeding at six months was positively associated with older maternal age, with “Adj OR per 5 year increase in age 1.58…,” indicating a greatly increased breastfeeding percentage with each additional 5 years of age (120). It has also been found in several studies that older mothers continue breastfeeding for longer periods than younger mothers, including in the U.S. (121)
It is also well known that the body burden of persistent developmental toxins, which become concentrated in breast milk, increases with years of exposure to the environment, including years of ingesting foods that contain those toxins. "PBTs (persistent, bioaccumulative and toxic chemicals) accumulate in the lipids of humans, and neither urinary nor fecal excretion is a significant route of elimination." (121a)
In the largest study of its kind (as of January, 2009), researchers looked at more than 1,200 cases of autism and more than 300,000 US births. The team found a 20% increase in the risk of autism with each 10-year increase in the parents' ages (122). Similar results regarding parental age and autism were found in a study in northern California, USA. (123) One report cited six studies finding a direct association between parental age and at least one form of autism.(124)
The last-mentioned-report also cited two studies that were said not to find such an association. Of those two studies that failed to find the association, one was very small (61 participants) (125), and the other was a study of Danish children (126). In that regard, bear in mind that breastfeeding has been reported to be about 99% in Denmark, so that (unlike in the U.S., U.K. and Australia) infants of younger parents would probably be about as likely as children of older parents to be breastfed. Higher rates of breastfeeding could logically not be associated with higher parental age in a country in which breastfeeding is essentially universal.
To sum up preceding paragraphs: In some countries, older mothers are more likely to breastfeed, and they are also likely to breastfeed for longer periods, compared with younger mothers. In those countries, children of older mothers are much more likely to be autistic than children of younger mothers. However, in the only comparison involving a country in which all mothers are about equally likely to breastfeed, an association between parental age and prevalence of autism was not found.
Section 1.2.s.1.c Birth order and risk of autism in the U.S.: Birth order associations point in the same direction as socio-economic status and parental age: In all cases, if a category normally includes less breastfeeding, there are fewer children in that category who turn out to be autistic.
The same study cited above (using ADDM Network data) also found a couple's fourth child has half the risk of ASD compared with the first, regardless of the parents' ages. And the odds continuously decrease from first to later children (127).
Data from the U.K. Department of Health for 1995 shows a 17% decline in rate of breastfeeding rate between the first and later births (128). Apparently many women experience pain or other difficulties in breastfeeding, which results in not breastfeeding subsequent babies. In a Canadian study, it was found that “not having previous breastfeeding experience predicted its continuation,” which is to say that later babies, if breastfed at all, will normally be breastfed for a shorter period than a first baby (129).
First babies in countries with medium or lower rates of breastfeeding are not only (a) more likely to be breastfed, and (b) likely to be breastfed for longer periods, but they are also (c) fed much more potent doses of developmental toxins. The mother’s accumulated body burden of persistent toxins is partially excreted in breast milk; with each succeeding baby, the mother’s lifetime accumulation of persistent toxins has been reduced by breastfeeding of the preceding baby. A study of breast cancer risk factors published in 2008 looked into concentrations of dioxins that were measured in various tissues of 27 infants that had died unexpectedly; information was provided by the parents about birth order and breastfeeding history of the infants. It was found that the closer the infant had been to first in birth order, the higher the dioxin concentrations in the deceased infants’ tissues, “thus showing” (according to the study’s authors) “that the mothers can decontaminate themselves by breast feeding” (130). Having observed that, the authors had no hesitation about encouraging breastfeeding as a means of “decontaminating” the mothers, even after seeing clear evidence that the excreted toxins were absorbed by the infants, in direct proportion to the excretion from the mothers. “Because of the well-known beneficial effects of breast feeding and considering the results of the present study, this type of infant nutrition can be recommended without any restrictions.” This is an illustration of the blinders that many people in health fields are wearing, which allow them to only see breastfeeding’s perceived benefits, without ever seeing a possible dark side to its promotion. Those researchers would probably have been happy to know that breast milk from mothers of firstborn children were found in a Korean study to indicate body burdens of dioxins and PCB’s twice as high as milk of mothers of multiple children, indicating major transfer of neurological toxins to the firstborn babies. Similar results were found in a U.S study, especially regarding PCBs.(131)
To sum up preceding paragraphs: Babies later in birth order are less likely to be breastfed, they are likely to be breastfed for shorter periods, and the levels of persistent toxins in later breast milk will be lower as a result of the earlier breastfeedings. And those babies who are breastfed less (and babies fed breast milk with reduced toxicity) are much less likely to become autistic than other babies.
This follows the same kind of pattern seen with parental age and parental socio-economic status: more breastfeeding – more autism. (see the previous two sections)
A more direct way of seeing this same effect of different levels of breastfeeding is the British study that found that 65% of children diagnosed with autism had received substantial breastfeeding, whereas only 28% of children in the general population as a whole had received that much breastfeeding. (Comparing on basis of exclusive breastfeeding for at least four weeks or not, in UK and Northern Ireland. (details in Appendix 2.a).)
Remember from earlier that childhood cancer incidence has also followed these same patterns: higher incidences of both breastfeeding and cancer among firstborn babies, among babies of older mothers, and among babies of parents of higher socio-economic status. In addition, cancer incidences in the U.S. West (the region with relatively low levels of environmental carcinogens) correlate nearly perfectly with the variations in levels of breastfeeding among different states. (see www.breastfeeding-and-cancer.info )
Section 1.2.s.2 Other Social or Geographic Differences: Rural women are also less likely to breastfeed (132). Married women breastfeed their infants at about twice the rate compared with unmarried mothers at six months after birth, with an even higher difference at 12 months. (133)
A regional population (in Utah) that stands out with very unusually-high breastfeeding rates:
Utah had the third-highest rate of breastfeeding in the United States in the CDC’s 2000 survey; the margin of error of the sample/survey was such that Utah could very likely have been found to be first if a higher percentage of the population had been surveyed. Utah also has an autism rate that is extraordinarily high -- one child out of 47 according to 2008 data (136). By contrast, overall ASD prevalence for the United States as of 2008 was reported to be one out of 110, although that figure was in 2012 updated to be one out of 88. By comparison with either national figure, one out of 47 for Utah clearly merits serious attention. But it becomes even worse as one looks closer. In the 2008 Autism and Developmental Disabilities Monitoring (ADDM) study in Utah, it was found that one out of 25 white children in the Utah study area had ASD (see the 40 out of 1000 figure in this snippet) (137). Considering the disproportionate male-female ratio of autism, that works out to about one out of 17 white boys. (138)
The ASD rate for whites for this Utah location, 40 out of 1000, stands out in relation to the data for whites in the other thirteen ADDM study locations. That average for all of the other thirteen sites is 12.8 per 1000. So the white population of this Utah district has an autism rate that is over three times as high as the average autism rate of whites at all thirteen other U.S. study sites. There are only two other sites that are even as much as half as high in autism prevalence among whites as the Utah study site.
The reader should stop and think about the ratio noted above, combined with the four-out-of-100 rate of autism among whites in this study location. The only known autism rates of major countries that even approach this percentage are countries in which breastfeeding rates are high (Norway, Sweden, Finland, Denmark , Austria, Australia, New Zealand, and South Korea -- see Section 1.2.p.1). See www.breastfeeding-toxins.info concerning the toxins known to be concentrated in breast milk that are harmful to neurological development.
The CDC shows rates of breastfeeding among blacks or African Americans at 6 and 12 months after birth as being about half as high as among whites (142). According to another source, breastfeeding among blacks after the first days is even lower than half of the rate among whites: “Not only have Black women initiated breastfeeding at roughly half the rate of White women, but the majority of Black women who do breastfeed introduce formula to their infants while still in the hospital” (143). And autism rates among blacks are also generally about half as high as among whites, as reported by many sources. See the chart on the right for the apparent effect of this ethnic difference in breastfeeding rates, with a 0.6% rate of autism among blacks compared with 1.2% among whites.
In what is apparently the only study providing details related to the above ethnic differences, it was found that "Non-Hispanic blacks in this study who breast-feed at about the same level as whites have children with about the same autism rates as those of whites." (143b) So it appears that there is no ethnic susceptibility that accounts for the fact that blacks have autism rates about half as high as those of whites. That is additional reason to focus on the fact that breastfeeding rates are about half as high among blacks, bearing in mind the fact that breast milk contains many times the concentration of dioxins compared with infant formula, and at levels that EPA research has found to be over 80 times the EPA-determined safe level (see www.breastfeeding-toxins.info).
Hispanics: At least two studies have found breastfeeding rates among Hispanics to be consistently lower than among whites: (Colley and colleagues, 1999; Ryan and colleagues,1991) (144). Note in Figure 1.3 that ASD rates among U.S. Hispanics are also lower than those of whites. (Lower autism among Hispanics could also relate to a diet that is typically higher in grains and beans, with less dioxin-containing fats, dairy products and snack foods compared with the typical American diet.) Death rates from cancer are more than a third lower among Hispanics that among non-Hispanic whites.(89a)
One study found breastfeeding not to be lower among Hispanics, but that study was carried out by a land-line telephone survey, which probably missed many of the Hispanics who are of the lower economic strata in which breastfeeding is less prevalent.
A CDC survey reported breastfeeding rates in California to be about 18% lower among Hispanics than among whites. In line with that, the state of California reports that 36% of Californians are Hispanic, but only 28% of those with diagnoses of autism are Hispanic (145). (The only individual-state breakdown of Hispanic vs. white rates of breastfeeding that this author has found so far is for California.)
Section 1.2.s.4 Low-Breastfeeding / Low Autism Countries:
Irish breast-feeding rates, at least at initiation, are the lowest of any major people in Western Europe or North America, with the closest second being France (146). And Irish rates of autism also appear to be unusually low. AactionAutism of Ireland reports the best estimate for general autism prevalence in Ireland to be one out of 150 in their website accessed in 2012, and a 2009 estimate is one out of 166. (147) In both cases this is low compared with the only known rates for the high-breastfeeding countries (normally about 1% of the general population). (see Section 1.2.s.5)
In the historically relatively low-breastfeeding U.K., autism among children is estimated to be about 1%, according to the U.K.’s National Autistic Society’s web pages accessed in 2012. (148), This is especially low as compared with the known (and reasonably estimated) rates among children in the high-breastfeeding countries, which are normally well above 2% of children. (see Section 1.2.s.5, to follow)
French breast-feeding rates are also very low (see Section 1.2.p).
One source for an autism rate in France reports in 2012 that about ¾ of 1% of French babies being born will eventually be diagnosed with autism,(148a) a very low figure in comparison with the 2½% and higher rates in the high-breastfeeding countries. "A handful of small studies in France... have found rates around 5 cases per 10,000 people," according to a 2011 article on the website of the Simons Foundation Autism Research Initiative.(148c)
Belgian breastfeeding rates are also very low (see this chart and also Section 1.2.p). The only data found for autism prevalence in Belgium were quoted in a 2004 document that indicated a range of prevalence (depending on how autism and ASD are defined) of between 5 and 20 per 10,000 population.(148b) Even if the higher figure were to be quadrupled, it would still be far lower than autism percentages in the high-breastfeeding countries.
Section 1.2.s.5 High Breastfeeding / High Autism Countries:
Autism symptoms were identified in a very high 2.7% of children in Norway in one study, as indicated in an article by a researcher with the CDC (152). In that regard, note the line at the top of this chart, which is the breastfeeding rate for Norway. Japan is another country found to have an unusually high rate of autism; "the highest recorded autism prevalence is from a 2008 study in Japan, which calculated a whopping 181 cases per 10,000 people." (148c) (Notice that this figure indicates almost 2% of the entire population, not just of children.) Japan’s breastfeeding rates are also very high, and the deep cultural respect for authority in Japan (the government promotes breastfeeding) probably means that intensity and exclusiveness of breastfeeding there is extraordinary, in addition to the high rates. (Section 1.2.p.1) South Korea’s breastfeeding rate appears to be very high. (Section 1.2.p.1) In the CDC’s “Summary of Autism Spectrum Disorder (ASD) Prevalence Studies” (151), a 2011 study of over 55,000 7-to-12-year-old South Korean children was indicated as having found a 2.64% prevalence of ASD. Of all countries’ autism rates for which data have been made public, only top-breastfeeding Norway has an autism rate as high as this rate for South Korea.
Sweden’s very high rate of breastfeeding is conspicuous on this chart. The only studies that have apparently been published regarding autism in Sweden applied to children studied in 1992 and 1994, and the averaged rate from those studies was the highest autism rate ever reported for any country that applied to the years preceding 1995. Denmark appears (in this chart) to have reached the high-breastfeeding category by the early 1990’s, and a 2001 report shows Denmark with a 99% breastfeeding rate (154) The only published study of autism prevalence in Denmark applied to children observed in the 1994-1999 period, and at that time Denmark had the highest autism rate of all countries for which studies of prevalence up through the 1990’s are available.(155).
The only available data for autism in Finland are as follows): “In Finland, there are approximately 50,000 people with autism spectrum disorders” (156). Considering that Finland’s population is about 5 million, and that an extremely disproportionate number of those with ASD are typically those born just in the last two decades, the percent born since 1995 who have been becoming autistic could be close to 3% of the population of children born since 1995. For Switzerland, breastfeeding rates are not shown here, but they are very high (See Section 1.2.p.1); there are also apparently no figures for autism among children in Switzerland, but Der Bund newspaper (Switzerland’s third largest) estimated in 2011 that 1% of the entire population has autism (157). As in the case of Finland, going by the general trend that the vast majority of those diagnosed with autism have been born in the last 15 - 20 years, 1% of the entire population could easily mean close to 3% of the recently-born. For additional insight into how major the problem is in Switzerland, one can go to Google/Switzerland and do a search for “autismus in der Schweiz” and see many listings of websites of organizations devoted solely to dealing with problems of autism, which one would not necessarily expect for such a relatively small country. As shown in the chart above, Austria’s breastfeeding rate was high as of 1997 and very possibly much sooner than that. The website of Austria’s major autism-assistance organization (ÖAH) reports in 2012 that 48,500 children in Austria had ASD. (Österreichische Autistenhilfe, Vienna) In relation to Austria’s population of 8.2 million, with an average lifespan of over 80 and a fertility that has for decades been below replacement levels, that 48,500 is probably at least 2-1/2% of the country’s children; yet again, in the case of another high-breastfeeding country, this rate is over twice as high as the rates in the low-breastfeeding countries.
According to the chart at the beginning of Section 1.2.p.1 and according to statistics quoted in the LaLeche League’s breastfeeding data web page, Australia is well into the high-breastfeeding category; and a recent study has found an extraordinarily-high incidence of four children per 100 with ASD in Western Australia. (J Autism Dev Disord. 2011 Dec;41(12):1601-8. A comparison of autism prevalence trends in Denmark and Western Australia, Parner ET, et al., Institute of Public Health, Department of Biostatistics, University of Aarhus, Aarhus, Denmark) New Zealand’s rate of breastfeeding is also very high according to the LaLeche League, and Autism New Zealand reports 40,000 citizens with autism, which is almost 1% of the country’s total population of 4.3 million, again putting another high-breastfeeding country into the high-autism category. (http://www.autismnz.org.nz/Autism-New-Zealand/More-About-Autism.php#6)
For the only remaining European country in which breastfeeding is known to be high, Germany, there appears to be less information available about autism prevalence compared with other countries, but what is available says that more than 1% of the entire population has autism,(158) which puts Germany into the high-autism category when that figure is related to the far higher percentage of autism among children than among adults. At http://www.autismus-web.de/links.htm one can see that there are about 75 autism-assistance organizations in Germany; this seems to be a large number, in a country of less than 82 million with a very low birth rate, for a condition that affects mainly children.
To sum up, in every advanced country in which breastfeeding is known to be very high, autism has also been found to be very high. The opposite is true for the low-breastfeeding countries.
Section 1.2.s.6 Breastfeeding and Autism BOTH being Unusually Stable during the Same Time Period in the UK As can be seen in charts showing breastfeeding rates of European countries in recent decades (such as at www.breastfeeding-rates.info), the general trend of breastfeeding rates has been upward, and the U.K. was unusual in having a very stable rate of breastfeeding in the years leading up to 2000. In connection with this unusual, geographically restricted stability in breastfeeding rate, it should be mentioned that there was a study in the UK that is sometimes referred to by those who hold that autism hasn’t really been increasing; that study found that there had not been an increase in autism in a certain town in the UK among children born in the years preceding 1999 (159). A study that failed to find increasing prevalence of autism for any time period during the last two decades appears to be unusual if not unique; and it may be more than coincidental that this study was done in a country in which the prevalence of breastfeeding had also not been increasing during the relevant period.
Section 1.2.s.7 Certain High- or Low-Autism U.S. States
These maps (160), indicate concentrations in Minnesota of descendants of Norwegian and Swedish immigrants, whose mother countries are known to have high rates of breastfeeding. (German ancestry is also high in Minnesota, and Germany’s rate of breastfeeding is also high.) These maps help illustrate apparently differing effects of breastfeeding, varying according to the mothers’ dietary habits. As could have reasonably been predicted from the fact that breastfeeding rates are culturally influenced and very unusually high in the above three countries, Minnesota is at the very highest level in breastfeeding; it was ranked fourth highest among U.S. states in the CDC year 2000 national survey of breastfeeding at six months after birth, but the margins of error in the sampling were such that Minnesota’s actual true rate might have been higher. (161) Knowing the developmental toxins concentrated in the breast milk of the typical U.S. mother (see www.breastfeeding-toxins.info), and knowing other factors contributing to high levels of toxins in Minnesota (to be presented later), it should not be surprising that prevalence of autism in Minnesota is the highest in the U.S. (162) And not just moderately higher than the average: More than twice as high as the median for the U.S. states.
When observing the above, remember also that two of the mother countries, Norway and Sweden, both with unusually high rates of breast feeding, were found to be extremely high in autism (Norway and Sweden). (Autism data for Germany seem not to be available.)
With a breastfeeding rate even higher than that of Minnesota, the state with the first or second highest rate of breastfeeding in the U.S. (depending on the particular survey) is Oregon, which also has the second-highest rate of autism in the U.S., at almost exactly twice the national median. (162)
As has been noted, diet (mostly animal-based fats) is considered by the EPA and ATSDR to be the source of about 90% of the average body burden of dioxins. Typical Scandinavian cuisine would normally only add to the levels of dioxins in breast milk consumed by infants in Minnesota. Recipes for favorite traditional Norwegian dishes (easily found with a web search) show very high animal-fat content, especially butter. Swedish cuisine is very similar to that of Norway (163). An article in The Canadian Physician (VOL 39: January 1993) refers to ”the very high level of cholesterol and fat in the normal Scandinavian diet." The only comment found on the subject of intergenerational transmission of culinary traditions includes the following: "WHEN I WAS OLD ENOUGH MY GREAT GRANDMOTHER STARTED TO TEACH ME THE OLD WAYS OF COOKING IN SWEDEN ….TODAY AT 59 YEARS OLD I STILL MAKE THOSE DISHES THAT MY GREATGRAND MOTHER TAUGHT ME AS A YOUNG CHILD" (164) That sort of maintenance of cultural traditions would be especially likely to hold sway in communities where there are concentrations of people with common ancestry (as shown in the above maps), along with Lutheran church festivities and other vehicles that promote continuation of an ethnic heritage. It also makes sense that a diet high in fat -- an excellent source of energy for keeping warm, which promotes comfort during long, cold winters in the (very northern) old country -- would be continued in a new cold domicile in the U.S.; Minnesota has 17 of the nation's coldest 21 cities with populations over 50,000 (165) Supply of dairy products in Minnesota is also very ample, keeping prices down and encouraging consumption: The region consisting just of Minnesota and its neighbor Wisconsin produces more milk than any of the other three USDA regional groupings of major dairy states in the eastern and southern two-thirds of the U.S. (166).
So it is probably safe to assume that consumption of dairy products and fat is unusually high in Minnesota. And knowing what was stated earlier about dairy products and animal-based fats as top sources of dioxins in humans, it is very likely that dioxin content in typical breast milk in Minnesota is unusually high. That could only contribute to the likelihood that the high level of breastfeeding in Minnesota is causally connected with that state's place at the very top of U.S. states in prevalence of autism.
As pointed out earlier (Figure 1.3 and accompanying text), rates of autism among Hispanics are significantly lower than among whites. That is partly associated with what is probably a lower rate of breastfeeding among Hispanics, and partly connected with the way the Hispanic diet differs from the typical American diet, which in turn affects the levels of toxins in the typical Hispanic breast milk. Compared with whites, Hispanics are reported to purchase less dairy products and snack foods, such as potato chips, candy, and cakes .(167) Remember from above the importance of dairy products and animal fats (such as are at high levels in most snack foods) as sources of dioxins in the diet.
Section 1.2.u The Case of Washington State: Back to the subject of regional variations in diet and the effect of those variations on toxins in breast milk: Prevalence of breastfeeding in Washington state is very high; but reported autism rates in this case (although above average) are much lower than those reported for Minnesota and Oregon, departing from the simplified pattern that has been discussed so far. There are good reasons for this deviation, as follows:
1) Noticing the far lower levels of Norwegian and Swedish ancestries in Washington than in Minnesota, it is reasonable to expect dioxin ingestion from dairy fat consumption to be much lower in that state;
2) Regarding the other largest sources of dioxin and mercury body burdens (meat and fish), it is significant that there are over 2-½ times as many vegetarian restaurants per million population in Washington as in Minnesota (168)
3) Regarding the general environmental pollution that underlies toxin levels in much of Washington's food supply, and regarding the pollution levels that affect what mothers and infants in that state breathe, absorb and ingest directly, note that the State of Washington is very unusually strong in preventing pollution, as evidenced by the following:
-- Bear in mind that
a) residential wood burning is a known substantial source of emissions of dioxins, particulate matter and lead (and probably mercury -- see Section 2.1 about toxicity of wood burning), and also that
b) those toxins enter the air in the immediate areas of breastfeeding mothers and infants.
Then note that Washington prohibits outdoor wood boilers and has very strict regulations about other residential wood burning; there are residential "burn bans" if pollution exceeds a certain level. A search for regulations on websites of other state governments' environmental agencies (especially including the high-autism states) yields nothing of similar restrictiveness. Three of Washington's publications regarding wood smoke pollution are of such recognized quality that they are recommended reading even on a state environmental website from distant Minnesota.
-- A detailed 2010 study of pollution levels in Washington's Puget Sound found that most contaminants were at far lower levels than had been projected, some by as much as 99%; and the study's lead researcher concluded that "Regulations and increased public focus on pollution prevention appear to be paying off."
The above are merely examples, which are probably representative of many other aggressive actions taken by the Washington Department of Ecology that promote low levels of toxins in the environment. And it is unlikely that a state's environmental department would be so unusually active and effective unless many of the state's citizens were actively supportive of efforts to reduce pollution. There should be little doubt that such unusual legal requirements (and probable public involvement) have substantially reduced emissions of developmental toxins in Washington. And those actions appear to stand out in comparison with the lack of such measures on the parts of the states that, in contrast with Washington, have the very highest rates of autism.
So therefore the association of autism with high levels of breastfeeding obviously needs to be refined. High levels of autism appear to be associated with high levels of breastfeeding in an area if there are reasons to expect women's body burdens of dioxins and mercury to be typical or high in that specific area.
As noted in www.breastfeeding-toxins.info, PCB exposure (like that of dioxins in general) even at low levels during the perinatal periods is reported to be able to influence development in a way that can "cause irreversible neurological damage." In addition to the above, there is other evidence from research involving humans (to follow) that moderate, background-type exposure of infants to PCBs harms mental development. The following is taken from a State of California website: (182) Various researchers "have reported persistent neurological effects" of PCB exposures. Another study, with 395 children, "reported that exposure in utero to 'background' PCB concentrations is associated with poorer cognitive functioning (cognitive abilities and verbal comprehension) in preschool 42-month-old children." Another study, of 212 eleven-year-olds, involved children born to mothers who were known to have consumed Lake Michigan fish contaminated with PCBs, comparing them with a control group without such exposure. The study found that the most highly-exposed children were "three times as likely to have low average IQ scores and twice as likely to be at least two years behind in reading comprehension." (emphasis added) Other strong effects were related to memory and attention.
One substantial study found harmful effects of PCBs transferred to human infants specifically by breastfeeding. A large team of German scientists and MD's, studying 171 healthy mother-infant pairs, found "negative associations between (human) milk PCB and mental/motor development ... at all ages, becoming significant from 30 months onwards." And also, "negative associations with PCB increased with age." They based their observations on data both from the breastfeeding period (PCB concentrations in the milk x months of breastfeeding) and from measurements of serum at 42 months of age (recognizing that most of a breastfed child's PCB levels at 42 months would have resulted from PCBs transmitted in breast milk). They looked for association of development with PCB levels in umbilical cord blood, but they found none of significance.(180)
Oregon, as mentioned, has an autism rate twice as high as the national median. Nothing stands out on this map of PCB concentrations like western Oregon. And that specific dark area is also the section of Oregon with the highest levels of autism, within a very high-autism state. There are also many paper and pulp mills in that same area, and such mills are known sources of dioxins and other neurological toxins. So the environment in which the average nursing mother in Oregon has been eating and breathing seems to be unusual, and not in a good way.
Maine is the state with the third-highest level of autism, and it has one of the higher breastfeeding rates in the U.S. in CDC surveys (see below). This state also has very unusually large numbers of paper and pulp mills (19, most of which include the more-polluting pulp operation);(183) and Maine (along with Minnesota) has the least benefit from solar radiation among the 48 contiguous states. Its cold winters mean that levels of combustion (source of dioxins, particulate matter and PAHs) would be high, especially from residential burning of Maine's abundant wood. See Section 3.1-2 about the disadvantages of reduced sunshine, and Section 2.4.c for other factors that affect levels of developmental toxins in Maine’s environment.
One has to look closely in Figure 1.5 to see the small state of Vermont, which is essentially the un-colored section directly below the "a" in "Concentrations" in the map's heading. The lack of color in that thinly-populated, very non-industrial state's location on this map says something about the kind of environment in which Vermont's mothers live, and about the probably-low average levels of toxins in their breast milk. There is apparently only one company in Vermont with a paper and pulp mill (184). The above helps explain why Vermont can be among the states with high levels of breastfeeding while at the same time having only medium levels of autism and childhood cancer. PCBs are one major segment of the overall group of dioxins, and dioxins in general are known to be endocrine disruptors and therefore neurodevelopmental toxins. (see www.breastfeeding-toxins.info) Unfortunately the EPA does not provide data or maps specifically about dioxin levels, but one can get an approximate idea of dioxin levels by seeing a map of general atmospheric pollution; both general atmospheric pollution AND dioxins are produced by various forms of combustion. As indicated in the EPA-provided map on the left, Vermont is the only state among the U.S. northeastern states that, as an entire state, is free of significant air pollution problems. The only other places in northeastern states where low levels show up are in the least-populated parts of the states. One would have to go over 1000 miles to reach another U.S. state with air quality so uniformly good. Given the above, levels of dioxins and other toxins in Vermont’s environment (and therefore in its air, water, soil, and much of its food) must be unusually low. Therefore typical breast milk in Vermont must be low in the developmental toxins of the kinds that contribute to high levels of mental impairment in other states that have high rates of breastfeeding.
Oregon and Utah are clearly states with breastfeeding rates at the very highest level in the U.S. And Minnesota is in the upper part of the range. According to Special Education data, Oregon and Minnesota have autism rates that are second-highest and highest in the U.S. Utah is well below the top according to Special Education data, but more recent in-depth research in a Utah county has found that the school data was considerably under-counting the real levels of autism in Utah. Autism was found to affect one out of 25 white children, or one out of 47 total children in Utah, which would place Utah among the very highest-autism states according to the more thorough determination method. (Those figures compare with the most-recently quoted autism figure of one out of 88 children in all U.S. states.) (See Section 1.2.s.2)
Maine is another step down from the top level in breastfeeding rates, but still in the upper part of the range, in a comparison among the 48 contiguous states. Its position as third-highest in autism prevalence according to Special Education data is affected not only by a relatively high breastfeeding rate but also by other factors that cause high levels of developmental toxins in that state’s environment. (See earlier in this section.)
Section 1.2.x.2 Effects of Coastal vs. Inland Locations: According to a study of mercury levels in U.S. women by a researcher with the EPA and others, "Women living near the coastal areas had approximately three to four times greater risk of exceeding acceptable levels of Hg (mercury) exposure than did noncoastal-dwelling women." (185) That could help explain why the states with the second and third highest rates of autism in the U.S. (and high breastfeeding rates) are states with the bulk of their populations near an ocean (Oregon and Maine), while some landlocked states with high breastfeeding rates do not have high autism rates. Highest-autism Minnesota, although not on an ocean coast, is home to the most active port on the Great Lakes (Duluth) as well as the Mississippi River port in St. Paul. Over 5 million tons of commodities passed through Twin Cities river terminals in 2010, apparently with most of that activity right in the middle of the city of St. Paul (186). It is possible that high mercury levels in near-coastal locations is related to greater consumption of seafood; considering what is known about Great Lakes fish, significant consumption of such food in Minnesota could be a substantial part of toxic exposure in that state.
See Section 1.4 concerning other toxins, including dioxins, that are also heavily present in marine diesel emissions.
An earlier statement is worth repeating: High levels of autism appear to be associated with high levels of breastfeeding if there are reasons to expect women's body burdens of dioxins and mercury to be typical or high in that area. But it should be kept in mind that reasons for expecting high body burdens of toxins can be only partly shown by maps such as those above, or by considering distance from the coast. It is apparently, more than anything, a matter of individual long-term dietary habits, especially regarding consumption of animal-based fats.
Vermont and all low-autism states outside the far south are well inland, and are therefore not as subject to high levels of atmospheric mercury, and probably other toxins, as the coastal states are.
The states in the far South that have low levels of autism despite being coastal have the advantages of (a) extra solar radiation (see Sections 3.1-2), (b) high African-American population percentages (bear in mind that African-Americans breastfeed at about half the rate compared with whites, and are also half as high in their rates of autism -- see Section 1.2.s), and (c) those states almost all have generally low rates of breastfeeding (see Section 1.2.x.5).
Section 1.2.x.3 Other Factors that Greatly Affect the Toxic Contents of Breast Milk: On the subject of low pollution and consequently low toxins in breast milk: The reader may have noticed in Figure 1.4a that the area with relatively high percentages of Norwegian and Swedish ancestry extends west from Minnesota into the Dakotas, especially to North Dakota. And rates of breastfeeding are above average in those states (although much lower than Minnesota's). But rates of autism in those two states are substantially below average. So it is worth looking at levels of pollution in those states, which are likely to end up in breast milk. Figure 1.5 shows very low levels of PCBs where those two states are located. The American Lung Association in its 2009 "State of the Air" report ranked Fargo (the largest city in North Dakota) as the cleanest city in the United States, and gave the rest of the state 11 "A" ratings on air quality.(Wikipedia). Less than 2% of North Dakota's land area is forest land, meaning that firewood for residential burning would be especially expensive, reducing that potential source of particulate matter, dioxins and lead in indoor air and in a community’s air to an extremely low level. If one wants to find a state in which to reside in order to have non-toxic breast milk, North Dakota would be very high on the list, along with Vermont.
In areas with substantial forest land such as Minnesota, Maine, and the Pacific Northwest, lakes typically form sheltered basins in forested areas where wood-burning emissions and other pollutants collect, often with many nursing women and infants residing and breathing the bad air in those wooded basins. (See Section 2.1 about toxic hazards of wood burning.) In the near-absence of forests in the Dakotas, the lakes don't form such sheltered areas for collecting polluted air. (See these leading pictures from tourist-promotion sites for both Dakotas.)
Population density is another determinant of toxins in the air, almost all of which arise from various forms of combustion. In that regard note that population density in the Dakotas is one-sixth as high as in Minnesota (Census Bureau). The dark areas showing Norwegian and Swedish ancestries in the Dakotas show percentages, in thinly-populated areas; that probably makes formation of communities with common ancestries (and therefore long-term continuation of the high-fat Scandinavian diet) less likely in the Dakotas. And, as noted in the previous section, a location that is distant from coasts (such as that of the Dakotas) apparently has a very distinct advantage in reduced atmospheric levels of developmental toxins as well as reduced consumption of seafood.
Fig. 1.7 Average Precipitation Levels in the U.S.
Another environmental feature that helps keep toxin levels down in the Dakotas and in most of the non-coastal West is a low level of precipitation. Precipitation brings toxins in the atmosphere down to the human-level environment and is also instrumental in the formation of dioxins (more on this later). Precipitation affects the amounts of toxins that are deposited on vegetation that is subsequently consumed by farm animals whose meat is eaten by childbearing women in the region, and it also affects the amounts of toxins that end up in lakes and rivers; those toxins then come up the food chain into freshwater fish that are eaten. There are also far fewer trees in low-precipitation areas, especially trees that are good sources of logs for burning, so that the particulate matter, dioxins and lead that are typically emitted inside homes by residential wood burning would rarely be present in those areas. As this map shows, Minnesota (and the vast majority of its population) is mostly in the zone of medium precipitation, and the Dakotas (with their low rates of autism) are in the zone of low precipitation. High-autism Maine and the most-populated, high-autism parts of Oregon both have high precipitation.
Of the ten states on this map that are mostly low in precipitation (mostly red, brown and/or tan, but excluding the very exceptional California), all but one of them is below the national median rate of autism; their average is 25% below the national median rate of autism. The exception: Utah is one of the states that is highest in autism. (Section 1.2.s.2.) Note that Utah also has one of the very highest rates of breastfeeding.
In addition to reduced deposition of toxins, low-precipitation zones also receive more sunshine than is normal for their latitudes; this is partly because of reduced cloud cover and partly because of very little forest cover in these areas to shield the deposited dioxins from destruction by solar radiation. A greater amount of solar radiation (a) reduces formation of dioxins (by drying up HCL that would otherwise be available to provide chlorine needed for creation of dioxins), (b) shortens the toxic lives of dioxins that are present, and (c) enables the body to create vitamin D, thereby promoting immune function, which is associated with lower levels of autism (more detail in Section 3).
Low precipitation areas (except in California) are also typically low in population density, which means less combustion of all kinds taking place, and therefore less creation of dioxins, PAHs, and particulate matter.
So we have seen that, at the high end of the widely varying rates of breastfeeding in the U.S., the direct association with autism is strong, but it is complicated by
a) effects of different levels of precipitation and sunshine, which greatly influence the levels of toxins in women’s bodies and in breast milk,
b) other pollution-reducing circumstances or human initiatives, which reduce body burdens of developmental toxins in some areas, and
c) effects of varying diets (such as a high-fat Scandinavian-type diet that is probably common in Minnesota), which in turn affect the levels of toxins in typical breast milk.
Section 1.2.x.5 Probable Effect of Low Levels of Breastfeeding: At the low end of the spectrum of varying breastfeeding rates within the U.S., the association between breastfeeding and autism is not at all complicated. The seven U.S. states with the lowest rates of breast feeding(161) are all in the bottom third of autism rates in the contiguous U.S. states (Kentucky, West Virginia, South Carolina, Arkansas, Alabama, Louisiana and Mississippi). (162) (Iowa's reported autism rates were omitted from this list on the grounds that its data are not comparable with data from the other states, since its four-year trend was completely at odds with the trends in the other 47 contiguous states, implying that Iowa was out of step with the rest of the nation in methods of diagnosing the condition.)
Section 1.3 Lead:
A 2003 U.K. government study found ready-to-feed milk and infant formulae to be less than a third as high in lead as the average ready-to-feed “All Foods” category.(173) A study by an international team, published in Environmental Health Perspectives in January of 2014, found that “infant blood lead increased by 2.2 (95% CI: 1.1, 3.3) μg/dL among infants exclusively breastfed in the preceding month, compared with 1.1 (95% CI: 0.01, 2.2) μg/dL among those not breastfed in the preceding month (p-value for interaction = 0.06), indicating effect modification by breastfeeding status….” Continuing to quote from that same source, “a study of breastfeeding duration and infant blood lead reported that longer breastfeeding was associated with higher infant lead concentrations in three countries, in three different decades, in settings with differing breastfeeding patterns, environmental lead sources, and infant lead levels (Lozoff et al. 2009).“ They quoted from another study as finding “breast milk to be the strongest correlate of 6-month blood lead levels, whereas formula lead correlated poorly with infant blood lead levels,” which tied in with a hypothesis of lower absorption of lead from formula than from breast milk.(174)
To read about sex-specific effects of lead, with females being more affected: See "Toxicological Profile For Lead," Agency for Toxic Substances and Disease Registry August 2007, p. 119
Section 1.4 Particulate Matter (PM), Diesel Emissions, and Household Smoking
The EPA oversees substantial research on "particulate matter", but typically only publishes environmental pollution data for "diesel particulate matter", as in the EPA's NATA 1999 air toxics assessment. That phrase was replaced in the NATA 2002 assessment with "diesel engine emissions". There is considerable overlap in what is encompassed in the meanings of the three above phrases, as well as differences. But particulate matter from diesel emissions seems to be the specific kind of PM that the EPA considers to be of the greatest significance.
In an EPA document, the authors pointed out findings of a study suggesting that "…the central nervous system is a potentially important toxicologic target of PM2.5 (very tiny particles of the kind predominant in diesel emissions)… In support of this significant result, studies of mice chronically exposed to ambient PM2.5 documented loss of brain neurons (Veronesi et al. 2005) and changes in gene expression in the brain….."(191) (italics added) In a report about work at the University of Rochester's Environmental Sciences Center, findings are stated that "inhaled ultrafine particles can reach the central nervous system" and can do so efficiently.(192)
In addition to complete particles reaching the nervous system, organic compounds (which include dioxins and PAHs) adsorbed onto particles can be freed from the particles and "rapidly absorbed into the bloodstream." (193) (parenthetical expression added) The EPA document on PM Centers cited earlier in this section refers to "a number of PM Center studies (providing) a strong evidentiary basis for oxidative damage as a general toxicological mechanism of PM injury." Metals in PM were found to play a role in formation of "reactive oxygen species," which are extremely reactive molecules and ions that can harm cells. If words like "oxidative" and "reactive oxygen" are not familiar terminology to the reader, bear in mind that oxidation damages or destroys matter, sometimes quickly (as in burning) and sometimes slowly, as with rust.
Aside from evidence about general neurological harm resulting from oxidative damage caused by particulate matter, a team of scientists studying the connection between vehicular exhaust and autism referred in 2011 to "emerging evidence that oxidative stress and inflammation are also involved in the pathogenesis of autism."(194) It should also be noted that diesel engine exhaust was upgraded in 2012 from classification of likely carcinogen to "known" carcinogen.
Notice that most of the above indications of harm that can be caused by PM refer to effects on tissues and brains in general, regardless of age. The especially great vulnerability of developing brains should be considered in light of the statement by the NIH (quoted in Section 1.a of www.breastfeeding-vs-formula.info) about the "greatest risk … when organ and neural systems are developing." The 2011 study quoted in the previous paragraph states that "Diesel exhaust particles present in traffic-related pollution have been shown to have endocrine-disrupting activity and to transplacentally affect sexual differentiation and alter cognitive function in mice ." (194) (emphasis added). Another relevant experiment was conducted on male rats over a three-month period beginning at birth, in which it was found that diesel exhaust was responsible for "disrupting the endocrine system".(195) Also, scientists replicated lungs of infants to compare with replicated lungs of adults, tested both for particle deposition after exposure to particles, and concluded that "tracheobronchial dose on a per kg body mass basis……may be more than six times higher in the resting newborn than in the resting adult."(196)
In Section 4.4 of the EPA's 2002 Health Assessment Document for Diesel Engine Exhaust, it is pointed out that, "Extensive studies with salmonella have unequivocally demonstrated mutagenic activity…. Several of the chemicals found in diesel emissions possess mutagenic activity in a variety of genetic assays." That same document points out that approximately 80%-95% of the mass of particles in diesel exhaust are in the size range from 0.05-1.0 microns which, "due to their small size, can effectively reach the lower portions of the respiratory tract."
The fact that diesel emissions are a major source of dioxins (and a rapidly-growing source of dioxins in the U.S., according to the EPA's latest data – see Section 1.9.4) ties in with the previously-mentioned effects observed to result from PM and diesel emissions: altered cognitive function, loss of brain neurons, changes in gene expression, and harm to the developing immune system. (These effects and the action of dioxins as endocrine disruptors, resulting in interference with normal brain development, were discussed in www.breastfeeding-toxins.info) With dioxins from diesel emissions increasing so dramatically, it is probably safe to assume that diesel emissions in general, including their important content of PAHs, have also increased greatly.
Although PM is the component of diesel exhaust that seems to receive the most attention, harm to the developing brain is seen to result also from other diesel emission components that are sometimes studied separately, including PAHs.(194) (197) (PAHs are known to cause cancer in animals, and some PAHs are known to be endocrine disruptors and mutagens – see Section 1 of www.breastfeeding-vs-formula.info).
Regarding how best to protect infants against the effects of diesel emissions, it is noteworthy that researchers cited above found that, "Because these effects were not inhibited by filtration, the gaseous phase of the (diesel) exhaust appears more responsible than particulate matter for disrupting the endocrine system." However, later in that same EPA document (section 5.3) it is stated that "When adsorbed onto diesel particles, the gases and vapors can be transported and deposited deeper into the lungs, and because they are more concentrated on the particle surface, the resultant cytotoxic (harmful to cells) effects or physiological responses may be enhanced." So there appears to be some question regarding which of the specific components of diesel emissions are likely to cause the most serious damage to neurological development.
Diesel emissions have been found in a study to be harmful to the endocrine output of male test animals. "Sperm production and hyaluronidase activity, one of the biochemical markers for testicular toxicity, were reduced in the diesel exhaust-exposed rats…. These elements indicate that testicular function was suppressed by the inhalation of diesel exhaust. …the male reproductive system may be particularly susceptible to toxic insult during the gestation period, as has been observed….in various studies." (195) (199) It should be noted that, although the level of the test animals' exposure in this experiment was well above the average urban U.S. diesel pollution levels, that exposure was for only a total of 30 hours per week, and it didn't begin until after birth. In that regard, remember from a study quoted previously that diesel emissions have been shown to act transplacentally (194), and remember that the brain is going through very important development before birth. So the exposure to diesel emissions applied in this study probably came after the equivalent period when harmful exposure to diesel emissions in a typical urban environment would have already been well underway, and was only for 30 hours per week, but this abbreviated exposure nevertheless had a significant effect. Bear in mind that testosterone is important to proper development of the brain. (Section 1.2.b.1)
Diesel emissions from trucks and trains are especially likely to be harmful because they are released (a) close to ground level and (b) from large numbers of exhaust pipes that are travelling thousands of miles on roads and tracks that are widely distributed within populated areas. Those emissions quickly and directly reach the air breathed by many infants and childbearing women, and their particulate matter lands on surfaces crawled on by many infants, as well as on objects handled and mouthed, and on soil that could then be ingested by infants. A study of effects of proximity to California freeways (published in 2011) found a doubled risk of autism among infants residing within about 1000 feet of a freeway. (194) That study was probably mainly finding the effects of diesel emissions from passing trucks and buses, as indicated by the following: According to EPA data for the year 2000, total dioxin toxic equivalency produced by on-road diesel emissions in the U.S. was about 17 times as high as the total produced by on-road unleaded gas fuel combustion emissions (198)
Marine diesel emissions aren't normally released as closely into populated areas as diesel emissions from trucks and trains (and many European cars), but they are nevertheless often released very near to populated areas. Probably the outstanding example of this is the state of Louisiana, as seen on this map showing the locations of Louisiana's ports. Just one of these ports (Port of South Louisiana, marked on lower right of this map) is the largest tonnage port in the entire western hemisphere. The ports of New Orleans and Baton Rouge are also major ports. And there are also 29 other ports in Louisiana, many of them on inland waterways, most of them well within populated areas. Since marine fuel is diesel, and considering all of the diesel-powered loading/unloading machinery, dredging equipment, and diesel trucks and trains going to and from these ports, it is almost certain that Louisiana is the U.S. state whose population is most heavily affected by diesel emissions. Bear that in mind when remembering or looking at the map of cancer incidence by U.S. states as shown in www.breastfeeding-and-cancer.info , in which there is only one orange-colored (high-cancer) state in the entire 3/4 of the U.S.A that is outside the northeastern quarter of the U.S.: that state is Louisiana.
The "bunker" type of fuel that is used in ships and for heating in some large urban buildings is an atypical form of diesel fuel. It is a tar-like product consisting of the residual that remains after distillates are extracted from crude oil in the process of making other kinds of fuel, with many toxic components concentrated in that residual. Most people are surprised to learn that the EPA has calculated that many thousands of deaths occur in North America every year as a result of diesel emissions from ocean-going ships,(200), although substantial death rates have also been attributed to land-based diesel emissions (per EPA announcements <<add details>>). An EPA document regarding diesel pollution from ocean shipping points out that the PM contained in marine diesel emissions includes mercury, lead, and dioxin, as well as arsenic and other metals. (201). It also points out that "Marine diesel engine emissions consist of a higher fraction of ….. metallic ash (approximately 7-11%) than (is) typically found in land-based engines".(202) Another authoritative source places the fraction of metallic ash in diesel emissions of PM 2.5 and PM 0.1 (the deepest-penetrating categories of PM) at between 17% and 25%.(203) The higher proportion of metallic ash in marine diesel emissions is important because (a) some of the metals are known to be neuro-developmental toxins, (b) formation of dioxins during combustion is promoted by metals' acting as catalysts during the combustion (204) and (c) as mentioned earlier in this section, metals are important in formation of reactive oxygen species, which damage tissues, including neurological tissues. Between the above and the presence of sodium chloride in sea air (as a source of the chlorine needed to form dioxins during normal combustion), marine diesel emissions may be substantially higher in dioxins than is average for other diesel engine exhaust, and they almost certainly contain a higher proportion of mercury and lead.
Household smoking: For information about general adverse health effects on children in households in which smoking is done, especially SIDS, see Section D of www.breastfeeding-benefits.net. Carcinogens and particulate matter are only part of the many toxins known to be present in tobacco smoke. A study dealing with PAHs, which are known carcinogens and which have been found in breast milk in greatly varying amounts according to extent of household smoking, is discussed in www.breastfeeding-toxins.info. Apparent cognitive effects were also found in 2012, finding that non-smokers exposed to sidestream smoke scored almost 20% lower in memory tests than those who were not exposed to such smoke. (http://www.nlm.nih.gov/medlineplus/news/fullstory_129283.html ) According to a Spanish study, pregnant women who smoke or inhale secondhand smoke put their children at risk for learning difficulties, attention-deficit/hyperactivity disorder and obesity. The investigators also found that babies who have been exposed to nicotine have impaired physiological, sensory, motor and attention responses. ( http://www.nlm.nih.gov/medlineplus/news/fullstory_129421.html )
Summarizing: Particulate matter and diesel emissions can be generally harmful to central nervous systems, and diesel emissions and tobacco smoke are known to be carcinogenic. Infants can receive dosages that are effectively several times higher than adults just by breathing, not to mention the concentrations that may be carried in breast milk. Infants can receive those effectively very high dosages at the worst possible time, when their brains are developing.
Section 1.5 Mercury
An EPA web page on mercury points out the following: "for fetuses, infants, and children, the primary health effect of methylmercury is impaired neurological development." (205) "Methylmercury exposure adversely affects a number of cellular events in the developing brain both in utero and post-natally,(206) p. 49) …There is an extremely high level of scientific certainty that methylmercury causes these changes (abnormalities in the human brain)." (p. 51) The only question is when the effect is most likely to occur: "it is not possible to precisely identify the period of development during which mercury is likely to damage the nervous system of the developing fetus or growing child". (207) One study of hazardous air pollutants found a moderate association of autism with estimated airborne metal levels at birth, most notably mercury, cadmium, and nickel. (208)
Mercury to which children (and all of us) are exposed comes only partly from nearby sources, since airborne mercury can stay in the air for a year and travel thousands of miles. (209) What isn't breathed in by humans and animals is deposited to a great extent onto trees and plant life or is taken in through the stomata of plants, or falls onto the soil from where it enters plants' roots, thereby entering the food chain. But absorption by marine plant life, which is then eaten by fish, which in turn are eaten by other fish, is normally considered to be the largest primary avenue for mercury into human bloodstreams. This effect of increasing mercury at higher levels in the food chain usually has greater impact in freshwater fish than saltwater fish.
Exposure of infants and child-bearing women to mercury varies tremendously, and is a serious concern. Among children aged 3-6, the 5% who consume the most fish and shellfish receive ten times more exposure to mercury from the fish than does the average child. Among women of child-bearing ages, the 1% who consume the most fish receive over thirty times as much mercury as the average. 5% of children have methylmercury exposures from fish/shellfish two-to-three times the EPA's recommended safe maximum amount (RfD). (210) However, the benefits of Omega 3 fatty acids in fish to mental development are also believed to be significant. A 2005 research study found that infant "cognition" at six months of age was normally lower when mothers had higher levels of mercury, but it was higher with mothers who ate more than average amounts of fish, which caused the authors to recommend that mothers eat ample amounts of specific species of fish that are known to be low in mercury (211).
Wildfires and residential wood burning cause deposited or absorbed mercury to re-suspend into the air, and this re-suspension takes place in concentrated form; the re-suspension during fires is likely to be from the heated soil (including deposited, decayed vegetation) as well as from living vegetation. An environmental toxicologist at the Oregon Department of Environmental Quality was quoted in The Oregonian as saying that he "could tell when wildfires were burning by looking at data from mercury monitors. The fires send mercury levels three or four times higher." According to the EPA, 50 tons of mercury were emitted just from burning of coal in U.S. power plants in 1999 alone, even after considerable reductions had taken effect as required by the Clean Air Act of 1990 (211).
Section 1.6.a Pesticides: (In this section, the reader should be aware that pesticides are widely used around and inside residences as well as agriculturally.) In a study published in 2007 by researchers with the state of California, of children who went through gestation in the vicinity of where organochlorine pesticides (principally dicofol and endosulfan) were applied agriculturally, it was found that eight subjects had ASD where the normal expected number of cases would have been 1.8. "Risk for ASD was consistently associated with residential proximity to organochlorine pesticide applications occurring around the period of CNS embryogenesis (early development of the central nervous system); this association appeared to increase with dose and was attenuated with increasing distance of residence from the field site." (212) The EPA discontinued the registrations of endosulfan and dicofol in 2010 and 2011, after both had been in use since the 1950's.
Chlorpyrifos has also been found to cause developmental deficits in male rats without causing the same deficits in developing females (216) In the late 20th Century, chlorpyrifos was the most commonly used residential insecticide in the U.S., found in products for both indoor and outdoor use; it has since then been withdrawn from residential use. (217) And it has probably been replaced with other pesticides that, similarly, had never been tested for toxicity to human infants before going into wide use.
"Many pesticides target the nervous system of insect pests. Because of the similarity of neurochemical processes, these compounds are also likely to be neurotoxic to humans…. Some 60% of all herbicides… have been reported to interfere with thyroid function…. Even within the normal range, a relatively slight reduction of the concentration of maternal thyroid hormones during pregnancy can lead to intelligence deficits in the children." (218) Vinclozolin, a fungicide used on many types of fruits and vegetables, is a potent anti-androgen. (219).
"Many of the persistent organochlorine pesticides …have been identified as endocrine disruptors…. pups (exposed to some of these chemicals) were impaired on both learning and retention of active avoidance tasks." (220) The pesticides procymidone and vinclozolin are anti-androgens. "A number of organochlorine pesticides, including Kepone, methoxychlor, and zearalenone, have been shown to masculinize female rats. Tamoxifen demasculinizes male rats." (221)
The EPA conducted a study assessing data availability on close to 3,000 chemicals that the United States produces or imports at more than 1 million pounds per year and concluded that only 23% of those chemicals had been tested for reproductive and developmental toxicity. Test data were considered available if any studies relevant to reproductive and developmental toxicity were located. (222)
Note that this small percentage of any kind of developmental toxicity testing applied to the highest-volume chemicals in the U.S.; nearly 100,000 different chemicals are currently in commercial or industrial use in the U.S., very few of which have been tested for human toxicity. Even if testing is performed, one may wonder whether the testing with animals is normally sufficient to find out about all or most of the likely harmful effects on humans.
A study of Missouri men “showed high levels of three widely use pesticides—alachlor, atrazine, and diazinon—in their urine. Men showing the highest levels of these compounds were more likely to have poorer sperm quality; … the chance of low sperm counts was 30 times greater for those with the highest levels of (alachlor) in their urine compared with those with the lowest levels." (223)
Section 1.6.b DEHP and other Phthalates: A web page of the FDA (224) points out that DEHP (a phthalate, found in many plastics) has been shown in experiments with animals to cause testicular atrophy. (Research including humans to follow) The special significance of testicular atrophy as regards neurological impairment can be seen in Section 1.2.b of this paper, which explains the importance of testosterone in development of the infant brain.
Research directly involving humans has been especially plentiful in the case of DEHP and other phthalates. A study published in 2006 investigated phthalate contamination of breast milk of Danish and Finnish mothers and found various forms of phthalates to be present. (Note that extended breastfeeding is generally nearly universal in the Scandinavian countries.) The authors concluded, “Our data on reproductive hormone profiles and phthalate exposures in newborn boys are in accordance with rodent data and suggest that human Leydig cell (which produces testosterone) development and function may also be vulnerable to perinatal exposure to some phthalates. Our findings are also in line with other recent human data showing incomplete virilization in infant boys exposed to phthalates prenatally.” (parenthetical expression and emphasis added) (225) A study of effects of human mothers’ exposure to phthalates found that this exposure was likely to partially “undermasculinize” sons of those women. “The effect was most striking in boys whose mothers carried the strongest mixtures of phthalates…. The researchers noted that they observed the effect at levels of phthalates equivalent to those seen in about one in four American women.” (226) “Phthalates in pregnant women’s urine was linked to subtle, but specific, genital changes in their male infants – … incomplete descent of testes and a smaller scrotum and penis (227) Phthalate exposure in childhood was associated with attention deficit hyperactivity disorder (ADHD) in a cross-sectional study of Korean school children between the ages of 8 and 11 years.(228)
In a New York City study, phthalate exposures of human infants were strongly related to measurement of tendencies toward aggression, attention problems, conduct problems and depression. (229) A Swedish study found that autism rates were twice as high as average for children in households with PVC flooring (known to contain DEHP), especially in parents’ bedrooms; and also, “our study confirms that prenatal smoking and smoking during the child's first year of life can be coupled to ASD.”
It should be noted that DEHP has been widely used as a plasticizer for manufacturing many plastic products with which infants can come into contact, including flexible toys, floor tiles, table cloths, furniture and auto upholstery, baby pants, shoes, rainwear, and food and beverage containers. (231) It has apparently been banned in children's products as of 2008, but there are probably many still in use. An especially likely avenue for exposure of infants is via runoff of DEHP from shower curtains into tubs in which infants will later be bathed, with soapy water being a likely medium for lifting and re-suspending the dried DEHP residue and helping it soak in through the skin, especially into the very exposed male scrotum and then into the testicles.
The ATSDR is particularly concerned about infants' chewing on plastic objects not designed for that purpose. According to a small poll taken by the author of this paper, that sort of thing is extremely widespread. But the ATSDR points out that even skin contact with plastics can be a source of exposure to DEHP. The agency indicates that other likely sources of low-level exposure include packaging "especially of fatty foods like milk products, fish or seafood, and oils." (Fatty foods are of special concern, since fat helps the DEHP to dissolve and transfer.)
Since mere skin contact with plastics can be a source of exposure to DEHP, consider how much greater would be the exposure of an infant in a tub to water containing runoff from DEHP-containing shower curtains, or bromine or PCBs in the water supply, or possible toxins in cleaning solutions.
As of a 2007 report, "during the last 30 years, PBDE levels in humans have doubled about every 3 to 5 years and continue to increase." (89b) PBDEs are chemicals whose main environmental properties and mechanisms of toxicity are similar to those of the structurally-related PCBs and dioxins. (232) According to the Swedish National Food Administration, with concurrence from the U.S. EPA, "The critical effects of PentaBDEs are those on neurobehavioural development … and, at somewhat higher dose, thyroid hormone levels in rats and mice…."(233). PBDEs are also likely to be endocrine disruptors. (234) Bear in mind the importance of testosterone to development of the brain when reading the following quote: "…most PBDEs have antiandrogenic activity…. Some PBDEs and their metabolites (e.g. OH-BDE-47) have been found to inhibit activity of CYP17, a key enzyme in the synthesis of testosterone…." (235) According to Italian researchers, "Many experimental studies consistently reported neurotoxic effects following perinatal exposure to PBDEs." (236) According to the U.S. Agency for Toxic Substances and Disease Registry (ATSDR), "PBDEs share some toxicological properties with .... PCBs, ....and dioxins." (236b) The "child-specific pathways" of exposure to PBDEs that principally concern the EPA are "breast milk consumption and increased contact with the floor." (236a) One study estimated PBDE intake from food to be 307 ng/kg/day for nursing infants compared with 0.9 ng/kg/day in adult females.(236a2)
(Aside from breastmilk consumption by infants, the principal source of exposure to PBDEs is house dust, specifically dust emitted by electronics.)
Given the similarity of PBDEs' toxicological properties to those of the structurally-related PCBs and dioxins (as stated in the Dutch and U.S. government sources cited above) it should be safe judge that PBDEs are probably also carcinogenic.
According to the EPA, "Some evidence suggests that there is an overlap in the range of PBDE toxicity and the range of current exposures. (236d) In other words, there is good reason to believe that current exposures to PBDEs have toxic effects, which include neurotoxic effects in the case of these chemicals. When noting that (according to the EPA) current PBDE exposure levels in 2009 were already high enough to probably have toxic effects, remember that PBDEs have been very rapidly increasing in levels found in humans. Then remember also that, according to what is apparently the only data provided by the EPA allowing a comparison, breast milk is over 50 times as high in PBDEs as infant formula. (see www.breastfeeding-toxins.info)
According to a 2008 EPA report on PBDEs, "The animal model indicates a potential for concern for early lifetime exposure (i.e., fetal or infant exposure) to the chemical. The identification of BDE-99 in human maternal and cord serum, milk and children’s serum .... implies humans are exposed to BDE-99 (one form of PBDE) during a period of rapid development of the brain, a critical window of development, indicating a potential for susceptibility."(236e) In a more recent study cited by the NIH, "Exposure to (PBDEs) was associated with a higher risk for physical and mental impairment when children reach school age. We observed associations of in utero and/or childhood exposure to these flame retardants and fine motor coordination, attention and IQ in school-age children." (236f) Another major study of association between PBDE levels in breast milk of human mothers and development of their children found a strong connection between higher levels of PBDEs in the milk and activity/impulsivity behavior of the children, of a kind that could reasonably indicate greater likelihood of developing into Attention Deficit/Hyperactivity Disorder. (see www.breastfeeding-health-effects.info )
PBDEs are used as flame retardants in TV sets, computers, other electronics, some plastics, and foam cushioning (although almost all use of PBDEs in foam cushioning manufactured in the U.S. was discontinued by early 2005). Use of PBDEs is still permitted in the United States but has been banned in some European countries. "North America consumes over half of the world's production of polybrominated diphenyl ether (PBDE) flame retardants. About 98% of global demand for the Penta-BDE mixture, the constituents of which are the most bioaccumulative and environmentally widespread, resides here. …." (237)
Although breast milk is the major route for human ingestion of PBDEs being focused on here, the original sources of those toxins in our environment (in bold just above) should also be carefully considered, especially by parents of children and young people who spend a great deal of time near such devices. Rapid neurological development during infancy is a period of particular concern regarding effects of endocrine disruptors, but the hormonally-influenced developmental teenage period is also a time in which exposure to chemicals with hormonal effects (including the anti-androgenic effects of PBDEs) should be minimized. That would mean possibly reduced time near computers and TVs, in combination with good ventilation and/or exhausting of the air around such devices.
Concern about a nursing mother's current exposure is especially warranted in the case of PBDEs. In the case of dioxins, PCBs, lead and mercury, the toxins excreted to the infant are related mainly to the body burden of those chemicals that has built up in the mother's body over many years, and the concentrations of those toxins in the milk are known to decline over the months of breastfeeding, as the lifetime accumulation of toxins is transmitted to the infant. However, as measured over a period from 36 to 120 days postpartum, the concentrations of PBDEs in breast milk do not appear to decline as months pass, and may even increase, presumably because current exposure of the mother can add to her PBDE levels at least as fast as they are excreted. (237b) See Section 1.7.3 concerning the high (especially in the U.S.) and increasing levels of PBDEs in breast milk.
Regarding effects of PBDEs on immune function and brain development, note the following which is mainly from a major review article from the NIH's National Library of Medicine: "Hydroxylated BDEs are structurally very similar to thyroid hormones, and have been shown to displace thyroid hormones... (Meerts et al. 2000)."(237c) ("It is now widely accepted that thyroid hormones, l-thyroxine (T4)... act as modulators of the immune response." (237d)) PBDEs have also been reported to decrease levels of total and free T4 (T4 cells regulate the body's immune responses) in adult animals (Fowles et al. 1994; Hallgren et al. 2001), and following developmental exposure (discussed below)." Also "Thyroid hormones are known to play a relevant role in brain development (Chan and Rovet, 2003; LaFranchi et al. 2005), and hypothyroidism has been associated with a large number of neuroanatomical and behavioral effects (Schalock et al. 1977; Haddow et al. 1999; Zoeller and Crofton, 2005)." Also, as pointed out by McDonald (2005), is that PBDEs may be converted to polybrominated dibenzo-p-dioxins (PBDDs) and dibenzofurans (PBDFs) when flame-retarded plastic material is subjected to thermal stress (Ebert and Bahadir, 2003)." Also, ”Of relevance is that while a low dose of each of these compounds (PCBs and PBDEs) did not produce any behavioral effect when given alone, upon co-exposure the same low doses of BDE-99 and PCB-52 produced significant behavioral alterations. These were equal, if not greater, than those caused by a high dose of each compound alone. This finding is suggestive of a strong synergistic effect..... one should also consider that in addition to PBDEs and PCBs, exposure to several other developmental neurotoxicants (e.g. lead, methylmercury, perchlorate, dioxins etc.) can occur. The significance of these multiple co-exposures is still elusive, but their potential adverse effects on child neurodevelopment have been pointed out (Grandjean
Section 1.7.2.a Total Accumulation of toxicity of pollutants is very much affected by sun exposure or lack thereof. At least one of the pollutants that is most implicated in neurological harm, dioxin, can be relatively quickly degraded by sunlight, sometimes in less than a day. (238) That helps explain why levels of neurological impairment are low in the U.S. Southwest, except for autism in certain highly-polluted big California city areas. (See Sections 3.1 and 3.2 about other benefits of sun exposure.) At the other extreme are Maine and Minnesota, with the lowest solar radiation levels of all the contiguous states; those two states have either an extremely high level of mental impairment in general (in the case of Maine) or an extremely high level of autism (in the case of Minnesota). Pollutants In far northern areas (including toxins blown in from the south) retain more of their toxicity than would be the case to the south, because of reduced solar radiation; and that toxicity continues to accumulate in the soil and water through many decades. The EPA quotes two studies estimating the half-lives of dioxins on soil to be 9 to 15 years, and half-lives of dioxins in soil are estimated to be 25 to 100 years. (239). In addition to variations in the amount of solar radiation approaching the earth, as shown on this map, the amount that actually reaches ground level can also vary greatly depending on forest cover. That is another area in which Maine has an unusual disadvantage regarding solar benefits, since it is 90% forested. And it is an area in which the low-precipitation parts of the U.S. have advantages with regard to environmental toxins, since they have little forest cover of the kind that would shield deposited dioxins from the effects of solar radiation. (See Section 1.2.x.4.)
Because of their extremely long lives in soil, dioxins in soil are continuing to increase even while the new amount added each year is declining; therefore the soil that is very often ingested by infants (Section 2.4) has been continuing to increase in dioxin content in recent decades. As will be described in Section 2.4, actual observed accumulations of dioxins in soil have turned out to be roughly ten times higher than the EPA had predicted in four cases, with no mention of predictions that had been any more accurate than that. The EPA acknowledges that they may have underestimated the effect of increases that result from long-term accumulation of toxins that degrade extremely slowly.
The continuing increases of dioxins stored in locations that are shielded from sunlight almost certainly applies also to water bodies, considering not only the shelter from sunlight below the surface but also the continuing additions to the water bodies via erosion and runoff. Fish that eat vegetation or ingest sediment in water that drains from typical dioxin-containing soil, and/or that eat smaller fish that ingest that vegetation and/or sediment, will "bio-accumulate" higher levels of toxins before (often) being eaten by mothers and infants. It is probably no coincidence that the only state < we have been able to find> that tells residents not to eat almost any freshwater fish caught in that state is in southern New England. That state is Rhode Island, densely-populated and industrial, whose waters and surfaces are on the receiving end of considerable pollution blown in by the prevailing winds from the congested Northeastern Corridor. Soil and pavement are very major sources of toxins that have been deposited from the atmosphere, which toxins are then subsequently eroded and run off into water bodies, according to the EPA.
Buildup of dioxins in below-surface locations also applies to bathing water and drinking water (especially if well water) coming from below the surface, and also to foods grown in that soil. (see next section)
Section 1.7.2.b Other implications about foods to be avoided by infants and child-bearing women: Farm animals eat not only vegetation that grows in soil that keeps accumulating dioxins but also significant amounts of the increasingly toxic soil itself, sometimes ingesting up to as much as 18% soil in what they eat (f240) The toxins then accumulate in the future food supply of mothers and infants: meat, fat tissue that becomes an ingredient of processed foods, and cheese, butter, and other dairy products. Vegetables growing in dioxin-containing soil can absorb endocrine disruptors from that soil; in one experiment, carrots grown in soil to which dioxin had been added increased their dioxin content by over 800% (241) Potatoes, beets, and other root and tuber crops could be expected to absorb dioxins from soil in which they grow. The green-living advice common in recent years, about buying locally-grown foods, should probably not be heeded when purchasing food for infants and child-bearing women (including future mothers and nursing mothers) living in the lowest-solar zones on the above map. Likewise, vegetables grown in one's own backyard garden could be hazardous if the home is near a major throughway, railroad, or port, or downwind from an industrial source of dioxin-containing emissions, or near a hazardous waste site.
Section 1.7.2.c Soil and dust, ingestion of which should be especially avoided in northern areas and high-pollution areas: In addition to dioxins from foods, infants very often ingest soil and dust which contain dioxins. Section 2.4 deals with that topic, pointing out that researchers have found dioxins in soil to be far higher than expected, and levels of dioxins in soil and dust would be unusually high in areas with low solar radiation.
PBDEs were first introduced in the 1960s. A study of 47 breast milk samples in Texas (quoted in 2003) found PBDE levels similar to levels found in blood and fat tissue from California and Indiana, which were ten to one hundred times higher than levels found in humans in Europe.(242) Another study looked at a pooled sample of breast milk taken from women living in Austin, TX and Denver, CO, finding a level of PBDEs approximately 40 times higher in U.S. human milk than the levels reported for Sweden. (Papke et al., 2001) In 1998, research with archived samples of breast milk in Sweden found that PBDE levels in the milk had been doubling every 5 years over the preceding 25 years, but no one had known about it. (243) It is interesting to note that the Swedish National Food Administration was clearly concerned about the effects of PBDEs on neurological development even though the levels of that chemical in their country were apparently a very small fraction of those in the U.S. With regard to this rapidly-increasing toxin in the environment, note that it has anti-androgenic activity and limits synthesis of testosterone (Section 1.7.1), and therefore disrupts the activity of male hormones needed (a) for proper neurological development as well as for ability to concentrate and (b) for other mental/psychological functions (see www.breastfeeding-health-effects.info)
Lead has been conspicuous in its huge decline in the environment since the 1970’s, and its effects appear to be unusual among neuro-developmental toxins in that girls are more sensitive to it than boys. (see Section 1.3) This helps explain the greatly increased difference between mental impairment numbers of males versus females born in recent decades. “Numerous studies have reported lead concentrations in maternal blood and breast milk.” (244) Also, absorption of ingested lead is “as much as 5– 10 times greater in infants and young children than in adults (Alexander et al. 1974; Chamberlain et al. 1978; James et al. 1985; Ziegler et al. 1978).” (245)
PCBs, also, declined substantially in the environment in recent decades, following the banning in 1977 of their use in most manufacturing in the U.S. Girls could be expected to have benefitted disproportionately by the decline in prevalence of PCBs for the following reasons: (1) Various studies have found PCBs to be in concentrations over ten times as high indoors as outdoors, probably as a result of the presence indoors of older appliances from which PCBs are known to sometimes leak; girls are known to spend more time indoors than boys, and would therefore benefit more from the gradual replacement of older appliances; and (2) PCBs from the atmosphere are known to accumulate in the leaves and above-ground parts of plants; (246); as noted in Section 1.9, girls have been found to have a far higher rate of object-to-mouth activity than boys, and that activity no doubt sometimes brings plant leaves (containing PCBs) into the mouth.
Therefore females in general would have benefited more than males from the discontinuation of PCBs in most manufacturing, but breastfed children of both genders would still be receiving greatly disproportionate effects from the substantial levels of PCBs that still remain in circulation. According to the ATSDR again (p. 569), ”PCBs tend to accumulate in breast milk fat,” with accumulations increasing with the woman’s age and being higher in industrial areas than rural areas. “It is estimated that an infant that is breast fed for 6 months will receive 6.8–12% of its lifetime PCB body burden (Kimbrough 1995; Patandin et al. 1999)” Therefore, in much less than 1% of its lifetime, a breastfed infant will receive 7 to 12% of its expected lifetime burden of PCBs. And that concentrated dosage of a neurological toxin takes place during the time when the infant is going through an extremely vulnerable and critical stage of its brain’s development.
In a study by a team of scientists reported in 2007, rats were exposed as fetuses and nursing pups to PCBs at levels judged to be of the same order of magnitude as levels for populations near severely contaminated U.S. waste sites. The results were reported as follows: “While the brain region of the pups raised without exposure to the toxicant was developing typically, the brain region in the pups exposed to the toxicant in utero and while nursing was profoundly altered. The animals could hear, but their brain’s representation of what they heard was grossly disturbed. The balance of inhibitory and excitatory signaling between nerve cells, which contributes to the appropriately controlled responses of the brain to stimuli, was disrupted.” The neural circuitry was disorganized in the region of the brain that processes sound, decreasing ability to learn. The lead scientist pointed out that “Strong evidence indicates that there is imbalance in signaling throughout the brain of children with some developmental disorders, such as autism.”(247) <<Merzenich study?> People who are familiar with behavior of the autistic will probably recognize familiar topics when reading about disrupted balance between inhibition and excitatory signaling within the nervous system. The reader may also wish to review www.breastfeeding-toxins.info for a description of the neurological harm that has been found in other studies to result from exposure to PCBs.
Section 1.9 While Mental Impairment has been Rising, especially among Male Children: Changing Environmental Factors Associated with this Trend
Lead in the environment has decreased drastically since 1980, and PCBs have also declined; those declines should have been expected to lead to a decline in mental impairment resulting from those factors, but obviously there have been other risk factors that have been increasing.
1.9.1 Indoor pollution increasing: Emissions of dioxins and PAHs from residential wood burning are from sources that are obviously very close to many infants, mothers and mothers-to-be. (See Section 2.1 about the frequent toxicity of wood burning.) Levels of these toxins in indoor air have probably been increasing in many households even while amounts emitted may have been falling in some cases, because of residences' becoming more tightly sealed in recent decades. And there are several other sources of toxic indoor pollutants aside from wood burning, especially formaldehyde in plywood/pressed wood panels and DEHP in vinyl flooring, which would have become more concentrated indoors following the tighter sealing of homes.
1.9.2 DEHP (see Section 1.6.b), BPA (endocrine disruptor – see www.breastfeeding-toxins.info), and plastics in general increasing: To people who have been observing the typical consumers' world in recent decades, it is probably apparent that use of plastics as containers for food and beverages (including milk) has been increasing; and most of those plastic containers (including plastic film wrappers) contain DEHP or BPA or both, which can leach out into the food or drink and then be ingested. Production of BPA in the U.S. increased over 100-fold between 1991 and 2004. One relatively recent source of possible transfer of DEHP to foods that should be of special concern is the use of soft plastic film that covers frozen foods even while they are being cooked. The proliferation of plastics in general means that (by plastics' adding the element chlorine to the mix) burning of trash, wildfires etc. have all the elements needed for major formation of dioxins during the combustion; if there is no source of chlorine, dioxins can't be produced.
1.9.3 Increasing Exposure to Dioxins from Food and Disposable Diapers:
Bear in mind that consumption of meat is always mentioned first in listings (by the EPA and other concerned agencies) among the three major sources of human ingestion of dioxins, with dairy products and fish being the next two. Also, "Vegetarians consume only 2 percent of the dioxin load of the general population because their diet is dominated by foods low on the food chain." (248b) With the above in mind, note that per capita meat consumption has greatly increased in the last 50 years. (89)
There have been huge increases in use of disposable diapers, placing possible sources of dioxins almost in contact with male glands that produce the neurologically crucial testosterone: Usage of disposable diapers more than quintupled (to 1.93 million tons) in the U.S. between 1970 and 1980, and rose by more than an additional 40% by the year 2000. (249)
There have been major increases in recent decades in emissions from diesel trucks and many off-road diesel emission sources. The EPA provides data showing that, between the years 1987 and 2000 (2000 appears to be the latest year for which the EPA provides this data), dioxins released in diesel emissions increased about 100%: a 74% increase from off-road diesel emissions (including emissions from trains, ships, construction equipment and tractors) and a 134% increase from heavy-duty diesel truck emissions during that relatively short period.(250) With dioxins from diesel emissions increasing so dramatically, it should be safe to assume that diesel emissions in general, including their important content of carcinogenic PAHs, have also increased greatly. (See Section 1.4 concerning the toxic effects of diesel emissions.) Increase in diesel emissions in the U.S. is especially likely because diesel motors often continue in use for over thirty years in the U.S.; continued use of an ever-growing number of those older motors, with their declining combustion efficiency, can be expected to have a cumulative effect on increasing diesel pollution levels. Except for newly-manufactured vehicles, emissions of diesel trucks and non-road diesel-powered vehicles/equipment are not regulated in most states in the U.S. This is in contrast with the regular inspections typically required in Europe. For information about dioxins (including from diesel emissions) in breast milk, see Section 1.9.11)
Diesel emissions from offshore ships, rising from smokestacks and continuing to rise for some time because of their heat, will often be on a downward path by the time they reach some heavily-populated coastal areas. Statistics on changes in marine diesel emission exposures in the U.S. don’t seem to be available; but, with the major increase in international trade that took place during recent decades, they must have increased substantially. And, as explained in Section 1.4, those emissions are unusually toxic.
1.9.5 Major Releases of Dioxins Continuing or Increasing: In addition to increases in exposure to dioxins and other toxins as indicated above, also substantial are continuing re-releases of old toxins stored in what the EPA calls "reservoir" sources. Dioxins are persistent in the environment; if they are sheltered from the degrading influence of sunlight, they can continue for a century or more to be released to the environment in toxic form; such shelter exists below the surface of the soil, in sediment at bottoms of lakes, inside long-lived vegetation, and inside chemically treated utility poles, railroad ties and wooden docks. The EPA points out that "…at least one-third of the overall risk to the general population from dioxin-like compounds comes from reservoir sources." (251) Dioxins are released into the air from soil through "volatilization," or in road dust, or when soil erodes, or in smoke from wildfires, or are leached out of chemically-treated wood (252). The EPA considers forest fires and accidental fires at landfills to be the largest sources of such re-releases (253) The re-released toxins land on surfaces with which infants come into contact, settle into lakes and streams and become part of water supplies from which humans and farm animals drink, in which infants bathe, in which fish spend their lives, and which are absorbed into vegetation; from the vegetation they work their way up the food chain through farm animals and fish, to be eventually consumed by humans. Note that, since dioxins below the surface are estimated to have a half-life of up to a century, the slowdown in deposition of new dioxins from atmospheric sources will have only a very gradual effect on releases from those sources. It is probable that the reservoirs will merely continue growing, although growing at a slower pace.
A 2007 German study found that, "in comparison with recent data, the decline in human PCDD/F (dioxin) and PCB levels observed during the nineties seems to have stopped." (253a)
Note that dioxins have been found to specifically harm the male glands that produce the testosterone that is essential for brain development (Section 1.2.b.1). Also, it seems to be generally acknowledged in this author's polling among parents of both boys and girls that boys are more likely than girls to get dirty with soil; bear in mind that dioxins can be absorbed through the skin, and that thumb sucking sometimes continues into the period during which children (mainly boys) could be playing in soil.
Section 1.9.6 To summarize some key points:
a) male mental disability has been increasing substantially (most noticeably in connection with disproportionately-male autism), and while
b) childhood cancer incidence has been increasing at the same time that overall cancer incidence has been declining,
we have been seeing major increases in certain toxins in the environment that are specifically connected with male brain development and cancer, most of which are found in breast milk. Other major sources of toxins are at least stable. Summarized below are the implicated toxins that have been increasing:
a) major increases in DEHP in many kinds of plastics and BPA in food packaging; DEHP can cause testicular atrophy and neuro-developmental harm (Section 1.6.b); BPA is an endocrine disruptor and strongly suspected as a cause of damage to brain development and development of the male reproductive system (see www.breastfeeding-toxins.info); both have been found in breast milk; (90a1) production of BPA in the U.S. increased over 100-fold between 1991 and 2004.
b) major increases in the bio-accumulative PBDEs, with their endocrine-disrupting, anti-androgenic, testosterone-limiting activity, found in breast milk in the U.S. in concentrations 10 to 100 times as high as in Europe (Section 1.7.1 and 1.7.3) As of a 2007 report, "during the last 30 years, PBDE levels in humans have doubled about every 3 to 5 years and continue to increase." (89b)
c) major increases in breastfeeding rates in the past half century, which is especially significant in that all of the above neuro-developmental toxins, as well as carcinogens, are known to be concentrated in breast milk; included (among several others) are dioxins, in toxic equivalency over 80 times higher than the safe dose determined by the EPA (see www.breastfeeding-toxins.info);
d) very large increases in diesel emissions, which are known carcinogens and are strongly associated with toxicity to testicular function (Section 1.9.4), and which contain dioxins; dioxins are separately known to cause impaired synthesis of testosterone;
e) dioxins in soil accumulating unexpectedly rapidly (Section 1.7.2) and continuing to increase, and that source being one that can be expected to affect boys more than girls.
f) greatly increased exposure to dioxins in disposable diapers (see section 1.9.3), which rub against skin within 2-3 millimeters of the extremely vulnerable male testicles, where the neuro-developmentally crucial testosterone is produced;
g) extensive use of certain pesticides, many new types of which were introduced in the 1980's, and which have been widely found in breast milk;.(92). as indicated in Section 1.6.a at least one widely-used pesticide has been found to cause developmental deficits in male rats (without causing the same deficits in developing females); others have been very closely associated with prevalence of autism, which mostly affects males; and several others are known to have negative effects on male hormones specifically;
h) bromine, in greatly increasing use as a substitute for chlorine in swimming pools and spas, is known to be a neurological toxicant, and by its ability to penetrate the skin of partly-submerged infants and boys it probably affects male production of testosterone needed for neurological development (Section 1.2.b.1); it is also excreted in breast milk; (91)
i) aside from the above specific examples, bear in mind that nearly 100,000 different chemicals are currently in commercial or industrial use in the U.S., very few of which have been tested for human toxicity, and a high percentage of which are relatively new in our environment.
Mercury has not been identified as contributing to mental impairment in males more than females, but it has been increasing in the environment and in the food supply. It is known to be present in breast milk (90a1) (243a) and has almost certainly been increasing in breast milk while it has been increasing elsewhere in the environment. According to the EPA, mercury in the atmosphere tripled between the era before human activity and current times. (254) A web page of the U.S. Geological Survey points out that, even though awareness of toxicity of mercury started in the 1950's, it wasn't until the late 1980's that investigations found high levels of mercury in fish commonly in northern-tier states and Nordic countries, and in the 1990's surveys found it in fish in other regions of the U.S. as well. (255). (Mercury can drift hundreds or thousands of miles in the atmosphere before settling on surfaces; therefore much of the mercury rising from stacks would continue to rise for some distance with the accompanying heat while blowing to the northeast with the prevailing winds, bypassing southern areas before settling in the north.) So there appears to have been an upward trend in mercury in fish, which is a major source of mercury ingestion by infants and child-bearing women, a trend that has been especially noticed during this last generation. And that recent increase is of particular concern because mercury found in greatest quantities in fish is the specific form (methylmercury) that is most likely to affect humans; and "Recent research suggests that prenatal effects (on the nervous system) occur at intake levels 5-10 times lower than that of adults."(same USGS web page) The USGS quotes the best estimates as indicating that mercury in the atmosphere is increasing by about 1.5 percent per year. After finding a 15% increase in mercury in Minnesota lakes between 1996 and 2006, the first cause hypothesized by scientists was "mercury-spiked emissions from power plants around the world….atmospherically transported." (EPA newsletter, March, 2009) In addition to the probable increase in average mercury per ounce of fish consumed during this period, total ounces of fish consumed by Americans increased 24 percent from 1980 through 1989. (256)
Although mercury is the best known contaminant that has been building up in fish, dioxins in fish are also a serious concern, as is PCP (pentachlorophenol) that leaches out of preservative-treated wooden docks and then bio-accumulates in fish. The latter two toxins, also, long persist in the underwater areas that are sheltered from solar radiation, and they are almost certainly increasing as more toxins flow into the water and as more PCP leaches out of docks every year.
1.9.10 Effectively a decline in beneficial sun exposure, following health advice of recent decades: Lower sun exposure leads to lower vitamin D levels. Vitamin D deficiency is associated with reduced immune function, and low immune function has been associated with autism in an NIH-funded study of autism. Also, according to an article in a publication of the American Medical Association, "Vitamin D deficiency can lead to reduced levels in the developing brain of calcitriol, a critical neurosteroid involved in brain development. Of interest, while health care providers have exhorted patients during the last 20 years to reduce sunshine exposure, autism prevalence has been increasing. It is also of interest to note that evidence indicates a substantial incidence of vitamin D deficiency in the United States and elsewhere among infants and toddlers.”
In 1970 the average age of a first-time mother was about 21, and by 2008 the average age was 25.1, with large numbers of births taking place into the 40-44 age group (257). That is a large and growing sector of the population that is giving birth at an age by which they would have built up a far higher body burden of dioxins and mercury (and probably other toxins) than was typical in earlier generations. The burden would be higher both because of more years of accumulation and because of higher levels of toxins in their environment.
Declining (??) dioxin levels in breast milk? People who promote as-exclusively-as-possible breastfeeding often quote a World Health Organization (WHO) study finding that toxin levels in breast milk have been declining "in most industrialized countries;" but the U.S. is conspicuously absent from the data provided by WHO, including in all documents found in a detailed search of WHO's website in January of 2012. The European countries, data from a few of which WHO does provide, have been more aggressive than the U.S. in combating pollution, from diesel combustion sources especially. Measurements of dioxin emissions per liter of diesel fuel consumed show far higher rates in the U.S. than in the European countries where tests were conducted (Germany and Belgium).(257a) The emission differences may be accounted for by the differences in regulation (see Section 1.9.4); the only readily-found study comparing dioxin emissions from diesel engines of different conditions determined that a "high-mileage" diesel engine emitted almost three times as much dioxin toxic equivalency as a newly-rebuilt engine. (257b) Dioxins from diesel emissions have been rapidly rising in the U.S. – see Section 1.9.4; this is especially significant in that diesel emissions are very often released intensively within populated areas (unlike smokestack sources, which are the emitters whose releases have declined). Authors looking for trends in dioxin levels in breast milk for the U.S. sometimes say that the trend here is "ambiguous," or they tell only about the finding concerning "most industrialized countries," implying that the U.S. would be in that category. "Ambiguous" seems to be a word that avoids recognizing an upward trend in the U.S., unless data can be shown other than what is shown in this chart; substantial searching by this author has been unable to find anything else. (Note that observations for the U.S. are shown with the darker dots on this 2001 chart.)
So it appears to be a completely open question as to the trends of dioxins in breast milk in the U.S. While dioxin emissions from the source that intensively reaches populated areas at human level (diesel combustion) have been rapidly increasing, dioxins from smokestack sources have been declining; bear in mind that the stack emissions start out high and (being hot) rise much higher, and are then carried by winds to distant locations, probably mainly to rural areas. So the dioxin emissions that have declined are from sources that probably had only minor impact on human mothers; however, cows (sources of the main alternative to breast milk) probably have benefited from the declines in smokestack emissions of dioxins.
In any case, dioxins are only one category among many neuro-developmental toxins found in breast milk, most of which have definitely been increasing in the environment, especially PBDEs. (see Section 1.9.6-7)
Part 2: More on Sources of Pollutants associated with Developmental Disabilities
As mentioned earlier, the EPA points out that dioxins are unintentional byproducts of several industrial chemical processes and of most forms of combustion, including forest fires, fuel emissions and waste combustion, and are included in the food we eat. Dioxins are "ubiquitous in the environment -- air, water, and soil", according to the EPA. (258) In the atmosphere the dioxins become attached to particulate matter and are typically deposited onto vegetation or other surfaces, especially via precipitation. Once on and in the vegetation, the dioxins affect humans when (a) consumed in affected food, especially animal-based foods from fish and animals that consume the affected vegetation, resulting in bio-accumulation, or (b) when re-suspended during residential burning and wildfires. Dioxins in the air are also deposited onto the ground and other surfaces (including indoors) with which infants come in contact.
PAHs (see www.breastfeeding-toxins.info) are apparently especially likely to be a product of imperfect combustion. This may help explain why three counties in California with very high rates of autism (Placer, Tuolumne and Mariposa) are counties in which there is considerable vehicular traffic at high altitudes, at which levels the vehicles' engines are normally not tuned for proper combustion. << show map of CA with these 3 standing out, away from urban areas/ combine with pesticide effect>> All (?) (most?) other California counties with high rates of autism are urban, where there is considerable vehicular traffic and/or industrial sources of dioxins and PAHs.
Since most people are surprised to be told that burning of wood and eating freshwater fish can be sources of neurological toxins, additional attention to that subject will be given below. It will be assumed here that there is no need to dwell on the sources indicated in bold above or on other sources mentioned earlier, but that should in no way imply that those are not similarly substantial sources.
Section 2.1 Burning of Wood and Foliage Emits Toxins
Combustion of wood is known to emit dioxins and lead (259) as well as mercury (at least when combined with foliage -- see Section 1.5) and PM. According to tests by Nestrick and Lamparski, burning 1 kilogram (2.2 pounds) of wood produced as much as 160 micrograms of total dioxins. (Keep in mind that, as explained above, dioxins and other endocrine disruptors adversely affect neurological development, and that there is good evidence that they "can affect test animals’ bodily functions at very low levels — well below the “no effect” levels determined by traditional testing.") The same research found that lead produced from burning one kilogram of wood was 0.1mg to 3 mg. Keep in mind the EPA's finding that any amount of lead can be harmful, especially to children. Another source, calculating on the basis of EPA data, estimates that dioxin emissions from forest fires exceed all other U.S. sources of dioxin emissions combined.(259a)
The EPA lists residential wood combustion as the largest source of PM 2.5 in California, producing almost 40 tons of those emissions in that state in 2005 alone (well above the totals for both industrial processes and on-road vehicles); and "fires" (mainly forest fires/wildfires) are listed as the fourth-highest source.(260) See Section 1.4 about the toxicity of particulate matter, especially PM 2.5. Adding tremendously to the significance of the above is that so much of this pollution originates inside residences, where part of it escapes directly into the indoor air breathed by infants and pregnant women. Much or most of the remainder is emitted into the nearby community's air, from where it becomes part of the general air supply breathed by infants and pregnant women in that area. It should be of special concern that this largest-in-all-of-California source of PM 2.5 tends to be concentrated in certain Northern California areas and communities, where the climate is colder and the wood supply is especially plentiful. Burning of brush (in backyard burning and wildfires) is not specifically known as a source of lead, but it is a known source of dioxins (260a) and it almost certainly emits particulate matter.
Foliage and wood (as well as fossil fuels) contain the three elements which, when chlorine is present during combustion, can produce dioxins.
The final ingredient (chlorine) can be provided by atmospheric pollutants and especially by the plastics contained in typical trash. This potential for creating dioxins during burning of organic matter is present even when the fuel doesn't already contain toxins. But in addition, vegetation also typically absorbs and retains existing toxins (which can be re-suspended during burning). It appears to be generally agreed, including in research by NASA, that many houseplants are effective at reducing indoor pollution because they absorb toxins from the air (through openings normally on the undersides of the leaves). Outdoor vegetation can be expected to do that same absorption of toxins. The toxins will probably remain contained within the plant or tree, continuing to accumulate through the years for longer-lived vegetation. Those stored toxins will almost certainly be dispersed into the air when the vegetation is burned during wildfires. (Obviously, the effect would be reduced if some toxins had travelled to the roots.) Preservative-treated wood contains dioxins, which would greatly increase the toxic effects of any such burning. So residential burning as well as wildfires could be expected to be substantial sources of toxins able to be re-suspended into the air, especially if much of the vegetation burned is years old. This re-suspension is in addition to the creation of dioxins that takes place as a result of the burning.
Residential burning is especially likely to create toxins if it isn't done correctly, and it probably isn't done correctly a very high percentage of the time. The recommendations for burning so as to avoid creation of toxins are probably not widely observed by the wood-burning public; those instructions include keeping the fire hot, and not allowing it to smolder (which probably stems at least in part from the fact that dioxins form most efficiently in the lower end of normal combustion temperature ranges). One may wonder how often a fire is kept hot during an evening that is chilly but not cold, as well as how hot a fire stays while unattended overnight in a home that relies on wood for its main source of heat.
Q: Why, if we claim a causal connection as stated above, should autism have been increasing substantially in recent decades? After all, burning of wood is not at all a recent development.
A: First, wood burning is only one of several important sources of neurological toxins. More importantly, wood and vegetation emit harmful levels of dioxins when burning because
(1) chlorine, essential for creation of dioxins, has been provided in increasing quantities by sources in the environment of recent decades; those sources include atmospheric hydrochloric acid and other increasingly common waste stream sources of chlorine (including PVC, or polyvinyl chloride plastic) that could be included with the burning;
(2) pollution from human sources has increased and has caused wood and vegetation to be receiving and absorbing toxins at increased rates, creating the potential for re-suspension of existing toxins during combustion
Section 2.3 Toxins in freshwater fish and seafood:
Fish consumption makes up about one-third of the total general population's CDD/CDF TEQ (dioxin) exposure.(261) Toxins including mercury, dioxins and PAHs are deposited into water bodies via atmospheric deposition, via streams, or via runoff from pavement and land following rain or snow. After originating from human-generated pollution and entering bodies of water, those toxins pass up the food chain from sediment to fish, whose flesh is tender and seemingly well suited to feeding infants. A "National Dioxin Study" found that fish from the Great Lakes region were among the most severely contaminated in the United States. Possibly even worse are fish in densely-populated, industrial Rhode Island, where the state government tells people not to eat freshwater fish caught anywhere in the state, with the exception of trout that are added from outside the state's normal waters. There is nothing inherently toxic about fish and lake or ocean water. The toxicity comes mainly from precipitation and drainage into the water bodies from the increasing environmental pollution, combined with (as mentioned earlier) leaching of PCP from preservative-treated wooden docks. It used to be said that seafood from the ocean was safer than freshwater fish, but that is apparently no longer necessarily the case, as the oceans become more polluted. It is best to avoid larger fish, which are higher up the food chain. Also check with the EPA or other sources about latest recommendations regarding species to avoid.
According to the Seattle/King County, WA Public Health website, "infants and toddlers often eat dirt and other non-food items, Some little children just put everything into their mouths as a mode of exploration." The NIH's Medline Plus encyclopedia refers to "pica", the condition of deliberate eating of non-food substances on a consistent basis, as affecting 10% to 32% of children ages 1 to 6. According to two MD's writing for Medscape.com (262), pica "is the most common eating disorder in individuals with developmental disabilities."
Since this eating of non-food substances applies to a significant proportion of infants even when those who do it inconsistently are not included in that percentage, that implies that this means of ingesting possibly toxic substances in harmful quantities could be very common. Bear in mind that the earlier years of life are the period during which the infant brain is going through critical stages of development. And bear in mind the extremely long lives of dioxins in soil, which means that dioxins continue to accumulate to ever-higher concentrations in soil, as more and more dioxins are deposited through the years.
It is apparently difficult to grasp how high concentrations of dioxins in the soil can become as they accumulate through the years, even for the EPA's scientists. The EPA acknowledges that actual levels of dioxins observed in four reports on rural soil concentrations in the U.S. exceeded their predictions by amounts in the range of 1000%. Nothing was mentioned about any estimates that had turned out to be any more accurate than that. The EPA acknowledged that they may have greatly underestimated the effects of accumulation of dioxins through the years, overestimating the extent of degradation that would take place. (263)
Among the mentally retarded, the relatively common occurrence of pica is reported to be positively correlated with degree of retardation ( )
A study of effects of proximity to California freeways (referred to in Section 1.4) found a doubled risk of autism among infants residing within about 1000 feet of a freeway. (194) Beyond that (for the approximately-three-mile width of the area studied), there seemed to be little change in autism levels depending on distance from the freeway. But the study was conducted in what is considered by the Census Bureau to be urban areas, where general pollution levels are normally high compared to non-urban areas. Greater distances from busy highways (beyond the 1000-foot threshold) would almost certainly be found to have beneficial effects if the region studied were to extend into non-urban areas that don't have their own serious pollution sources.
The big question is the distance that non-road combustion emissions will travel and still seriously affect people. As opposed to vehicular emissions that originate very close to ground level and therefore affect people nearby, emissions from tall smokestacks from power plants, large factories, and large ships are initially emitted high above the surface and are directed upward; then the heat of the emissions keeps carrying them still farther upward for some time after exiting the stacks. The wind carries them for many miles, until eventually major parts of the emissions are deposited onto surfaces. Some are likely to be deposited relatively nearby, possibly starting a few miles downwind from the source. At the other extreme, one of the most neurologically toxic emissions, mercury, can travel around the world before being deposited. See in Section 2.4.c about the effect, formally acknowledged by the EPA, of significant pollution in Pennsylvania, New York, and the New England states resulting from sources up to 550 miles away. (264)
In addition to the more or less gradual effects of gravity, precipitation considerably accelerates deposition of pollutants. (See Section 1.2.x.4) That helps explain why the drier states generally have low autism rates, with the exception of very-high-breastfeeding Utah.
Section 2.4.c The Northeastern Coastal Corridor, and Population Density:
Three of the four states with the very highest population densities in the entire U.S. are Rhode Island, Massachusetts and Connecticut. Those states are in fifth, sixth and seventh places among the highest-autism states. And those three states are not hard to find in a general atmospheric pollution map if one looks closely for completely-colored-in states, indicating unusually widespread, high levels of atmospheric toxins in those states. The state that is highest in population density, New Jersey, is high in autism but not among the very highest states; that is probably because it is not on the receiving end of a pollution stream that affects the other three highest-density states, as described below.
In addition to population-related pollution generated within Rhode Island, Connecticut and Massachusetts, these states (plus high-autism Maine) are downwind in the receiving region for the northeastern corridor's population-, industry- and traffic-related air pollution that extends northeast from Washington, D.C. and is typically blown up the coast by the prevailing winds. This atmospheric stream picks up extra potency in the high-density Philadelphia/Northern New Jersey/New York City area and also receives contributions from (a) polluted areas farther west in Pennsylvania, and (b) from the considerable shipping and other traffic going to and from the Atlantic port cities. (This image is a wind forecast, based on typical known wind patterns, provided by Intellicast.com.)
All six of the states that fall entirely within this coastal corridor are also at the very highest level of cancer incidence, as seen in the map of U.S. cancer incidence in www.breastfeeding-and-cancer.info . Those states are New Jersey, Connecticut, Rhode Island, Massachusetts, Maine, and New Hampshire; New Hampshire and Maine are not high-density or heavily industrial contributors to the pollution in this stream but they are both very much downwind on the receiving end of it, as can be seen looking north from Boston on this map. The only other state, of all 50 states, that is in this group with the highest cancer incidence is Kentucky; it is probably not merely coincidental that Kentucky is home to the number-one-by-far U.S. dioxin-emitting factory, Westlake Vinyls, Inc., with 15 times the releases of the second-place emitter and 31 times that of the third-place emitter.(264b)
It should not be presumed that a state's population density (and its accompanying higher pollution levels) is by itself sufficient to be a complete indication of autism or cancer risk in a state. The four states with the highest levels of autism in the U.S. (Minnesota, Oregon, Utah, and Maine) are not high in overall population density. But in those states there are specific environmental factors that contribute to unusually high autism levels. As shown in the top right corner of Figure 14d, Maine is directly downwind from the congested Northeastern Corridor. Breastfeeding in those four states is either high (Maine) or very high (Utah, Minnesota and Oregon). Maine and Minnesota are the two states of all the contiguous states that have the least benefits of solar radiation (see Section 3 about those benefits). In the cases of Minnesota and Oregon there are high percentages of a specific ancestry (Scandinavian) that is associated with a high-fat, high-toxin diet. (Section 1.2.t) Maine has an especially large supply of wood (90% forested), which encourages widespread residential and other wood burning, which would be especially intense in a state with long, cold winters. (See Section 2.1 about toxins emitted by wood burning.) The 90% forest cover in Maine would further reduce the already minimal amount of beneficial solar radiation received at ground level in that state. The large number of unpaved roads in Maine (“Vacationland” and logging country) probably contributes to volatilization and drainage release of dioxins contained in soil, via road dust and erosion. See Section 1.2.x 1 about Oregon’s special problems with PCBs and paper/pulp mills. Oregon and most of the Northeastern Corridor are very coastal, which is associated with greatly elevated risk of excessive mercury levels in mothers in such areas as well as other toxic emissions from marine shipping (see Section 1.2.x.2) .
New York, Pennsylvania, and the six New England States recognize that the air in their corner of the U.S. suffers from being downwind from most of the other states. Those eight states petitioned the EPA to require certain utilities and other facilities in 30 upwind states to reduce their emissions, on grounds of their northeastern atmospheric pollution resulting from being downwind from those 30 states. In 1999 the EPA approved the petition as applied to facilities in 22 states, including states as far away as Alabama and Missouri (265).
Data from the EPA can help one determine where pollutants are highest, but those data should ordinarily be considered as only educated approximations when looked at below the state level, since monitoring stations are often placed in only about one out of four counties, if there are monitoring stations at all for the particular pollutant under consideration.
Part 3: Effects of Climate, and Probably of Vitamin D, on Sources of Disabilities
3.1(a) Creation of dioxins requires chlorine, the active form of which is reduced by sunshine: Dioxins are created during combustion of organic materials; but the element chlorine must be present, since chlorine is an essential part of every molecule of dioxin. Low concentrations of chlorine are normally present in the atmosphere in any area where pollution is present, incorporated into hydrogen chloride (HCl). HCl becomes dissolved in water vapor in the form of hydrochloric acid and is one of the three "most abundant sources of chlorine available for participation in the formation of CDDs/CDFs (dioxins)…" (265a) But sunlight can dry out the water in which the hydrochloric acid is dissolved, leaving the HCl relatively unreactive and unlikely to support formation of dioxins during combustion. <<cite ref>>
3.1(b) Creation of dioxins is promoted by colder temperatures: Dioxins have been found to be typically formed at cooler temperature ranges of combustion.<<cite ref>> Combustion in cold areas is likely to take longer to reach hotter operating temperatures, and the combustion chamber is more likely to descend into the cooler part of the operating range during idling of motors, during intermittent operation of incinerators, or when heating levels are turned down. Furnaces and wood-burning stoves in very cold states would almost certainly be larger than average. That should be considered in light of standard anti-pollution advice to use wood stoves that are the smallest that can provide the needed heat, since turning a fire down low is known to produce more toxins than a hot fire. Stoves that are big enough to keep a house warm during an entire Maine or Minnesota winter would certainly tend to be kept at a low flame during the fall and spring.
Background levels of dioxins in air were measured in a Minnesota location about 25 miles northwest of Minneapolis-St. Paul, with no major industrial or commercial activity occurring in the area. Ambient air samples were collected in the winter and summer of 1988, checking for levels of two different varieties of dioxins. The differences between summer and winter levels were quite remarkable, with maximum average levels of one variety being 17 times higher in the winter than during the summer, and maximum average levels of another dioxin variety being 342 times higher during winter than during the summer.(p. 427 of ATSDR 1998 publication). The author of the study attributed the differences to increased emissions from combustion sources during the winter, and that certainly seems to be a logical assumption for Minnesota. Such wintertime readings were not readily available for other states, but it is probable that wintertime increases in neurological toxins are unusually high in Minnesota, with its unique combination of very cold temperatures and substantial city populations. (Minnesota has 17 of the 21 coldest U.S. cities with populations over 50,000, per city-data.com.) The effects of those toxins during a major part of each year in Minnesota no doubt contribute to that state’s having the highest rate of autism in the U.S. If there were such a thing as a map of dioxin exposure in the U.S., Minnesota would probably show up as an outstandingly red area.
3.1(c) Potency of dioxins declines with greater exposure to sunlight: Dioxins are subject to destruction by sunlight, within a few days. Intensity of sun exposure has been seen to be the main variable affecting the lifetime of dioxins in atmosphere. So it is very likely that dioxins emitted into the atmosphere in high-solar areas would be completely degraded before they ever land on the vegetation that will subsequently enter the food chain or be burned; if not before, then soon after deposition. In regions with lower amounts of sunlight, or even in heavily-shaded local areas within high-solar regions, dioxins would be far more likely to retain their toxicity; and they would probably then keep accumulating into increasingly potent concentrations in the vegetation or soil, unless they are degraded by solar radiation that reaches surfaces of those substances. (See Section 1.7.2 for more details.) If dioxins in the vegetation don't enter the food chain directly or degrade, they normally eventually become part of the soil, from where they could be recycled on the way to human ingestion. Or the dioxins might also be re-suspended in a wildfire and thereby form atmospheric concentrations affecting downwind infants and mothers-to-be. If dioxins accumulating in forest soil aren't re-suspended in fires, they can be transported by soil erosion (aided by unpaved roads) that goes to bodies of water, ending up in fish eaten by women and infants.
The above probably helps to explain why two of the three states with the highest rates of autism in the U.S. (Minnesota and Maine) are at the far northern border of the contiguous states; the other one of the top three (Oregon) is near the northern border and its heavily-populated western section receives below-average amounts of sunshine. In addition to extending the toxic lives of dioxins, low sunlight goes along with lower temperatures, and dioxins are known to be created especially in the lower ranges of combustion temperatures. In sunnier locations, high engine operating temperatures are likely to be reached sooner during wintertime, and ongoing combustion is more likely to be sufficient to keep the combustion chambers of engines, stoves and fireplaces steadily at high temperatures. Also, since dioxins are produced by typical combustion processes, there would be more combustion for heating in colder locations, producing more dioxins. See Section 3.1.b about the extreme increases in dioxins in Minnesota air during the winter.
(a) Greater sun exposure leads to higher vitamin D levels. Vitamin D deficiency is associated with reduced immune function, and low immune function has been associated with autism in an NIH-funded study of autism.
(b) Residential wood fires and wood-burning stoves are known sources of PM, dioxins and lead, and most children in areas with greater warming effects from sunshine would almost certainly have comparatively lower exposure to those sources. See Section 2.1, concerning toxic hazards of wood burning. As is the case with wildfires, quantity of dioxins emitted by the burning depends partly on exposure the firewood has had previously, including to sunlight;
(c) Children in areas with more sun and in areas with less rain are likely to spend less time indoors, where, according to the EPA, pollution "may be two to five times higher than outdoor levels." (266). Obviously being outdoors while there is a fire in the vicinity would be bad; and outdoor air in urban areas or near major highways appears generally also to be worse than indoor air (267); but during normal times in areas with average or lower pollution, being outdoors more and having the windows open wider would probably benefit the infant's general health and ability to tolerate sporadic environmental toxins.
(d) Remembering that lactation concentrates environmental toxins that are ingested by a mother, before they are excreted to the infant, consider that the effects of (b) and (c) above would be magnified by breastfeeding, at the time when the infant's neurological development is probably at its most vulnerable stage (see Introductory Summary, beginning at "150 times higher")
Section 3.3 General Increase in Mental Decline among U.S. Male Children:
Related to autism (with its extremely disproportionate affect on males) is the fact that far larger numbers of males born in the U.S. in recent decades apparently have some kind of mental impairment, as reported to the Census Bureau. (The Census Bureau’s question that provides this data asks, "Because of a physical, mental or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions?”) The percentage of males reported to have such difficulties who were born since the early 1990’s is twice as high as the percentage of females in the same age group (that is, 5.2% for male children nationwide, which includes many of those with autism); this in sharp contrast with the apparent gender-equality that applies to those born in the half-century leading up to the mid-1970’s. (see (1) The data indicate these reportedly serious mental difficulties for about one out of eleven 5-to-17-year-old boys in Maine. But there is good reason to observe a general downgrading of male mental abilities, not merely increasing problems at the bottom. 60% of all masters’ degrees in the U.S. currently go to women. “Throughout the ’90s, various authors and researchers agonized over why boys seemed to be failing at every level of education, from elementary school on up….” (268) In a 2003 Business Week cover story (269), a professor of psychiatry at Harvard Medical School is quoted as saying, “It's not just that boys are falling behind girls, It's that boys themselves are… doing worse than they did before." Similar effects appear to be in evidence in most countries of the developed world, in higher education (270) and among boys in the only other country for which this author has been able to find comparative data (the U.K.). See more in Section 1.2.b.5, concerning male-female differences in higher education.
Changes of this magnitude over a few decades could not possibly be attributable to heredity. And, assuming some validity in the averaged data taken from tens of thousands of responses to the Census Bureau regarding mental impairment, the changes obviously represent extremely serious consequences. See in Section 1.2.b.1 and Section 1.9.4 about recently-increased environmental toxins that affect males specifically, and which become concentrated in human milk.
From the inception of these publications in early 2012 until present, the invitation has been extended to all readers to submit criticisms, asking them to point out how anything written here is not well supported by authoritative sources (as cited) or is not logically based on the evidence presented. As of August 1, 2013, after about 17 months, only two criticisms of contents of our articles have been received in response to that invitation. (That is significant, considering the many thousands of visits we receive from readers every month.) Our publications have been improved as a result of those two criticisms, and we look forward to receiving more. To read those criticisms and our responses to them, as well as to read several other e-mails containing comments or questions and our responses to them, go to www.pollutionaction.org/comments.htm. All comments are welcome, especially those that point out any deficiencies in our evidence in relation to conclusions drawn or any lack of quality in the reasoning as presented. Please send comments, criticisms, or questions to firstname.lastname@example.org . Quite clearly, many people don't like our conclusions; they just can't find anything wrong with the evidence or reasoning that leads to the conclusions. Those who can't provide any criticisms of any of our content also include officials of government agencies that promote breastfeeding, who have received several letters from us, as well as the World Health Organization and the American physicians' associations that advocate breastfeeding. The latter organizations haven't even responded to our letters (two to each organization) questioning them about the evidence on which they base their advocacy of breastfeeding.
Appendix (Appendix 1 has been moved to www.breastfeeding-health-effects.info)
1) A study of interest (Whitely and colleagues) was conducted regarding 1189 children age 3 to 11 formally diagnosed with various forms of Autism Spectrum Disorder, residing in the U.K. and Republic of Ireland, drawing on records received between 2002 and 2007. The records showed that 65% of the children with those conditions had been “exclusively breastfed” for over four weeks. (4) After doing a search of available sources for a comparison figure for exclusive breastfeeding for over four weeks for the U.K. as a whole for the period in which those children would have been newborns, this author has come up with data from two different sources, which are consistent in leading to a figure of about 28%.(4) So the children who turned out to be autistic had been breastfed at a rate over twice as high as what the comparable figure would have been for the U.K. as a whole.
2) In an investigation of rates of breastfeeding among 45 Kentucky children diagnosed with autism (Williams et al.), the percent of ASD-diagnosed patients who had been breastfed at 6 months was 37%, as compared with 13% in the control group (or 14% in the general Kentucky population).(277c) The authors (two MD's) determined a "P value" regarding the above finding of .003, meaning the odds of that difference resulting purely from chance, as opposed to from a causal relationship, are 3 out of 1000. The odds that the greatly increased level of autism found in the Whitely study (with a 26-times larger study group) resulted merely from chance would probably have been even smaller than 3 out of 1000.
The chance that both of the above studies would have arrived at similar findings, without there being a causal relationship between breastfeeding and autism, would appear to be remote. But consider the even greater evidence of a causal relationship provided by the study below:
3) In a U.S. study provided on the NIH website (Shamberger, 2011), looking at the correlation between autism and breastfeeding rates, observation of all 50 states as well as 51 counties revealed, "there was a direct correlation (of increased autism rates) with the increasing percentage of women exclusively breast-feeding." And "the longer the duration of exclusive breast-feeding, the greater the correlation with autism."110b) (parenthetical expressions added)
Note that all of the above studies appear to support a finding that, the greater the exposure to breast milk, the greater the level of autism among the breastfed infants. In the Whitely study, the duration of breastfeeding used for the comparison was only four weeks, a level that was met by about 28% of mothers in the study area. In the Williams study, the duration of breastfeeding used for comparison was a full six months, a level met by only 13-14% of mothers in the study area. The shorter duration of breastfeeding was associated with an approximately 130% (65/28) higher-than-normal level of autism. The greater duration of breastfeeding was associated with an approximately 175% (37/13.5) higher rate of autism. That same kind of "direct correlation (of increased autism rates) with the increasing percentage of women exclusively breast-feeding" and with the "longer duration" was also found in the Shamberger study.
If any reader can think of any other reason why children with autism would have been more than twice as likely as the average child to have been breastfed, other than as a result of a causal relation between the breastfeeding and the autism, please inform this author of your idea, at email@example.com , and it will be posted at the end of this paper.
The above studies were the only studies providing findings of this kind that were found in a substantial web search in mid-2012. There are two major organizations in the U.S. that are doing in-depth, long-term research on causes of autism, both of which (in response to our inquiries) have indicated that their research may at some time include the question of breastfeeding, but they have no data to share at this time.**
** (responses of April 18 and May 3, 2012 from the MIND Institute of California regarding its CHARGE study and from the CDC regarding the SEED study. The CDC said that they are not currently conducting breastfeeding analysis but may do so in the future.)
To read an interesting set of comments from mothers of autistic children about their breastfeeding histories, as were posted on a blog of the Autism Speaks organization, together with this author's observation about the merits of the blog to which they were responding, go to http://www.pollutionaction.org/autismspeaksblog.htm .
Appendix 3: Contents of this appendix, an examination of how the health data of Americans born following the increase in breastfeeding (beginning in 1972) has compared with the health data of those born when breastfeeding was relatively rare (mid-20th century), with explanation of why the beliefs in health benefits of breastfeeding turned out to have been erroneous, can be found at www.breastfeeding-health-effects.info .
Some of the full articles below are available for free online, but to obtain the full text of some of these articles for free, you may have to visit a university library or ask at the reference desk at your local public library.
(0.1) Surgeon General's Call to Action to Support Breastfeeding, 2011, p. 2 at http://www.surgeongeneral.gov/library/calls/breastfeeding/calltoactiontosupportbreastfeeding.pdf
(0.2) Agency for Healthcare Research and Quality, U.S. DHHS, Systems to Rate the Strength of Scientific Evidence, Evidence Report/Technology Assessment: Number 47 http://archive.ahrq.gov/clinic/epcsums/strengthsum.pdf
(1) As reported to the U.S. Census Bureau, data for recent decades shows a very disproportionate number of male children with disabilities, especially mental impairment, with the gender ratio becoming more uneven among more recent births. This is evident in a National Academies Press publication (TABLE 3-1 of The Future of Disability in America, Institute of Medicine (US) Committee on Disability in America; Field MJ, Jette AM, editors. National Academies Press (US); 2007, found at http://www.ncbi.nlm.nih.gov/books/NBK11437/table/a2001315cttt00007/?report=objectonly) The U.S. Census Bureau’s question that was apparently used for obtaining this data asks, "Because of a physical, mental or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions?” The percentage of males said to have such mental difficulties who were born since the early 1990’s is twice as high as the percentage of females in the same age group (that is, 5.2% for male children nationwide, which includes many of those with autism, vs. 2.6% of females); this is in sharp contrast with the apparently gender-equal numbers that apply to those born in the half-century leading up to the mid-1970’s. And those born in the period between the mid-1970’s and the early 1990’s had an intermediate male-female disproportion of impairments. This data is from U.S. Census Bureau Table B18104: SEX BY AGE BY COGNITIVE DISABILITY Universe: Civilian non-institutionalized population 5 years and over. Data Set: 2008-2010 American Community Survey 3-Year Estimates (accessed Jan. 2012 at http://factfinder2.census.gov , using their search process) The even ratio of mental disability among people born up to the mid-1970's, becoming very uneven later, is compatible with various studies.(Leonard et al. 2002; Gissler et al. 1999, as reported in Maulik PK, Harbour CK, 2011: Epidemiology of Intellectual Disability. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Available online: http://cirrie.buffalo.edu/encyclopedia/en/article/144/ ) According to U.S. Dept. of Education IDEA data (Table 1-12: Children and students served under IDEA, Part B, in the U.S. and outlying areas, by gender and age group: Fall 1999 through fall 2008 at https://www.ideadata.org/arc_toc10.asp#partbCC), the ratio of male to female children age 6-21 with disabilities in recent years has been 2 to 1, but among children 3 to 5 the ratio has been 7 to 3; this implies a ratio of impaired male to female children that has been growing still more uneven than the 2 to 1 ratio; remember that the 2-to-1 ratio was itself a dramatic change from gender equality a few decades earlier. The above widens the scope of the uneven gender ratio of impairment beyond what is seen in the major increases in diagnosed cases of autism in recent decades.
(1a) Durkin MS, Schupf N, Stein ZA, Susser MW: Childhood cognitive disability. In: Public health and preventive medicine, fifteenth edition, Wallace RB, editor. Hightstown, NJ: McGraw-Hill; 2007. pp. 1173–1184.
Also Durkin MS, et al. (2010) Socioeconomic Inequality in the Prevalence of Autism Spectrum Disorder: Evidence from a U.S. Cross-Sectional Study. PLoS ONE 5(7): e11551. doi:10.1371/journal.pone.0011551 At http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0011551
(1b) Autism and Intellectual Disability Are Differentially Related to Sociodemographic Background at Birth, Helen Leonard, et al., PLoS One. 2011; 6(3): e17875. Published online 2011 March 30. doi: 10.1371/journal.pone.0017875 PMCID: PMC3068153 at http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0017875
(2) "The Epidemiology of Autism Spectrum Disorders*, Craig J. Newschaffer,1 et al., Department of Epidemiology and Biostatistics, Drexel University Drexel E-Repository and Archive (iDEA) ANRV305-PU28-21 ARI 22 December 2006 7:53. Also a CDC web page at http://www.cdc.gov/ncbddd/autism/data.html
(2b) Pediatric cancer survivors: Assessment of late effects : "Pediatric cancer survivors are at risk for chronic medical and psychologic problems resulting from the malignancy and its treatment." from Nurse Practitioner, 12/1/00 by Ward, Jennifer Dawn at http://184.108.40.206/hepatoblastoma_article_8.htm
(3) source of Figure 1b: The Surgeon General’s Call to Action to Support Breastfeeding 2011 U.S. Public Health Service Office of the Surgeon General at http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf)
(4) Trends in Developmental, Behavioral and Somatic Factors by Diagnostic Sub-group in Pervasive Developmental Disorders: A Follow-up Analysis, pp. 10, 14 Paul Whiteley (Department of Pharmacy, Health & Well-being, Faculty of Applied Sciences, University of Sunderland, UK), et al. Autism Insights 2009:1 3-17 at http://www.la-press.com/trends-in-developmental-behavioral-and-somatic-factors-by-diagnostic-s-article-a1725) Also: Patterns of breastfeeding in a UK longitudinal cohort study, Pontin et al., School of Maternal and Child Health, University of West of England, Bristol, UK. Whitely et al. looked at a comparison figure of 54%, but that figure was unrealistically high for the general UK population, since it came from a study (Pontin et al.) of breastfeeding by mothers who were largely from “more affluent families”, in the words of that study’s authors; more affluent mothers are well known to breastfeed at unusually high rates in countries in which breastfeeding is not nearly universal. For breastfeeding prevalence data that would apply to the general U.K. population, the authors of the Pontin study referred the reader to (1) a 2005 study that showed a 33% rate at the end of the first month; note in Figure 1.9 and in Section 1.2.s.6 that breastfeeding rates in the U.K. by 2005 (the year of the study that found the 33% rate) had risen about one-fifth just since the years of the births of most of the children whose data would have been reported in the Whitely study; and (2) Pontin et al. also refer the reader to Infant Feeding 1995 (Foster et al.), which they say shows a 21% figure for exclusive breastfeeding for the next period following the first month; examination of the data in that book reveals that the 21% figure would apply at about eight weeks after birth, and that a figure in the upper 20%’s would apply at just after four weeks.
(18) Being breastfed in infancy and adult breast cancer risk among Japanese women Y. Minami/ M. Kawai (Division of Community Health, Tohuku University Graduate School of Medicine) et al. Cancer Causes Control, 2012
(19b) National Report on Human Exposure to Environmental Chemicals Dioxin-Like Chemicals:etc. Updated April 2010 Centers for Disease Control and Prevention, Atlanta, GA at http://www.cdc.gov/exposurereport/data_tables/DioxinLikeChemicals_ChemicalInformation.html
(21) Clin Exp Allergy. 2006 April; 36(4): 402–425. Blackwell Publishing Ltd Too clean, or not too clean: the Hygiene Hypothesis and home hygiene SF Bloomfield et al. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448690/
(22) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448690/ also Development and Maturation of the Immune System: Vulnerability to Toxicants at http://oehha.ca.gov/public_info/public/kids/pdf/Holladayed.pdf, p. 8
(23) Cell Research advance online publication 24 April 2012; doi: 10.1038/cr.2012.65 Early exposure to germs and the Hygiene Hypothesis Dale T Umetsu Division of Immunology, Karp Laboratories, Children's Hospital Boston, Harvard Medical School, Boston, MA http://www.nature.com/cr/journal/vaop/ncurrent/full/cr201265a.html
(23a) (Bone Strength: Current Concepts Charles H. Turner Orthopaedic Research Laboratories and Biomechanics and Biomaterials Research Center, Indiana University Purdue University at (http://www.melioguide.com/media/121650/turner_bone_strength.pdf)
(23a1) "Environmental toxicants and the developing immune system: a missing link in the global battle against infectious disease?" Bethany Winans, et al., Reprod Toxicol. 2011 April; 31(3): 327–336. Published online 2010 September 22. doi: 10.1016/j.reprotox.2010.09.004 PMCID: PMC3033466 NIHMSID: NIHMS245165 accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033466/ citing the following:
Heilmann C, Grandjean P, Weihe P, Nielsen F, Budtz-Jorgensen E. Reduced antibody responses to vaccinations in children exposed to polychlorinated biphenyls. PLoS Med. 2006;3:e311. [PMC free article
Weisglas-Kuperus N, Patandin S, Berbers GA, Sas TC, Mulder PG, Sauer PJ, et al. Immunologic effects of background exposure to polychlorinated biphenyls and dioxins in Dutch preschool children. Environmental health perspectives. 2000;108:1203. [PMC free article]
Glynn A, Thuvander A, Aune M, Johannisson A, Darnerud P, Ronquist G, et al. Immune cell counts and risks of respiratory infections among infants exposed pre- and postnatally to organochlorine compounds: a prospective study. Environmental Health. 2008;7:62. [PMC free article]
Dallaire F, Dewailly E, Muckle G, Vezina C, Jacobson SW, Jacobson JL, et al. Acute infections and environmental exposure to organochlorines in Inuit infants from Nunavik. Environ Health Perspect. 2004;112:1359–63. [PMC free article]
Dewailly E, Ayotte P, Bruneau S, Gingras S, Belles-Isles M, Roy R. Susceptibility to infections and immune status in Inuit infants exposed to organochlorines. Environ Health Perspect. 2000;108:205–11. [PMC free article]
Jedrychowski W, Galas A, Pac A, Flak E, Camman D, Rauh V, et al. Prenatal ambient air exposure to polycyclic aromatic hydrocarbons and the occurrence of respiratory symptoms over the first year of life. European journal of epidemiology. 2005;20:775–82.
Weisglas-Kuperus N, Vreugdenhil HJ, Mulder PG. Immunological effects of environmental exposure to polychlorinated biphenyls and dioxins in Dutch school children. Toxicol Lett. 2004;149:281–5.
Guo YL, Lambert GH, Hsu CC, Hsu MM. Yucheng: health effects of prenatal exposure to polychlorinated biphenyls and dibenzofurans. Int Arch Occup Environ Health. 2004;77:153–8.
Vos JG, Moore JA. Suppression of cellular immunity in rats and mice by maternal treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin. International archives of allergy and applied immunology.
(23a2) US Department of Health and Human Services, National Institutes of Health, National Cancer Institute. President’s Cancer Panel: Reducing Environmental Cancer Risk. Annual Report. 2008–2009. http://deainfo.nci.nih.gov/advisory/pcp/pcp.htm.
(23b).(Apriil 25, 2012 editorial "A Research Strategy to Discover the Environmental Causes of Autism and Neurodevelopmental Disabilities," in Journal Environmental Health Perspectives, reported in ScienceDaily (Apr. 25, 2012)
(24) (New York Times.com> Magazine First Person Toxic Breast Milk? by Florence Williams, Jan. 9, 2005)
(24b) Maternal Conditions and Perinatal Characteristics Associated with Autism Spectrum Disorder and Intellectual Disability
PMCID: PMC3538698, a publication found in the website of the NIH's National Library of Medicine at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538698/
(25) Breastfeeding Wars: Why Locking Up Baby Formula Is A Bad Idea, Amy Tuteur, M.D. in Time Ideas, accessed 8/4/12 (http://ideas.time.com/2012/08/03/why-locking-up-formula-is-a-bad/?iid=hl-article-latest#ixzz22gpKNKuR
(26) Being breastfed in infancy and adult breast cancer risk among Japanese women Y. Minami/ M. Kawai (Division of Community Health, Tohuku University Graduate School of Medicine) et al. Cancer Causes Control, 2012
(26a) Chemosphere. 2007 Apr;67(7):1265-74. Epub 2007 Jan 26. Polycyclic aromatic hydrocarbons (PAHs) in human milk from Italian women: influence of cigarette smoking and residential area. Zanieri L, et al., University of Florence, Department of Chemistry, Florence, Italy. At http://www.ncbi.nlm.nih.gov/pubmed/17258279
(27) Chemosphere. 1996 Feb;32(3):543-9. Decrease in milk and blood dioxin levels over two years in a mother nursing twins: estimates of decreased maternal and increased infant dioxin body burden from nursing. Schecter A, Papke O, Lis A, Ball M, Ryan JJ, Olson JR, Li L, Kessler H Department of Preventive Medicine, State University of New York, Health Science Center-Syracuse, USA
(27a) Do Human Milk Concentrations of Persistent Organic Chemicals Really Decline During Lactation? Chemical Concentrations During Lactation and Milk/Serum Partitioning, Judy S. LaKind et al. Environmental Health Perspectives http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info:doi/10.1289/ehp.0900876
The exact wording that was paraphrased here was, "The proper development of many systems and functions depends on the timely action of hormones, particularly sex steroids; therefore, interfering with such actions can lead to a wide array of effects that may include altered metabolic, sexual, immune, and neurobehavioral functions. Effects of this type, that occur following exposure during fetal life via the placenta or early in life caused by either direct exposure to chemicals or exposure via maternal milk, are discussed in this section."
(31) Committee on Developmental Toxicology, Board on Environmental Studies and Toxicology, in Scientific Frontiers in Developmental Toxicology and Risk Assessment (2000) , Commission on Life Sciences, The National Academies Press, p. 56 at http://www.nap.edu/openbook.php?record_id=9871&page=56
(32) United States Office of Research May 25, 2001 Update, Environmental Protection and Development Agency, Dioxin: Scientific Highlights from Draft Reassessment (2000)
(33) Male Reproductive Health and Environmental Xenoestrogens, Jorma Toppari, et al., Environmental Health Perspectives - Vol 104, Supplement 4 - August 1996 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1469672/pdf/envhper00347-0052.pdf p. 757: “There is considerable literature documenting the toxic effects of dioxins on the male reproductive system.”
(33a) Lower Serum Testosterone Associated with Elevated Polychlorinated Biphenyl Concentrations in Native American Men
Alexey Goncharov, et al., Environ Health Perspect. 2009 September; 117(9): 1454–1460. Published online 2009 May 20. doi: 10.1289/ehp.0800134 PMCID: PMC2737025 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737025/
(34) ATDSR document on dioxins, section on environmental sources
(34b) http://www.epa.gov/iris/supdocs/dioxinv1sup.pdf in section 4.3.5, at end of that section, "...the resulting RfD in standard units is 7 × 10−10 mg/kg-day." In the EPA’s “Glossary of Health Effects”, RfD is defined: “RfD (oral reference dose): An estimate (with uncertainty spanning perhaps an order of magnitude) of a daily oral exposure of a chemical to the human population (including sensitive subpopulations) that is likely to be without risk of deleterious noncancer effects during a lifetime.”
(34c) U.S. EPA. Estimating Exposure To Dioxin-Like Compounds - Volume I: U.S. Environmental Protection Agency, Washington, D.C., EPA/600/8-88/005Ca., 2002, revised 2005 – http://cfpub.epa.gov/si/si_public_record_Report.cfm?dirEntryID=43870, Section II.6, "Highly Exposed Populations" (nursing infants are considered to be one of the highly-exposed populations), 4/94 (p. 39) "Using these procedures and assuming that an infant breast feeds for one year, has an average weight during this period of 10 kg, ingests 0.8 kg/d of breast milk and that the dioxin concentration in milk fat is 20 ppt of TEQ, the average daily dose to the infant over this period is predicted to be about 60 pg of TEQ/kg-d."
(34d) Schecter, A., et al. Chlorinated Dioxins and Dibenzofurans in Human Tissue from General Populations: A Selective Review, Environmental Health Perspectives Supplements 1994; 102(Supple 1): p. 159-171 and Schecter, A., et al. Congener-specific Levels of Dioxins and Dibenzofurans in U.S. Food and Estimated Daily Toxic Eequivalent Intake, Environmental Health Perspectives Journal 1994; 102(11): p. 962-966.
(34e) Chemosphere 2007 Jan;66(2):311-9. Epub 2006 Jun 14. A comparison of PCDD/PCDFs exposure in infants via formula milk or breast milk feeding. Hsu JF, et al.
(37a) Infant Exposure to Dioxin-like Compounds in Breast Milk Lorber1 and Phillips2 VOLUME 110 | NUMBER 6 | June 2002 • Environmental Health Perspectives http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=54708#Download
(37b) Transfer of Polycyclic Aromatic Hydrocarbons to Fetuses and Breast Milk of Rats Exposed to Diesel Exhaust, Tozuka, Watanabe et al., Kanazawa University and Tokyo Metropolitan Public Health Research Institute; Journal of Health Science 50(5) 2004 pp. 497-502
(40) Industrial Health 2000, 38, 259–268 Review Article: The Effects of Dioxin on Reproduction and Development Junzo YONEMOTO National Institute for Environmental Studies, Japan p. 262; Glorieux et al., 1988; Rovet et al., 1987; Haddow et al., 1999)." (Prioritization of Toxic Air Contaminants -- Children's Environmental Health Protection Act (State of California), October, 2001
(40a) C.A. Laroo et al., Emissions of PCDD/Fs, PCBs and PAHs from a Modern Diesel Engine Equipped with Catalyzed Emission Control Systerms, Environmental Science and technology, ACS Publications, June 30, 2011
(46) Environ Health. 2008; 7: 2. Published online 2008 January 17. doi: 10.1186/1476-069X-7-2 Rudel et al; licensee BioMed Central Ltd. PCB-containing wood floor finish is a likely source of elevated PCBs in residents' blood, household air and dust: a case study of exposure
(47) Judy L. Cameron, Dept. of Psychiatry, Neuroscience, and Cell Biology and Physiology, University of Pittsburgh, in "Effects of Sex Hormones on Brain Development," Chapter 5 of Handbook of Developmental Cognitive Neuroscience, MIT Press, 2001, edited by Charles A. Nelson and Monica Luciana. Charles A. Nelson is Research Director, Developmental Medicine Center at Children's Hospital Boston, and Professor of Pediatrics and Richard David Scott Chair in Pediatric Developmental Medicine Research at Harvard Medical School; Monica Luciana is Associate Professor of Psychology and Child Development at the University of Minnesota. Selected pages can be found at no charge at http://www.worldcat.org/title/handbook-of-developmental-cognitive-neuroscience/oclc/45059115/viewport or at that organization’s website, doing a search including the above book title and “sex steroids.”
(48) McEwen, Steroid Hormones and Brain Development: Some Guidelines for Understanding Actions of Pseudohormones and Other Toxic Agents, Environmental Health Perspectives Vol. 74, pp. 177-184, 1987. Research in the author's laboratory was supported by NIH Grant NS07080 and NIMH Grant MH41256. Institutional support from the Rockefeller Foundation for research in reproductive biology was also acknowledged.
(50) Sex matters in autism and other developmental disabilities, Thompson, Caruso and Nellerbeck, Journal of Learning Disabilities , Sage Publications, London,Thousand Oaks and New Delhi p. 352, referring to COLLAER, M. L. & HINES, M. ‘Human Behavioral Sex Differences: A Role for Gonadal Hormones during Early Development?’, Psychological Bulletin
(52) Sherry G. Selevan, Carole A. Kimmel and Pauline Mendola, National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA)
(53) In "Epidemiologic Evidence of Relationships Between Reproductive and Child Health Outcomes and Environmental Chemical Contaminants", published in Journal of Toxicology and Environmental Health Part B, Volume 11, Issue 5 & 6 May 2008 , pages 373 – 517
(55 ) "Prevalence of Autism Spectrum Disorders --- Autism and Developmental Disabilities Monitoring Network, Six Sites, United States, 2000" and "Prevalence of Autism Spectrum Disorders --- Autism and Developmental Disabilities Monitoring Network, United States, 2006", Corresponding author: Catherine Rice, PhD, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA 30333,
(58) National Report on Human Exposure to Environmental Chemicals Dioxin-Like Chemicals: Polychlorinated Dibenzo-p-dioxins, Polychlorinated Dibenzofurans, and Coplanar and Mono-ortho-substituted Polychlorinated Biphenyls Centers for Disease Control and Prevention Atlanta, GA Accessed at http://www.cdc.gov/exposurereport/data_tables/DioxinLikeChemicals_ChemicalInformation.html Page updated April 2010
(60) Developmental and Reproductive Toxicity of Dioxins and Related Compounds: Cross-Species Comparisons" Richard E. Peterson et al, School of Pharmacy and Environmnental Toxicology Center, Univ. of Wisconsin EPA/600/J-93/470 Critical Reviews in Toxicology, 1993
(67a) Takeuchi, Breastfeeding in Japan: historical perspectives and current attitudes and practices, Jpn Hosp. 1992 Jul;11:79-92. at http://www.ncbi.nlm.nih.gov/pubmed/10120553
(68) Breastfeeding trend in Japan: Japanese Culture and Breastfeeding Cynthia D. Payne, IBCLC, quoting Hiroko Hongo, MSW, IBCLC and Kazue Nakamura MD, IBCLC Report from the 2003 LLLI Conference From: NEW BEGINNINGS, Vol. 20 No. 5, September-October 2003, pp. 181, accessed at http://www.lalecheleague.org/nb/nbsepoct03p181.html)
(81b) Concentration of Persistent Organochlorine Compounds in the Placenta and Milk of the Same Women, Katarzyna Czaja et al., Ch. 21 of Persistent, Bioaccumulative, and Toxic Chemicals I, Robert L. Lipnick et al. editors, ACS Symposium Series, American Chemical Society, 2001; citing Jensen, A.A. et al, Chemical Contaminants in Human Milk, CRC Press, Inc., Boca Raton, Ann Arbor, Boston, 1991. Findings of above confirmed in animal tests, with even greater contrasts, in Ahlborg et al., Risk Assessment of Polychlorinated Biphenyls (PCBs), Nordic Council of Ministers, Copenhagen. Report NORD 1992; 26
(81c) U.S. EPA (2010) An exposure assessment of polybrominated diphenyl ethers. National Center for Environmental Assessment, Washington, DC; EPA/600/R-08/086F. online at www.epa.gov/ncea
(81g) Section 5.6.2 of above. The EPA states the figure as "44.1 ng/g lwt" (44.1 ng = 44,100 pg). For comparison purposes, the lipid (fat) weight indicated here needs to be converted to whole weight, which can be done as follows: The EPA here assumes a fat content of 4%. Using that figure, 44,100 pg/g lwt becomes 1760 pg/g wwt.
(82) National Academies Press: Health Risks from Dioxin and Related Compounds: Evaluation of the EPA Reassessment (2006), Board on Environmental Studies and Toxicology, National Academy of Sciences; the original source is not quoted directly because it is part of a draft, not for quoting
(82c) Kommission “Human-Biomonitoring” des Umweltbundesamtes: Stoffmonographie PCB - Referenzwerte für Blut (Commission on Human Bio-Monitoring of the (German) Federal Environmental Office: Substance Monograph on PCB - - Reference Values for Blood) At http://www.umweltdaten.de/gesundheit/monitor/pcbblut.pdf , Section 8.3. found within http://www.umweltbundesamt.de/gesundheit/publikationen/index.htm , website of Umwelt Bundes Amt (German Federal Environmental Office). This article cited for this breastfed infant exposure data the source: Institut für Wasser-,Boden und Lufthygiene des Umweltbundesamtes, Kommission „Human-Biomonitoring“ des Umweltbundesamtes • Berlin: Referenzwerte für HCB,b-HCH, DDT und PCB in Frauenmilch (Institute for Water-, Soil and Air Hygiene of the Federal Environmental Office, Commission on Human Bio-Monitoring: "Reference Values for HCB,b-HCH, DDT und PCB in Human Milk." The text drawn on says, " "Die derzeit durchschnittlich vom Erwachsenen täglich aufgenommene Menge an PCB (ca. 0,02 μg PCB/kg KG ) liegt deutlich unter der ATD von 1 μg PCB/kg KG. Der gestillte Säugling erhält dagegen eine deutlich höhere PCB-Zufuhr (3 μg PCB/kg KG.", which Bing Translator translates as " "The amount taken daily average currently by the adults of PCB (approx. 0.02 μg PCB/kg bw ) is well below the ATD of 1 μg PCB/kg. The breastfed infant, however, receives a significantly higher PCB intake (3 μg PCB/kg bw."
(83) Infant Exposure to Dioxin-like Compounds in Breast Milk, Lorber and Phillips Volume 110 | Number 6 | June 2002 • Environmental Health Perspectives http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=54708#Download Also EPA Home/Research/Environmental Assessment: An Evaluation of Infant Exposure to Dioxin-Like Compounds in Breast Milk, Matthew Lorber (National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency) et al.
(85) Intake, fecal excretion, and body burden of polychlorinated dibenzo-p-dioxins and dibenzofurans in breast-fed and formula-fed infants. Abraham K, Knoll A, Ende M, Päpke O, Helge H. Children's Hospital, Virchow-Klinikum, Humboldt-Universität Berlin, Germany
(86) Regulatory Toxicology and Pharmacology, 37 (2003) 202 217 Dioxin risks in perspective: past, present, and future Hays and Aylward at http://acdrupal.evergreen.edu/envirohealth/system/files/Dioxin+risks+in+perspective.pdf
(89b) Brominated Flame Retardants, Third annual report to the Maine Legislature, Jan. 2007, Maine Dept. of Environmental Protection, Maine Center for Disease Control and Prevention, Dr. Deborah Rice et al.
(90) Shokuhin Eiseigaku Zasshi. 2004 Aug;45(4):175-83. PubMed – NCBI Polybrominated diphenyl ether flame retardants in foodstuffs and human milk. Akutsu K, Hori S. Osaka Prefectural Institute of Public Health: 1-3-69, Nakamichi,Osaka 537-0025, Japan
(90a) Zanieri L, Galvan P, Checchini L, Cincinelli A, Lepri L, Donzelli GP, et al. Polycyclic aromatic hydrocarbons (PAHs) in human milk from Italian women: influence of cigarette smoking and residential area. Chemosphere. 2007;67:1265–74., cited at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033466/
(90b) Particle and Fibre Toxicology, Effects of prenatal exposure to diesel exhaust particles on postnatal development, behavior, genotoxicity and inflammation in mice. Karin S Hougaard et al., National Research Centre of the Working Environment, Copenhagen, Denmark. Published: 11 March 2008 Particle and Fibre Toxicology 2008, 5:3 doi:10.1186/1743-8977-5-3 This article is available from: http://www.particleandfibretoxicology.com/content/5/1/3
(91) CAS No: 7726-95-6) Health-based Reassessment of Administrative Occupational Exposure Limits, Committee on Updating of Occupational Exposure Limits, a committee of the Health Council of the Netherlands
(98) Breastfeeding in countries of the European Union and EFTA: current and proposed recommendations, rationale, prevalence, duration and trends Agneta Yngve et al., Public Health Nutrition: 4(2B), p. 641
(99a) WHO, Nutrition Data Banks, Global Data Bank on Breastfeeding "...exclusive breastfeeding rate under 4 months -- Poland has increased from 1.5% in 1988 to 17% in 1995; and Sweden has increased from 55% in 1992 to 61% in 1993. https://apps.who.int/nut/db_bfd.htm See also text in www.breastfeeding-health-effects.info regarding probably low actual level of breastfeeding despite routine presentations of (just-previously-bottlefed) babies to mothers for breastfeeding in maternity wards in a former Soviet-Bloc country.
(102) Fleischer Michaelsen K et al., Feeding and Nutrition of Infants and Young Children: Guidelines for the WHO European Region, with Emphasis on the former Soviet Countries. Copenhagen, World Health Organization, 2003
(106) Bettiol S, et al. (2010). Bettiol, Silvana. ed. "Symptomatic treatment of the cough in whooping cough". Cochrane Database Syst Rev (1): CD003257. doi:10.1002/14651858.CD003257.pub3. PMID 20091541
(106b) Cancer Treat Rev. 2010 Jun;36(4):277-85. Epub 2010 Mar 15.Epidemiology of childhood cancer. Kaatsch P. Institute for Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Germany. (http://www.ncbi.nlm.nih.gov/pubmed/20231056 )
(106b1) Parking DM et al., International Incidence of Childhood Cancer IARC scientific publication, Vol. II. Lyon: International Agency for Research on Cancer, 1998 p. 144, quoted in Kaatsch Peter, Epidemiology of childhood cancer Institute for Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Germany, Cancer Treatment Reviews 36 (2010) 277-285 High-breastfeeding countries listed were Sweden, Norway, Denmark, Finland, Italy, Spain, New Zealand, Australia, and Germany. No data for Belgium.
(106c) Childhood cancer epidemiology in North America, Logan Spector, PhD, Univ. of Minn, citing Pizzo and Poplack, 2002, and SEER AYA monograph;. also “Childhood cancer rates rise in Europe”, in The Guardian, U.K., 9 December 2004)
(106c2) Little J., Epidemiology of Childhood Cancer, IARC Scientific Publications No. 149, Lyon; International Agency for Research on Cancer, 1999; cited in "Trends in childhood cancer incidence in Europe, 1970-99", Steliarova-Fourcher et al., on behalf of the ACCIS Scientific Committee, in www.thelancet.com, Vol. 365, June 18, 2005, p. 2088
Published online 2011 August 17. doi: 10.1016/j.canlet.2011.08.003 PMCID: PMC3185182 NIHMSID: NIHMS320383
(106c2a) Steliarova-Fourcher et al., Geographical patterns and time trends of cancer incidence and survival among children and adolescents in Europe since the 1970s (the ACCIS project): an epidemiological study. www.thelancet.com Vol. 364, Dec. 11, 2004
(106c2b) Karim-Kos HE, et al., Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur J Cancer. 2008 Jul;44(10):1345-89. Epub 2008 Feb 14 at http://www.ncbi.nlm.nih.gov/pubmed/18280139
. Ann Oncol. 2003 Aug;14(8):1312-25. Measuring progress against cancer in Europe: has the 15% decline targeted for 2000 come about? Boyle P, et al. http:/www.ncbi.nlm.nih.gov/pubmed/12881398 Source for other text at about this point: (http://www.atsdr.cdc.gov/com/cancer-fs.html)
(106c2c) Breastfeeding data from CDC's "Breastfeeding among U.S. Children Born 2000-2009," CDC National Immunization Survey, averaging 2001-2003 years' data for "Ever" breastfed, breastfed at 6 months, and breastfed at 12 months.
(106c3) Birth characteristics and brain cancers in young children, Julie Von Behren et al., International Journal of Epidimiology, Vol. 32 "With over 700 cases, this is one of the largest childhood CNS case-control studies to date."
(106c5) J Neurol Neurosurg Psychiatry 2004;75:ii12-ii17 doi:10.1136/jnnp.2004.04074, Brain tumours: incidence, survival, and aetiology, Table 2, at http://jnnp.bmj.com/content/75/suppl_2/ii12/T2.expansion.html Factors researched include ionizing radiation, mobile phones, extremely low frequency electromagnetic fields, viruses, atopy, nitrosamine/nitrite/nitrate, aspartame, tobacco, alcohol, hair dyes, solvents, pesticides, traffic-related air pollution, rubber and vinyl chloride manufacture, petroleum refining, head injury.
(106d) http://www.qub.ac.uk/research-centres/nicr/FileStore/PDF/Filetoupload,176738,en.pdf, (Queens University Belfast) Figure 4.4: "International comparisons of world age-standardised incidence rates for childhood cancer: 1998-2000." We averaged the cancer rates for boys with the rates for girls for each country. The low-breastfeeding countries were U.K., Ireland, France and Belgium, and the high-breastfeeding countries were Denmark, Germany, Austria, Australia, Sweden, Spain, Finland and Italy; Denmark was the only country with a prevalence below the highest prevalence among the low-breastfeeding countries, and that was only 0.05 lower)
(107) Regulatory Toxicology and Pharmacology, 37 (2003) 202 217 Dioxin risks in perspective: past, present, and future Hays and Aylward at http://acdrupal.evergreen.edu/envirohealth/system/files/Dioxin+risks+in+perspective.pdf
(110b) Autism rates associated with nutrition and the WIC program. Shamberger R.J., Phd, FACN, King James Medical Laboratory, Cleveland, OH J Am Coll Nutr. 2011 Oct;30(5):348-53. Abstract at www.ncbi.nlm.nih.gov/pubmed/22081621 The full text, including the quoted passages, can be purchased for $7 or reference librarians at local libraries could probably obtain it at no charge. It should be noted that Dr. Shamberger's only real concern about breastfeeding was deficiencies of three specific vitamins if the breastfeeding was exclusive.
(111) Oxford Journals aje.oxfordjournals.org Am. J. Epidemiol. (15 May 2005) 161 (10): 916-925. doi: 10.1093/aje/kwi123 Risk Factors for Autism: Perinatal Factors, Parental Psychiatric History, and Socioeconomic Status Heidi Jeanet Larsson et al J Child Psychol Psychiatry. 2005 Sep;46(9):963-71. Effects of familial risk factors and place of birth on the risk of autism: a nationwide register-based study. Lauritsen MB, et al.
(113) http://www.cdc.gov/breastfeeding/data/NIS_data/2000/socio-demographic.htm Also The Surgeon General’s Call to Action to Support Breastfeeding 2011 U.S. Public Health Service at www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf, p. 8
(116) J. Paediiitr. Cliihl Health (2()00) 36,164-168 Rates of breastfeeding in Australia by State and socio-economic status: Evidence from the 1995 National Health Survey S Donath and LH Amir The Key Centre for Woirien's Heatth. University of Melbourne. Melbourne. Victoria. Australia
(117) Lande, B., et al. (2003), Infant feeding practices and associated factors in the first six months of life: The Norwegian Infant Nutrition Survey. Acta Paediatrica, 92: 152–161. doi: 10.1111/j.1651-2227.2003.tb00519.x
(118a) Black Breastfeeding Advocacy: It Takes All Styles By Kimberly Seals Allers WeNews commentator February 23, 2012 Womensnews.org at http://womensenews.org/story/sisterspace/120222/black-breastfeeding-advocacy-it-takes-all-styles
(121) Research Handbook on the Economics of Family Law, Cohen and Wright, p. 176, citing Scott et al, 1999, and Ynge and Sjostrom, 2001; Maternal and Child Health Journal Volume 2, Number 3 (1998), 167-179, DOI: 10.1023/A:1021879227044 Factors Associated with Very Early Weaning Among Primiparas Intending to Breastfeed Melissa Avery et al; Clinician Support and Psychosocial Risk Factors Associated With Breastfeeding Discontinuation Elsie M. Taveras, et al., Pediatrics, 2003, Vol. 113
(121a) Environmental chemicals in human milk: a review of levels, infant exposures and health, and guidance for future research Judy S. LaKind, et al., Toxicology and Applied Pharmacology 198 (2004) 184– 208
(122) Am J Epidemiol. 2008 December 1; 168(11): 1268–1276. Published online 2008 October 21. doi: 10.1093/aje/kwn250 American Journal of Epidemiology © 2008 Advanced Parental Age and the Risk of Autism Spectrum Disorder Maureen S. Durkin et al.
(125) Juul-Dam N, Townsend J, Courchesne E. 2001. Prenatal, perinatal, and neonatal factors in autism, pervasive developmental disorder-not otherwise specified, and the general population. Pediatrics 107:E63
(126) J Autism Dev Disord. 2001 Jun;31(3):279-85. Obstetric complications and risk for severe psychopathology in childhood.Eaton WW, Mortensen PB, et al. Department of Mental Hygiene, Johns Hopkins University
(127) Am J Epidemiol. 2008 December 1; 168(11): 1268–1276. Published online 2008 October 21. doi: 10.1093/aje/kwn250 American Journal of Epidemiology © 2008 Advanced Parental Age and the Risk of Autism Spectrum Disorder Maureen S. Durkin et al.
(130) Dioxin emissions from a municipal solid waste incinerator and risk of invasive breast cancer: a population-based case-control study with GIS-derived exposure Jean-François Viel, et al. International Journal of Health Geographics, 2008, Volume 7, Number 1, 4
(131) PCDDs, PCDFs, and PCBs concentrations in breast milk from two areas in Korea: body burden of mothers and implications for feeding infants, Jiyeon Yang et al. Chemosphere 46 (2002) 419–428); and Infant Exposure to Chemicals in Breast Milk in the United States: What We Need to Learn From a Breast Milk Monitoring Program Judy S. LaKind, et al., Children's Health Review Environmental Health Perspectives • VOLUME 109 | NUMBER 1 | January 2001 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242055/pdf/ehp0109-000075.pdf
(133) Child Trends. (2013). Breastfeeding. Available at: http://www.childtrends.org/?indicators=breastfeeding In their "Breastfeeding" report is the following: " Differences by Marital Status: Married mothers are significantly more likely to breastfeed their infants than are nonmarried mothers. Eighty-two percent of infants born in 2007 to married women were ever breastfed, compared with 61 percent born to unmarried mothers. (Appendix 1) The difference was greater for breastfeeding at six and twelve months: married mothers were almost twice as likely as unmarried mothers to still be breastfeeding at those time points."
(137) Community Report From the Autism and Developmental Disabilities Monitoring (ADDM) Network Prevalence of Autism Spectrum Disorders (ASDs) Among Multiple Areas of the United States in 2008, Funded by CDC
(138) The authors withheld the identity of this location from their report, but there is apparently only one place in Utah that fits the data provided in the ADDM report, which is West Valley City: (1) about 2000 students in a single-year age group (U.S. Census 2000 data), and (2) the lowest proportion of whites in the state (the percent of white 8-year-olds in the ADDM study area was even lower than West Valley City’s general white percentage, but West Valley’s white percentage is the lowest in Utah, and only one other city or county in Utah even comes close to such a low percentage of whites).
(146) See Figures 1.8 and 1.9; Also data provided by LaLeche League for Northern Ireland, accessed at http://www.lalecheleague.org/cbi/bfstats03.html, in line with data for Dublin area from: Public Health Nutrition. "Breast-feeding practices in Ireland", Tarrant RC, Kearney JM., School of Biological Sciences, Dublin Institute of Technology, Republic of Ireland, accessed at Proc Nutr Soc. 2008 Nov;67(4):371-80. Epub 2008 Aug 20.
Researchers track down autism rates across the globe, Virginia Hughes 7 April 2011. Regarding Japan, see also http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083083/
(149) J Am Acad Child Adolesc Psychiatry. 1997 Nov;36(11):1561-9. Autism and associated medical disorders in a French epidemiological survey. Fombonne E et al., Institut National de la Santé et de la Recherche Médicale (INSERM), Paris.
(152) Autism and Developmental Disabilities Monitoring Network Surveillance Year 2006 Catherine Rice, PhD et al, National Center on Birth Defects and Developmental Disabilities, CDC, at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5810a1.htm
(158) website of Regionalverband für den Bereich Karlsruhe, Pforzheim, Bruchsal, Calw, Rastatt, Baden-Baden, Landau, Germersheim und weitere Orte at http://www.autismus-karlsruhe.de/21.html Haufigkeit – Autismus Karlsruhe e.V. That refers to ASD prevalence of "ueber ein Prozent der Bevoelkerung" (more than one percent of the population) in Germany.
(162) IDEA data, averaging years 2005-2008 Data Tables for OSEP State Reported Data, Percentage of students ages 6 through 17 served under IDEA, Part B, as a percentage of population, by disability category and state: at https://www.ideadata.org/arc_toc10.asp#partbCC
(173) Survey of Metals in Infant Food, Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, TOX/2003/05 at http://cot.food.gov.uk/pdfs/TOX-2003-05.PDF, Table 2
(174) Ettinger et al. (2014), Maternal Blood, Plasma, and Breast Milk Lead: Lactational Transfer and Contribution to Infant Exposure, Environ Health Perspect; DOI:10.1289/ehp.1307187 at http://ehp.niehs.nih.gov/1307187\
-- also Bellinger DC, Stiles KM, Needleman HL. Low-level lead exposure, intelligence and academic achievement. Pediatrics. 1992;90:855–861
-- also McMichael AJ, Baghurst PJ, Wigg MR, Vimpani GV, Robertson EF, Roberts RJ. Port Pirie cohort study: environmental exposure to lead and children’s abilities at the age of four years. N Engl J Med. 1988;319: 468–475
(182) "Prioritization of Toxic Air Contaminants: Dioxins" - Children’s Environmental Health Protection Act October, 2001 (State of California) At http://oehha.ca.gov/air/toxic_contaminants/pdf_zip/dioxin_Final.pdf, p. 17 ff
(185) Adult Women's Blood Concentrations Levels Vary Regionally in the U.S., by Kathryn R. Mahaffey,1et al (1Office of Science Coordination and Policy, EPA) found at http://www.medscape.com/viewarticle/587407_4
(191) "Particulate Matter (PM) Research Centers (1999–2005) and the Role of Interdisciplinary Center-Based Research", (Fanning et al.), p.4, found at http://www.epa.gov/ncer/science/pm/documents/11543.pdf
(191a) Adolescent Pregnancy and Parenthood: Recent Evidence and Future Directions In Press, American Psychologist Rebekah Levine Coley and P. Lindsay Chase-Lansdale The Irving B. Harris Graduate School of Public Policy Studies, University of Chicago, p. 23
(192) Found a http://www.niehs.nih.gov/research/supported/centers/core/grantees/rochester/index.cfm "Previous studies indicate that UFP (ultrafine particles) can translocate ...... to extrapulmonary organs …. within 4 to 24 hours post exposure. Additional studies were designed to determine whether translocation of inhaled UFP takes place to regions of the brain, ...We demonstrated ..... increases in the striatum (a section of the brain), frontal cortex, and cerebellum. .....We conclude that the olfactory neuronal pathway is efficient for translocating inhaled UFPs to the central nervous system ....."
(193) in the EPA's Health Assessment Document for Diesel Engine Exhaust (2002), in the section that deals with bioavailability of organic constituents present on diesel exhaust particulates (specifically in sections 3.5.3 and 3.5.4)
(194) "Residential Proximity to Freeways and Autism in the CHARGE Study" , Environmental Health Perspectives, Published in 119(6) Jun 2011, Heather E. Volk, Irva Hertz-Picciotto et al., reported (with doubling comment) in ScienceDaily (Dec. 17, 2010), "Proximity to Freeway Associated With Autism"
(195) "Inhalation of Diesel Engine Exhaust Affects Spermatogenesis in Growing Male Rats," N Watanabe and Y Oonuki, Department of Environmental Health, Tokyo Metropolitan Research Laboratory of Public Health, Tokyo, Japan. firstname.lastname@example.org. Environmental Health Perspectives, Vol. 107, No. 7, accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1566672/
(199) Inhalation of Diesel Engine Exhaust Affects Spermatogenesis in Growing Male Rats," N Watanabe and Y Oonuki, Department of Environmental Health, Tokyo Metropolitan Research Laboratory of Public Health, Tokyo, Japan. email@example.com. Environmental Health Perspectives, Vol. 107, No. 7, accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1566672/
(200) “Proposal of Emission Control Area Designation for Geographic Control of Emissions from Ships”, EPA-420-F-09-015, March 2009; the complete, lengthy document can be read online at http://www.epa.gov/nonroad/marine/ci/420f09015.htm .
(201) EPA's Proposal to Designate an Emission Control Area for Nitrogen Oxides, Sulfur Oxides and Particulate Matter,Technical Support Document Chapter 3: Impacts of Shipping Emissions on Air Quality, Health and the Environment
(203) ”Research findings on particulate air pollution from the Southern California Particle Center", John R. Froines, Ph.D., Director, presented at EPA webinar Dec 8, 2010, found at http://www.epa.gov/airscience/seminars/SCPCwebinar8Dec10.pdf
(208) "The Epidemiologyof Autism Spectrum Disorders*, Craig J. Newschaffer,1 et al., Department of Epidemiology and Biostatistics, Drexel University Drexel E-Repository and Archive (iDEA) http://idea.library.drexel.edu ANRV305-PU28-21 ARI 22 December 2006 7:53
10168 : "Maternal Residence Near Agricultural Pesticide Applications and Autism Spectrum Disorders among Children in the California Central Valley", Eric M. Roberts et al.
-006, December 1997, Mercury Study Report to Congress. Volume IV: An Assessment of Exposure to Mercury in the United States, (216) Chlorpyrifos exposure during a critical neonatal period elicits gender-selective deficits in the development of coordination skills and locomotor activity. Dam K at al. Brain Res Dev Brain Res. 2000 Jun 30;121(2):179-87. PubMed - NCBI accessed at http://www.ncbi.nlm.nih.gov/pubmed
(217) Journal of Exposure Analysis and Environmental Epidemiology (2001) 11, 501–509. 10.1038/sj.jea.7500193 Quantitative analysis of children's microactivity patterns: The Minnesota Children's Pesticide Exposure Study N C G FREEMAN et al.
(220) Cognitive Effects of Endocrine-Disrupting Chemicals in Animals, Susan L. Schantz and John J. Widholm, Department of Veterinary Biosciences and Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, Illinois, in Environ Health Perspect 109:1197–1206 (2001). [Online 14 November 2001] Found at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240501/pdf/ehp0109-001197.pdf
(225) Main KM, et al. 2006. Human Breast Milk Contamination with Phthalates and Alterations of Endogenous Reproductive Hormones in Infants Three Months of Age. Environ Health Perspect 114:270-276. http://dx.doi.org/10.1289/ehp.8075
(229) The Mount Sinai Children’s Environmental Health Study, “Prenatal Phthalate Exposure Is Associated with Childhood Behavior and Executive Functioning, S.M. Engel et al. http://ehsehplp03.niehs.nih.gov/article/info:doi%2F10.1289%2Fehp.0901470
(230) Associations between indoor environmental factors and parental-reported autistic spectrum disorders in children 6–8 years of age Malin Larsson, et al. NeuroToxicology Volume 30, Issue 5, September 2009, Pages 822–831 at http://www.ncbi.nlm.nih.gov/pubmed/19822263
(232) Rev Environ Contam Toxicol. 1995;141:1-26. Polybrominated biphenyl and diphenylether flame retardants: analysis, toxicity, and environmental occurrence. Pijnenburg AM, Everts JW, de Boer J, Boon JP. National Institute for Coastal and Marine Management (RIKZ), Ministry of Transport, Public Works and Water Management, The Hague, The Netherlands.
(235) Developmental Neurotoxicity Of Polybrominated Diphenyl Ether (PBDE) Flame Retardants Costa and Giordano 2008 Neurotoxicology National Center for Biotechnology Information, U.S. National Library of Medicine at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2118052/
(236) Polychlorinated Biphenyls (PCBs) and polybrominated diphenhyl ethers (PBDEs) in milk from Italian women living in Rome and Venice", Ingelido et al., Chemosphere, Vo. 67, issue 9, April 2007, obtained from Air Force Institute of Technology, ILL.
PMCID: PMC1626425 Polybrominated Diphenyl Ether (PBDE) Levels in an Expanded Market Basket Survey of U.S. Food and Estimated PBDE Dietary Intake by Age and Sex Arnold Schecter et al.
(236c) U.S. EPA (2010) An exposure assessment of polybrominated diphenyl ethers. National Center for Environmental Assessment, Washington, DC; EPA/600/R-08/086F. online at http://www.epa.gov/ncea data taken from Abstract
(236d) U.S. Environmental Protection Agency 12/30/2009 Polybrominated Diphenyl Ethers (PBDEs) Action Plan at http://www.epa.gov/oppt/existingchemicals/pubs/actionplans/pbdes_ap_2009_1230_final.pdf , p. 12. Note that the EPA has established (in a 2010 document) that the average PBDE intake of an infant via breast milk for a period of 15 to 364 days is 141 ng/kg/day. (236c) Schecter et al. 2005 analyzed PBDEs in breast milk in the U.S. The highest 5% of breast milk levels in the U.S. were 6 to 21 ng/g wet weight. (EPA 11/08 draft, p.8 at http://www.epa.gov/bns/reports/dec2008/dec2-3/TC-%20PBDE_2008.pdf)
(236e) http://www.epa.gov/bns/reports/dec2008/dec2-3/TC-%20PBDE_2008.pdf, pp. 9-10
(236f) Flame Retardants in Furniture, Carpets Might Affect Kids' Development California study found that higher exposures were linked to IQ, attention deficits HealthDay, Medline Plus, NIH 11/25/2012. Similar findings stated in Costa et al., (237c)
(237) Environ Int. 2003 Sep;29(6):771-9. Polybrominated diphenyl ether flame retardants in the North American environment. Hale RC, Alaee M, Manchester-Neesvig JB, Stapleton HM, Ikonomou MG. Department of Environmental and Aquatic Animal Health, Virginia Institute of Marine Science, College of William and Mary, VA, USA. PubMed – NCBI http://www.ncbi.nlm.nih.gov/pubmed
(237b) Environmental Chemicals in Breast Milk J.S. LaKind et al., Figure 5, Encyclopedia of Environmental Health 2011, Pages 347–356 National Institute for Environmental Health Sciences http://dx.doi.org/10.1016/B978-0-444-52272-6.00019-2
(237c) Developmental Neurotoxicity Of Polybrominated Diphenyl Ether (PBDE) Flame Retardants Costa and Giordano 2008 Neurotoxicology National Center for Biotechnology Information, U.S. National Library of Medicine at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2118052/
(240) Dioxins and Dioxin-like Compounds in the Food Supply: Strategies to Decrease Exposure By Institute of Medicine (U.S.). Committee on the Implications of Dioxin in the Food Supply, National Academy of Sciences. National Academies Press, 2003
(241) Agency for Toxic Substances and Disease Registry (ATSDR). 1998. Toxicological profile for Chlorinated Dibenzo-p-dioxins (CDDs). Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, p. 421
(243) Hooper K, She J 2003. Lessons from the Polybrominated Diphenyl Ethers (PBDEs): Precautionary Principle, Primary Prevention, and the Value of Community-Based Body-Burden Monitoring Using Breast Milk. Environ Health Perspect 111:109-114. http://dx.doi.org/10.1289/ehp.5438 Online: 11 December 2002 See also Brominated Flame Retardants: Cause for Concern? Linda S. Birnbaum et al., Environmental Health Perspectives • VOLUME 112 | NUMBER 1 | January 2004 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1241790/pdf/ehp0112-000009.pdf pointing out "concentrations (of PBDEs) from humans have been increasing exponentially"
(243a) Protecting Children from Harmful Chemical Exposures Chemical Safety and Children’s Health Prepared by: IFCS FSC Working Group Chaired by Hungary Chemical Safety in a Vulnerable World IFCS/FORUM-IV/11 INF 7 October 2003 Fourth Session of the Intergovernmental Forum on Chemical Safety Bangkok, Thailand, pp. 9-12, accessed at http://www.who.int/ifcs/documents/forums/forum4/en/11inf_en.pdf
(245b) U.S. EPA (2010) An exposure assessment of polybrominated diphenyl ethers. National Center for Environmental Assessment, Washington, DC; EPA/600/R-08/086F. online at http://www.epa.gov/ncea Executive Summary, p. xxiii
(248) Journal of Exposure Analysis and Environmental Epidemiology (2001) 11, 501–509. 10.1038/sj.jea.7500193 Quantitative analysis of children's microactivity patterns: The Minnesota Children's Pesticide Exposure Study N C G Freeman et al, Table 5
(248b) Schecter, A., et al. Congener-specific Levels of Dioxins and Dibenzofurans in U.S. Food and Estimated Daily ToxicEequivalent Intake, Environmental Health Perspectives Journal 1994; 102(11): p. 962-966, cited at http://www.nrdc.org/breastmilk/chem9.asp
(250) An Inventory of Sources and Environmental Releases of Dioxin-Like Compounds in the United States for the Years 1987, 1995, and 2000", EPA/600/P-03/002F, November 2006: especially Table 1-17. 2000 appears to be the most recent year for which the EPA provides national dioxin release data
(253a) PCDD/F and dioxin-like PCB in human blood and milk from German mothers. Wittsiepe J, et al., Ruhr-Universtität Bochum, Abteilung für Hygiene, Sozial- und Umweltmedizin, Bochum, Germany. Chemosphere. 2007 Apr;67(9):S286-94. Epub 2007 Jan 10. http://www.ncbi.nlm.nih.gov/pubmed/17217986
(257a) C.A. Laroo et al., Emissions of PCDD/Fs, PCBs and PAHs from a Modern Diesel Engine Equipped with Catalyzed Emission Control Systerms, Environmental Science and technology, ACS Publications, June 30, 2011
(258) EPA/600/P-03/002F, November 2006: "An Inventory of Sources and Environmental Releases of Dioxin-Like Compounds in the United States for the Years 1987, 1995, and 2000" , Section 2.4.1. Review of Laboratory-Scale Studies
(259a) http://www.dioxinfacts.org/sources_trends/forest_fires2.html .
(24a3) Broadening the Perspective of Pica: Literature Review ELLA P. LACEY, PhD at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579989/pdf/pubhealthrep00198-0031.pdf
(265a) <<reference needs to be inserted here, from EPA doc? re dioxins forming from HCl present)>> Various experiments have found a very direct correlation between the concentration of HCl present and the amount of dioxins produced during combustion. In one experiment (Eklund et al., 1988), the production of chlorinated compounds (which include dioxins) was shown to drop to zero when the concentration of HCl was below a certain level.(p. 2-22) And in some experiments it was found that, for a given percentage increase in HCl fed into the combustion, the increase in dioxins produced was disproportionately higher than the increase in HCl. p. 2-26).
(267) EPA/600/8-90/057F May 2002 Health Assessment Document for Diesel Engine Exhaust National Center for Environmental AssessmentOffice of Research and Development U.S. Environmental Protection Agency Washington, DC, p. 2-113
(NBA1) Gehrs BC, Riddle MM, Williams WC, Smialowicz RJ (1997). "Alterations in the developing immune system of the F344 rat after perinatal exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin: II. Effects on the pup and the adult." Toxicology 122(3):229-40
(277c) Breastfeeding and Autism P. G. Williams, MD, Pediatrics, University of Louisville, and L. L. Sears, MD, presented at International Meeting for Autism Research, May 22, 2010, Philadelphia Marriot https://imfar.confex.com/imfar/2010/webprogram/Paper6362.html)
*Note from and About the Author, and Acknowledgements: There can be advantages to having a study done by a qualified outsider. Research by PhD's tends to go into great detail in narrowly-defined areas, and they typically conclude with recommendations for future multi-year studies on the subject. I feel that this matter deserves a strong orientation toward determining what can and should be done now to address serious problems. There is already a large amount of research published that relates to this subject, which can be brought together, analyzed and put promptly to use. I received scores in the top 1% on standardized tests when in high school, hold a B.A. cum laude from Oberlin College, did well in challenging biology and chemistry courses, and stood in the top third of my class during a year at Harvard's Graduate School of Business Administration. There were important aspects of the business-school case-study method that have been helpful in making this paper more practically useful (I believe) than much or most of what has been written on the subject, as follows: After carefully studying large amounts of printed matter on a subject, doing whatever numerical calculations seem relevant, and considering pros and cons of various alternatives, one is expected to come up with well-considered recommendations for action. Apparent insufficiency of information available on a subject should not lead one to be satisfied to recommend future long-term studies, if there is a serious problem now. Work around gaps in the available data as best you can, and come up with an action plan reasonably quickly that you can defend in plain English on the basis of the data and common sense. As applied in this case, that approach meant poring through hundreds of studies and reports, plotting local disability data and analyzing regional pollution data sets (with the aid of spreadsheet software), winnowing out some apparent patterns, utilizing the excellent computer expertise, diligent data analysis and real-world knowledge of Matt Hulbert, general assistance and excellent advice from Greta Hammen, accurate data entry, computations, and map-shading assistance from various associates (especially Richard Hybl and Tim Gill), considerable and invaluable assistance from reference librarians at the Central Rappahannock Regional Library (especially Lee Criscuolo and Courtney McAllister) in locating difficult-to-access scientific articles, very helpful thoughts and guidance to information sources from Professor James Corbett of the University of Delaware's College of Earth, Ocean, and Environment, and drawing on insightful comments and suggestions from various acquaintances, employees and friends, including parents from three separate families each with at least one boy and one girl. Normal business calculations are lacking here, for good reason; the costs of most of the proposed remedial measures are so minimal in relation to the lifetime costs of mental impairment and cancer that calculations are unnecessary; some would protect other family members as well as the infant against exposure to known or probable toxins (such as residential wood smoke), some would probably also improve immune function (296), and several would actually save money (such as restricting smoking and eating less meat). In any case, we should not have to wait for completion of ongoing five-year studies before taking constructive steps. For more information about what is behind what is written here, go to www.pollutionaction.org .
Full disclosure: I own and manage a small U.S. company (in Fredericksburg, Virginia) that manufactures durable goods and which competes in a minor but significant way with imports from Asia. My attention was drawn to the subject of mental impairment partly by seeing an increase in sales of my company’s damage-resistant products for use in residences for mentally-handicapped young people, but also by awareness of the increasing toxic pollution emitted by ships bringing imports to U.S. shores. That pollution is mentioned in this paper as only one of many sources of atmospheric toxins that could be involved in causing mental impairment. I have no interest in infant formula.
Office Address: Pollution Action, 27 McWhirt Loop, Ste. 111, Fredericksburg, VA 22406
From this paper's inception in early 2012 until present, the invitation has been extended to all readers to submit criticisms of contents of this paper, asking them to point out how anything written here is not well supported by authoritative sources (as cited) or is not logically based on the evidence presented. As of January 27, 2014, only one comment pointing out an inaccuracy has been received in response to that invitation. (That is significant, since these writings have been viewed by over 10,000 readers per month.) We have received some e-mails that have not criticized contents of this paper but which are of interest, and have responded to most of them, and those inquiries and responses are entered at www.pollutionaction.org/comments.htm . All specific comments are welcome (as opposed to general expressions of distaste), especially those that point out any deficiencies in our evidence in relation to conclusions drawn or any lack of quality in the reasoning. Please send comments to firstname.lastname@example.org .