228 CNO Report 23 APR 2016

228CNO25APR2016

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CNO Report 228

Release Date 23 APR 2016

Draft Report Compiled by

Ralph Turchiano

http://www.clinicalnews.org

 

 

1.       Physicians’ knowledge about FDA approval standards for ‘breakthrough therapy’

2.       Maple syrup protects neurons and nurtures young minds

3.       Increase in coffee consumption could provide protective effect in non-alcoholic fatty liver disease

4.       Fast food may expose consumers to harmful chemicals called phthalates

5.       Compound from hops lowers cholesterol, blood sugar and weight gain

6.       Great willow herb as an antidote in therapies against multi-drug resistant bacteria

7.       Antihistamines affect exercise recovery, may or may not be a problem

8.       Watercress extract detoxifies carcinogens in smokers, clinical trial demonstrates

9.       The unique biology of human breast milk

 

Public Release: 12-Apr-2016

Physicians’ knowledge about FDA approval standards for ‘breakthrough therapy’

The JAMA Network Journals

In a study appearing in the April 12 issue of JAMA, Aaron S. Kesselheim, M.D., J.D., M.P.H., of Brigham and Women’s Hospital, Boston, and colleagues surveyed internists and specialists to examine their knowledge about Food and Drug Administration (FDA) approval standards and perceptions of the “breakthrough therapy” designation.

Since 2012, the FDA can designate a drug as a “breakthrough therapy” if preliminary clinical evidence–such as an improvement in a pharmacodynamic biomarker–suggests an advantage over existing options. The term is routinely used in press releases and prescribing resources. Although the term breakthrough leads consumers to overly optimistic beliefs about drug effectiveness, it is not known how physicians understand this term, or more generally, what FDA approval means.

Of 1,148 physicians contacted, 692 physicians (60 percent) responded. Participants were asked 3 questions about FDA approval and 5 about breakthrough therapies. Respondents showed limited knowledge of FDA approval: 73 percent incorrectly believed FDA approval meant comparable effectiveness to other approved drugs; 70 percent incorrectly believed approval required both a statistically significant and clinically important effect. Among the 3 breakthrough knowledge questions, 52 percent incorrectly believed that strong evidence (randomized trials) is needed to earn the breakthrough designation.

“The misconceptions identified may lead physicians to overprescribe newly approved drugs–particularly breakthrough therapies– and inadequately communicate how well these drugs work to the patients who will use them,” the authors write.

Public Release: 13-Apr-2016

Maple syrup protects neurons and nurtures young minds

Two young students show how maple syrup prevents the development of amyotrophic lateral sclerosis in the C. elegans worm

University of Montreal Hospital Research Centre (CRCHUM)

 

Montreal (Quebec), April 13, 2016 – Catherine Aaron and Gabrielle Beaudry were 17 when they knocked on the door of the laboratory of Alex Parker, a neuroscience researcher at the University of Montreal Hospital Research Centre (CRCHUM). While students at Collège Jean-de-Brébeuf in Montreal, they were looking for a mentor for an after-school research project. Two and half years later, the results of this scientific adventure were published today in the Journal of Agricultural and Food Chemistry.

“We wanted to test the effect of a natural product on a neurodegenerative disease such as Alzheimer’s. Professor Parker had already discovered that sugar prevents the occurrence of amyotrophic lateral sclerosis (ALS) in an animal model of the disease, the C. elegans worm. That’s how we got the idea of maple syrup, a natural sugar produced in Quebec,” said Beaudry.

Supervised by PhD student Martine Therrien and Alex Parker, Aaron and Beaudry added maple syrup to the diet of these barely 1 mm-long nematodes. “We just gave them a supplement of maple syrup at various concentrations and compared with a control group that had a normal diet,” said Aaron. “After twelve days, we counted under the microscope the worms that were moving and those that were paralyzed. The worms that had consumed the highest dose of syrup were much less likely to be paralyzed.”

Alex Parker’s C. elegans worms are genetically modified to express a protein involved in ALS in motor neurons – TDP-43. “When they are adults, around 12 days, their motor neurons break down. Normally, at two weeks of life, 50% of the worms are completely paralyzed. But among those that received a diet enriched with 4% maple syrup, only 17% were paralyzed. We can therefore conclude that maple syrup protects neurons and prevents the development of amyotrophic lateral sclerosis in C. elegans worms,” said Parker, a researcher at the CRCHUM and professor at the Faculty of Medicine, University of Montreal.

How can we explain this dramatic effect? “Sugar is good for the nervous system. Diseased neurons require more energy to combat toxic proteins. But maple syrup is rich in polyphenols, powerful antioxidants found in certain foods. We isolated phenols contained in the maple syrup, and we showed that two polyphenols in particular, gallic acid and catechol, have a neuroprotective effect. In pure maple syrup, these polyphenols are found in low concentrations. Probably a combination of sugar and polyphenols prevents the occurrence of the disease in worms,” said Therrien, a PhD student at the CRCHUM.

But don’t go ahead and gorge yourself on maple syrup thinking it’ll protect you against neurological diseases! “The life expectancy of C. elegans worms is only three weeks. They are spared the long-term toxic effects of sugar. Humans who consume comparable amounts of sugar risk developing chronic diseases such Type 2 diabetes and obesity,” cautioned Parker.

Amyotrophic lateral sclerosis is a rare neuromuscular disease that causes paralysis and death a few years after the onset of symptoms. So far, no cure is available for patients. This latest study on maple syrup and the C. elegans worm was conducted for educational purposes. Other studies by Alex Parker with C. elegans have led to the discovery of promising drugs, which will be tested in patients in a few years.

Catherine Aaron and Gabrielle Beaudry won the Sanofi Biogenius Canada People’s Choice Award – Quebec section – for this project in April 2014. Aaron is now a first-year medical student at the University of Montreal, and Beaudry studies psychology at the University of Sherbrooke.

Public Release: 13-Apr-2016

Increase in coffee consumption could provide protective effect in non-alcoholic fatty liver disease

A daily dose of coffee could improve several key markers of non-alcoholic fatty liver disease by reducing permeability of the gut

European Association for the Study of the Liver

April 13, 2016, Barcelona, Spain: Adding coffee to the diet of people with non-alcoholic fatty liver disease (NAFLD) could help reverse the condition, according to a new study conducted in mice presented at The International Liver CongressTM 2016 in Barcelona, Spain.

The study found that a daily dose of coffee (equivalent to six cups of espresso coffee for a 70kg person) improved several key markers of NAFLD in mice that were fed a high fat diet. These mice also gained less weight than others fed the same diet without the dose of caffeine.

The scientists also showed how coffee protects against NAFLD by raising levels of a protein called Zonulin (ZO)-1, which lessens the permeability of the gut.1 Experts believe that increased gut permeability contributes to liver injury and worsens NAFLD.2 People suffering from NAFLD can develop scaring of the liver, also known as fibrosis, which can progress to a potentially life-threatening condition known as cirrhosis.3

“Previous studies have confirmed how coffee can reverse the damage of NAFLD but this is the first to demonstrate that it can influence the permeability of the intestine,” said Vincenzo Lembo, at the University of Napoli, Italy and study author. “The results also show that coffee can reverse NAFLD-related problems such as ballooning degeneration, a form of liver cell degeneration.”

Researchers analysed three different groups of mice over a 12 week period. Group one received a standard diet, group two had a high fat diet and group three was given a high fat diet plus a decaffeinated coffee solution.

Coffee supplementation to a high fat diet significantly reversed levels of cholesterol (p<0.001), alanine aminotransferase (an enzyme which levels increase in the blood when the liver is damaged) (p<0.05), amount of fat in the liver cells (steatosis) (p<0.001) and ballooning degeneration (p<0.05). The combination of coffee and a high fat diet also reduced weight gain over time (p=0.028) in the mice. The study results suggest that coffee supplementation could cause variations in the intestinal tight junctions, which regulate the permeability of the intestine.4

“Italy is famous for its coffee and this Italian study has reinforced our knowledge on the link between it and non-alcoholic fatty liver disease,” said Professor Laurent Castera, EASL Secretary General. “Although not suggesting that we should consume greater levels of coffee, the study offers insights that can help future research into and understanding of the therapeutic role coffee can play in combating NAFLD.”

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About The International Liver Congress™

This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ takes place from April 13 – 17, 2016, at the Fira Barcelona Gran Via, Barcelona, Spain.

Public Release: 13-Apr-2016

Fast food may expose consumers to harmful chemicals called phthalates

George Washington University Milken Institute School of Public Health

WASHINGTON, DC (April 13, 2016) — People who reported consuming more fast food in a national survey were exposed to higher levels of potentially harmful chemicals known as phthalates, according to a study published today by researchers at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University. The study, one of the first to look at fast-food consumption and exposure to these chemicals, appears in the journal Environmental Health Perspectives.

“People who ate the most fast food had phthalate levels that were as much as 40 percent higher,” says lead author Ami Zota, ScD, MS, an assistant professor of environmental and occupational health at Milken Institute SPH. “Our findings raise concerns because phthalates have been linked to a number of serious health problems in children and adults.”

Phthalates belong to a class of industrial chemicals used to make food packaging materials, tubing for dairy products, and other items used in the production of fast food. Other research suggests these chemicals can leach out of plastic food packaging and can contaminate highly processed food.

Zota and her colleagues looked at data on 8,877 participants who had answered detailed questions about their diet in the past 24 hours, including consumption of fast food. These participants also had provided researchers with a urinary sample that could be tested for the breakdown products of two specific phthalates–DEHP and DiNP.

Zota and her colleagues found that the more fast food participants in the study ate the higher the exposure to phthalates. People in the study with the highest consumption of fast food had 23.8 percent higher levels of the breakdown product for DEHP in their urine sample. And those same fast food lovers had nearly 40 percent higher levels of DiNP metabolites in their urine compared to people who reported no fast food in the 24 hours prior to the testing.

The researchers also discovered that grain and meat items were the most significant contributors to phthalate exposure. Zota says the grain category contained a wide variety of items including bread, cake, pizza, burritos, rice dishes and noodles. She also notes that other studies have also identified grains as an important source of exposure to these potentially harmful chemicals.

In addition, the researchers also looked for exposure to another chemical found in plastic food packaging–Bisphenol A or BPA. Researchers also believe exposure to BPA can lead to health and behavior problems, especially for young children. This study found no association between total fast food intake and BPA. However, Zota and her colleagues found that people who ate fast food meat products had higher levels of BPA than people who reported no fast food consumption.

This study fits into a bigger field of ongoing research showing that phthalates are in a wide variety of personal products, toys, perfume and even food. In 2008 Congress banned the use of phthalates in the production of children’s toys because of concerns about the health impact of these chemicals.

But Zota notes that DEHP and DiNP are two phthalates still in use despite concerns that they leach out of products and get into the human body. Studies of the health impact of exposure to these chemicals have suggested they can damage the reproductive system and they may lead to infertility.

Large studies that might conclusively link phthalates in fast food and health problems could take years to conduct. In the meantime, Zota offers some common sense advice. She notes that frequent consumption of fast food is not recommended because such foods contain higher amounts of fat, salt and calories. “People concerned about this issue can’t go wrong by eating more fruits and vegetables and less fast food,” Zota suggests. “A diet filled with whole foods offers a variety of health benefits that go far beyond the question of phthalates.”

Public Release: 18-Apr-2016

Compound from hops lowers cholesterol, blood sugar and weight gain

Oregon State University

CORVALLIS, Ore. – A recent study at Oregon State University has identified specific intake levels of xanthohumol, a natural flavonoid found in hops, that significantly improved some of the underlying markers of metabolic syndrome in laboratory animals and also reduced weight gain.

The findings were published in a special issue of Archives of Biochemistry and Biophysics that was focused on “Polyphenols and Health,” and they suggest a possible new approach to issues such as human obesity, high cholesterol and elevated glucose.

Combinations of these problems, collectively known as metabolic syndrome, are linked to some of the major health issues and causes of death in the developed world today – especially cardiovascular disease and type-2 diabetes.

In this research, laboratory mice were fed a high-fat diet, and given varying levels of xanthohumol. Compared to animals given none of this supplement, the highest dosage of xanthohumol given to laboratory rats cut their LDL, or “bad” cholesterol 80 percent; their insulin level 42 percent; and their level of IL-6, a biomarker of inflammation, 78 percent.

Because they were still growing, eating a rich diet, gaining weight and becoming obese, the weight of the lab animals increased, but by 22 percent less in those receiving xanthohumol, even though all animals ate the same amount of food. Intake of xanthohumol appears to increase their oxygen consumption and metabolic rate, with implications for weight control.

“This is the first time we’ve seen one compound with the potential to address so many health problems,” said Cristobal Miranda, a research assistant professor with OSU’s Linus Pauling Institute and lead author on this study. “These were very dramatic improvements.”

More research will be required to show safety and efficacy in humans, the researchers said.

“Work is still needed to further demonstrate the safety of high doses of xanthohumol, but dosages 15-30 times higher than we used have already been given to animals with no apparent problems,” said Fred Stevens, a professor in the OSU College of Pharmacy, principal investigator with the Linus Pauling Institute, and corresponding author on the research.

“After further study, this might provide an effective treatment for metabolic syndrome at a very low cost.”

This study for the first time also identified one of the mechanisms of action of xanthohumol – it appears to decrease plasma levels of PCSK9, a protein that plays a role in cholesterol levels. Lowering levels of PCSK9 should increase the clearance of LDL cholesterol from the blood.

Metabolic syndrome is defined by clinical diagnosis of three or more of several conditions, including abdominal obesity, elevated lipids, high blood pressure, pro-inflammatory state, a pro-thrombotic state, and insulin resistance or impaired glucose tolerance. About 25-34 percent of the adults in the United States meet these criteria, putting them at significantly increased risk for cardiovascular disease and type-2 diabetes.

Direct health care costs arising from obesity or related disorders account for up to 10 percent of U.S. health care expenditures, the researchers noted in their study.

Xanthohumol has been the subject of considerable research for its potential health benefits, as have other flavonoids such as those found in tea, garlic, chocolate, apples and blueberries.

Xanthohumol is found naturally in hops and beer, but the highest level used in this research was 60 milligrams per kilogram of body weight per day. This corresponds to a human equivalent dose of 350 milligrams per day for a 70-kilogram person, which far exceeds any amount that could be obtained by ordinary dietary intake. A level that high would equate to a beer intake of 3,500 pints per day for a human adult.

However, that amount of xanthohumol could readily be obtained in a dietary supplement that could be taken once a day.

Public Release: 18-Apr-2016

 

Great willow herb as an antitode in therapies against multi-drug resistant bacteria

A common herb could help reduce antibiotic doses and result in less severe side effects in treatments against multi-drug resistant microorganisms

De Gruyter Open

 

Although often considered a weed, due to its anti-inflammatory and antioxidant properties, willow herb has long enjoyed a solid reputation for easing problems of the prostate gland and urinary tract. New tests confirm that combining some of the commonly used antibiotics with great willow herb extracts may be beneficial in treating bacterial and fungal infections as well.

Many strains of bacteria are becoming resistant to even the strongest antibiotics, causing deadly infections and becoming a global health issue. In America alone this accounts for at least 23,000 deaths each year, as an abuse of antibiotics promotes the development of antibiotic-resistant bacteria. As more and more bacterial strains do not react to any of currently known antibiotics, scientists often turn to nature, screening for plant-derived compounds to identify new drug leads which would be able to control the populations of multi-drug resistant bacteria. An article published now online in Open Chemistry suggests that some of the willow herb extracts exert a synergistic effect with common antibiotics.

Using different solvents, the scientists from the National Institute of Chemical-Pharmaceutical R&D, ICCF-Bucharest in Romania prepared a series of great willow herb extracts. They then screened the extracts – rich in phenolic acids and flavonoids – for their antimicrobial effect against selected bacterial and fungal strains, to further test different concentrations of extracts along with a series of antibiotics for the possible effects of these combinations on the observed antimicrobial effect.

Interestingly enough, they were able to observe the synergistic effect on bacterial strains which were resistant to some of the commonly used antibiotics. The authors hence suggest that this development could lead to reducing the antibiotic doses, and consequently to less severe side effects in therapies against multi-drug resistant microorganisms. Courtesy of the herbal healer, some bacterial or fungal infections can be treated with better effects when compared to a therapy based only on antibiotics, as it has potential to influence the antimicrobial effect of some common antibiotics and antibiotics may be co-administered with plant-derived compounds to potentiate their antimicrobial effect.

Public Release: 14-Apr-2016

Antihistamines affect exercise recovery, may or may not be a problem

University of Oregon research identifies 3,000 genes that are busy after exercise, including 795 that are altered by strong doses of histamine blockers

University of Oregon

EUGENE, Ore. — April 14, 2016 — After vigorous exercise, some 3,000 genes go to work to aid recovery by boosting muscles and blood vessels, but in the presence of high doses of antihistamines almost 27 percent of the gene response is blunted, according to University of Oregon researchers.

Whether the antihistamine effect on 795 affected genes might suggest a problem for competitive athletes and devoted exercisers, however, is not known, said John R. Halliwill, professor of human physiology. He was one of 10 co-authors of the study now online ahead of print in the Journal of Physiology.

Histamine is a substance in the body that responds to pollens, molds, animal dander, insect bites and other allergens. Too much response in some people fuels uncomfortable allergic reactions, prompting the use of antihistamines.

Halliwill discovered in 2005 that histamines also relax blood vessels, increasing blood flow that aids post-exercise recovery. That emerged from his original focus on why some people, including athletes, pass out after vigorous physical exertion. He later found a link between an over-activation of two histamine receptors to drops in blood pressure.

The new study — led by doctoral student Steven A. Romero and in collaboration with Hans Dreyer, a departmental colleague who studies muscle physiology — expanded the research to a wider genetics level. Researchers sequenced RNA, molecules essential for protein synthesis and signaling among genes, with state-of-the-art equipment in the UO’s Genomics Core Facility.

“We were looking for pathways associated with the growth of new blood vessels,” said Halliwill, who is director of the department’s Exercise and Environmental Physiology Lab. “We saw evidence of that, but we also saw gene expression associated with glucose uptake by muscles, restructuring of muscle in response to exercise, immune responses and intercellular communications.”

In the research, 10 men and six women, all 23-25 years old, physically fit and active, performed an hour of knee-extension exercise at 60 percent of their peak power, about 45 kicks per minute. Biopsies were done before and three hours after exercise to obtain samples of the quadriceps (vastulus lateris), skeletal muscles on the side of the thighs.

Eight participants took 540 milligrams of fexofenadine and 300 milligrams of ranitidine — levels nearly three times the recommended dosages of the over-the-counter antihistamines. Each target one of the two known histamine receptors involved in recovery responses.

During exercise, blood flow, blood pressure and heart rate were monitored. The three-hour recovery window allowed the team to study gene transcription slightly beyond previous work that had found histamine improved blood flow for two hours after exercise.

The antihistamines had no effect prior to exercise and little influence on gene expression at the conclusion of the workout. Three hours after exercise 88 percent of the 795 genes affected by the antihistamines mostly responded with lower levels of expression.

“Histamine, a substance that we typically think of negatively and is most often associated with seasonal allergies, is an important substance contributing to the normal day-to-day response to exercise in humans,” said Romero, who is now at the University of Texas Southwestern Medical Center in Dallas on a postdoctoral fellowship from the National Institutes of Health.

In their conclusion, the authors noted that the research highlighted only a small fraction of genes likely involved in signaling pathways influenced by histamine receptors activation during recovery.

“Our data really highlight that there remain many unanswered questions regarding the use of exercise to promote beneficial adaptations in humans, Romero added. “Integrative physiologists from across the world have spent a great deal of effort conducting elegant studies in humans and yet we still have much work left to do.”

A key question is whether people should avoid taking antihistamines when they exercise. It’s too early to make that call, Halliwill said.

“We’ve got more work that we have to do,” he said. “We need to do a training study in which we put people on histamine blockers and see if their adaptations to exercise training are as robust or diminished. There are a lot of redundancies in physiological systems. I wouldn’t be surprised if blocking histamine receptors ends up being overcome by something else, but I also wouldn’t be surprised if we can demonstrate that some responses to exercise training do become blunted if you take high doses of histamine blockers.”

Public Release: 19-Apr-2016

Watercress extract detoxifies carcinogens in smokers, clinical trial demonstrates

University of Pittsburgh Schools of the Health Sciences

NEW ORLEANS, April 19, 2016 – Watercress extract taken multiple times a day significantly inhibits the activation of a tobacco-derived carcinogen in cigarette smokers, researchers at the University of Pittsburgh Cancer Institute (UPCI), partner with UPMC CancerCenter, demonstrated in a phase II clinical trial presented today at the American Association for Cancer Research (AACR) Annual Meeting in New Orleans.

The trial also showed that the extract detoxifies environmental carcinogens and toxicants found in cigarette smoke, and that the effect is stronger in people who lack certain genes involved in processing carcinogens. This trial was supported by a grant from the National Cancer Institute (NCI).

“Cigarette smokers are at far greater risk than the general public for developing lung cancer, and helping smokers quit should be our top cancer prevention priority in these people,” said Jian-Min Yuan, M.D., Ph.D., associate director of the UPCI’s Division of Cancer Control and Population Science and an epidemiologist with Pitt’s Graduate School of Public Health. “But nicotine is very addictive, and quitting can take time and multiple relapses. Having a tolerable, nontoxic treatment, like watercress extract, that can protect smokers against cancer would be an incredibly valuable tool in our cancer-fighting arsenal.”

Dr. Yuan, who also is Pitt’s Arnold Palmer Endowed Chair in Cancer Prevention, and his colleagues enrolled 82 cigarette smokers in the randomized clinical trial. The participants either took 10 milligrams of watercress extract mixed in 1 milliliter of olive oil four times a day for a week or they took a placebo. Each group of participants then had a one week “wash-out” period where they didn’t take anything and then switched so that those getting the placebo now received the extract. They all continued their regular smoking habits throughout the trial.

In one week, the watercress extract reduced activation of the carcinogen known as nicotine-derived nitrosamine ketone in the smokers by an average of 7.7 percent. It increased detoxification of benzene by 24.6 percent and acrolein by 15.1 percent, but had no effect on crotonaldehyde. All the substances are found in cigarette smoke.

Participants who lacked two genes involved in a genetic pathway that helps the antioxidant glutathione remove carcinogens and toxicants from the body saw an even bigger benefit to taking the watercress extract, which increased their detoxification of benzene by 95.4 percent, acrolein by 32.7 percent and crotonaldehyde by 29.8 percent.

A phase III clinical trial in hundreds of people must be performed before the treatment could be recommended for smokers, and Dr. Yuan warned that while eating cruciferous vegetables, such as watercress and broccoli, is good for people, they are unlikely to have the same pronounced effect as the extract.

Public Release: 19-Apr-2016

The unique biology of human breast milk

Cell Press

Humans may have the most complex breast milk of all mammals. Milk from a human mother contains more than 200 different sugar molecules, way above the average 30-50 found in, for example, mouse or cow milk. The role of each of these sugars and why their composition changes during breastfeeding is still a scientific puzzle, but it’s likely connected to the infant immune system and developing gut microbiome. A Review of what’s known and the different jobs of human breast milk appears April 19 in Trends in Biochemical Sciences.

Breast milk is often an infant’s first meal, but many of the sugar molecules in the milk are not meant to feed the baby. Infants are born sterile of any bacteria in their guts, but within a few days they have millions, and after a week there are billions. The sugars that come from mother’s milk are usually the first compounds that these bacteria have to chew on, a free lunch that is intended to culture specific bacterial species.

“The first impact breast milk has is favoring the colonization of the gut by specific bacterial groups that can digest these sugar molecules,” says Review co-author Thierry Hennet, from the Institute of Physiology at the University of Zurich. “Infants don’t have the machinery to digest these sugars so they are literally for the bacteria–it’s like a seeding ground, and breast milk is the fertilizer.”

Human breast milk also helps lay the foundation for the new baby’s immune system. After birth, milk is rich in antibodies and molecules that slow the growth of harmful bacteria and coordinate white blood cell activity.

After one month, when the infant begins developing an adaptive immune system of his or her own, the composition of breast milk transitions so that levels of maternal antibodies drop by more than 90 percent. There is also a sharp decrease in the diversity of breast milk sugars, indicating less selection for bacterial species. Instead, mature human breast milk has an increased number of fat and other nutrients that support infant growth.

Despite the many functions of breast milk, children can grow up healthy with limited supplies or without ever being exposed, raising controversial questions about what is normal when it comes to breastfeeding. Breast milk clearly reduces infant mortality and significantly decreases a newborn’s risk for gut and airway infections, but there’s little support for longer-term benefits.

“We have to be careful about giving any recommendations,” says Hennet, who co-wrote the Review with Lubor Borsig, also a physiologist at the University of Zurich. “On the one hand, breast milk is the product of millions of years of evolution and certainly possesses the optimal nutrients for a newborn, but the question is how long does the newborn really need this supply? We feel families should make that decision, and not scientists.”

What researchers can do is continue to work on understanding the role of all of the different molecules in breast milk, something that has become much easier with advances in gene sequencing technologies. The next few years are likely to yield new understanding of the hormones within human breast milk and the exact role of the bacterial populations that it cultures in the infant gut.