Abstract
Background
Mother’s milk is not “just nutrition.” Rather, it contains a variety of factors with medicinal qualities that have a profound role in infant survival and health. Mother’s milk is a dynamic and complex fluid, containing nutrients and bioactive factors needed for infant health and development. Beyond somatic growth, pure mother’s milk as a multi-faceted biologic fluid has several other benefits, including modulation of postnatal intestinal function, immune evolution, and brain development. The composition of human milk is dynamic in nature. The primary components of mature milk are carbohydrates, fat, protein, vitamins, minerals, digestive enzymes, and hormones. In addition to these nutrients, mother’s milk is also rich in immune cells, including macrophages; stem cells, and numerous other bioactive molecules (Andreas et al., 2015).
Mother’s milk is considered the purest form of nutrition. However, new evidence emerging has suggested that noxious alteration in mother’s milk composition may occur due to various causes. Diet and the nutritional status of the mother are thought to be among many factors altering human milk composition. As of now, the exact factors responsible for noxious alteration in human milk, the influence of noxious alteration in human milk on infant health, and the management of noxious alteration has not been studied meticulously.
All over the world, a great deal of attention has been paid to the diet and lifestyle of the breastfeeding mother. Throughout the world many cultures make a direct connection between diet and the milk produced; there are so many recommendations and taboos regarding what a breastfeeding mother eats. Most of these ideas do indeed have a scientific basis, while some are the result of cultural attitudes, notions, and superstitions.
Ayurveda is a comprehensive system of health care that originated in India more than 5000 years ago. Within this body of knowledge are the methodologies to provide health care throughout the course of life, from the antenatal period to the geriatric stage. Factors causing mother’s milk vitiation, features of various types of mother’s milk vitiation, its effect on an infant’s health, and the general treatment of vitiated (non-pure) mother’s milk has been explained in extensive detail within the Ayurveda healthcare approach (National Institute of Indian Medical Heritage, Hyderabad, 2010 a).
We reviewed the Ayurveda Classics in terms of various aspects of mother’s milk including definitions, properties, functions, factors causing mother’s milk vitiation its effect on infant health, and general treatment of vitiated mother’s milk. Additionally, we examined recent relevant English-language literature published 2015–2020. Our aims were to (1) describe the causes of mother’s milk vitiation; (2) its influence on the composition of mother’s milk as explained in Ayurveda, in the light of contemporary evidence; and (3) to critically analyze the influence of the consumption of vitiated mother’s milk on an infant.
Ayurveda Perspective of Human Milk
Ayurveda, the traditional Indian system of medicine, consists of eight major disciplines related to human health. Kaumarabhrithya (Ayurveda pediatrics) deals with the healthy upbringing of infants, methods for purification of mother’s milk and treatment of diseases thought to be caused by the consumption of vitiated mother’s milk and other common diseases specific to infant life (National Institute of Indian Medical Heritage, Hyderabad, 2010 b). As per the principles of Ayurveda, mother’s milk is considered as supreme food/best nutrition for the growth and development of the infant (Gupta, 2009).
Based on diet/nutrition, children up to the age of 1 year are called ksheerapa (infants whose staple food is milk) (National Institute of Indian Medical Heritage, Hyderabad, 2010 b). It indicates the advocacy of breastfeeding in children up to age of 1 year in Ayurveda. Further, annaprashan/ phalaprashana sanskara (the first food/fruit introduction ceremony for an infant) at the age of 6 months has been mentioned (Gupta, 2009, and Sarma, 2010). Ayurveda texts recommend exclusive breastfeeding up to 6 months. Gradual Stanyapnayan (weaning) after the initiation of teeth eruption in children, with special diet during this phase, is also advised (Gupta, 2009).
Shuddha Stanya (pure human milk) bestows features of the un-impendent development of strength and body parts, longevity, and growth and development (Kshirottpatti Adhyay) in the infant (Sarma, 2010).
Formation of Human Milk and its Properties
According to the concepts of Ayurveda, the body is made up of seven dhatu (i.e., seven major structural components), namely rasa, rakta, mamsa, meda, asthi, majja, and shukra, and mother’s milk is considered as the updhatu of rasa dhatu (i.e., minor structural components of primary product of digested food). (Gupta, 2009 and National Institute of Indian Medical Heritage, Hyderabad, 2010 a).
Stanya (mother’s milk) is defined as an essence of Rasadhatu (the primary product of digested food) collected in the breast after circulation in the whole body. Whereas, according to conventional medicine, mother’s milk constituents are made from three sources: some are synthesized in the mammary secretory cell from precursors in the plasma, some are produced by other cells in the mammary gland, and some are transferred directly from plasma to milk (Institute of Medicine, 1991).
The Charaka Samhita (7th Century BCE), the foremost classic text on Ayurveda, described the physical characteristics of pure mother’s milk as having a natural color, smell, taste, consistency, and ability to mix uniformly with water (National Institute of Indian Medical Heritage, Hyderabad, 2010 a). Mother’s milk is Madhur (sweet in taste), Snigdha (unctuous), Sheeta (cold in nature), Chakshushya (beneficial for eyes), Jivaniya (a vitality enhancer), Bruhaniya (nourishing) and Satmya (congenial); Nasya (a nasal instillation of human milk) cures Raktapitta (a bleeding disorder), and its Tarpan (the therapeutic retention of liquid medicines over the eyes) reduces Netrashoola (pain in the eyes) (National Institute of Indian Medical Heritage, Hyderabad, 2010 a).
Key Messages
Although human milk is considered the purest form of nutrition for an infant, less is known about the causes of alteration in mother’s milk that reduce the quality of the milk.
Ayurveda, a comprehensive system of healthcare that originated in India more than 5000 years ago, has detailed explanations about factors causing impaired quality of mother’s milk, features of various types of problems, and the influence on an infant’s health.
The Ayurvedic concepts about noxious alteration in mother’s milk may be utilized in clinical pediatric practice after conducting appropriate and rigorous scientific revalidation.
Variations in Composition of Mother’s Milk: Its Causes (Stanydushti Hetu) and Influence on Child Health
The composition of mother’s milk is dynamic and changes over time, adapting itself to the changing needs of a growing child. Further, the variations in mother’s milk are also due to variations in maternal diet, maternal health, and environmental exposure (Antonakou, 2018). All physiological and biochemical phenomena influencing the composition of plasma may also influence the configuration of milk and its composition can also be modified by hormones or other bioactive factors that are capable of influencing biosynthetic processes in the mammary gland. As per the principles of Ayurveda, for production of optimum quality human milk, apart from the nutritional status of the mother, dietary practices (aahar vidhi) and lifestyle (vihar) are given the utmost importance, as they influence host physiology. Two types of factors are attributed to the vitiation of mother’s milk (National Institute of Indian Medical Heritage, Hyderabad (2010 a).
Aahar Hetu (Dietary Factors)
Erroneous dietary practices by the mother, namely ajirnabhojan (eating before the digestion of previously taken food), asatmya aahar (consumption of non-congenial food), visham bhojan (consuming less or more food at an improper time), viruddh aahar (eating combinations of antagonistic foods i.e., certain types of food may have opposite properties, opposite activities on the tissues, may exert some unwanted effects on the body when processed in a particular form, or may exert undesirable effects when combined in certain proportions), atimatrashan (overeating) and excess use of lavan amla and katu rasatmak aahar (excess salty, sour, and pungent foods), kshar aahar (alkaline food), and praklinna anna (humid/moist food).
Three aspects of maternal nutrition, namely current dietary intake, nutrient stores, and alterations in nutrient utilization, could have an influence on human milk composition. Further, many researchers have shown evidence of the influence of maternal diet on different nutritional components. The amount and composition of carbohydrate and protein remain relatively constant in mature human milk; the composition of fat is highly variable and is affected to a large extent by maternal nutrition intake. Type of fat in mother’s milk can be altered by the fat the mother eats (Bravi et al., 2016). Furthermore, variations in maternal diet (changing fat vs. carbohydrate consumption, or changing the consumption of specific sugars), is associated with changes in the milk microbiome (Babakobi et al., 2020). The quantity of micronutrients including Vitamins A, B1, B2, B6, B12, D, K, E, and iodine vary in human milk depending on maternal diet and body stores (Hampel et al., 2018). Maternal diet also alters the sensory qualities of human milk and the nursling’s behavior (Mastorakou et al., 2019). Development of the infant gut microbiome is affected in part by what the mother eats during pregnancy and breastfeeding (Demmelmair et al., 2020).
Vihar Hetu (Lifestyle-Related Factors)
These include Mana sharir santap (mental and physical stress), ratri jagaran (night awakening), madyapan (use of wine), bhukte diwaswap (napping just after meal), avyayam (lack of exercise), abhighaat (trauma), krodh (anger), and so on. Of the lifestyle factors, the effect of smoking and alcohol use has been studied so far. The passage of mycotoxin to mother’s milk has been found following the mother’s exposure to smoking (Memiş & Yalçın, 2019). Alcohol use during the period of breastfeeding was found to significantly compromise a child’s development. (May et al., 2016). These two types of factors cause aggravation of tridosha (three regulatory functional factors of the body); these aggravated dosha move through the channels carrying mother’s milk (stanyavaha srotas) and may vitiate the milk.
Conventional researchers have noted three types of changes in human milk, namely changes in the nutritional component, changes in the bioactive component, and the passage of microbes/toxin/allergic substances in mother’s milk due to various factors. Ayurveda scholars were able to divide the changes in human milk into eight categories (Figure 1). These features of vitiated milk mentioned in Ayurveda need further validation with appropriate studies.
Pathology of Human Milk Vitiation as per the Ayurveda Principle with Eight Types of Afflictions and its Influence on Infant Health.
The qualitative and quantitative alteration of mother’s milk composition has an adverse influence on the health of children. Among all the nutrient components in the mother’s milk, fatty acids have been reported to have extreme sensitivity to maternal nutrition and are implicated in the neurological development of the child (Guesnet et al., 2018). Researchers conducting studies on mice have highlighted the importance of maternal diet during lactation on offspring health. High fat diet consumption during pregnancy and lactation in mice has shown decreased exercise performance and training efficiency in the offspring, further increasing the risk of obesity development in adult life (Kasch et al., 2017). Further, other researchers’ studies on animals have revealed that maternal high fat diet in early life can inhibit intestinal development, induce dysbiosis, low-grade inflammation leading to the disruption of the intestinal mucosal barrier in offspring, and enhance DSS-induced colitis in adulthood (Bibi et al., 2017). Milk from mothers with beriberi contains less thiamine that that of healthy women, and infants nursed by those mothers develop the disease by 3 or 4 weeks of age (Barennes et al., 2015). Maternal diet during lactation may influence the development of allergies in the child (Baïz et al., 2019; Jeurink et al., 2019). Intake of vegetable oils, margarine, nuts, and fast food has shown higher risk of allergic disorder in infants (Beckhaus et al., 2015). It has also been observed in many case reports that components of foods ingested by the mother pass into the milk and then cause allergic reactions in the infant (United States Institute of Medicine et al., 1991).
Ayurveda medicine considers mother’s milk as an updhatu (minor structural components) of Rasa dhatu (the primary product of digested food); milk vitiating factors primarily affect the formation of plasma by impairing agni (digestive power) ultimately leading to the vitiation of mother’s milk by vitiating the tridosha. Each vitiated dosha alters the physicochemical and biochemical properties of milk, as explained in Figure 1.
Ayurveda texts state that various diseases/symptoms occur in infants due to the consumption of vitiated milk. Researchers have revealed that the vitiation of mother’s milk can be possible through three types of changes: changes in nutritional components, changes in bioactive components, and the passage of microbes/toxin/allergic substances in mother’s milk leading to different diseases in the infant who consumes it. Thus, the clinical features of an infant who consumes vitiated mother’s milk may be due to three types of alteration in mother’s milk. They can be classified as emaciation (Krushibhavati), tiredness (Klama), decreased growth (krucchen ch vivardhate), loss of energy (Balhraas) and a weak cry (Kshamswaro) due to changes in nutritional components. Constipation or the suppression of feces, urine, and flatus (badha vinmutra marut), diarrhoea (bhinna vit), vomiting (chardi), tenesmus (kunthan), excessive salivation (lalalu), anemia (pandu), and jaundice (kamala) due to changes in the microbiome/bioactive component of mother’s milk. A runny nose (pinasa), dyspnoea, cough, and expectoration (shwas, kasa, tamaka shwasa) due to the passage of microbes/toxin/allergic substances in mother’s milk. Exact mechanisms underlying these findings, though, are very clear as per the principles laid down in Ayurveda; however, these are poorly understood in light of contemporary knowledge and therefore, need further investigation.
Management of Vitiated Mother’s Milk
There is evidence of management of allergic manifestation in infants caused by components of foods ingested by the mother by diet modification or diet restriction. It has been observed that maternal dietary restrictions for 3 months during lactation resulted in a lower rate of atopic dermatitis among the mothers’ infants for 6 months (Greer et al., 2019). Further, problems related to allergic reactions in infants caused by components of foods ingested by the mother and passed through her milk can be prevented by excluding the allergens from her diet (United States Institute of Medicine et al., 1991). Management of vitiated milk including Panchakarma, galacto depurant herbs (general and specific based on type of alteration in milk), and Pathya Aahara to be administered to the lactating mother has been proposed in Ayurveda as mentioned in Table 1 (Caraka, Sharir Sthana 8/56; Caraka, Chikitsa Sthana 30/263-280).
Ayurveda Management of Vitiated Human Milk.
Note. HM = Human Milk. The dosage of drugs/herbal formulations and type of bio-cleansing therapies to be administered to the lactating mother depends upon factors like the strength of the mother (Rogi bala) and the type and extent of vitiation of dosha (Roga bala), and hence will be at the discretion of the treating physician. Botanical names of the herbs mentioned in Table 1 have been adopted from The Plant List [http://www.theplantlist.org/]. Translation for various Ayurveda terminology used in table has been adopted from the National AYUSH Morbidity & Standardized Terminologies Portal (NAMASTE PORTAL; http://namstp.ayush.gov.in/#/sat).
The complete description of the mother’s milk, including its importance, benefits, age of exclusive breastfeeding, weaning and so forth, holds true even today and is congruous with the World Health Organization’s and the United Nations Children’s Fund’s advice regarding breastfeeding (UNICEF, 2018; WHO, 2019). The influence of maternal nutrition on mother’s milk composition has been well studied. However, there is a paucity of scientific investigations on the effect of inappropriate dietary practices and the lifestyle of lactating mothers, as described in Ayurveda, on the physiology of the mother and the transformation it brings in the physicochemical properties of mother’s milk. Therefore, there is a need to investigate the independent effects of dietary practices and lifestyle on host physiology and the changes it makes to the composition of mother’s milk. The effect of bio-purificatory procedures and herbs advocated for the management of vitiated mother’s milk on mother’s physiology and milk composition is a potential area for further research. Further, in clinical practice, pediatricians need to keep in mind the concept of noxious alteration in mother’s milk, while analysis of various complaints of breastfeeding infants and, based on these complaints, dietary/lifestyle advice and treatment for the mother, may be prescribed. By doing this, unnecessary infant medication can be avoided.
In this current document, we attempted to analyze the Ayurveda concepts of noxious alteration in mother’s milk with the help of available modern literature. However, to understand whether the documented knowledge in various classical scriptures of Ayurveda is reliable, valid, and reproducible, there is a need for evidence creation through analytical research studies on the assessment of the influence of inappropriate maternal dietary practices and lifestyle regimen on host physiology; the physical and chemical properties of mother’s milk along with changes in its nutritional components, as explained in the concept of stanydushti; and the effect of noxious alteration in mother’s milk on an infant’s nutritional status, growth, and health. Further, interventional studies of appropriate research design and technical sophistication are needed to investigate the effect of various treatments explained for the management of vitiated milk.
Conclusions
Ayurveda medicine considers pure human milk as the best food for the overall growth and development of children during the early phase of life. Apart from nutritional status, the aaharvidhi (dietary practices) and lifestyle of the mother is of utmost importance in healthy milk production. Researchers have revealed that all physiologic and biochemical phenomena that influence the composition of plasma may influence the composition of milk. Thus, the physiological and biochemical process vindicates the concept of mother’s milk vitiation as explained in Ayurveda. This concept of the noxious alteration in mother’s milk explained in Ayurveda needs rigorous scientific revalidation for utilization in clinical pediatric practice.
Footnotes
*Editor’s Note
JHL has a policy of not publishing references from predatory publishers. The references in the Reference List with * were published in journals whose publishers have been criticized by some academics for low standards of peer review as well as some allegations of academic misconduct. Others have felt these publishers have done their due diligence. Due to the importance of the topic covered in this review, we left the inclusion of these articles to the authors’ discretion. The authors have reviewed all references and take responsibility for their quality
Disclosures and Conflicts of Interest
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All the authors are Ayurveda researchers and practitioners. However, we declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
