Such Sweet Sorrow

I kind of figured sugar would sneak back. It always does! Just when you think it should be terminally ashamed of the stuff it’s done, it shows up as somebody else and fools everybody. I mean, forget trying to pretend that you don’t recognize it in a crowd, that you can’t see under its mask. Sugar is, well, sugar, eh? No matter how it tries to sweet-talk its way around you, it is what it does. Period.

But what is that? Apart from fuelling our atavistic requirements for easily assimilable energy, and therefore surviving early Darwinian whittling, I’ve often wondered if there’s more to sugar than meets the tongue. It has too large a presence in our world to be confined to pleasure alone. Almost every organism seems drawn to it. Should this be telling us something?

Every once in a while my overweening, but naïve hunches are rewarded with information that addresses much the same issues but in ways I hadn’t considered: http://www.bbc.com/future/story/20180328-how-sugar-could-help-heal-wounds?

Moses Murandu is a man who grew up in the rural Easter Highlands of Zimbabwe, and later moved to England to work in its National Health System. ‘A senior lecturer in adult nursing at the University of Wolverhampton, Murandu completed an initial pilot study focussed on sugar’s applications in wound healing and won an award from the Journal of Wound Care in March 2018 for his work. […] To treat a wound with sugar, all you do, Murandu says, is pour the sugar on the wound and apply a bandage on top. The granules soak up any moisture that allows bacteria to thrive. Without the bacteria, the wound heals more quickly.

‘In some parts of the world, this procedure could be key because people cannot afford antibiotics. But there is interest in the UK, too, since once a wound is infected, it sometimes won’t respond to antibiotics. […] And a growing collection of case studies from around the world has supported Murandu’s findings, including examples of successful sugar treatments on wounds containing bacteria resistant to antibiotics.’

Well, it’s safe to say that I don’t know how much sugars will contribute to our health and well-being, but they do serve as a reminder that western science is not the sole guardian of knowledge. Or wisdom. Answers are not rare -they are lying around everywhere just waiting for the right questions to discover them. The right curiosity. And we run a risk dismissing traditional enlightenment -folk wisdom- out of hand.

The problem, as I see it, is one of attribution. The credibility we assign each source should be determined by the results of testing its hypothesis, finding the appropriate question to interrogate whatever is proposed as an answer. Finding the key that fits the lock… And the thesis investigated does not have to be of mind-bending importance; science is not the exclusive purview of people in white coats. Nor those of a certain age…

I recently happened upon a Tim Horton’s café in close approximation to a message from my stomach that it needed both a coffee and a bagel. Not being in the mood to argue, I decided to accede, although my loyalties normally lie with Starbucks. I had been wrestling with the question of habit on my walk –my strange unwillingness to explore new ground, consider new sources. Tim’s could be the answer waiting for the question.

Science, if it be considered from the inductive perspective, I reasoned, required the inference of laws from particular instances -answers from the right questions. In other words, Propose, Test, and then validate or refute. It isn’t enough to simply assume…

I had chosen a busy time unfortunately, and I was lucky to find a single table in a corner by the window. It was squeezed between a group of elderly women crowded around a larger table busy consuming their donuts and politely slurping their coffees, and a small table like mine occupied by a harried looking mother trying to bottle-feed a squirming, unhappy baby in her arms and a young boy busily kicking the legs of his chair.

The elders were surprisingly quiet, but not the little boy, so my ears naturally focussed on him.

“Why can’t we go, Mommy?” he kept asking.

I could tell his mother had almost reached the end of her tether, and she stared at him crossly, determined not to interrupt the feeding. “Because I’m still feeding Janny, Tim,” she replied, tensely. “She’s really hungry.”

The boy tilted his head curiously. “She’s squiggling around; she’s not even sucking…”

At that point the baby began to cry even louder-scream, actually- so the mother put the bottle on the table and positioned the baby on her shoulder to burp it.

But Tim still looked puzzled. “But she doesn’t like the bottle, Mommy,” he said, as if his mother should have noticed by now.

His mother shrugged, almost in tears. “I know, Timmy, but you were hungry too, remember? That’s why we came in here instead of going back to the car.”

Tim sat back in his chair for a moment to process the problem. “Well, why don’t you let Janny suck your breasts?” he said, in the rather loud voice of a four year old.

I could see his mother blush as soon as he said it, but Timmy had merely proposed a tentative hypothesis that could easily by tested to see if he had asked the right question, and his face was as innocent as a new nappy.

His mother leaned over the table with Janny so she could show Tim that they could talk quietly about it. “I would if we were sitting in the car…” she said, but he continued to stare at her, still puzzled. “And the car is still a long way away, Timmy.”

Tim leaned over the table like his mother. “Why can’t you breast her here?” he asked innocently.

She smiled and glanced around the room, embarrassed. “Some people don’t like to see mothers breast feed their babies in public.” She tried to whisper but Janny was really screaming now. She glanced at the washroom, no doubt wondering if she could feed her baby in there, but it must have been a small room, because there was already a line of needy hopefuls that had formed at the door

Tim smiled as if he knew how to solve the problem with his initial hypothesis, and he leaned towards me on his chair. “Hey mister,” he said in his best, grown-up voice, “Do you mind if Mommy breasts Janny in here?”

His mother was now beet red, and she glared at her little son and then attempted to smile at me. “I… I’m sorry…I…” But she was too embarrassed to continue.

“I don’t mind at all,” I said, trying to reassure her with a reciprocal smile. “You can use my jacket to cover yourself, if that would help…” I said, beginning to take off my jacket.

One of the elderly women at the next table leaned over and gave a thumbs-up to the frazzled mother. “We’ve all been there, dear,” she said and winked before she turned back to inspect her plate for donut remnants.

I handed the mother my jacket and the baby settled into the welcoming breast somewhere underneath. Propose, test, validate…

I added some extra sugar to my coffee, and settled back in my chair to celebrate the triumph of citizen science that even a child could perform. It’s just a matter of finding the right question, after all…

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Take my milk for gall

Come to my woman’s breasts and take my milk for gall. Even Lady Macbeth was not without an opinion on the uses of a woman’s breast… And so it continues to this day; almost everybody has an opinion on breast feeding. This runs the full gamut from the harangue of Elisabeth Badinter in her March 2012 article in Harper’s Magazine: The Tyranny of Breast Feeding to the quasi-religious sermons published by the La Leche League that engender parent-like guilt for even considering alternatives.

It is, as they say, a Motherhood Issue: something valued in principle, honored for its obvious benefit to baby, and yet often abandoned in the frustrating weeks and months after birth when the glow has faded along with sleep and patience. There are data from various national surveys which show that on average although around 90% of Canadian mothers start out with good intentions and exclusively breast feed their baby -i.e. offering only breast milk (plus or minus vitamins, medicines, etc.) and no supplementation with other liquids, (formula, juices, etc.)- less than 25% continue with it. The World Health Organization recommends exclusive breast feeding each infant for the first six months of its life. Yes, the benefits to baby are that important!

Interesting though, despite the obvious benefits, there are various impediments to the practice: Culture -or is it country and its customs?- for one. The WHO has a global data bank on breastfeeding and some of the figures reveal startling differences by country alone -and not all related to social disparities in health, education or economics.

But admittedly, there are Canadian studies that suggest that breast feeding is chosen less often among single mothers, women with less education, or lower incomes. Some may not even choose to start breast feeding, let alone abandon it early. And when it is chosen, almost 50% of the ones who choose not to continue, stop within the first six weeks… So given this finding, is there anything that might help support, or lend itself to intervention in that critical window of time?

There is an article in the Canadian Medical Association Open Access Journal in January of this year (cmajo january 16 2013 vol.1 no. 1 E9-E17) that looked at just that, in 2 regions in the province of Nova Scotia between 2006 and 2009. Their exclusive and dropout breastfeeding figures were different from the Canadian average, but even so, they did identify “four potentially modifiable risk factors: prepregnancy obesity, smoking during pregnancy, no intention to breast feed, and no early breast contact by the infant.”

It’s that latter factor -the “no early breast contact by the infant” (read skin-to-skin contact, I would imagine) that intrigues me, though: that such a simple thing -placing the baby on the mother’s skin near her breast after delivery- could create so much difference! This is a policy I would have thought would be universal by now: we even encourage it after extraction of the baby during a Caesarian section in our hospital if the baby is healthy. Its what almost every woman craves -and baby as well- so why not?

And yes, the other modifiable risk factors loom large as potential targets -especially the ‘no intention to breast feed’ decision. One wonders whether frequently bringing up the topic in a respectful and sensitive manner as the pregnancy progresses (and her trust and bond with the health-care provider increases) might be helpful.

The other interesting thing I learned from the paper was that “educational interventions are more effective if focused on improving maternal self-efficacy than on enhancing knowledge.” Most women nowadays know why they should breast feed; it’s how to breast feed, especially with difficult infants and problems latching once they’ve left the hospital, that frustrates them and causes them to stop trying after a few weeks -or even days… Small communities seem particularly at increased risk, often because of a scarcity of easily accessible resources. Recognizing that continued support is very important in the early days after delivery is obviously an important key. So postpartum enthusiasm for breastfeeding on the part of the nurses and staff before the woman even leaves the hospital is the first step. Ideally, a 24 hour breast feeding hot line (perhaps utilizing the existing hospital maternity ward) would be helpful -night time is when the woman is tired and irritable and more prone to frustration. Lactation consultants -maybe also recruited from maternity nurses in the local hospital- would be another important resource. Of course, a knowledgeable and empathetic family doctor or midwife -and an understanding and patient partner- complete the readily accessible communal facilities… Support and understanding are what a community can supply with very little extra resources: the ounce of prevention strategy, I suppose.

But preemptive encouragement is even cheaper; so is motivation -prenatal motivation especially. It doesn’t take much time for the doctor or midwife to inquire about it, and often merely the willingness to listen to her concerns about breast feeding -or her doubts about her abilities- is enough to get the woman thinking.

No… I suspect that breast feeding is not for every new mother… but who knows, maybe it could be.