NICHD supported researcher says more studies needed to evaluate any risks
Friday, June 26, 2015
This transcript has been revised to include the word "percent" after the number "86." The word “percent” was inadvertently omitted in a response to a question about the study findings.
Listen to this podcast (MP3 - 13.6 MB).
Meredith Carlson Daly: Eating the placenta, it's trendy and touted by some who believe there are health benefits for mothers, but a new study found no such benefit. The placenta is the temporary organ that grows in the uterus to provide the fetus with nutrients and oxygen. Researchers at Northwestern University School of Medicine reviewed 10 published research studies on the practice. They found no data to support the common claims that eating the placenta either raw, cooked, or encapsulated offers protection against postpartum depression, reduces post-delivery pain, boosts energy, helps with lactation, promotes skin elasticity, enhances maternal bonding, or replenishes iron in the body. The researchers also noted that there have been no studies conducted on whether eating the placenta has any potential risks. The study appeared recently in Archives of Women's Mental Health.
I'm Meredith Carlson Daly, and this is "Research Developments," a podcast from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the NICHD. Joining me to talk about the study and to separate fact from fiction is one of its authors, Dr. Crystal Clark, Assistant Professor of Psychiatry and Behavioral Sciences at Northwestern University's Feinberg School of Medicine. The study was funded in part by the NICHD.
Thanks so much for speaking with me, Dr. Clark.
Dr. Crystal Clark: Thank you for having me. It's my pleasure.
Ms. Daly: Dr. Clark, you specialize in reproductive-related mood disorders. How long has the idea been that a new mother consumes the placenta and she'll supposedly get these wonderful health benefits?
Dr. Clark: Well, in all of our research into this practice, we were not able to determine exactly when this began, particularly in the U.S. and mothers here practicing placentophagy, but with all the best accounts, we were able to locate it back to the 1970s as a practice in the U.S. And there seems to have been a resurgence, so to speak, in more recent years where we see celebrities practicing placentophagy, and it's not clear if maybe that's why more patients are asking doctors about it or working with midwives to have their placenta encapsulated. I only recently, within the past couple of years, started getting more questions myself about this practice.
Ms. Daly: Just to clarify, you've said the formal name is "placentophagy." Is that how you say it?
Dr. Clark: "Placentophagy."
Ms. Daly: Placentophagy. And that is the practice of consuming the placenta.
Dr. Clark: Right.
Ms. Daly: And just explain what encapsulates. How does it work?
Dr. Clark: So a mother—and we were focused particularly on human placentophagy because we know that most mammals do eat the placenta, but the human is not one of the mammals that does. So the practice of placentophagy, human placentophagy is when a mother, basically after birth, she takes her placenta home with her. What we understand is that hospitals will put it in some type of container for travel. A mom will take it home, and then she will have someone chop it up, so to speak, for lack of a better way to explain it, and they will dehydrate it. And after dehydrating it and crushing it up, it goes into an actual pill. They put it inside like a capsule, so that the woman can take it like she would a vitamin.
Often the woman is hiring some type of placenta encapsulation service, which is commonly performed by a midwife or a doula, and that's pretty much how it works.
Ms. Daly: And you mentioned that the practice sort of began with animals. Is that what inspired this, that animals eat their placenta?
Dr Clark: It is unclear what inspired the practice. What we understand is that what's cited by those who advocate for placentophagy is that the traditional Chinese medical text from 1593 documents the use of the placenta to treat ailments, like infertility or liver and kidney problems, and often advocates will cite that medical text as the reason why a woman should engage in placentophagy. But there is not much documentation of actual mothers eating their placenta after birth in all that we searched in any of the literature. So it is not really clear why we've jumped from, okay, animals eat their placenta, there is some use of the placenta for treatment of ailments in other cultures, and how that translated then to moms should eat their placenta postpartum for postpartum complications such as postpartum depression or postpartum anemia. So it's really unclear how we've jumped to that conclusion.
Ms. Daly: Why do animals eat their placenta? Do we know?
Dr Clark: So what we understand about animals eating their placenta is partly that they are protecting themselves and their newborn from predators because the smell of afterbirth, so they eat their placenta for that reason. It's possible that it does offer them also some other benefits such as reduction of pain and maybe even some nutrients, but what we know about animals is that they eat it raw, and they eat it in its entirety right after birth. And that's not what human mothers who practice placentophagy are doing when most often they are encapsulating it, not eating it raw. They don't eat it in one setting, and it's not right in the delivery room.
Ms. Daly: I probably should have put a disclaimer as I started this interview to say you don't want to have eaten before you listen to this.
Dr. Clark: Yes.
Ms. Daly: You looked at several studies. What exactly did you and your coauthors find?
Dr. Clark: Yes. We looked at several studies. We were able to find 10 that related to human placentophagy in some way, and what we overall found was that there was no evidence to support the claims of human benefit or to inform any potential risk. We found four specific studies related to human placentophagy. Three talked about the attitudes and perceptions and more so behavior of maternal placentophagy, and really documented that the most common reason that mothers were engaging in placentophagy was to reduce or prevent postpartum depression. So they were really focused on improving their mood or preventing their mood from getting worse postpartum.
So another study—and the only study to look at actual human benefits of placentophagy—it looked at the effects of placentophagy on milk production and the population of 210 women who were fed freeze-dried human placenta. And what the difficulty is with this study was that it wasn't very rigorous. We didn't have a control group, and it was very vague as to how they determined increased milk production. So 210 women were given freeze-dried human placentas, and 86 [percent] reported a good result, but it's not clear what "good" meant, how much more production did they have.
Furthermore, the same study documented another group where they provided women freeze-dried beef who had just had babies, and they were trying to determine whether or not their milk production increased. And it was found that these women also had an increase in milk production who were fed freeze-dried beef. So it's not clear if all of this was placebo in both groups, that being the women fed freeze-dried human placentas and the separate—kind of a separate study, not so much a control group—who were fed freeze-dried beef.
Ms. Daly: Both groups had increased milk production?
Dr. Clark: Yeah, they had an increase in milk production. I'm not sure if that's coming out very clear.
Ms. Daly: Yeah. No, I think that's clear. And then you were mentioning that the other studies were all in animals, and wasn't there a study in mice where you did see a health benefit from mice ingesting the placenta?
Dr. Clark: So mice, there were definitely some studies, six studies that we were able to find related to animal models, and there was a study that looked at an animal model where the mice had an improvement of pain postpartum and even during labor from eating the placenta. But what was different and not translatable to human placentophagy practice is that mice ate the entire placenta post birth, and they ate it raw. And what was found in the study is that after 24 hours of the placenta sitting at room temperature, it actually lost this effect of enhancing endogenous pain factors within the mouse.
It also showed in the study that if you heated the placenta above 35 degrees Celsius, it was no longer effective. So that, again, doesn't translate to human practice because they're dehydrating—or the advocates or the placenta encapsulators dehydrate the placenta. So it's likely being destroyed if there's something in there that's a nutrient, and often these placentas are left at room temperature prior to being processed.
Ms. Daly: I notice that your coauthor, Dr. Cynthia Coyle, has said there are no regulations for how the placenta should be stored or prepared or even what quantities to consume. I'm wondering why you think there have not been more studies that look at the potential risks.
Dr. Clark: Yeah. That's really a concern of mine. There aren't any regulations, and people who provide a service are quite variable on how they go about encapsulating the placenta, although there are definitely more and more, apparently, training programs being developed. But there hasn't been any look at the risk of whether or not a woman gets sick, does it cause them any health problems long term, and that might not be something we would see right away. We know that the placenta filters toxins, and it can also get infected, but we are not aware of how much of the metal, for example, that can be found in the placenta, such as mercury or selenium—we're not aware of how much remains once it's processed or after it's processed.
Ms. Daly: Dr. Clark, what advice would you give women who are considering eating their placenta after they give birth?
Dr. Clark: I'd first say that it's the woman's choice what she chooses to do with her body, which as a reproductive psychiatrist who is commonly advising my patients what is the best thing to do for their treatment in pregnancy or postpartum, what we're often talking about is the balance of risk and benefits and what they ultimately want to choose to do for themselves. But what I recommend my patients who are thinking about placentophagy is that the reality is we don't have any evidence to support the claim of the advocates, nor do we have any evidence to inform the risks. And so my concern for them would be this is unknown territory. We don't know what the ultimate outcome could be through eating the placenta, but even more importantly, I want them to not forego an evidence-based treatment. So if they have postpartum depression, I am encouraging them to use the evidence-based treatment for sure, and if they choose to engage in placentophagy, then that's their choice, but don't forego the evidence-based treatments we have.
Ms. Daly: Where do you think your research will go next?
Dr. Clark: So I'm not sure where we're going to go next exactly. We're definitely looking at how widespread the practice is, particularly here in Chicago and even more locally here at Northwestern. Just out of curiosity, we want to know how many of our patients are engaging in this practice and how much more should we be educating our patients as well as health care providers about the practice. What I hope to see others who are interested in this area of research do is to look at what is in the process, in encapsulated placenta, what is maintained, what nutrients are there, what toxins might be maintained there, what metals still exist after processing, and is there really anything in the process, in an encapsulated placenta, that might be of benefit or might be of harm. And then, furthermore, if it continues to be a practice that women engage in, it would be nice to know, to follow these women who eat their placenta and see what risks or benefits they experience.
Ms. Daly: Since your research was published and you speak to patients about it, have you been surprised by the reaction, by the interest?
Dr. Clark: I've been very surprised by the reaction and the interest because I didn't expect this to be this popular. We've had quite the interest. A lot of media has picked this up andwe've been aware of a lot of science interests as well. And I didn't expect this to be so widespread, mainly because the preliminary results of our survey data just looking at how widespread the practice is here in Chicago would suggest that it's still a pretty rare practice. So what we can appreciate is that it varies from geographical location to location, and thinking that it's rare, I'm thinking, okay, well, we did our part to just find out if there was any risk or benefits, and it was a pretty simple review. And this isn't really hard science. We haven't done a randomized control trial. So I was really surprised that people, number one, have been surprised that we didn't find anything. We've even gotten responses that we're accusing those who have engaged in placentophagy and found it beneficial, that we're accusing them of being liars. That's been surprising. So we've definitely had positive and negative feedback. For it to be a rare practice, it's been quite a—even an international interest in this practice and what these studies have found.
Ms. Daly: Well, so you're a practicing psychiatrist. Help us understand why this hits a nerve.
Dr. Clark: That remains—that question continues to baffle me as well. I do not know. I do not know the answer to that. I definitely think the media has played a significant role in the upsurgence of the practice, and we were able to actually do a trend on Google as to how often the term has been searched. And it's been most searched within the past few years, and so we can link that to celebrities coming out and stating that they've eaten their placenta and the benefits that they've claimed they've received from it.
But other than that, what really brought it about in the first place remains unclear and why people hold onto this belief, even with us stating that, okay, all of the studies that have been cited to support this practice actually don't show any proof or evidence of benefit, but yet the responses, for those who advocate for it, have been very strong, that they believe that something good happened when they took their placenta, when they ate their placenta, and that's what they believe.
Another reason I believe this may have hit a nerve with postpartum mothers is that—what we understand is that new moms are looking for organic ways to treat postpartum depression as well as prevent postpartum depression and to be healthy, and that seems to be something that more and more people—and definitely women in general—are interested in, more natural ways of well-being. So, in that vein, definitely more women are asking about omega-3 or B12, and I think placentophagy fits into that to some regard.
Ms. Daly: I've been speaking with Dr. Crystal Clark about her study which was published in the journal Archives of Women's Mental Health. Thanks again for joining us today, Dr. Clark.
Dr. Clark: All right. Thank you again for having me.
Coyle CW, Hulse, KE, Wisner KL, Driscoll KE, Clark CT Placentophagy: therapeutic miracle or myth?
Archives of Women’s Mental Health. (June 2015)
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute's website at http://www.nichd.nih.gov/.