How would you like your placenta? Broiled or freeze-dried?

After nearly 11 years (!) at this blogging thing, I thought I had covered pretty much every medical topic a skeptic and supporter of science-based medicine would be interested in covering. However, if there’s one thing I’ve learned over the years, it’s that there’s always something I’ve missed, some hole in my blogging oeuvre that needs to be filled. Perhaps when I’ve been at this for 20 years I’ll have filled them all in. Even if that becomes true sometime in the next nine years, I will likely have only filled in the old gaps, while new ones will have formed. Dealing with pseudoscience is very much like playing Whac-A-Mole. Knock one bit of quackery or pseudoscience down, and one of its compatriots pops up somewhere else.

Even so, oddly enough I’ve never covered the strange practice of mothers eating their placentas after giving birth. It’s not true that I’ve never mentioned it; I did over nine years ago in a brief post about Tom Cruise saying he was going to eat Katie Holmes’ placenta, but that’s not the same thing. However, I’ve never taken a look at the wackiness that is placentophagia. Leave it to Kate Tietje, who calls herself Modern Alternative Mama, to give me the perfect excuse to rectify that oversight in my blogging, thanks to a post with the gag-inducing title Can Mamas Share Their Placentas with Friends? It begins with this “dilemma” (if you can call it that):

Recently, a friend was preparing to start taking her placenta pills.

She had had her third baby about 9 months ago, and with her previous babies, found that she felt so good and energetic in the first several months after birth that she didn’t need any help — until around the 9-month mark. Then, her energy began to dip and postpartum depression began to set in.

With her second baby, she took her placenta pills from months 4 – 10, and found they helped a lot — but that she ran out too soon. With her third baby, she decided to wait longer, until she began to feel she needed them, before starting.

Only, when she opened the bag of the dehydrated placenta strips, disaster! The strips hadn’t been fully dried, or something had gone wrong — and they were covered in white, fuzzy mold. They had to be thrown out.

She was left with flagging energy and depression, and no placenta. What’s a struggling mama to do?

What indeed?

Yes, two of the benefits claimed by advocates of placentophagia is, of course, increased energy and elevated mood, prevention of postpartum depression, even. Indeed, there is a veritable laundry list of claimed benefits:

  • Help to balance your hormones
  • Replenish depleted iron levels
  • Assist the uterus to return to its pre-pregnancy state
  • Reduce post-natal bleeding
  • Increase milk production
  • Make for a happier, more enjoyable post-natal period
  • Increase your energy levels
  • Prevent aging

Online, you can find recipes to make all sorts of placenta preparations, including roast placenta, placenta cocktail, placenta lasagne, and even placenta spaghetti Bolognaise. (I kid you not.) There are even books on how to prepare placenta. There are even videos on YouTube telling you how to do it, such as this one (don’t watch unless you are not squeamish; I’m a surgeon and can deal with it, but I don’t know if you can):

There are even a large number of services that will take a placenta, freeze dry it, and “encapsulate” it, making placenta capsules that can be taken for weeks to months after birth. As Teitje’s story relates, there are also recipes to dehydrate the placenta in a process not unlike making beef jerky for later consumption.

The rationale, such as it is apparently, for human placentophagia is that many, if not most, species of placental mammals eat the placenta after giving birth. Exceptions include seals, cetaceans, camels and, for the most part, humans. That’s because, of course, we want to be just like other mammals because nature, I guess. History provides examples of placentophagia, but in general it seems not to have been a widespread practice in most human cultures throughout history. Indeed, not long ago a scientific paper made the news because two ecologists, while not advocating placentophagia, asked the provocative question: Given that most mammals engage in placentophagia, why don’t humans do it too? (Unfortunately, my library does not subscribe to the particular journal.) One thing that human placenta has been used for is in—surprise! surprise!—traditional Chinese medicine and other ancient, prescientific medical systems.

So what is the evidence that eating placenta has health benefits or does any of the things claimed for it? In brief, there is very little evidence. The ever-intrepid Harriet Hall summarized the existing evidence she could find in 2011. To say that it was thin was to be too kind. It included a 1954 study (never replicated) claiming to show that taking a supplement derived from placenta could increase milk production, some rodent studies, some speculative papers on the practice, but nothing that could be considered a relevant study in humans. The best advocates of placentophagia could do was to speculate that eating the placenta is a good source of iron, which might well be true but who cares? There are other ways of getting iron if you are a human female.

I decided to search PubMed to see if there were any newer studies. There was, of course, the aforementioned speculative ecology paper in 2012 and another 2012 study that was nothing more than a self-reported survey of mothers who ate placenta asking them their motivations and experiences doing it. What there were not were anything resembling rigorous studies. Indeed, a review article, hot off the presses, could only list the same rodent studies that Harriet listed plus a few more and the same 1954 human study:

Animal data also do not support claims that placentophagy in humans helps to enhance lactation, reduce pain, facilitate uterine contraction, or replenish hormones (i.e., prolactin, estrogen, progesterone, oxytocin) associated with postpartum recovery since statistically significant findings in animal data do not translate into meaningful benefits for humans. Additionally, the placebo effect, which is very powerful in humans (Annoni 2013; Benedetti et al. 2011; Geers et al. 2013; Kirsch et al. 2014), is not tested in animal models. Reports of human benefit may, at least partially, be a result of placebo effects, which could be addressed through a randomized placebo-controlled clinical trial. Overall, human data on placentophagy enhancing milk production is dated, inconclusive and, to our knowledge has not been systematically investigated further. Based on the studies reviewed, it is not possible to draw any conclusions relevant to human health. We conclude that the animal and human data strongly support the need for more precise evaluation of the benefit, if any, of placentophagy practices in human patients.

So basically, the best we can say is that there is nothing resembling rigorous data or studies that support any of the claimed health benefits for placentophagia. To her credit, Tietje actually admits that all the evidence that exists consists of basically anecdotes. But to her that’s just fine. She even asserts that anecdotal data are “not not as useless as some seem to think; I think more and more that anecdotes can be pretty powerful.” Yes, they can be pretty powerful–powerfully misleading. That’s why anecdotes alone are seldom useful in medicine other than for hypothesis generation. Indeed, if you want to see just how deceptive large numbers of anecdotes can be, you need look no further than the antivaccine movement. Despite the many studies failing to find a link between vaccines and autism, parent anecdotes linking the first symptoms of autism to vaccination keep the myth that vaccines cause autism alive. Tietje, of course, is one of those believers who buy that myth. So it’s no surprise that she finds the anecdotes claiming that eating placenta reduces postpartum depression, increases energy levels and mood, and provides all sorts of other health benefits compelling.

So what are the risks? For one thing, if membranes ruptured early, there could be significant bacterial contamination. As Jen Gunter (who should know, given that she’s an OB/GYN) points out, somne placentas from normal deliveries can reek of infection due to bacteria only visible by a search with a microscope. Most placentas are colonized with bacteria from passage through the birth canal, anyway. If properly refrigerated or frozen and then adequately cooked, they’re probably not dangerous to consume, but it’s a different issue for encapsulated placenta, where dehydrated and frozen placentas are often ground with no sterilization of equipment between preparations and, apparently, no concern for contamination and cross contamination. Yum.

Strangely enough, Tietje, while acknowledging the risk of infection, still seeks to justify women sharing placentas:

One woman pointed out that we share breast milk…so why not placentas?

That last point stuck with me.

Breast milk is made by our bodies, specifically for our babies. Biologically, the perfect food for any baby is its own mother’s milk, straight from her breast. But, if that’s not available, we don’t say, “Well, just use formula instead, it’s dangerous to use another mother’s milk.” (Well, some people do — but we actually have studies that show that babies benefit more from breast milk than formula, especially preemies and medically fragile babies.)

No. Another mother’s milk is not the perfect food. That’s especially true if it’s been pasteurized by a milk bank before being given to the baby. But it is still a superior food for babies than commercial formula.

Her rationale follows that, for women suffering postpartum depression, consuming her own placenta is the best thing because it’s “perfect” for her, but consuming some other woman’s placenta might be the next best thing. So she thinks it might just be a perfectly fine thing for a woman to do. Hilariously, she then contradicts herself. Claiming that “we don’t have any evidence to suggest that it’s [placentophagia] harmful,” she then goes on to warn:

Placentas do contain blood, so we want to make sure the person who is sharing doesn’t have any blood-borne disease that could be transferred.

I’d say that blood-borne illness is a risk of harm, wouldn’t you? And Tietje’s trust that a woman’s denial that she has a blood-borne illness is any guarantee that she doesn’t have a blood-borne illness. Of course, many people who harbor various blood-borne illnesses, if asymptomatic, might not be aware that they are harboring such an illness. Then there are other dangers that might not be eliminated by cooking.

Placenta eating is one of the sillier crazes I’ve heard about. It’s nothing more than the naturalistic fallacy gone haywire. Sure, most female mammals do it, but humans aren’t most female mammals and, for whatever reason, it appears that evolution led to human females ceasing to eat placentas after giving birth sometime before the rise of civilization, or perhaps parallel with it. Whatever the case, humans don’t do it any more—except when for some reason they want to be like animals because they think it’s somehow more “natural.” Let’s just put it this way. Even Andrew Weil doesn’t really recommend it.

No wonder “Modern Alternative Mama” thinks it’s a perfectly acceptable, “natural” idea.