Diet requirements when Breastfeeding ~ (part 4)

Dear parent, breastfeeding or pregnant mom, friend of breastfeeding and interested individual. This is the last of 4 blog posts on Breastfeeding. Thank you, Jeanelde, for providing me with the topics and the questions with each topic, these past few weeks.

In Part 1 we looked at “Getting Started with Breastfeeding and mastering a good latch”. Part 2 covered “Supply and Demand” and Part 3: “Pain and Discomfort”. Today we will be looking at “Diet requirements when Breastfeeding” (part 4).

How do I need to adjust my diet when breastfeeding?

Are you eating a healthy balance of proteins, carbohydrates and vitamins & minerals, and drinking enough fluids, like you did during your pregnancy? Then you do not need to adjust your diet when breastfeeding, eat the healthy food you have been eating during pregnancy. Baby is used to the flavors and received the nutrients directly (via simple diffusion) from your blood steam to hers/his, NOW during breastfeeding the milk is made from your blood, so in fact whatever baby is receiving from you now is more “diluted” than during pregnancy.

Having a baby is the MOST incredible thing you will ever do and most of us (if not all) want beautiful babies that grow up to be healthy, happy and bright. What you do before and during pregnancy (especially what you eat) has the most profound effect on baby’s healthy and yours for that matter. By following a healthy diet you will have a healthier pregnancy and newborn-baby baby. After birth your amazing body can make milk from pizzas, but a poor diet is going to affect you more than your breastfed baby. If nutrient intake is lower than the total demand for maternal maintenance needs and milk production (because of low energy intake, low nutrient density of the diet, or both), the mother’s body will mobilize available nutrients from body tissues during lactation32 so the mother will suffer not the breastmilk. During the 9 months of pregnancy weight gained was due to your growing baby, the uterus, amniotic fluids, placenta, breasts, extra blood and other fluids and some was for the “maternal energy stores” (fat ;-), that is now being used throughout lactation to cover part of the energy cost of breastfeeding. The remaining energy will be met with your diet, if you are eating healthy.

In a New Beginnings article Sheri Khan wrote: “In recent years, research has confirmed that even if some nutrients are missing in a woman’s daily diet, she will still produce milk that will help her child grow. There is very little difference in the milk of healthy mothers and mothers who are severely malnourished. For example, if a mother’s diet is lacking in calories, her body makes up the deficit, drawing on the reserves laid down during pregnancy or before. Unless there is a physical reason for low milk production, a woman who breastfeeds on cue will be able to produce enough milk for her baby, regardless of what she eats.”

Among women exclusively breastfeeding their infants, the energy demands of lactation exceed pre-pregnancy demands by approximately 640 kcal/day during the first 6 months post-partum compared with 300 kcal/day during the last two trimesters of pregnancy. The number of calories you might need depends upon how much body fat you have and how active you are. While women are often advised to consume about 500 extra calories daily while they are breastfeeding, research32 now indicates that this could be too much for some women, while for others it could be insufficient. So no need to count calories (who have time for that anyway!); eat a healthy well-balanced diet like you did during pregnancy and you will be fine!

What about fluids? Nancy Mohrbacher and Kathleen Kendall-Tackett say that contrary to popular belief, drinking more fluids is not associated with greater milk production, drinking to satisfy thirst is sufficient . Do I need to drink milk to make milk? Think about it, no other mammalian mothers drink milk, yet they all produce milk adapted to the needs of their young….

What about allergies? At present time, there is lack of evidence that maternal dietary restrictions during pregnancy and breastfeeding play a significant role in the prevention of atopic disease in infants. How nice would it have been if fussiness and spots were due to what we ate? Because then we could control fussiness and spots by what we eat! Between 2 and 3 weeks of age, noticeable developmental change takes place: the “baby-moon” is over, babies feed more often, are awake for a little longer, and cry more. Many parents interpret this as cramps and due to that the mother ate. PLEASE, babies are individual little creatures, not everything baby does is because of you (or what you ate)!!

The role of mom’s diet has been exaggerated and many moms are given a list of “forbidden foods”. The percentage of babies who are truly sensitive to specific foods is pretty small, most moms can eat a healthy, balanced diet and nothing is forbidden. Use common sense and eat moderate portions of everything you like. Mantra: anything goes but moderation is key ;-). If you have a family medical history of allergy, and you think baby is reacting to something you ate, rather speak to a breastfeeding friendly dietician before eliminating necessary foods from your diet unnecessarily.

One of the LLLI (La Leche League International) philosophy concepts states, “Good nutrition means eating a well-balanced and varied diet of foods in as close to their natural state as possible.” Thus, in general, no food is excluded from a “list of foods” a breastfeeding mother “should” eat.

Can I enjoy alcoholic beverages when breastfeeding?

Yip, but keep in mind the effect of alcohol on you, (the mother), on the milk and on your baby.

Bear in mind that two standard drinks or more at a time can impair your judgement and functioning, and contribute to depression and fatigue (not something you need now!). Also daily consumption of alcohol has been shown in the research to increase the risk for slow weight gain in the infant and is associated with a decrease in baby’s gross-motor-development.

Be careful if people suggest alcohol to increase your milk supply. Alcohol can inhibited the “let down reflex”, and reduce the volume of milk baby is receiving per feed by as much as 23%. It may be the barley that is the prolactin-stimulating component of beer, not the alcohol that helps. Non-alcoholic beer would probably have the same effect.

Alcohol does not accumulate in breastmilk; it passes easily into breastmilk by simple diffusion, reaching levels almost equal to that in the mother’s blood stream. The Molecular weight of alcohol is 46 Dalton and anything lower than 500Da enters milk easily. It also leaves the milk easily. Thus no need to pump and dump milk after drinking alcohol, other than for comfort, because pumping and dumping does not speed the elimination of alcohol from the milk, it is not “trapped” in breastmilk, it returns to your bloodstream when your blood alcohol level drops.

Alcohol peaks in mom’s blood and milk approximately ½ -1 hour after drinking (but there is considerable variation from person to person, depending upon how much food was eaten in the same time period, mom’s body weight and percentage of body fat, etc.). Thomas W. Hale, R.Ph. Ph.D. (author of Medications and Mothers’ Milk) says: “mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.”

Still unsure? If you drank alcohol, do not breastfeed until you are completely sober. Again, moderation is KEY.

What do I do when I get sick (e.g. common flu or a stomach bug)?

To answer this question I need to know if you are worried about baby or yourself. Most of us will worry about our baby contracting the same illness, so let us tackle that one first ;-).

One of the beauties of breastmilk is, if you are ill and when your body makes antibodies to combat that illness, these antibodies are passed directly into your breastmilk, giving protection and disease-fighting abilities to your breastfed baby, protecting baby against that illness. I’m not saying baby will not get ill, but if baby does, it will be much less severe than if baby had not been breastfeeding. Breastmilk also contains many disease fighting factors effectively defending baby against many pathogens every time s/he breastfeeds.

Some features of some of the Immuno-protective Components of Breastmilk

Component Property
Secretory IgA (sIgA) Immunoglobulins (also known as antibodies) to environmental antigens (any substance that causes your immune system to produce antibodies). Acts as a physical barrier in baby’s mucus membranes (throat, lungs, intestines) preventing harmful pathogens to enter baby’s bloodstream
Lactoferrin Bacteriostatic (prevents the growth of bacteria), antiviral properties. Iron-binding protein, which means less iron is available to “feed” pathogens (pathogen is anything that causes a disease)
Lysozyme Bacteriocidal (it kills bacteria). Very soothing to human tissue and reduces inflammation and redness
Bifidus factor Promotes growth of beneficial Lactobacillus bifidus and low pH of pooh. Inhibits growth of ShigellaSalmonella, and some E. coli strains
Oligosaccharides Complex carbohydrate, food for good bacteria. Block antigen attachment to gut epithelial receptors, thus protecting the breastfed baby against, for example, potential diarrhea
Milk lipids Antiviral, antibacterial, antiprotozoal properties
Milk leukocytes Phagocytosis (literally eats) of bacteria, viruses, and fungi. Secrete numerous bioactive (having an effect upon a living organism, tissue, or cell) substances

Now that you feel calm about continuing to breastfeed baby during your mild illness, let us look at YOU:
Have you ever been told you need to stop breastfeeding because you need medical testing or medication? Or told that you cannot receive treatment until you are done breastfeeding? The good news is that most medications are compatible with breastfeeding, and for those few medications that are a safety issue there are usually acceptable substitutions. This being said, PLEASE DO NOT “simply” use “just-any” medications while pregnant and/or breastfeeding. Check first with a knowledgeable source whether it is safe or not!

Although mothers are frequently told they need to stop breastfeeding (temporarily or permanently) to take a medication, this is rarely necessary, according to Thomas Hale, RPh, PhD (Medications and Mothers’ Milk 2014, p. 7-12): “It is generally accepted that all medications transfer into human milk to some degree, although it is almost always quite low. Only rarely does the amount transferred into milk produce clinically relevant doses in the infant. Most importantly, it is seldom required that a breastfeeding mother discontinue breastfeeding just to take a medication”.

If you feel the need to take medication for your illness try and avoid extra strength, max strength, long acting medications or medications containing a variety of ingredients. To check whether meds are safe during breastfeeding, go to the LactMed Database (http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm), it is a free online resource for information on breastfeeding and medications, maintained by the National Library of Medicine in the US. If your healthcare provider does not know about this resource, spread the word! They also have a free smartphone app that is very useful.

Other things you can do are: REST!!, eat well (have some Chicken soup, apparently chicken contains a natural amino acid called cysteine, which can thin the mucus in your lungs and make it less sticky so you can expel it more easily), drink enough fluids and make sure you have good support, to feed you, and help with household tasks while you recover.

[Regarding breastfeeding during more serious illnesses, South Africa’s Infant and Young Child Feeding (IYCF) policy (2013) says: “HIV-positive mothers (and whose infants are HIV uninfected or of unknown HIV status), should continue breastfeeding for 12 months. The infant should receive ARVs from birth until six weeks of age as prescribed in accordance with current PMCT guidelines”. The IYCF policy also lists these maternal medical conditions that may justify temporary or permanent avoidance of breastfeeding: ◉Severe illness that prevents a mother from caring for her infant, for example sepsis, renal failure. ◉Herpes simplex virus type 1: direct contact between lesions on the mother’s breasts and the infant’s mouth should be avoided until all active lesions have resolved. ◉Maternal medications: sedating psychotherapeutic drugs, anti-epileptic drugs and opioids and their combinations may cause side effects such as drowsiness and respiratory depression, radioactive iodine -131, excessive use of topical iodine or iodophors (especially on open wounds or mucous membranes), cytotoxic chemotherapy.]

Do I need to take any extra vitamins or boosters?

If you eat a reasonably-well balanced diet, vitamin supplements are not considered necessary for breastfeeding mothers. Evidence does not warrant routine vitamin-mineral supplementation for lactating women.

Vitamin D: Mothers who have little exposure to sunlight need to get adequate amounts of vitamin D from supplements or vitamin D-rich foods. The Womanly Art of Breastfeeding says: “if a breastfeeding mother is getting an adequate supply of vitamins in her diet, her milk will contain adequate nutrients in the perfect balance for her baby”. La Leche League International’s “The Breastfeeding Answer Book”, lists the following risk factors for vitamin D deficiency: ◉having a dark skin, ◉consistently converging skin with clothing or sunscreen when outdoors, ◉living in areas where there is little sunlight for parts of the year or do not go outdoors and ◉living in areas of heavy air pollution, which blocks sunlight and ◉if mother is vitamin D deficient. Other risk factors include: ◉increased birth order, ◉exposure to lead and ◉the replacement of human milk with foods low in calcium or foods that reduce calcium absorption. During pregnancy baby builds her/his Vitamin D stores from mom’s body and by about two months these stores will be “depleted”. By then mom and baby will be taking strolls outside and baby will be making Vitamin D in her/his skin with the help of sunlight AND s/he will be receiving Vitamin D through the breastmilk.

Iron: The Breastfeeding Answer Book45 says the iron in human milk is better absorbed by your baby than the iron in cow’s milk or iron-fortified formula. This means that the quantity of iron in human milk is appropriate for baby instead of the larger quantity in cow’s milk. During pregnancy baby builds her/his iron stores from mom’s body and by about six months these stores are “used up”. The full-term-healthy-baby usually has no need of additional iron until about the middle of her/his first year, when s/he will be taking addition iron from solids.

Vitamin B12: Research shows vegetarian diets that contain no animal protein may require vitamin B12 supplementation to avoid a deficiency in mother or baby. What about extra calcium for vegan mothers? One study showed vegetarian mothers tend to consume less calcium than other mothers, but the levels of calcium in their breastmilk were not affected. This is believed to be caused by the fact that vegetarians consume less protein and therefore need less calcium.

But what if I want to take a supplement? It is suggested that “Supplements may be advised when dietary sources are marginal and it is unlikely that appropriate dietary practices will or can be followed”. Most mineral supplements (like iron, calcium, copper, chromium, zinc) do not affect breastmilk levels. Water soluble vitamin supplements (B vitamins, vitamin C) usually increase breastmilk levels. Interestingly enough, breastmilk levels of some water soluble vitamins, such as vitamin C, only increase up to a certain point, then remain steady – even if you increase the dose.

What about boosters? MOBI* Motherhood International (*Mothers Overcoming Breastfeeding Issues) (www.mobimotherhood.org), discuss various so-called “lactogenic foods” and beverages they have found helpful in boosting milk supply. They say: “A woman who has never breastfed, reading at MOBI, could get the impression that breastfeeding must be really, really hard. This is not our intention. For most women, breastfeeding is not hard, especially if they are knowledgeable about the most common problems that can derail a breastfeeding relationship: events surrounding the birth, position and latch, and temporary, painful conditions such as engorgement, cracked nipples, plugged ducts, thrush and mastitis”. So if you think you have a milk supply, first see an IBCLC or La Leche League Leader.

How can I take extra care of myself during the breastfeeding months to ensure that I am functioning at my best for myself and my baby?

3 little words: good FOOD, good REST and good SUPPORT. William Sears reports that many mothers say: “My baby needs me so much that I don’t even have time to take a shower.” He says it is natural to put a baby’s needs first, yet that does not mean you always put your needs last. You cannot parent a draining baby if you are drained. Dr Sears says next time you are on an airplane, notice how the flight attendant demonstrates the proper use of oxygen: “Put on your oxygen mask first before putting on your child’s.” If you are suffocating, you are no good to your child. When you “pass out”, who will look after your child?? Moral of the story is to take care of you!

Remember what I said in Part 1 about successful breastfeeding? Lots of milk + confident mother + good latch from baby + all in a basket of support.

Over the past weeks blog-posts we have looked at “lots of milk” and “good latch from baby” quite a lot. So how do you become confident and what about support to complete the “successful breastfeeding” recipe? When do we feel confident? Easy answer: when things are going well, when we are coping. Yes, it is a simplified answer I know, but am I wrong?

If there is ONE thing I can tell new parents (and breastfeeding mothers): “don’t do it alone”. Don’t be afraid to reach out and ask for assistance, ask for help, and ask for company, every day. An African proverb says: “it takes a village to raise a child”.

With all this excitement and change that come with the role of parenting, it is extremely important that parents continuously reaffirm the importance of their own relationship. It is common for a new baby to take center stage and to put maintenance of your relationship at the bottom of the priority list. Remember the two of you became a family before children were in the picture and you will remain a family after the children have grown and left home. A rock-solid partnership (continually renewed and refreshed) will be the foundation for the security of any and all children you add to your original family of two, so spend time together, even if it just having a cup of coffee while baby sleeps, and reconnect again. What about single parenting? Get your own parents involved or join a single-parent-support-group, just “don’t do it alone”.

A parting tit-bit: research studies done by Dr Neifert showed families in which mothers received breastfeeding support and other gentle teaching, reported longer duration of breastfeeding, less postpartum depression, more pleasure in mothering, and follow-up by six years: children demonstrated higher IQ and language scores, fewer behavioral problems, and better conflict resolution. SO? Seek HELP if you feel you or your baby need it and if you are doing fine, enjoy every minute of your breastfeeding experience, babies don’t breastfeeding forever……

I trust you have found this information valuable! If you have any concerns or questions please feel free to email me at leana.habeck@gmail.com or like our page on fb:
The Breastfeeding Clinic Facebook Page,

or for tit-bits of info: https://www.facebook.com/pages/Antenatal-Postnatal-Tit-Bits/618430578228800.

Have a wonderful breastfeeding relationship!
Take care!

Leana, a mother of 3 beautiful breastfed children, has a degree in Nursing (from University of Stellenbosch) and she is a qualified Perinatal Educator (University of Johannesburg). She has been helping many parents prepare for birth and early parenthood through antenatal classes in Stellenbosch and Somerset West. Leana is also a La Leche League Leader and IBCLC (International Board Certified Lactation Consultant). Over many years, together with two colleagues at “The Breastfeeding Clinic” in Somerset West and Stellenbosch, she has helped many families nourish their babies with breastmilk.