Nutrition, Breastfeeding, and “Diet Rules”
by Nancy Mohrbacher, IBCLC
Have you heard that a breastfeeding mother should eat a perfect diet or that she should avoid certain foods? In her book, Breastfeeding: A Guide for the Medical Profession, Ruth Lawrence, MD, says:
“Most writings for the nursing mother…set up complicated ‘rules’ about dietary intake…Thus one barrier to breastfeeding for some women is the ‘diet rules’ they see as too hard to follow or too restrictive.”
Fortunately, there are no hard-and-fast “diet rules” for breastfeeding mothers. You don’t have to change your eating habits in order to give your baby the best. The National Academy of Sciences’ Subcommittee on Lactation confirmed this in its 1991 summary, Nutrition During Lactation: “Women living under a wide variety of circumstances in the United States and elsewhere are capable of fully nourishing their infants by breastfeeding them. Mothers are able to produce milk of sufficient quantity and quality to support growth and promote the health of infants–even when the mother’s supply of nutrients and energy is limited.” The following questions and answers are designed to clear up some of the confusion that surrounds the topic of nutrition and breastfeeding.
“DO I HAVE TO EAT MORE THAN USUAL TO MAKE ENOUGH MILK FOR MY BABY?”
Although it used to be estimated that nursing mothers need an extra five hundred calories a day to produce milk, recent studies indicate that this recommendation may be too high. The National Academy of Sciences’ 1991 report says that eating more calories “has not been linked with increased milk production, at least among well-nourished women in industrialized countries.” Even in developing countries where poor nutrition is a problem, supplementing breastfeeding mothers’ diets has been reported “to have little or no impact on milk volume.”
The food a nursing mother eats is only one of her sources of energy. She also draws on the fat stores she laid down during pregnancy. Milk production is such an efficient process that during the early months the energy supplied from stored body fat may be all the extra energy that is needed for some mothers, especially those who are not very physically active. Researchers have found that a woman’s metabolism becomes more efficient during lactation. This may mean that each extra calorie goes further in a breastfeeding mother, safeguarding her own health and assuring she has the energy she needs to produce an adequate milk supply for her baby. Losing too much weight too quickly, though, indicates that mother needs more calories.
“IS IT ALL RIGHT TO LOSE WEIGHT WHILE BREASTFEEDING?”
Breastfeeding makes it easier to shed the extra pounds put on during pregnancy, according to Dr. Judith Roepke, a nutritionist at Ball State University in Indiana. Dr. Roepke says that lactation may be an ideal time to lose weight. Breastfeeding naturally mobilizes fat stores, even fat accumulated before pregnancy. But it is important to go slowly. Dr. Roepke suggests that nursing mothers do nothing consciously to bring about weight loss during the first two months after birth. During that time your body needs to recover from childbirth and establish a good milk supply. Most breastfeeding mothers will lose a few pounds while following a normal diet. Breastfeeding mothers often shed extra pounds gained during pregnancy when their babies are three to six months old. In one study, breastfeeding mothers lost more weight when their babies were three to six months old than formula feeding mothers who were consuming fewer calories.
If you aren’t losing weight as quickly as you’d like, you can begin by increasing your activity level and decreasing your caloric intake. By taking a two-mile walk five times a week with the baby in a stroller or baby carrier while at the same time eliminating 100 calories from your daily diet (the number of calories in three teaspoons of margarine or butter), you can expect to lose two or three pounds a month.
It is important for weight loss while breastfeeding to be slow and gradual. Crash diets, fad diets, and quick weight loss can cause problems. Environmental contaminants, including PCBs and pesticides, are stored in body fat. Losing weight too quickly–more than about four pounds per month, or about a pound per week–may release these contaminants into a mother’s bloodstream and increase the levels in her milk.
Most mothers find that weight loss takes care of itself while breastfeeding. Avoiding “junk foods” high-calorie, high-fat foods with little nutritional value) and concentrating on good nutrition are often all it takes.
“IF I DON’T EAT WELL WILL MY MILK STILL BE GOOD FOR MY BABY?”
Even with a less-than-ideal diet, a mother’s milk is the perfect food for her baby. Studies conducted in dveloping nations indicate that even “mild malnutrition appears to have only a slight effect, if any, on milk output…” and no effect on the composition of mother’s milk. As Ruth Lawrence, MD, writes, “All over the world women produce adequate and even abundant milk on very inadequate diets.”
While it is true that a mother who is not eating well will produce the milk her baby needs, any new mother–no matter how she feeds her baby–will feel better, have more energy, and be more resistant to illness if she eats wisely and well.
“WHAT DOES ‘EATING WISELY AND WELL’ MEAN?”
The principles of good nutrition are the same for the breastfeeding mother as for the rest of the family: eat a wide variety of foods in as close to their natural state as possible. Don’t limit yourself to only a few choices in vegetables or a strictly meat and potatoes diet. Chicken, turkey, fish, eggs, and dairy products are all sources of animal protein, in addition to “red meats” like beef, pork, and lamb. Legumes such as beans and peanuts are also good sources of protein, especially when combined with grains, seeds, certain nuts, and dairy products.
Even during the winter months, supermarkets sell a tremendous variety of fresh as well as frozen produce. You can vary the greens in your salads by using different varieties of lettuce as well as spinach, parsley, sprouts, and green and red cabbage. Lots of vegetables–carrots, broccoli, cauliflower, green pepper–can be eaten raw for a quick snack as well as cooked for dinner. You can get essential vitamins from a wide variety of sources. For example, three-and-a-half ounces of green pepper or Brussels sprouts contain as much vitamin C as the same amount of orange juice.
There’s even variety in grains. Whole-grain bread provides lots of fiber along with B vitamins, but so do foods like whole-grain cereals, brown rice, cornmeal, and oatmeal. A peanut butter sandwich (two ounces of peanut butter on two slices of bread) provides fourteen grams of protein.
Many women worry about getting enough calcium in their diets, especially since medical science has learned that calcium deficiencies may contribute to the degenerative bone disease osteoporosis. Milk is one possible source of the extra calcium that is recommended for pregnant and lactating women. But if you don’t like milk or are sensitive or allergic to it, there are other options. Yogurt and cheese are good alternatives. So is cooked bok choy, a type of cabbage, a cup of which contains eighty-six percent as much calcium as a cup of milk. Half a cup of ground sesame seeds contains twice as much calcium as a cup of milk.
Are vitamin supplements necessary? If you eat a well-balanced and varied diet, vitamin supplements are usually not necessary while breastfeeding. But some vitamin deficiencies in the mother eventually do affect the levels of that vitamin in her milk. So if your diet is restricted or could be better, vitamin supplements may be a good idea. For example, vegetarian mothers who completely avoid all animal products should take a vitamin B-12 supplement while they are breastfeeding to ensure their babies get the B-12 they need.
“HOW CAN I FIND THE TIME TO EAT WELL WHILE CARING FOR A NEW BABY?”
For many breastfeeding mothers, knowing what to eat is not nearly as challenging as finding the time for shopping and cooking. But good nutrition doesn’t have to mean spending more time in the kitchen. Many foods are both nutritious and handy for snacking or for quick meals. Peanut butter, cheese, yogurt, whole-grain bread or crackers, whole tomatoes, sprouts, fresh fruits, whole or sliced raw vegetables, hard- boiled eggs, and nuts can be eaten with little or no preparation. More frequent smaller meals can be just as nutritious as three larger meals. Some mothers try to have a healthy snack and something to drink every times they sit down to nurse.
Planning meals a week at a time cuts down on trips to the grocery store. Cleaning and cutting up vegetables in big batches makes it easy to reach into the refrigerator for a handful to eat as a snack or add to a salad or casserole. Making double batches of main dishes or casseroles takes only a little more time and gives you a supply of quick-to-fix meals in your freezer for times when things get too hectic to start from scratch.
“ARE THERE CERTAIN FOODS I SHOULD EAT OR AVOID WHILE BREASTFEEDING?”
Contrary to popular belief, there are no foods that must be eaten or avoided by nursing mothers. If you have healthy eating habits, there is no reason to change them while you are breastfeeding. There are no foods (such as milk) that a breastfeeding mother must have, and there are no foods that she must avoid. Although many cultures around the world recommend that nursing mothers avoid certain foods, these restrictions vary from place to place. Most breastfeeding mothers find that they can eat anything they like in moderation without any effect on their babies.
When a new baby is fussy, a mother who is breastfeeding may worry that something she has eaten is the cause. But no matter how a baby is fed, fussy periods are normal during the first three months of life. It is unlikely that the baby is reacting to a food you have eaten.
Occasionally, however, especially in families with a history of food allergy, a food in the mother’s diet does affect her nursing baby. Some mothers do notice that their babies become very fussy after they eat a certain food (especially one that is very strong or spicy) or when they have an unusually large amount of a particular food or drink. If this happens, avoid that food or drink and continue breastfeeding, and everything will be back to normal within a day or so.
However, not all food sensitivities are so obvious. Some babies react to a food that is a regular part of their mothers’ diet. When the cause is a regularly eaten food, such as cow’s milk and dairy products (the most common food allergen), it may take as long as two to three weeks for the baby’s disposition to improve after the food has been eliminated from the mother’s diet. Before eliminating any important food from your diet, be sure to talk to a doctor or nutritionist about alternative foods or a vitamin/mineral supplement.
Two other common questions are: “Can I eat chocolate?” and “What about caffeine?” Nursing mothers are often told to avoid caffeine, but recent studies have shown that only a very small amount of caffeine appears in human milk. Moderate amounts of caffeine–the amount of caffeine in five or fewer cups of coffee per day–will not cause a problem for most breastfeeding mothers and babies. However, if you happen to have a fussy, wakeful baby, try cutting back on your caffeine intake for two to three weeks to see if the baby’s sleep pattern and disposition improve. Chocolate contains theobromine, a substance similar to caffeine, but most mothers find that moderate amounts do not affect their breastfeeding babies. So, yes, nursing mothers can eat chocolate–and any other food–in moderation.
“HOW MUCH AND WHAT SHOULD I DRINK WHILE NURSING?”
“Drink to thirst” is a nursing mother’s best guide to how much fluids to drink. Many mothers have a glass of water waiting for them when they sit down to nurse. This guarantees that they don’t overlook feelings of thirst and wait until they are parched to take a drink. Most mothers find that they are naturally more thirsty when they are nursing.
Good sources of fluids include water, fruit and vegetable juices, milk, and soups.
Each nursing mother’s need for fluids varies, and it is not necessary or beneficial to drink a fixed amount of fluids every day. Instead, watch your own body signs. You’ll know you are not drinking enough if your urine looks darker in color or you become constipated. Light-colored urine and regular bowel habits are good indications that you are drinking enough. Studies confirm that forcing fluids, which can be physically uncomfortable, does not increase milk supply.
Concerning alcoholic drinks, again moderation is the key. Breastfeeding women can indulge in alcohol, as long as it is consumed infrequently in small amounts. Although alcohol passes quikcly into breast milk, it also passes quickly out. (The alcohol in one glass of wine or beer will be completely out of a mother’s milk within two to three hours after consumption.) Studies have found that the effects of alcohol on a breastfeeding baby are directly related to the amount the mother drinks. Regular consuumption is not recommended for nursing women. Too much alcohol has been found to inhibit the release of milk in some mothers and render a baby sleepy and lethargic.
“WHAT CAN I EAT OR DRINK TO INCREASE MY MILK SUPPLY?”
There are many myths about “magic” foods that will increase a mother’s milk supply–for example, “you need to drink milk to make milk.” However, cows don’t drink milk, and there is no evidence that particular foods or drinks affect milk supply. Milk supply is determined mainly by supply and demand–the more often a baby nurses effectively, the more milk there will be. Conversely, the less often (or less effectively) a baby nurses, the less milk there will be.
If you are concerned about your milk supply, you can determine whether your baby is getting enough milk by counting your baby’s wet diapers and bowel movements. At least six to eight wet cloth diapers (five to six disposables) and two bowel movements a day (fewer bowel movements are normal in a baby older than six weeks) indicate that the baby is getting enough milk. A weight gain of at least four to seven ounces per week (at least a pound a month) is another indication that the baby is getting enough. If your milk supply is low and your baby is nursing effectively, nursing more often will quickly increase your supply.
“Eat to hunger” and “drink to thirst” are the most important points to remember about nutrition and breastfeeding. There are no complicated “diet rules” to follow and no foods you have to eat or avoid. No matter what your food habits or preferences, you can give your baby the best by breastfeeding.