Guest blog post from Stephanie Canale on Mamasuncut.com
You know it when you see it: The gut-wrenching-hours-long crying of an infant that appears to be in pain...COLIC. Anyone who has had a baby with colic (or been around one) can attest to the stress that surrounds this medical mystery.
Many new mothers may ask themselves, "Is my diet causing this?" Especially if you're nursing! Perhaps it's the dark chocolate bar you munched on or the creamer you added to your cup of coffee that's the culprit?! To find the answer, we need to understand what colic is first…
What is Colic?
Colic is poorly understood but is classically defined by doctors as an unknown condition causing a healthy baby to cry for more than three hours per day, three days per week and lasting more than three weeks.
It typically starts at two weeks of life, peaks at six weeks and then resolves by 3-4 months.
What Causes Colic?
There are many theories that try to explain the cause of colic. In truth, it's usually provoked by a combination of too much stimulation plus too much quiet (too little 4th trimester rhythmic calming). During the first 4 months, all babies - especially fussy ones - do best with hours and hours of holding, rocking, shushing…like they enjoyed in the womb.
In addition, about 10% of the time, a baby’s screams can be set off by a formula allergy (dairy or soy) or acid reflux.
Can a Breastfeeding Mom's Diet Trigger Colic?
When a baby is intensely crying for no apparent reason, it’s natural for a new breastfeeding mom to question if what she’s eating is affecting her child.
Sometimes that is exactly the case! Within less than an hour, tiny molecules of the food you eat start drifting into your milk. And, if your baby is sensitive or allergic to those foods, crying may ensue. For this reason, moms are often advised to cut out common allergens in their diet (like milk and soy) or in more extreme cases go on an elimination diet. When it works, improvement is typically seen within 3-5 days.
Food that are tough to digest and typically produce gas in adults are the first foods to avoid. Some examples are:
|Boysenberry||Apples||Condensed milk||Legume beans (e.g. baked beans, kidney beans, borlotti beans)||Apricots|
|Mango||White peaches||Evaporated milk||Pistachio nuts||Longon|
|Asparagus||Artichoke||Unripened cheeses (e.g. ricotta, cottage, cream, mascarpone)||Peaches|
|Sugar||Garlic (and powder)||Plums|
|Fruit juices||Onion (and powder)||Mushrooms|
|Dried fruit||Spring onion (white part)||Snow peas|
|High-fructose corn syrup||Barley||Isomalt|
Studies on Colic and a Breastfeeding Mother's Diet
A study published by Pediatrics in 2005 followed 90 breastfeeding mothers whose infants were shown to be experiencing colic. Half the group was asked to eliminate allergenic foods from their diet for a week resulting in 74% of the infants experiencing at least a 25% reduction in crying and fussing.
The bottom line is that – if nothing else is helping – by eliminating common allergens from her diet, a nursing mom can sometimes lessen her baby’s colic.
Increasing numbers of studies are suggesting that human milk is superior to formula for infants in terms of preventing infections and reducing rates of asthma and allergies. Many women are choosing to give their babies human milk from a donor mother or a milk bank, as opposed to formula, for reasons related to health, inability to breastfeed, very low milk production or personal choice. As donor milk has become increasingly popular, more milk banks are opening in response to the demand. Donor milk is now widely available outside of the NICU and mothers of term infants can choose to give their child human donor milk instead of formula.
Is Donor MIlk Tested or Screened?
Milk donors themselves are screened (via blood tests) for HIV-1, HIV-2, human T-cell leukemia virus 1 and 2, hepatitis B, hepatitis C, and syphilis. They are also asked if they use recreational drugs. Some exclusions and temporary disqualifications include certain medications, chronic diseases, and risk behaviors for communicable diseases. The milk itself is not tested.
Milk banking activity varies greatly between different parts of the world for a variety of reasons, some having to do with economics or funding and some due to religious and cultural factors.
The standard practice is that donor milk is typically pooled and pasteurized. Pasteurization is carried out in a water bath at 62.5°C for 30 min followed by rapid cooling. Milk bottles are then stored at –20°C until use of the milk. This method (Holder pasteurization) is widely felt to represent a good compromise between microbiological safety and nutritional/biological quality of donor milk. It is important that the cooling chain is never interrupted; therefore, special cooling bags or cooling boxes have to be used during transportation from home to the milk bank.
Breast milk contains live cells and the act of pasteurization has led to concerns that some or all of the protective effects of human milk may be lost. Studies assessing milk components before and after pasteurization have documented that several important components of human milk are reduced in concentration or are eliminated altogether, as summarized in the table below.
Breast Milk Components:
|Component||Retention % after Pasteurization (1)|
|Whey to casein protein ratio:||Destroyed relative to fat|
|Zinc||Different pattern seen|
Heat treatment affects anti-infective and cellular components, growth factors, and some nutrients, depending on the heat and duration of exposure. Enzymes are most heat sensitive while immune components are compromised but not completely destroyed.
Processing of human milk also affects unsaturated fatty acids and damages the membrane of milk fat globules. Human milk contains stem cells and it is thought they may be damaged during heat treatment. On the other hand, some important protective components such as the oligosaccharides are essentially resistant to the effects of heat.
Given these effects of high-temperature processing, it would be expected that the protective effects of human milk might be diminished but not abolished altogether. That is exactly what the literature shows. In 5 trials comparing formula with donor milk with regard to the incidence of necrotizing enterocolitis, the risk of necrotizing enterocolitis was not significantly diminished in each trial. All five 5 showed a significant protective effect of donor milk compared to formula (2).
A direct comparison of fresh against pasteurized human milk performed by Narayanan et al., and showed a somewhat reduced protective effect against infection (14.3 vs. 10.5% infection) which was still much stronger than the effect of formula (33.3% infection). It is pretty clear that the beneficial effects of pasteurized human milk are diminished when compared to freshly expressed milk but that enough of the protective effects remain to render donor milk the feeding of choice for premature infants in the absence of any or sufficient maternal breast milk (3).
Milk donation is an act of unselfishness. In most countries donors receive no compensation, but some donors receive modest monetary compensation for actual costs incurred.
Human Milk Banks in the U.S.:
At the time of writing this post there are currently 26 milk banks in the US.
How is donor milk screened?
The milk itself is not tested. Milk banks will culture the milk and the processing equipment at various times determined by their own schedule.
It is ideal to have own mother’s milk
Another mother’s milk or donor pooled pasteurized milk is another increasingly more popular choice.
Formula when needed or chosen by mom.
Arnold LDW: Human Milk in the NICU: Policy into Practice. Ontario, Jones and Bartlett Publishers, 2010.
Chauhan M, Henderson G, McGuire W: Enteral feeding for very low birth weight infants: reducing the risk of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 2008;93:F162-F166.
Narayanan I, et al: A planned prospective evaluation of the anti-infective property of varying quantities of expressed human milk. Acta Paediatr Scand 1982;71:441-445.
Many women are choosing vegetarian or vegan diets, thanks to numerous reports about the health benefits of such diets, including decreased incidence of heart disease, diabetes, hypertension and obesity. For many patients who change from carnivorous diets to vegetarian or vegan diets, they report “feeling better” and in my experience have fewer issues with inflammatory diseases including eczema, asthma and arthritis, for example.
The concern some have over a vegan diet is maintaining an adequate intake of certain key vitamins and minerals. The most common issues are vitamin B12 deficiency, as well as iron deficiency. In fact, vegan mothers are some of Lactation Lab’s most common clients, eager to ensure that their babies are getting the nutrition they need.
One interesting study found that vegan and vegetarian mothers are more likely to breastfeed their children when compared to non-vegetarian mothers and they also did so for a longer period of time(1).
Although plant-based diets are at risk for nutritional deficiencies such as protein, iron, VItamin D, calcium, iodine, omega-3’s and B12, well-planned diets rich in grains and legumes combined with supplements can provide adequate nutrition to both mother and baby during pregnancy and breastfeeding. Following a rich plant-based diet during pregnancy can also be protective against the development of preeclampsia, pregravid obesity and reduce the risk of their child developing asthma, diabetes and even some pediatric tumors (2).
In our own testing of the breast milk of vegan and vegetarian mothers at Lactation Lab, we have seen tendencies of lower in B12, calcium and iron. We recommend all vegan and vegetarian women make sure they have an adequate source of B12, which is important for maintaining healthy a healthy central nervous system, production of DNA and RNA, formation of red blood cells and overall metabolism.
Protein intake should also be increased by 10% in vegan pregnant and breastfeeding women (3,4) and additional servings of protein-rich plant foods such as legumes, soy milk, soy yogurt, tofu, and meat analogs based on wheat or soy protein, nuts and seeds are essential.
Bottom Line: There are many benefits to vegan and vegetarian diets. We recommend that vegans that are nursing consider taking the following supplements: Calcium, iron, B12, DHA and Vitamin D (universally recommended for all breastfeeding infants).
One topic of concern to some mothers with breast implants is whether they present any health risk to their baby through possible contamination of their breast milk. In particular, they ask about whether silicon, silicone gel or platinum used in implants can leak into their breast milk.
The American Academy of Pediatrics Committee on Drugs does not feel that the evidence currently justifies classifying silicone implants as a contraindication to breastfeeding.
Fenugreek is listed as generally recognized as safe (GRAS) by the FDA and as long as mothers are aware of the possible side effects, this is a good option to try to increase supply. However, mothers with thyroid conditions should proceed cautiously and consult with their physician before taking a fenugreek supplement.
A group of entrepreneur moms gathered recently to discuss how they’re working to support moms through the new challenges of modern motherhood. In an honest, unfiltered conversation, they shared their own ups and downs as parents, and shared advice and tips.
One recurring theme was the importance of paying attention to what we put into and on our bodies, minimizing exposure to toxins and other environmental hazards.
In case you missed it … Lactation Lab’s cutting edge breast milk tests were recently featured in a segment on ABC’s Good Morning America called, “What parents should know about the new test for your breast milk.”
Not only must women watch what they eat and drink during pregnancy and breastfeeding, they must also be mindful of the drugs they take to treat common and not-so-common illnesses. This is made even more challenging by the fact that very little research is available on the use of drugs during pregnancy and breastfeeding.
Consumer Reports has weighed in on the topic of exposure to toxic heavy metals by infants.
Consumer Reports’ testing shows concerning levels of arsenic, cadmium and lead in many popular baby and toddler foods.
This includes foods made just for babies and toddlers, such as popular snacks, cereals, prepared entrées, and packaged fruits and vegetables.
Over time, exposure to heavy metals can harm the health of adults and children. One of the biggest worries: cognitive development in very young children.
I’m often asked why it’s helpful to test breast milk -- and one of the best answers is in addressing a very common issue: helping babies who aren’t gaining enough weight through breastfeeding.
It’s a common occurance: a mom feels passionately about breastfeeding, but baby isn’t gaining enough weight; her pediatrician recommends formula to supplement and that’s the end of the story. But now that we can test breast milk for fat and calories, that story can be rewritten.
Here’s an example. Baby S’s birth…
Recent reports of high levels of lead in baby formula raise the question of whether lead can be found in breast milk. The short answer is that while breast milk is generally safe, it is possible for it to contain lead. Lead is a common contaminant in the environment and can make its way into breast milk if absorbed by the mother through food, water or airborne pollution.
Dr. Stephanie Canale, founder of Lactation Lab, developed a unique and proprietary test kit for measuring the level of lead and other toxins in breast milk.
How much protein does a breastfeeding mom need? And does it matter what kind? These are a couple of questions raised by a recent Consumer Reports article suggesting that most people require less protein than they think.
Proteins are important for immune and neurological function and are the building blocks for tissues, muscle and bones, says Dr. Stephanie Canale, founder of Lactation Lab. “It’s important that when we’re talking about a mother's recommended protein intake, we take into account a breastfeeding mother’s need for protein to recover from the physiological strain of pregnancy and childbirth," she said.
Long-chain polyunsaturated fatty acids such as DHA are essential nutrients required for normal health, growth and development. Increasing evidence shows that feeding infants breast milk with a higher DHA content improves their vision and neuro-development.
So, does educating mothers about the DHA levels in their milk have any impact on those levels? Numerous studies have found a link between maternal intake of DHA (through diet and supplements) and increased DHA levels in breast milk. A study in South Dakota examined 84 women who were educated about their DHA levels and looked at the resulting impact on the DHA levels in their milk.
My patients often ask me about the efficacy and safety of the supplements that claim to increase your milk supply. Do they really work?
If you’re struggling with milk supply issues, the first step is to evaluate simple factors including latch evaluation, oral examination of the infant, frequency of feeding or pumping and thoroughness of breast emptying. A lactation consultant, often available at your local hospital or breastfeeding support store, can be invaluable in identifying if there are underlying issues contributing to milk supply.
Breastfeeding has long been known to positively impact the health and immune systems of babies, but now new research is uncovering the power of breastfeeding in helping to prevent long term illnesses including asthma, allergies, celiac disease, Type 1 diabetes and obesity.
The New York Times reports that many studies have strongly suggested that the trillions of microorganisms that inhabit the human body influence our current and future health and may account for the rising incidence of several serious medical conditions.
It has been said many times over and most mothers who nurse would agree that there is no better breast pump than baby! From my experience, there appears to be a growing proportion of women who choose to pump milk from the outset. Some women either have difficulty with latching, have nipple issues or simply prefer to pump.
Here are a few tips I would like to share as a physician, mother, and “master pumper!”
Low levels of B vitamins in breastfeeding mothers can translate into low levels in their babies, and may slow growth in the early stages of life.
That's the conclusion of a paper analyzing the scientific research on the topic by Lindsey H. Allen of the U.S. Department of Agriculture. A lack of data places some limits on these conclusions, as much of the evidence is from the world's poorest areas where malnutrition is prevalent. But the overall picture points to an urgent need to improve the information available on breast milk quality.
Poor maternal status of thiamin, riboflavin, vitamin B-6, vitamin B-12, and choline, causes the concentrations of these nutrients to be low in breast milk and the infant to become deficient.
Mothers with a low intake of animal source foods are at higher risk of nutrient deficiency, especially for riboflavin and vitamin B-12. Inadequate intake of thiamin and vitamins B-6 and B-12 could contribute to reducing babies' growth in the first year of life.
Taking supplements during lactation rapidly increases the concentrations of thiamin, riboflavin, and vitamin B-6 in milk, but increases in vitamin B-12 levels are small even when high doses are given to the mother for 2 months.
The first month of a baby's life is thought to be a special period of vulnerability to vitamin B12 deficiency as it can be linked to poor neurodevelopment and slow growth.
Nutrient deficiency is usually not an issue for mothers consuming a healthy diet, but since animal products are the main dietary source of Vitamin B-12, vegetarians should be careful about deficient vitamin B-12 levels.
“Uncertainty over the nutrient composition of breast milk is what led me to develop a test for exactly what is in it,“ said Lactation Lab founder Stephanie Canale, M.D.
"While breast milk of mothers consuming a healthy diet is typically nutritious, special diets and other factors can result in less than optimal nutrition for the baby. Lactation Lab’s test kits and followup recommendations are designed to help ensure that a mother’s breast milk is the best it can be.”
Mothers who are concerned about the nutrient composition of their breast milk can use Lactation Lab's test kit to find out whether they need to adjust or supplement their diet.