How Much Protein Does a Breastfeeding Mom Need?

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.

Bottom line is that women of childbearing age should establish protein stores, conserve them and replenish them.

Premature infants require diets that are high in protein and the amount of protein in breastmilk steadily declines as children grow, says Dr. Canale. For example, a mother nursing a 28-week-old premature infant can have almost four times as much protein in her milk as a mother nursing a 2-year-old toddler.

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The USDA publishes a free online tool that includes breastfeeding in calculating recommended daily nutritional intake. For example, an active 30-year old mother who is 5’ 4” tall and weighs 120 lbs should consume at least 71 grams of protein per day during the first 6 months of breastfeeding, 27 grams more than if she were not breastfeeding, according to the USDA calculator.

Ohio State University and the World Health Organization both recommend around 17 grams of extra protein per day during the first six months of breastfeeding. Also, some animal studies show that higher protein diets are related to increased milk volume.

Dr. Canale recommends erring on the side of more protein, especially as extra protein has no negative health consequences and may have some beneficial effect on milk volume and quality.

Consumer Reports says most adults should aim for a diet that includes a variety of protein sources, such as lean meat, seafood, eggs, yogurt, tofu, quinoa, nuts, and beans. Dr. Canale largely concurs but adds that breastfeeding mothers should avoid seafood and limit consumption of fish such as tuna and mackerel, as they can contain excessive amounts of mercury and other toxins. Protein intake should be spaced out during the day, not concentrated in one meal.

Consumer Reports also suggests avoiding using protein supplements and shakes. “Though protein-packed meal-replacement shakes can seem convenient, they're often packed with unwanted sugars and other additives, and they generally lack the key nutrients you get from whole foods. And independent testing has shown that some protein products contain high amounts of arsenic, cadmium, and other dangerous heavy metals.”

Dr. Canale says breastfed babies are more vulnerable to the effects of heavy metals that can find their way into a mother’s milk. “This is one of the reasons I developed our test kits to measure the level of toxins in breast milk as well as protein and other nutritional content,” she says.

More Information:  Lactation Lab's test kit

Educating Breastfeeding Mothers About DHA Pays Dividends

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. 

Women who reported taking DHA supplements had higher levels than those who did not. In those who submitted a second sample, median breast milk DHA content increased from 0.19 to 0.22%.

The study found that providing nursing mothers with information about the importance of DHA and the levels present in their own breast milk motivated them to continue nursing and make dietary and supplement changes that increased their milk's DHA levels.

Breastfeeding mothers can check the level of DHA and other nutrients in their milk using Lactation Lab's test kit. Lactation Lab founder Dr Stephanie Canale MD developed  the kit to help educate breastfeeding mothers by measuring the nutritional value of breast milk, including the level of DHA. "As we learn more about the importance of the quality of breast milk through this type of research, it is helpful to have a tool to measure it," said Dr. Canale.
 

Source: International Breastfeeding JournalBrian A. Juber, Kristina Harris Jackson, Kristopher B. Johnson, William S. Harris and  Michelle L. Baack

Read more: Breast milk DHA levels may increase after informing women: a community-based cohort study from South Dakota USA

Do Supplements Really Work to Increase Milk Supply?

By Stephanie Canale MD

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.

I always ask my patients if they’re drinking enough water. Consuming enough fluids is more important for milk supply than any supplement.

If those issues have been ruled out, then a “galactagogue” or “lactagogue” - which means a food or supplement that can increase a woman’s milk supply - can be considered. They should be used with caution, and mothers should be aware of potential side effects and minimal data as to their effectiveness. While there are only two common herbal supplements that are designated by the FDA as safe for increasing milk supply (fenugreek and fennel), there are several others that have produced success for some women, so here is an overview.

Fenugreek (Trigonella foenum-graecum L.) is a member of the pea family sometimes used in artificial maple flavoring. Fenugreek has been used for many years to promote wellness, increase milk supply and to help with urethritis (urethral inflammation) and arthritis (joint inflammation). It has been used for many years in Indian and Chinese cooking. A meta-analysis (which is a study that looks at all of the studies together to draw a conclusion) showed that it was superior to placebos and can help increase a woman’s milk supply.

There are many different forms: teas, capsules, liquid, seeds and powders. The recommended dose of fenugreek is 2-3 capsules (580-610 mg per capsule) 3-4 times per day, and it may be discontinued once milk supply has increased to the desired level. Many women have reported results within 24-72 hours. It’s not clear exactly how fenugreek works, but some have proposed that it increases sweating and the breast is essentially a large sweat gland. Others have proposed that it increases certain naturally occuring hormones that stimulate milk production.

The side effects of fenugreek have been poorly studied. However, some generalized side effects that have been reported include nausea, headaches, vomiting, increased gas and gastrointestinal motility with loose stools. Some women have reported increased breast congestion and a maple-like taste to breast milk.

It is important for mothers to be aware of side effects and to monitor themselves and their infants. They should discuss supplements that they are taking with their primary care providers and lactation consultants.

Bottom Line: Fenugreek is listed as generally recognized as safe (GRAS) by the FDA and as long as mothers are aware of the side effects, this is a good option to try to increase supply.

Fennel (Foeniculum vulgare) is a licorice-flavored herb native to the Mediterranean and is best known for treating colic. Some anecdotal reports have found an increase in milk production. There is no consensus on the amount, formulation or frequency of consumption. It should be noted that fennel is also rich in vitamin C, potassium, manganese, copper, phosphorus and folate. It is also a great source of fiber and in moderation is a nutritious food to support a breastfeeding mother.

Bottom Line: Fennel is recognized as safe (GRAS) by the FDA and given the other health benefits of consuming it, this is a good option to try.

Palm Dates are one of the oldest galactagogues. Dates are low in fat and protein and rich in sugars. It is estimated that 100g of dates can provide upwards of 300 kcal and contain over 10 different essential minerals such as selenium, zinc, copper, potassium and magnesium. They contain B-complex vitamins, vitamin C and are high in fiber. Palm dates also have antioxidant properties. One study looked at 25 women who ate the flesh of 10 grade A palm dates 3 times a day and were found to have increased breast milk production. This was most noticeable in the first two-weeks postpartum. Breast milk volume almost doubled in the date-eating group as compared to the control group. Palm dates as supplements do not carry the GRAS rating by the FDA.

Bottom Line: Given the other benefits of palm dates, I don’t see a problem in trying them, despite the lack of firm evidence.

Coleus Amboinicus is a perennial succulent plant and has been used for centuries in Chinese cooking to treat a myriad of health conditions including chest pain, asthma, epilepsy, rashes and insomnia. It has also been suggested that Coleus species can increase a woman's’ milk supply. In my literature search, I could not find any evidence that was not anecdotal, and I could not find any recommendations of dosage, formulation and frequency.

Bottom Line: I would proceed with caution, try a small amount to begin with.

Blessed Thistle (Cnicus benedictus) is a Mediterranean weed also found in North America, which has been used for over 2000 years, mainly to stimulate appetite and aid in digestion. The chemical constituent of blessed thistle, cnicin, stimulates digestive enzymes and bile secretions. The herb is also theorized to stimulate blood flow to the mammary glands, thus enriching milk flow; however there are no studies documenting this. At levels of more than 5 grams per day, there have been case reports of increased risk of bleeding as it has been shown to possess platelet-activating properties. Caution must be used if concurrent antiplatelet medications are being taken.

Bottom Line: This is a common ingredient in many lactation teas and cookies and generally well tolerated. I would not use if you are taking any prescription medications such as proton pump inhibitors.  

Milk Thistle (silymarin; Silybum marianum; St. Mary’s milk) has been used for over 2000 years to treat many ailments. One study in rats did report higher levels of prolactin which is a theory as to how it can increase milk production. Another study did not find a difference in women who took the average of 420 mg/day of milk thistle in volume of breast milk production. It is not rated as GRAS by the FDA.    

Bottom Line: Many women have anecdotally reported benefits. I would recommend giving this a try.             

Goat’s Rue (Galega officinalis) is a plant native to the Middle East. It was often fed to animals as it was thought to increase their milk supply. There are no studies that looked at goat’s rue without the addition of fenugreek. There is anecdotal evidence to suggest that it can help. The mechanism by which it might work is not clear and caution should be used. It is not regarded as GRAS by the FDA.

Bottom Line: Goat’s rue is a common ingredient in lactation teas and generally well tolerated. I do not see any issues with trying this.

Shatavari (Asparagus racemosus) is asparagus, and over 300 species of asparagus can be found around the world. The roots and leaves of Asparagus plant (racemosus), also known as shatavari, are used as for immune support as well galactagogues. It is not clear how shatavari works to increase milk production.  It does not have a GRAS rating by the FDA.

Bottom Line: I would recommend trying to eat 1-2 serving of asparagus a week. There are many other benefits besides milk production!


In conclusion, fenugreek, and fennel are the only herbal supplements that are designated by the FDA as generally recognized as safe (GRAS).  Most commercially available products, including teas and capsules, contain a combination of fenugreek with various other herbal remedies. I recommend discussing all supplements with your healthcare provider and finding those that are best suited for you. For many, this is a combination of dietary changes and supplements.

 

Breastfeeding Boosts Babies' Good Bacteria

  Source: Wikimedia Commons

Source: Wikimedia Commons

 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.

Breastfeeding exclusively for six months enhances the kinds and amounts of beneficial bacteria that inhabit an infant’s gut.

Dr. Suchitra Hourigan, a pediatric gastroenterologist and director of the Inova Translational Medicine Institute in Falls Church, Va. told the Times that breastfeeding is the best and safest way to expose babies born by cesarean to their mother’s bacteria. "Breast milk contains many of the same beneficial bacteria found in a woman’s vagina, and breastfeeding infants are less likely than those consuming formula to develop respiratory and gastrointestinal infections and allergies as well as chronic diseases like diabetes, obesity and inflammatory bowel disease."

Dr Stephanie Canale MD, founder of Lactation Lab, advocates breastfeeding for as long as possible and notes that it is also important to ensure that breast milk is as nutritious and safe as it can be. To that end, she has developed a test kit that measures the nutritional value of breast milk and checks for excessive levels of toxins. "There's so much we're still learning about the incredible potential of breastmilk to positively impact short and long term health, and this new research is an important step in understanding how breastfeeding's impact on gut health can impact disease prevention," said Dr. Canale.

Source: The New York Times The Importance of Infants’ Exposure to Micro-Organisms

How Can I Be Sure To Pump Enough Milk?

 

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.

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Here are a few tips I would like to share as a physician, mother, and “master pumper!”

  • It is necessary to drink plenty of fluids throughout the day, and I would recommend hydrating on the way to work, having a water bottle close by at your desk, and keeping a few around the house to always have one handy.
  • In order to keep up your milk supply, it is also important to to eat and drink often and consume in excess of 500 calories more per day than usual.
  • I recommend investing in an automated pump. There are both manual and automated pumps on the market. A manual pump can take quite a bit of time but is useful for blocked ducts and during times of breast engorgement.
  • When using a manual pump I recommend massaging the breast with the free hand from the outer most areas to the nipple and continuing in a circular manner in order to massage the entire breast.
  • Before trying a pump it is important to know that one size does not fit all! Manual pumps vary in speed, attachments, size and weight, and women have nipples of different sizes and shapes, so choosing a pump that allows for physical variability is important.
  • It is a good idea to consult a lactation specialist or postpartum nurse and ask about nipple attachments and fitting of cups. A good pump should allow you to empty the breast with ease. It should not be painful to pump.
  • I do recommend consulting with a lactation specialist if you are having difficulty with pumping and for some renting a hospital grade pump may be the short-term answer. A hospital grade pump has more powerful suction.
  • Consider spare parts so that you always have a dry set ready to go. Some women enjoy the hands-free pumping bra while others get the hang of holding both cups with one hand. Making sure that the cup is the right size to avoid nipple injury is also key. Fluctuating the pump between a continuous and alternating method will also help extract more milk.

For women that have a long commute to work I recommend the following as a template or sample schedule: 

  • On waking, nurse or pump at home.
  • Pump in the car on the way to work (key for women who have a long commute, but please be safe in the car!)
  • Pump 1-3 times at work if possible, and consider blocking time on your calendar as you would block out a work meeting so you can protect your time.
  • Pump again on the way home.
  • Nurse or pump before bedtime.

I also suggest investing in good storage bags and making sure they are sealed and lying flat to maximize storage space in the freezer, and recommend freezing some bags of milk in 1 oz increments so that you can have small amounts of milk as needed to “top off” feeds. Make storing milk as easy as possible. Some women choose to invest in a small fridge-freezer for their office or simply buying a few insulated bags will work. I would always keep a spare insulated storage bag and spare bottles to pump into in the car in case they are forgotten.

A version of this post first appeared on New York Family.

Low Vitamin B in Lactating Mothers Can Slow Baby's Growth

 

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.  

Read more: B Vitamins in Breast Milk: Relative Importance of Maternal Status and Intake, and Effects on Infant Status and Function

Probiotics have benefits for baby, too

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The live active cultures found in yogurt and probiotics have been shown to promote healthy gut bacteria in adults, with positive effects on digestion and bowel regularity.

A new study suggests that consumption of probiotics by mothers may also be beneficial for their breastfeeding babies.

In a study of 57 moms, those that took a daily probiotic supplement had higher levels of iron, calcium and other nutrients in their breast milk than those that did not. Their babies also gained slightly more weight. The experimental group was supplemented with two synbiotic capsules containing different probiotic strains 30 minutes after dinner for 30 days.

UCLA physician Stephanie Canale recommends breastfeeding mothers take a probiotic, such as PRO-Women from Hyberbiotics.

For mothers who want to see how their diet affects their breastfeeding babies, Dr. Canale has developed a simple breast milk test that measures levels of iron and calcium and other nutrients.

“I developed these tests as I was concerned about my own breastfed baby gaining weight fast enough. Now we are delighted to offer these tests to any breastfeeding mother, from the comfort of their own home.”

Source: R. Mahdavi et al. / Journal of Trace Elements in Medicine and Biology 30 (2015) 25–29



 

Arsenic in rice: A cause for concern

A recent study by Healthy Baby Bright Futures finds that infant baby cereal contains six times as much arsenic as other cereals.  

  International Rice Research Institute

International Rice Research Institute

While arsenic is strictly regulated in drinking water, it is legal in any amount in infant rice cereal. It is a potent human carcinogen and a neurotoxin shown to permanently reduce children’s IQ.  

Arsenic is also found in higher concentrations in brown rice and rice milk, leaving us to wonder whether there is any risk to breastfeeding babies if the mother consumes large amounts of brown rice or rice milk.

“Infants are especially vulnerable because their bodies are so small, and on a per-pound basis, they’re getting much higher exposure than anyone else in the population,” HBBF research director Jane Houlihan told the New York Times. “They’re also vulnerable because it is a neurotoxic compound, and their brain is developing.”

The study’s sponsors, an alliance of scientists, nonprofit groups and private donors that aims to reduce children’s exposures to chemicals that may harm developing brains, recommends choosing these cereals instead of rice cereal: oatmeal, mixed grain, quinoa, barley, buckwheat, and wheat.

“As a precaution, I recommend breastfeeding mothers limit consumption of rice products,”- Stephanie Canale, MD, founder of Lactation Lab and a practicing family physician at UCLA.

Consumer Reports says rice eaters seeking to minimize their exposure to arsenic should  choose either white basmati or sushi rice from California, India or Pakistan, or brown basmati from the same origins. Further tips for reducing consumption of arsenic through rice can be found here.                                                               

As an added layer of security, Lactation Lab’s Premium Test Kit detects and measures levels of arsenic and other toxins in a mother’s breast milk, all from the comfort of her own home.

“Our tests revealed elevated levels of arsenic in one breastfeeding mother’s milk, which we believe originated from regular rice consumption at dinnertime,” said Dr. Canale. “With this information, she was able to adjust her diet to limit the risk of arsenic in her milk.”

Source: Arsenic in 9 Brands of Infant Cereal

Avocados linked to more nutritious breast milk

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Avocados offer a range of beneficial nutrients that can make a substantial contribution to a nutrient-rich diet when offered as a staple food for the breastfeeding mom.

That’s the conclusion of recent research published by the Journal of Nutrients.

The researchers note that avocados are unique among fruits and vegetables in that, by weight, they contain much higher amounts of the key nutrients folate and potassium, which are normally under-consumed in maternal diets.

Avocados also contain higher amounts of several non-essential compounds, such as fiber, monounsaturated fats, and lipid-soluble antioxidants, which have all been linked to improvements in maternal health, birth outcomes and  breast milk quality.

Did you know that avocados contain high amounts of folate, potassium, fiber, antioxidants, Vitamin A and Oleic acid - an essential omega 3 fatty acid?

Maternal diet affects every major aspect of reproduction from the early peri-conceptional period to the postnatal stages. It influences the entire range of maternal functions, including the production of adequate and nutritious breast milk.

The researchers recommend that avocados be considered for inclusion in future dietary recommendations for expecting and new mothers.

Source: The Role of Avocados in Maternal Diets during the Periconceptional Period, Pregnancy, and Lactation by Kevin B. Comerford (University of California), Keith T. Ayoob (Albert Einstein College of Medicine), Robert D. Murray (Ohio State University) and Stephanie A. Atkinson (McMaster University).

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Why do babies spit up?

 

The medical term for spitting up" is gastroesophageal reflux, or reflux. It happens when milk or solid food in the stomach comes back up into your baby's esophagus (the tube that joins the mouth and the stomach).

Babies spit up when they've eaten too much or when they've swallowed too much air while feeding. Spitting up usually happens when babies burp or drool. Spitting up is not vomiting and babies usually don't notice when they spit up. Vomiting is forceful and painful. Spitting up is common for most babies until about the time they can eat solid foods (usually around 6 months to 1 year of age).

While reflux is normal in babies,  you should contact your doctor if you notice your baby has the following symptoms:

  • Not gaining weight
  • Spits up a large amount of milk (more than 1 or 2 tablespoons)
  • Spits up or vomits forcefully
  • Has fewer wet diapers than normal
  • Seems very tired or lethargic
  • Spits up green or brown liquid

 

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When should I burp my baby?

Whether feeding your newborn by breast or a bottle, you may be stumped as to how often to do so. Generally, it is recommended that babies be fed on demand - whenever they seem hungry. Your baby may cue you by crying, putting fingers in his or her mouth, or making sucking noises.

A newborn baby needs to be fed every 2 to 3 hours. If you're breastfeeding, give your baby the chance to nurse about 10-15 minutes at each breast. 

Some newborns may need to be awakened every few hours to make sure they get enough to eat. Call your baby's doctor if you need to awaken your newborn more frequently or if your baby doesn't seem interested in eating or sucking.

Babies often swallow air during feedings, which can make them fussy. You can prevent this by burping your baby frequently. Try burping your baby every 2 to 3 ounces (60-90 milliliters) if you bottle-feed, and each time you switch breasts if you breastfeed.

if your baby tends to be gassy, has gastroesophageal reflux, or seems fussy during feeding, try burping your little one every ounce during bottle-feeding or every 5 minutes during breastfeeding.

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What should I eat while breastfeeding?

The best diet for a breastfeeding woman is well balanced and has plenty of calcium, This means eating fruits, vegetables, whole-grain cereals and bread, meats, beans and milk and dairy foods such as cheese.

         A breastfeeding mom needs to get enough calories -- about 500 more per day than           usual -- and needs to drink more fluids.

A balanced diet that includes 5 servings of milk or dairy products each day will provide enough calcium. If you don't eat meat or dairy products, you can get the calcium you need from broccoli, sesame seeds, tofu, and kale.

Talk to your doctor about taking extra calcium if you don't think you're getting enough from your diet. If you are concerned about the nutritional value of your breast milk, you can order one of our test kits.

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What are the benefits of breastfeeding?

Breastfeeding has many benefits for your baby. Breast milk is rich in nutrients. It contains antibodies, which help protect your baby against infections. And it helps to prevent babies from developing allergies as they grow.

Breastfeeding also has benefits for mothers.

It is clean and simple as you don't have to wash bottles or mix formula. It is cheaper than using formula. It helps the uterus contract back to normal size after having been stretched during pregnancy. It delays the return of periods (although you shouldn't count on it to prevent pregnancy). And it helps make time for you to be close to your baby.