Worried that my diet is compromising my breastmilk
	Should I limit my diet to prevent allergies
	How can I boost my baby's iron?
	Does my son need additional calcium?
	Is it OK for me to exercise?

Worried that my diet is compromising my breastmilk

I am often concerned because at times, I feel I am not eating healthy enough for a breastfeeding mom.  I am taking prenatals, but my biggest problem is forgetting to eat, then, when I do eat, sometimes I am not probably eating what I should.  For example, lunch today was a piece of ham rolled up with a piece of cheese and a left over cantaloupe slice from my 3 year old's lunch.  Other than that and his cold scrambled eggs left over from breakfast, I have just had water.  Supper is in the crock pot, so I am planning on scarfing something down between now and bedtime.  My milk production is high, but what I am curious about is whether or not the quality of the vitamins and nutrients in my breast milk is compromised by my hit and miss diet?

Thanks so much!





Based on the information that you shared, I am more concerned about you than about Elizabeth.  You say that your milk production is high and Elizabeth is gaining weight, so her nutritional status is probably not compromised by your hit-and-miss diet

Diet does have dome effect on the nutrient quality of the milk, especially that of the water soluble vitamins and certain minerals.  However, you indicated you are still taking your "prenatals."  If this is a balanced vitamin and mineral supplement for pregnant women, it will provide considerable protection to the milk and to you.

I am concerned that people like me not say a mother "should and should not" do this or that - because a lot of shoulds create barriers!  It does make sense that what we eat will affect our health and that of our babies, whether a mother is pregnant or lactating, so I think it is wise to be careful about food choices. However, I am especially concerned about the effect of this diet on your own nutritional status.  It appears that you are eating nutritious foods, but that the quantity of foods isn't sufficient for a breastfeeding mother of an almost 4-month old.  An average size woman should consume at least 1,500 - 1,600 calories each day to maintain a normal weight.  With the diet that you described, you are probably not getting this many calories.  Overtime, if your caloric intake is compromised and you lose weight too quickly in the postpartum period, your milk supply could be affected. So, for your sake and Elizabeth's, I would suggest looking closely at your diet and making some changes to boost your caloric intake.

To comment on your diet more specifically, I would need more information on your pre-pregnancy weight, your current weight, and your height. However, I will make a couple of general comments.  First, I don't see that you mention drinking any milk.  Sufficient calcium intake is important for all women, and you are advised to drink about three 8-ounce glasses of milk each day, or getting the equivalent in other calcium rich foods (e.g. yogurt, cheese) or calcium enriched products (i.e. calcium enriched soy milk and fruit juice).  Second, remember that you are a role model for Elizabeth and your 3-year-old child.  Your children will learn what and how to eat by watching you, so it is very important to set a good example of a healthy, balanced diet early on.  I know that this can be difficult with two young children, but you might try because this is likely to be the most important issue in the long run!

I suggest that mothers look at the food pyramid for ideas: breads and cereals on the bottom should be the foundation of all snacks and meals as a vehicle for other foods such as peanut and others nut butters, cheese, meats, and fish as sandwiches, which can be eaten at any time of day, including breakfast.  Next are fruits and vegetables.  These can be eaten raw, cooked, or as juices.  I enjoy the mixture of fruit with yogurt and milk.  It makes a delicious and nourishing beverage, which when consumed with a nut butter sandwich would be a fast and nourishing breakfast.

It sounds as though you have a very busy and active schedule with two small children. Remember, though that the time you take for yourself can be time for your children too.  You can eat with them, modeling appropriate table behavior and you can have them "read to you" while you eat.

Should I limit my diet to prevent allergies

I am expecting my third child in early October.  My first two boys are highly allergic. Their allergies include anaphylaxis to peanuts and my second was milk allergic.  My children's allergist suggested I eliminate peanuts, wheat, eggs, fish, milk, and limit soy consumption while I breastfeed. This seems a bit overwhelming to me as I thought breastfeeding was the best way to reduce allergies in children.  My OB has a different opinion, thinking that the allergist is being alarmist. What is the correct answer, I feel stuck and confused but I want to give my child the best start.

Thank you





This is fairly controversial, even in my profession.  There is some work that has been reported recently from England on this topic.  One study showed, for example, that in the last few weeks of pregnancy, mothers should be more conservative about the types of food that are potential allergens for their family. (JA Lovegrove, JB Morgan and SM Hampton Dietary Factors influencing levels of food antibodies and antigens in breast milk. Acta Paediatrica 85:778-84, 1996)

For example, many mothers think they need large quantities of some foods, such as milk, during pregnancy.  This is not true. Three 8-ounce glasses of milk is plenty for pregnant and lactating women.  This is the same amount as needed by non-pregnant adult women, too.

I would encourage you to consider modifying your diet late in pregnancy and during the early part of lactation.  I think that you can very easily eliminate peanuts, eggs, and fish, and consume more red meats instead, which are less likely to produce allergies.  You can be modest about your intake of wheat products - but don't eliminate wheat products.  You can also use more calcium-enriched soy products, which are less likely to produce allergies than cow's milk, if you are concerned about cow's milk allergies.

The key is that modification of your diet may not prevent the allergies in your baby, but that it will likely delay the onset of allergies in your baby, until the allergies are less likely to affect growth.  Finally, I would encourage you to seek out a perinatal nutritionist in your area to help monitor your diet during pregnancy and early lactation.

How can I boost my baby's iron?

My son currently has borderline anemia (hemoglobin 10.6).  He was born at 41 weeks gestation.  I took prenatal vitamins for the first 4 months, but finally associated them with my morning sickness. My doctor then had me take a regular multi-vitamin and 1000 mcg of folic acid and Tums for calcium.

He was exclusively breastfed for 8 months.  He was slow to start solids and mostly ate veggies and fruits and breastmilk until about 11 months.  At that point he started to eat a lot of table foods. At 13 months he started on cow's milk during the day, but continues to breastfeed at night and in the morning.  We now have him on an iron supplement.

My hemoglobin is usually borderline (in the high 10's or low 11's), but I did not become anemic during pregnancy.  I don't seem to have any clinical signs of anemia.  This borderline status seems to run in the family.

My question is actually as much about any future babies as it is about Lars.  Is there anything I can do during my next pregnancy, at the birth (I read that perhaps leaving the cord attached longer may help later hemoglobin for the baby, but have not been able to find any actual research) or while breastfeeding that will help the baby's iron status as they get older?





Certainly, you can ask that your obstetrician or midwife delay ligation of the cord until it stops pulsating.  This does get more blood into the baby, and can help with hemoglobin status.  I'm not aware of specific research on this, but it is the baby's blood in the cord, and it makes sound physiological sense to allow the blood to go back into the baby's body before the cord is cut.

Larger babies generally have a larger iron mass at birth - which can be protective.  In addition, it would be helpful to know about your serum iron status and total iron binding capacity - and the same for your baby.  You may, in fact, not be iron deficient, even if your hemoglobin is borderline. Hemoglobin levels provide information about iron in the red blood cells.  It is really a reflection of the iron status 2-3 months before you measure it. So, you may want to check with your physician to obtain more specific information about your iron status.

In terms of other things that you can do to make sure that you and future babies that you have aren't anemic.  First, you should know that there are other nutrients involved red blood cell formation - including iron, folic acid, Vitamin B-6, ascorbic acid, and copper - so a varied diet is important.  Also, it is important that your weight is optimal. Underweight mothers tend to have lower hemoglobin.  Good idea - starting soft cooked red meats about 6 months of age.  I would also suggest some discussion about iron supplementation before and during pregnancy.  I think you might find it helpful to consult with a Perinatal Nutritionist who could help you more personally as you prepare for your next pregnancy.

Does my son need additional calcium?

My son nurses for a total of about 30 minutes per day.  Does he need additional dairy products or calcium foods? He likes yogurt and cheese, but he won't drink cow's milk.





Yes, he does need additional dairy products. It is great that he likes both yogurt and cheese.  You say that Sam doesn't drink milk.  Do you drink milk?  Remember that you and your baby's father are role models for your son's diet.  Try putting milk in a cup.  Try letting Sam add interesting colors to the milk with fruit, such as blueberries or raspberries.  Or, try adding some yogurt to the milk for a tasty drink.  Let Sam participate in this, so he learns to enjoy the milk in different ways. Just put a small amount of milk in the cup each time - let him ask for more!  The Dietary Reference Intake (IOM 1997) for children ages 1 through 3 years is 500mg/day.  That is the equivalent of 26 oz of milk/day (about 300mg calcium/8 oz).

Is it OK for me to exercise?

Is it okay for me to exercise (e.g. strenuous aerobic activity) prior to breastfeeding my son?  I have been told that exercise will make my milk taste bitter and I will produce less at that particular feeding?





There is some research that indicated that "max" treadmill work - exercising to exhaustion - does raise lactic acid levels in the milk.  Lactic acid in high concentrations could taste bitter.  (GB Carey,Quinn TJ,and SE Goodwin. Breastmilk Composition after exercise of different intensities. J Hum Lact 1997; 13:115-120)

However, mothers who do what I would call "normal" aerobic exercise - jogging or dance, for example - do not raise the lactic acid levels in their milk to a detectable level.  Milk production is not negatively affected by this exercise either. In fact, some studies suggest that mothers who exercise produce more milk than mothers who do not.


 

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