I am a family physician, educator, and mother of two that breastfed both of her children. It was only when I was at work trying to juggle the challenges of a full time practice, being on call and worry over my daughter not gaining enough weight despite drinking enough volume of breast milk that I started to ask myself what is in MY milk.
The idea of women wanting to know what is in their milk is not new. In 1978 a new method was published called a creamatocrit. This was a rough way of extracting how much fat was in a breast milk sample based on the size of the fatty layer of milk after it was spun down in a centrifuge machine. The number of calories was then calculated from the size of the fatty layer.
Not everyone is able or chooses to breastfeed. But if you do it’s helpful to note certain vitamins and minerals in your milk are directly associated with what you eat and the supplements that you take. Numerous studies reveal that breast milk can differ significantly from mother to mother but that term milk within the same mother does not vary as much as we previously thought. Folks used to differentiate between foremilk and hindmilk noting the increased fat content at the end of a feed, however studies found that it does not vary more than roughly 5% from the beginning to the end of a feed. Most physicians would agree it is the volume of milk intake that is correlated with growth.
Each day I am asked by new moms about what supplements they should take now that they are nursing, and if what they eat affects the quality of their milk. Specifically, many women wonder do diet and supplements matter? Does what a women eats actually change the levels of nutrients in her milk? The answer: it does.
Many studies have looked at maternal status and breast milk concentration of nutrients and minerals. The most studied are essential fatty acids. They are called “essential” since our body doesn't make them so we need to consume them. DHA (docosahexanoic acid) has received a lot of attention as it has been shown to be very important for brain growth and neurodevelopment. Other omega-3’s and omega-6 fatty acids are positively correlated to mother’s levels.
For a study in South Dakota, nursing moms were taught about how their diet affects their milk. After the appropriate dietary changes were made they were able to increase their levels in a matter of weeks. The main dietary sources of omega-3 fatty acids are from fish. Due to mercury concerns it is recommended to eat no more than 2-3 meals per week. It should also be noted that there are certain types of fish that should be avoided all together when nursing (e.g., swordfish, mackerel and some tuna).
Not every vitamin and mineral will change over time. Minerals such as sodium, phosphorus, and zinc tend to be consistent across women and over periods of time. Some studies have found a link between maternal calcium and iron and the levels in their milk while others have not. It is difficult to fully understand the relationship as the many studies carried out to date have involved small sample sizes and vary in the methods used to measure these elements.
Other nutrients do vary in human milk as a result of maternal nutrition. Some of these include vitamin A, vitamin B6, and vitamin B12. Vitamin C and calcium have also been found to positively correlate with maternal levels. A mom can have a normal blood level of these vitamins but have low levels in her milk.
Vitamin A which is important for vision, skin and skeletal growth is related to maternal level. Vegetables that are rich in orange colors are also rich in Vitamin A. These include carrots, sweet potatoes and orange peppers for example. Other dietary sources of Vitamin A include liver from any animal, egg yolks and squash. Some dietary sources of vitamin B6 include, turkey, pork, pistachio nuts, sunflower seeds, fish and dried fruits. B12 is rich in chicken livers, clams, crab, fortified cereals, some milk and yogurt. Dietary sources of vitamin C are citrus, dark leafy greens, strawberries and melons. Dairy is a rich source of calcium in our diets but calcium can also be found in green leafy vegetables.
There is some evidence that increasing iron in the diet of a lactating women will also affect the levels in her milk, but it is unclear how much supplementation is enough and to what extent it will impact the milk. Studies have varied with the time at which iron levels have been measured in breast milk and have often failed to control for the amount of blood loss and changes in maternal iron stores after delivery.
The AAP (American Academy of Pediatrics) recommends a universal supplement of 1 mg/kg of iron and 400 IU of vitamin D per day for breastfed infants. Vitamin D is universally low across milk of all species and is typically well tolerated in baby. Many colleagues of mine do not necessarily recommend iron supplements as they can be difficulty for a newborn to digest and may be a cause of increased gas and fussiness. It is suggested that all infants be screened for anemia by 12 months of age.
The bottom line is that nursing moms should not be skimping on nutrition to lose their baby weight. I suggest that lactating women increase their intake by 500 calories a day more than baseline. We benefit from the additional calories that extra 10lbs that most nursing women cannot lose helps provide the essential nutrients for their growing children. In addition to taking a prenatal or postnatal, a mom should consume 200mg of DHA daily, and consider extra Vitamins A, C, B12, calcium and iron. For the latter vitamins, a discussion with your primary care provider is recommended.
Stephanie Canale, M.D.
Dr. Canale is from Montreal, Canada and earned her undergraduate and medical degrees from McGill University. She completed her residency training in Family Medicine at UCLA. After medical residency, she joined the teaching faculty at the UCLA Family Health Center, before joining the Santa Monica Parkside office. She enjoys seeing patients of all ages, especially families with young babies and young adults. Dr. Canale also teaches medical residents and students. Dr. Canale is a Member of the American Board of Family Medicine. She is married with two young children and despite loving the weather in Southern California still enjoys winter sports such as skiing and playing ice hockey.