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by Tamzin West, ABM BFC and IBCLC
The good news is that most people do not need to worry too much about what they’re eating while lactating. Even if you feel that your diet could be improved, your milk is still going to be amazing for your baby!
However, a reasonably healthy, balanced diet will help you to feel more energetic and give you all the nutrients you need for your general wellbeing. With that in mind, there are some nutrients which you need more of when breastfeeding, most of them being easy to get with just some small additions to your food. And no, that cauliflower is not going to make your baby windy![1]
This table shows recommended daily intake of nutrients when lactating, compared with not lactating, and some examples of how to obtain them. Those in bold indicate increased needs.
A note on Vitamin D: In the UK, recommendations are for everyone to take a vitamin D supplement[2], Sunlight is the ideal source of Vitamin D, but unfortunately most of us don’t get enough of it due to indoor lifestyles. People with darker skin tones and babies who are born in winter are also at higher risk due to lower exposure to sunlight. The amount of vitamin D in your breast milk IS affected by your own vitamin D levels, so this is an important consideration. Vitamin D is vital for the good health of bones, teeth and muscles. Infants consuming 500ml or more of formula per day receive their supplement in this way as it is added to the formula itself.
Generally with supplements it’s a good idea to talk to your health professional if you are considering taking something.
Special circumstances – Vegetarian and vegan diets
It is perfectly possible to breastfeed and follow a vegetarian or vegan diet. However, there are some important considerations which you might need to think about more while you’re breastfeeding:
Vitamin B12 – B12 is an essential nutrient, but unfortunately it’s difficult to get from plants. Therefore, it’s important for those who don’t eat any animal products at all to consider how they are going to get enough B12 in their diet. Nutritional yeast and yeast extract are both good sources, and it is often added to plant milks and breakfast cereals, so it’s worth double checking the ingredients when you’re buying those. Many vegans also choose to take a B12 supplement. B12 is one of the few nutrients in your breast milk which IS directly related to your own diet. Therefore, to make sure that your baby gets enough B12 from you, you need to make sure that you are consuming enough.
Protein – contrary to popular belief, protein is not generally an issue for vegetarians and vegans, and can be found easily in plant-based sources including beans, pulses, nuts, seeds and tofu. However, protein requirements when lactating are slightly higher than normal (see table above), and low protein may be associated with reduced breast milk production in some cases[3].
Calcium – calcium needs are increased from 700 to 1250mg per day when breastfeeding. For those who consume it, dairy is a convenient source. For vegans or anyone else who doesn’t, good sources of calcium include tofu, almonds and leafy greens. Non-organic plant milks are usually fortified with calcium, B12 and sometimes other nutrients such as iodine as well.
Iodine – iodine is important for thyroid function and is easily found in seafood. Sea creatures actually get theirs from algae and seaweed, which are also potential sources for those who don’t eat seafood. However, most people are not going to eat enough seaweed for all their dietary needs, and other plant sources may be variable.
Omega-3 – omega-3 fatty acids may be important for our cardiac and brain health. Oily fish is a great source, and the general population is recommended to eat 2 portions a week. We know that the amount of fat in breast milk is not influenced by diet, but the types of fat are[4]. Vegetarian sources of Omega-3 include several types of nuts and seeds, or an algae-based supplement. Currently as there is little research into potential benefits of supplementing with Omega-3 when breastfeeding, you might wish to do your own reading on the subject to make an informed decision. See the useful links section below for further information.
Special circumstances – Dairy-free breastfeeding
If your baby is diagnosed with Cow’s Milk Protein Allergy (CMPA), you can continue breastfeeding by removing all dairy products from your diet. Key considerations in this case are vitamin B12 and calcium (see the sections above for further information). You may be prescribed calcium and vitamin D supplements[5].
Other special circumstances
For all special diets for allergy, lifestyle or medical reasons please do consult with your medical professionals and make sure they are aware that you are breastfeeding.
Losing weight when breastfeeding
Rest and recovery are important when you have had a baby, particularly in the early months. Your body has just grown a baby and continues to nurture them – how amazing! There is no rush to “snap back” but if somewhere down the line you’d like to lose weight, most sources agree that a sensible weight loss of up to 1.5 lbs a week is not going to cause any problems for lactation. It is important to remember though, that breastfeeding uses an extra 300-500 calories a day, so do remember to include that when thinking about your diet. Some popular diet plans do have specific rules for breastfeeding. Supposed “quick-fix” strategies such as weight loss supplements, meal replacements and low-carb diets are best avoided as they will not include all the nutrients you need for your own wellbeing.
Taking vitamin supplements
There are lots of vitamin brands now offering specific “breastfeeding” vitamins. Some of these are quite expensive, although you can also find own-brand vitamins at a lower cost. There is no specific need to take these, and a standard multivitamin is fine if you wish to take one. If you do decide to take vitamin supplements, it’s worth double-checking quantities against the table above to avoid excessive quantities of vitamins A, B6 and iodine in particular.
Caffeine
Caffeine is found in coffee, tea, chocolate, energy drinks, some fizzy drinks and some medications. Around 1% of your caffeine intake will pass through into your breast milk, which is a very small amount. As with most things, consumption in moderation is not a problem for most people, but there are a couple of considerations. Most sources agree that under 300mg of caffeine per day is not generally going to cause problems when breastfeeding, however, some babies may be sensitive to it, particularly in the first 3 months or so. A standard cup of coffee has around 100-150mg, though this will vary depending on the size, strength and type of coffee. Signs of sensitivity in a baby include jitteriness, irritability and fussiness. There are, of course, many reasons why babies may be fussy or irritable, so you may wish to contact some breastfeeding support if you are worried.
Caffeine may also be associated with vasospasm and Reynaud’s Phenomenon. A high intake (over 450mg per day) may also lead to reduced iron in breast milk.
Alcohol
Like caffeine, alcohol does pass into breast milk, but only in very small amounts. The occasional or small amount of alcohol is not likely to harm your baby. Alcohol levels peak in breast milk between 30-60 minutes after drinking, so you could reduce the amount going to your baby by drinking and feeding around the same time, and then waiting 2-3 hours before feeding again. However, this is a cautious approach and not all sources agree that it’s really necessary. More conservative sources also suggest minimising alcohol consumption in the first 3 months after the baby’s birth, as newborns are not able to metabolise alcohol as well as slightly older babies.
Excess consumption of alcohol and binge drinking can be risky. Large quantities of alcohol can affect the let-down, which in turn can cause babies to become fussy and impatient at the breast. Excess consumption can also cause babies to become drowsy and weak, and can lead to poor weight gain.
It’s also important to consider how well you are able to look after your baby while consuming alcohol. If you are planning to have more than one or two drinks, consider whether someone else will be there to take charge of your baby’s care. It’s also very important not to fall asleep with your baby if you have been consuming alcohol, as this increases the risk of SIDS.
Despite common perceptions, it does not help to “pump and dump”. Alcohol will clear from your milk at the same rate as your bloodstream. It takes approximately 2-2.5 hours for one unit of alcohol to leave your system depending on your size, and 8-10 hours for four units to leave your body. One unit is roughly equivalent to a single spirit measure, half a standard glass of wine, or half a pint of beer.
Galactogogues & Lactation cookies
You will often see recommendations to eat certain foods to encourage your milk production (known as galactogogues), and there are also increasing numbers of commercial “lactation cookies” and similar products making claims that they will help you. Common foods and ingredients include oats, fenugreek, blessed thistle, milk thistle, fennel, brewer’s yeast, goat’s rue and many others. There is little evidence to support most of these, and nothing will work to increase your milk production without frequent, effective milk removal (i.e. feeding and/or expressing). However, the recommended foods do tend to be nutritious and we know that the placebo effect can be powerful, so there’s no harm in eating them if you enjoy them. Oats, for example, are a good source of zinc, iron, protein and fibre (among other things), and many people find a warm bowl of porridge a great comfort food. If eating oats makes you feel good, and that in turn helps you with feeding, that’s a good thing, but don’t rely on them to do everything for you.
Commercial lactation cookies tend to be very expensive, and are, sadly, a marketing gimmick. If you particularly want to use ingredients which are traditionally thought to be galactogogues, you can probably save lots of money by making your own.
A note about Fenugreek: there is some research that fenugreek helps to increase milk production for some people. However, there are some important contra-indications (meaning cases where you shouldn’t take it), particularly in relation to blood disorders, hypotension, hypoglycaemia and miscarriage. More information can be found here https://www.breastfeedingnetwork.org.uk/galactagogues/
Useful links
https://www.breastfeedingnetwork.org.uk/galactagogues/
https://breastfeeding.support/breastfeeding-and-drinking-alcohol/
https://breastfeeding.support/coffee-caffeine-breastfeeding/
https://kellymom.com/nutrition/mothers-diet/mom-weightloss/
https://www.vegansociety.com/resources/nutrition-and-health/life-stages/pregnancy-and-breastfeeding
[1] https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
[2] https://academic.oup.com/jn/article-abstract/106/3/312/4763550?redirectedFrom=fulltext
[3] https://pubmed.ncbi.nlm.nih.gov/18936218/
[4] https://cks.nice.org.uk/topics/cows-milk-allergy-in-children/management/suspected-cows-milk-allergy/
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