Q1. Can lactating mothers resume their dietary habit before pregnancy?
More nutrients are needed during the breastfeeding period than at any other time. It helps produce the nutritious breast milk and also replenish the loss during pregnancy and delivery. It also helps enhance wound recovery. It means a 50% to 90% increase in the demand for various nutrients. While mothers may feel hungry more often, the fat stored during pregnancy can be a source of energy. Therefore, increasing the daily energy intake by 20 to 30% (around extra 500kcal) is generally sufficient, and the quality of food is of utmost importance.
Q2. How are the quality and quantity of breast milk affected by maternal diet?
The nutrients in breast milk change with the needs of infant growth. The taste and nutritional value of breast milk are closely related to the mother’s diet. Research suggests that babies are less likely to be picky with food or develop allergies if a balanced, diversified diet is adopted by mothers during the lactation period. The amounts of healthy fats like DHA, vitamins A and D, iodine, choline and ‘bad fats’ like trans fat and saturated fat in the breast milk change with the mother’s diet and nutrient levels. Iron, calcium and folate on the other hand, tend to be stable in breast milk. In case of insufficient intake, the reserves in the mother’s body will be drawn to provide for the nutrient needs of infants in the breast milk. In short, it is important for mothers to maintain a good diet.
Many mother worry about low milk supply. They become overly cautious about food choices as some food are thought to affect milk production. Research shows that the effect of food choices on milk supply differs among individuals. The scientific evidence is still inconclusive. Some healthy foods that are considered to “lactogenic” can be included in the daily diet, e.g. papaya, oatmeal, salmon, nuts, etc. It is important, however, to limit the intake of foods that are high in saturated fat and sugar, such as pork knuckle, chicken feet, bubble milk tea and lactation cookies. These allegedly lactogenic foods can contribute to weight gain, thicken the breastmilk as well as increase the risk of milk duct clogging and infection.
One must beware of certain herbal supplements, whose excessive intake may upset the digestive system. Strong tasting foods may also affect the baby’s appetite. Consult your doctor before consumption. Milk production is all about demand and supply, during which the body will adjust to the baby’s needs. Getting a good latch and responsive feeding can effectively increase milk supply. A balanced diet, adequate rest, and a relaxed mood can also have a positive impact on milk supply.
Q3. What is a balanced diet for breastfeeding?
Consume about 4 fist-sized portions of high-fibre carbohydrates every day, e.g. red rice, brown rice, oatmeal, oat bread or root vegetables like corn or potatoes. High-fibre carbohydrates not only can increase satiety but also stabilise blood sugar and mood. Mothers are also advised to eat 2 to 3 palm-sized portions of high-quality protein every day, e.g. lean meat, seafood, egg, tofu or legumes. It is recommended to eat at least 2 bowls of vegetables and 2 fist-sized portions of fruits every day. Vegetables with a variety of colours can provide different antioxidants and enhance satiation to achieve effective weight control. Mothers should consume 2 to 3 portions of high-calcium food every day, e.g. low-fat milk, cheese, yogurt or calcium-fortified soy milk. It is not recommended to skip all oils in diet as good unsaturated fat is vital for the development of infant brain. It can also help prevent infection and constipation in mothers. Sources of good fat could come from nuts, salmon, avocado, etc. However, fatty meat, skin or processed foods should be avoided. In addition to three meals, mothers can add 2 to 3 portions of nutrient-dense snacks daily to increase satiety.
Q4. What are the essential nutrients for breastfeeding mothers?
Firstly, iodine is essential for infant growth and brain development. Research has shown that lactating mothers in Hong Kong often fail to obtain enough iodine from their diets, and they are advised to take an iodine supplement with at least 150mcg of iodine supplement per day and increase their dietary intake of iodine-rich foods, e.g. iodized salt, seaweed, seafood, egg yolk, dairy products, etc. Do not consume kelp more than once per week, or it may lead to excessive iodine intake.
Secondly, vitamin D not only facilitate calcium absorption and is thus vital for bone health. It can also boost immunity and stabilise mood. Sunlight is the most effective source of vitamin D.As vitamin D is limited in most foods, a daily supplement of 600IU of vitamin D is recommended if mothers cannot sunbathe or consume deep sea fish often. There is also inadequate vitamin D in breast milk, babies are generally not recommended to be exposed to prolonged sunlight. Therefore, international guidelines recommend that breastfed babies be supplemented with 400IU of vitamin D per day.
Thirdly, omega-3 fatty acid DHA is important for infant brain and visual development. It can also promote wound recovery in mothers as well as prevent mastitis and postpartum depression. Mothers are advised to have a daily DHA intake of 200mg from supplements. Supplements are not required if 8 to 12 oz of low mercury marine fish is consumed per week.
The fourth nutrient is choline. It supports normal cell function, promotes infant brain development and cortisol levels. Mothers need at least 550mg of choline per day, normal diet only reached around 60% requirement. Yet, most maternal supplements on the market contain no choline. Eggs are rich in choline, therefore mothers are advised to eat one egg daily. The natural lecithin can help prevent clogged milk ducts.
Finally, it is calcium. Calcium loss is inevitable during breastfeeding. Instead of using calcium tablets, two portions of high-calcium food can satisfy the daily requirement of 1000 mg. Research shows that mothers with adequate calcium intake during breastfeeding may even have better bone density in the long run.
Take multivitamin supplements used during pregnancy or lactation period if normal diets fail to provide adequate amounts of the nutrients. At any rate, a balanced diet is still important for mothers while taking supplements. In addition, vegetarian mothers are reminded to take vitamin B12 supplement to prevent deficiency.
Q5. Do I need to avoid certain foods while breastfeeding?
There are not many lactation dietary restrictions. Moderate consumption of food that makes mothers happy can make breastfeeding last longer. Sashimi, salad, soft cheese, etc. are allowed during lactation. However, seafood if high in mercury should be avoided. They must also come from reliable and hygienic sources.
Caffeine and alcohol can pass through breast milk, and if absorbed in excess can impede infant brain development, cause fussiness in babies and affect milk supply. Mothers are advised to limit daily caffeine intake to 200mg and consume alcohol only occasionally. The concentration of caffeine and alcohol peaks at 1 hour after consumption, and both require 2 to 3 hours to metabolise. Therefore it is better to consume caffeine or alcohol after breastfeeding, and wait at least 2 to 3 hours before the next feeding to minimise the impact on babies. Mothers is encouraged to refrain from using caffeine and alcohol until the baby is at least 3 months old, or avoid them altogether if the baby shows adverse reactions.
Unless the mother is allergic to certain foods, avoidance of food allergens during breastfeeding does not lower the risk of food allergies in infants. Breast milk is the best natural hypoallergic food. Mothers are advised to observe the baby’s reaction and skip those foods to which its digestive system, respiratory system or skin may react adversely without suspending breastfeeding immediately.
Q6. Does breastfeeding make it harder to lose weight?
Lactation is energy demanding and can actually promote weight loss. The energy consumed per day is equivalent to running for an hour. Mothers should avoid dieting as it may affect milk supply. In general, with a healthy diet, exercise and breastfeeding, mothers should be able to return to their pre-pregnancy weight within 6 to 9 months after giving birth.
Q7. When should babies start weaning?
The first 1000 days of life, i.e. from pregnancy to 2 years old, is a critical period for brain and physical development. As the body’s immunity only matures gradually after 2 years old, international institutions such as the WHO, UNICEF, AAP, ABM AND ACOG recommend exclusive breastfeeding for the first 6 months, and continued breastfeeding along with appropriate complementary foods introduced since 6 months, and for2 years or beyond. Breastfeeding has numerous health benefits for both the baby and mother. Breastfeeding is not always easy. All the efforts are worth it despite the difficulties. Salute to mothers!
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