Breastfeeding nutrition is a topic I get a lot of questions about, and yet this is a topic that many are afraid to discuss, especially when it comes to how a mother’s nutrient intake/status might affect the nutrient content of her breast milk.
But so many people ask me: “Can we boost the nutrient levels in breast milk?”
The reason this topic is so challenging to discuss—even taboo—is that…
1) There’s fear of making breastfeeding moms question their milk (something that’s pretty much already a given—been there!) OR
2) We want to avoid complicating nutritional advice on breastfeeding (sometimes with the overwhelm that naturally accompanies new motherhood, “eating enough” really is priority number one, however this ignores the micronutrient part of the conversation).
When I saw an amazing lactation consultant (IBCLC) in the early weeks of nursing my son, she told me that “it doesn’t matter what you eat, your breast milk composition doesn’t change.”
Some people say that because your body can pull from its nutritional stores during pregnancy to nourish your baby, your body can simply do the same while nursing.
Breast Milk Composition: Is it fixed?
Let me say that I empathize with all of the above reasons for not diving into the nuances of nutrition for breastfeeding. It’s incredibly taboo.
Fearing that your milk/supply is “not enough” for your baby is often cited as the #1 reason that women stop breastfeeding.
It’s a topic I really questioned if I should include in my book, Real Food for Pregnancy. The last thing I want to do is to inadvertently discourage breastfeeding.
Ultimately, after doing extensive research on the topic, I came to the conclusion that YES, while breast milk is the preferred food for infants, its nutritional composition is not fixed.
As one breast milk researcher explains, “breast milk is conditionally perfect,” meaning its nutritional composition DOES indeed shift based on a mother’s diet and/or nutrient stores. It absolutely CAN be deficient in nutrients.
Nutrient Deficiencies are Quite Common
When so many people are going into pregnancy with nutrient deficiencies, then coming out of pregnancy even more nutrient depleted, it’s actually doing mothers and babies a disservice to pretend that this is a non issue.
The assumption is often that maternal nutrient deficiencies are only common in developing countries, but this is not true. The giant U.S. survey on nutritional status known as NHANES found that 47% of pregnant or breastfeeding women are deficient in at least one micronutrient.
That’s almost half of mothers and expectant mothers!
Can We Boost the Nutrient Levels in Breast Milk?
I believe that support for breastfeeding can coexist with advice to optimize nutrient intake. This not only ensures that baby gets an adequate supply of micronutrients, but that mothers recover well from pregnancy and birth.
Simply put: We can do better for moms and babies.
I recently re-immersed myself in the research on breastfeeding nutrition, with a specific focus on how the nutritional status/intake of mom affects the nutrient levels in breast milk (and ultimately her infant).
I reviewed hundreds of studies and included research from 125 of them into a detailed webinar on nutrition for breastfeeding geared towards healthcare practitioners (it provides CEUs for registered dietitians and I include full citation list).
About 75% of the presentation focused on the micronutrient levels in breast milk.
Here are a few interesting facts about nutrition for breastfeeding from my research:
- The macronutrient in breast milk most sensitive to maternal intake, by far, is fat. Both the quality (type of fat) & quantity reflect maternal intake. This is new information for a lot of people in the lactation community (especially the quantity part), but there are a number of studies, including clinical trials of different levels of dietary fat intake (and types of fat), that have shown the above to be true.
- Most B vitamins are sensitive to changes in a mother’s intake and/or serum levels. The one to be most aware of is vitamin B12. Studies have shown that mothers who don’t get enough only provide an estimated 16% of their baby’s vitamin B12 requirements. Vitamin B12 is one of the top 3 most common micronutrient deficiencies affecting pregnant and nursing moms. Because vitamin B12 is vital for brain development and ensuring that your baby’s nerves get a protective coating of myelin, failure to get enough in the first year of life has been linked to irreversible neurological damage in up to 50% of infants who face deficiency (even after improving B12 status with supplementation). This sounds scary because it is and there is no way to sugar coat it. In the webinar, I talk about the different options for getting enough vitamin B12 from food sources or supplements. This is something that especially needs more attention in the vegetarian and vegan community.
- Choline needs are highest in lactation and, like pregnancy, there’s data that we need a LOT more than the current recommendations. Maybe this is why high choline foods (eggs, organ meats, and seafood) are a mainstay in many postpartum traditions from other cultures. With so much data accumulating on the importance of choline, I anticipate the recommended intake for breastfeeding women will increase the next time they revise the guidelines.
- Vitamin A needs (specifically retinol, the form found exclusively in animal fats) are high in lactation, but up to 60% of mothers have low retinol levels in milk (low vitamin A levels in milk are even more common for mothers of preterm infants). In the webinar, I talk about possible reasons for this & how to boost milk retinol levels. HINT: beta carotene from plants won’t help, since conversion to retinol is dismally low).
- Vitamin D levels in breast milk are highly dependent on a mom’s intake. Since most people don’t get enough, most breast milk is low in vitamin D, BUT that does NOT mean that vitamin D doesn’t transfer into breast milk. It means we need to ensure mothers get enough vitamin D to support not only her levels of this nutrient, but her baby’s as well. When mamas get enough, a separate infant vitamin D supplement becomes unnecessary. See this post for more on the amount of vitamin D research has found is required to adequately supply mom and baby.
If you find this type of information fascinating, you’ll want to watch my breastfeeding nutrition webinar, which focuses on how a mother’s nutrient intake/status impacts the nutrient transfer into breast milk.
It’s available on-demand on the Women’s Health Nutrition Academy website (click here). There are SO many more fascinating statistics and research findings packed into this webinar.
You get lifetime access to watch (and re-watch) the presentation as many times as you’d like. It’s 90 minutes + 30 minutes of Q&A. Dietitians earn 1.5 CEUs.
As I prepare for my second nursing journey later this year, I’m feeling rather empowered that there’s so much I can do to optimize my nutrient intake and thus the nutritional status of my baby.
I understand that some people may not feel the same way when given the same information, which is why it’s so important (if you’re a mama) to find a health professional who “gets it” and can meet you where you’re at with guidance that’s specifically tailored to your needs.
If that’s not possible, I’d recommend reading chapter 12 of Real Food for Pregnancy. Yes, I cover a lot of information, but I try not to get too deep into the weeds! You’ll walk away with clear guidance on what nutrients to have on your radar and how to optimize your intake with food (and, if needed, supplements). Knowledge is power!
If you’re a health professional working in the lactation space (and especially love getting into details from research studies, I highly encourage you to check out the breastfeeding webinar.
To my knowledge—and based on feedback from attendees—this is the most comprehensive training on breast milk nutrient composition available anywhere. You’ll walk away with information you can use in your practice right away. Check it out here.
Before you go, I’d love to hear from you:
- What have you heard about the nutritional composition of breast milk? Were you told it’s not impacted by your diet or something different?
Until next week,
P.S. – Way back when I was nursing my son, I recorded an interview on breastfeeding nutrition with the amazing Lisa Hendrickson-Jack of the Fertility Friday podcast. He was 8 months at the time, so there’s plenty of “real talk about breastfeeding.” If you’re in the thick of it and need some reassurance, check it out here.
P.P.S. – Don’t forget that focusing on foods/nutrients to support optimal levels in your breast milk also supports your own postpartum recovery. If you want to get a comprehensive education on optimizing postpartum recovery & nutrient repletion, I’ve got a separate webinar on that exact topic right here.
- Bird, Julia, et al. “Risk of deficiency in multiple concurrent micronutrients in children and adults in the United States.” Nutrients 9.7 (2017): 655.
- Allen, Lindsay H., et al. “Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review.” The Journal of nutrition 148.suppl_4 (2018): 1995S-2027S.
- Davenport, Crystal, et al. “Choline intakes exceeding recommendations during human lactation improve breast milk choline content by increasing PEMT pathway metabolites.” The Journal of nutritional biochemistry 26.9 (2015): 903-911.
- Guez, Sophie, et al. “Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy.” BMC pediatrics 12.1 (2012): 85.
- Allen, Lindsay H. “B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function.” Advances in Nutrition: An International Review Journal 3.3 (2012): 362-369.
- Hollis, Bruce W., et al. “Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial.” Pediatrics 136.4 (2015): 625-634.
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- Sauer, Charles W., Mallory A. Boutin, and Jae H. Kim. “Wide variability in caloric density of expressed human milk can lead to major underestimation or overestimation of nutrient content.” Journal of Human Lactation 33.2 (2017): 341-350.
- Torsvik, Ingrid Kristin, et al. “Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial.” BMC pediatrics 15.1 (2015): 218.
- Matamoros, Natalia, et al. “Vitamin A content in mature breast milk and its adequacy to the nutritional recommendations for infants.” Archivos argentinos de pediatria 116.2 (2018): 142-153.
- Gurgel, Cristiane Santos Sânzio, et al. “Effect of routine prenatal supplementation on vitamin concentrations in maternal serum and breast milk.” Nutrition 33 (2017): 261-265.