A lactating mother requires extra food to secrete adequate quantity/ quality of milk and to safeguard her own health. The nutritional link between the mother and the child continues even after birth. The new born baby depends for some period solely on breast milk for his existence. Breastfeeding is one of the most effective ways to ensure child health and survival. However, nearly 2 out of 3 infants are not exclusively breastfed for the recommended 6 months a rate that has not improved in 2 decades. Breast milk is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood illnesses. Breast milk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life.
Breastfeed children perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life. Studies shows Women who breastfeed also have a reduced risk of breast and ovarian cancers. Inappropriate marketing of breast-milk substitutes continues to undermine efforts to improve breastfeeding rates and duration worldwide.
At parturition, major hormonal changes lead to the onset of lactation. Estrogen and progesterone secretion fall markedly while the elevated prolactin concentrations are maintained. Prolactin causes the breasts to begin milk secretion. During the first 2 to 7 days postpartum, colostrum is secreted, a thick yellow fluid containing large amounts of immune factors, protein, minerals, and carotenoids. Colostrum can provide the newborn infant with large amounts of maternal antibodies, important because the immune system does not develop fully for some months. Between about 7 and 21 days postpartum the milk is transitional, and after 21 days mature milk is secreted. Suckling is required to empty the breast, which stimulates continued synthesis of prolactin and maintenance of milk production; once lactation is established suckling once a day can sustain milk production but synthesis stops within a few days of suckling cessation. Continued suckling inhibits release of luteinizing hormone and gonadotropin releasing hormone so the return of ovulation and menses is delayed, providing very effective birth control.
The volume of breast milk secreted increases rapidly to about 500 mL on day 5, 650 mL at 1 month, and 700 mL. A supplementation during the first 6 weeks postpartum, while there is minimal chance of conception, is recommended by WHO for increasing breast milk retinol and improving infant vitamin A status in developing countries. Vitamin B 12 concentrations in milk from Guatemalan women were one – tenth of those in California, and correlated with both maternal and infant serum B 12 with both groups having a high prevalence of deficiency. Human milk provides sufficient fluoride for the first 6 months of life, but the infant should be given 0.05 mg/kg/day starting at age 6 months.
Iodine can be very low in breast milk in populations with endemic iodine deficiency, and infants and young children consume little iodized salt. Even in Switzerland, for example, weaning infants are at risk of iodine deficiency, especially if they are not consuming infant formulas.
Lactating mother’s nutritional requirements should meet (1) her own daily needs (2) provide enough nutrients in milk for the growing infant and (3) furnish the energy for the mechanics of milk production. Diet of lactating mother and her nutritional status during pregnancy affect to a certain extent quality and quantity of breast milk. Nutritional needs exceed during lactation compared to pregnancy. In six months a normally developing infants doubles the birth weight equivalent of which is accumulated in 9 months of pregnancy.
- Nutritional requirements are maximum during lactation compared to any other age group in a woman’s life hence the diet should be balanced and meet the requirement. Number of meals can be increased.
- Galactogogue or lactogogue act by increasing the prolactin secretion which is turn increases milk production. They also work psychologically and have a marginal effect on milk production. Sucking is the best lactogogue. The diet can include lactogogues which stimulate the production of milk. Garlic, milk, almonds and garden cress seeds are considered to increase the milk production in certain regions of India. Some also believe foods of animal origin like animal origin like goats meat, fish and mutton increase the secretions of breast milk. Special foods like sonth laddu and gond laddu are given during lactation. This practice can be encouraged.
- Weight gain beyond that desirable for body size, should be avoided. When the baby is weaned, the mother must reduce her food intake in order that obesity may be avoided.
- It is better to control constipation by inclusion in the diet of raw and cooked fruits and vegetables, whole grains and adequate amount of water than by use of laxatives.
- No food need be withheld from the mother unless it causes distress to the infant. Occasionally, tomatoes, onions, members of cabbage family, chocolate, spices, and condiments may cause gastric distress or loose stools in the infant.
- If the mother is under 17 years of age and if she has multiple gestation, she needs to take additional care in meeting the nutritional requirements.
- If the mother looses rapid weight loss while breast-feeding, her choice intake is to be increased.
Maternal Nutrient Requirements During Lactation
The daily nutrient requirements of the lactating woman are higher than requirements during pregnancy. The higher recommended intakes are based primarily on the amounts secreted in milk. The most recent RDA assume that the mother secretes about 500 kcal/day in milk, including about 5% as protein, more than 50% as fat, and 38% as lactose (Institute of Medicine). This falls to 400 kcal/day in the second 6 months. In the first 6 months about 170 kcal/day are obtained from maternal weight loss. Thus the energy requirements in lactation are higher than those of the non – pregnant woman. Energy restriction to induce weight loss should not be attempted while breast feeding due to the risk of inadequate intakes of other nutrients in the diet. Exclusive breastfeeding and exercise, combined with a high quality diet, should lead to gradual weight loss during the postpartum period. The recommended intake of most micronutrients is also increased to cover the amounts secreted in milk. The only nutrient that is needed in lower amounts during lactation is iron, except for women who need to synthesize large amounts of blood to replace major blood losses during delivery.
Galactagogues are generally herbs or foods like these that, when ingested, increase a lactating mother’s milk supply. They’re often taken in supplement form or teas, but you can consume them as really delicious prepared foods too. Galactagogues and their milk-promoting functions generally aren’t scientifically proven, but instead are used because of anecdotal evidence passed on from mother to mother. Galactagoues include Almonds, Oats, Alfalfa, sprouts, Fennel, Fenugreek, Brewer’s yeast, Spinach, Flaxseed. Galactagogues are grand foods that can help spur your milk supply into overdrive.
Some moms find it helpful to cook with galactagogues items, grouping as many items together as possible. You can make cookies with almonds, oats, and flax seed. Tea with the fennel, fenugreek, and blessed thistle or a balanced green juice made up of spinach and sprouts.
Nutrient requirements during breastfeeding
Nutritional needs during breastfeeding are increased in response to breast milk production. They must meet the requirements of both baby and mother.
An additional 500 kcal for the first six months, and 400 kcal during the next six months, are required for a lactating mother. This can be met by eating, simply eating more of the usual balanced diet should allow you to meet the higher energy demand while you breastfeed. On average, 100 ml of human milk gives 70 kcal of energy. During the first six months after delivery, 750 ml of breast milk is produced daily. If the extra demand for energy is not met from dietary sources, then your reserved fat stores will be used instead.
The increase in protein requirements during lactation are minimal compared to that of energy. However, if your energy intake is low, protein will be used for energy production. The additional protein requirements during lactation can be met by consuming protein rich foods. If you do not have a high enough protein intake, then the proportion of casein in your milk may be reduced. Casein protein is an important component of human milk, and helps to provide our baby with calcium and phosphate. It also forms a clot in the stomach that allows more efficient nutrition. Insulin resistance is modulated by protein quality, rather than quantity. Proteins derived from fish might have the most desirable effects on insulin sensitivity.
Lactose is the predominant carbohydrate in human milk and is essential to the nutrition of the infant’s brain. While the concentration of lactose is less variable than that of other nutrients, the total production is reduced in mothers with severe malnutrition.
The lipids in breast milk are the fraction that most contributes to its energy content; they are the components that vary most in their distribution and quality. Maternal malnutrition is associated with lower concentrations of lipids in breast milk. The distribution pattern of fatty acids in breast milk is also sensitive to the mother’s diet.
DHA (docosahexaenoic acid) is a nutrient with a limited endogenous biosynthesis, so it must be obtained through the diet, as it is the most important omega-3 acid for the optimal development of the brain, retina and ear. The cholesterol content of breast milk is highly variable and is related to the duration of breastfeeding, maternal age, maternal diet, season and place of residence omega-3 polyunsaturated fat. Omega-3s are considered essential fats because your body alone cannot make them.
Water accounts for 85—95% of the total milk volume. There is a widespread belief that increasing water intake will increase milk production, but several studies have demonstrated that forcing the intake of fluids beyond that needed to quench thirst has no beneficial effects on lactation.
The concentration of sodium is higher in colostrum than in mature milk. Research has found no evidence of an association between sodium intake during lactation and sodium levels in breast milk. However, it is always advisable to consume small amounts of salt, always enriched with iodine (iodised salt)
The recommended concentration of folic acid in breast milk can be easily achieved through dietary intake or supplementation, if needed.
Dietary elements and minerals
The concentration of several vitamins and minerals in human milk is influenced by maternal diet and/or vitamin status. The concentrations of these nutrients in normal milk show the effect of maternal deficiency and supplementation on milk content and the infant. To predict risks caused by infant or maternal micronutrient deficiencies in lactation, and for planning interventions, it is useful to categorize nutrient deficiencies based on their effect on the nutrient in milk. Priority nutrients include vitamin A, thiamin, riboflavin, vitamins B 6 and B 12, iodine, and selenium. These nutrients are of most concern because low maternal intake or stores reduces their content in milk, which affects the infant adversely. However, the concentration in milk can be restored rapidly by maternal supplementation. Also infant stores of these nutrients are more readily depleted, increasing the infant’ s dependence on an adequate supply from breast milk or complementary foods. Lower – priority nutrients include folate, calcium, iron, copper, and zinc.
Maternal intake and stores of these nutrients have little or no effect on breast – milk concentrations or infant status, or on the amount required from complementary foods. Consequently the mother is less likely to become depleted, and maternal supplementation is more likely to benefit herself than her infant. Milk vitamin D may below if women are very deficient but their infants will respond readily to vitamin D supplements.
Low milk vitamin B 12 and subsequent infant deficiency as a result of strict maternal vegetarianism, and low milk vitamin D and abnormal vitamin D status of infants receiving insufficient exposure to sunlight. The American Academy of Paediatrics recommends that all infants who are breastfed should receive 400 IU vitamin D per day as a supplement. Infants fed formula but drinking < 1 L (1 quart) per day should also receive supplemental vitamin D.
Low concentrations of nutrients in breast milk imply that maternal and/or infant supplementation is needed; breastfeeding is always the best way to feed young infants.
Vitamin B 12 concentrations in milk from Guatemalan women were one – tenth of those in maternal and infant serum B 12 with both groups having a high prevalence of deficiency. Human milk provides sufficient fluoride for the first 6 months of life, but the infant should be given 0.05 mg/kg/day starting at age 6 months.
Vitamin A in breast milk is adequate in industrialized countries, but high – dose (200 000 to 300 000 IU) vitamin A supplementation during the first 6 weeks postpartum, while there is minimal chance of conception, is recommended by WHO for increasing breast milk retinol and improving infant vitamin A status in developing countries.
The plasma and tissue concentrations of vitamin C in smokers are lower than in nonsmokers, so an increase in vitamin C intake is recommended in mothers that smoke.
The concentration of vitamin E in breast milk is sensitive to maternal intake, so the maternal diet must be assessed and supplemented if intake is inadequate.
Vitamin K is also synthesized by bacteria lining the gastrointestinal tract. If the diet is adequate, the lactating mother does not require vitamin K supplementation. Newborns usually have low levels of vitamin K, as this vitamin is not easily mobilized through the placenta and the bacterial flora of the newborn is inadequate for its synthesis in the first days of life.
Copper and zinc
Concentrations seem to correlate strongly to maternal stores in the liver during the third trimester of the pregnancy, and maternal intake has little influence on them, although their bio -availability in milk is very high. Iodine, iron, copper, magnesium and zinc have a high bio-availability in breast milk. The selenium content is strongly influenced by the mother’s diet.
Iron supplementation is usually recommended to make up for losses sustained during childbirth, although it must be noted that women that practice exclusive breastfeeding usually experience amenorrhoea for a minimum of six months and thus do not lose iron through menstruation during that time. Therefore, it could be said that breastfeeding exerts a protective effect against maternal iron deficiency.
Calcium is essential during lactation, during which it is subject to special regulatory mechanisms that lead to increased absorption, decreased renal excretion and greater mobilization of bone calcium. To meet maternal calcium requirements, the American Academy of Pediatrics recommends lactating mothers to consume five servings a day of calcium-rich foods of any kind, such as low-fat yogurt or cheese, and other nondairy foods that contain calcium, such as fish consumed with its bones (for example, canned sardines), salmon, broccoli, sesame seeds or cabbages, which may provide the 1000—1500 mg daily recommended allowance for lactating women.
Zinc is essential to growth, cell immunity and enzyme synthesis. While zinc concentrations in human milk are not high, they suffice to satisfy the needs of the child due to its high bio-availability. We recommend increasing zinc intake by 50% during lactation.
Selenium is a mineral involved in the immune system, cholesterol metabolism and thyroid function. The concentration of selenium in breast milk is three times that in artificial formulae.
The iodine requirements of lactating women nearly double those of healthy adult women, as in addition to meeting maternal requirements, iodine levels must guarantee that the baby receives sufficient iodine from the milk to synthesize thyroid hormones. The iodine content of human milk is variable and depends on maternal intake.
Most Commonly Asked Questions
What about a vegetarian diet and breast-feeding?
Choose foods rich in iron, protein and calcium. Good sources of iron include lentils, enriched cereals, leafy green vegetables, peas, and dried fruit, such as raisins. Body absorb iron; eat iron-rich foods with foods high in vitamin C, such as citrus fruits. For protein, consider plant sources, such as soy products and meat substitutes, legumes, lentils, nuts, seeds, and whole grains. Eggs and dairy are other options. Good sources of calcium include dairy products and dark green vegetables. Other options include calcium-enriched and fortified products, such as juices, cereals, soy milk, soy yogurt and tofu. Consider supplements.
A daily vitamin B-12 supplement is recommended. Vitamin B-12 is found almost exclusively in animal products, so it’s difficult to get enough in vegetarian diets. If you don’t eat fish, you might consider talking to your health care provider about taking an omega-3 supplement. If you don’t eat enough vitamin D-fortified foods — such as cow’s milk and some cereals — and you have limited sun exposure, you might need vitamin D supplements. Your baby needs vitamin D to absorb calcium and phosphorus. Too little vitamin D can cause rickets, a softening and weakening of bones. Tell your doctor and your baby’s doctor if you’re also giving your baby a vitamin D supplement.
What foods and drinks should I limit or avoid while breast-feeding?
Certain foods and drinks deserve caution while you’re breast-feeding. For example:
- Alcohol: There’s no level of alcohol in breast milk that’s considered safe for a baby. If you drink, avoid breast-feeding until the alcohol has completely cleared your breast milk. This typically takes two to three hours for 12 ounces (355 millilitres) of 5% beer, 5 ounces (148 millilitres) of 11% wine or 1.5 ounces (44 millilitres) of 40% liquor, depending on your body weight. Before you drink alcohol, consider pumping milk to feed your baby later.
- Caffeine: Avoid drinking more than 2 to 3 cups (16 to 24 ounces) of caffeinated drinks a day. Caffeine in your breast milk might agitate your baby or interfere with your baby’s sleep.
- Fish: Seafood can be a great source of protein and omega-3 fatty acids. Most seafood contains mercury or other contaminants, however. Exposure to excessive amounts of mercury through breast milk can pose a risk to a baby’s developing nervous system. To limit your baby’s exposure, avoid seafood that’s high in mercury, including swordfish, king mackerel and tile fish.
This advice has been handed down for year not to eat beans, as they will make your baby gassy and don’t eat spicy food because your milk will become too spicy. This is based on the assumption that what you eats goes directly into your milk supply and that your baby will suffer from food specific allergies and intolerance. The theory goes: gas is due to red meats and beans and acid reflux from broccoli. Occasionally these things are true that sometimes babies do have allergies and when you cut out various foods from your diet, it makes a big difference. However, most babies who suffer from allergic reactions due to something you’re eating are often accompanied with other symptoms such as: hives, watery diarrhea, large patches of relentless eczema and very painful gassy.
Do we really burn extra calories while breastfeeding or during lactation?
Many breastfeeding moms report feeling extra hungry throughout their days of breastfeeding. This hunger is for an excellent reason. Your body is working very hard to produce its “liquid gold” – breast milk. The rumors you heard are correct: you burn an additional 500 calories a day while breastfeeding. While breastfeeding, it is essential to eat enough calories to fuel both you and your baby. It is not the time to try the latest diet or weight loss fad. In fact, you should not go on any specific “diets” Unless your baby has special dietary needs.
Do we need to consume extra calories while breast-feeding?
Yes, you might need to eat a little more — about an additional 330 to 400 calories a day — to give you the energy and nutrition to produce milk.To get these extra calories, opt for nutrient-rich choices, such as a slice of whole-grain bread with a tablespoon (about 16 grams) of peanut butter, a medium banana or apple, and 8 ounces (about 227 grams) of yogurt.
How can I plan meals to get the nutrients I need during pregnancy?
You should join the programme of Foodnwellness. This program gives you a personalized plan that includes the kinds of foods in the amounts that you need to eat for each trimester of pregnancy.
How Foodnwellness helps during this phase?
During lactation or breastfeeding, motivation for eating a healthy diet may change relative to the non-pregnant state as women prepare for motherhood and consider the impact of their dietary intake on the baby’s health. Personal values and beliefs about nutrition in pregnancy and lactation, advice from health professionals, and physical and physiological changes may interact with determinants of eating behaviors present in the non-pregnant state to change diet-related behaviors. Although most women are aware that healthy eating is important during pregnancy and lactation, women may lack knowledge of specific dietary recommendations or may not have the skills required to improve their diet. Women may receive plenty of advice from everywhere but it is worthy when you receive correct knowledge from panel of health professionals. Foodnwellness will always guide regarding every issue you face and it will be taken care of by our Dietitians.