Behind the hype: Eating well during breastfeeding - NPA279

Behind the hype: Eating well during breastfeeding

What's the issue?

Breastfeeding provides many benefits for both mother and baby^1,2,3,4,5,6. New mothers are often exposed to lots of advice and information on what to eat or avoid while breastfeeding. There is little evidence to support avoiding certain foods (unlike in pregnancy), or that eating certain foods improve milk supply. Instead, the focus needs to be on regularly eating a wide variety of healthy foods and drinking plenty of fluids to support milk production. It is also safest for breastfeeding mothers to be alcohol free.

Eating advice for mothers during breastfeeding

Encourage mothers to eat a variety of healthy foods from the four food groups for meals and snacks*. This will ensure an adequate supply of all the required nutrients. Nutrients of particular importance while breastfeeding are protein, calcium, iodine, and for some, vitamin D, B12 and iron⁶. Energy requirements are also slightly increased. Vitamin C is important for vegetarian and vegan mothers to increase iron absorption from plant-based protein foods eg, legumes, nuts, and seeds. Vegan mothers should seek advice from a registered health professional to make sure nutrient needs are met.

* 1. Plenty of vegetables and fruit, 2. grain foods (mostly wholegrain) 3. some milk and milk products (mostly low and reduced fat) and 4. some legumes (lentils, split peas, chickpeas, and cooked dried beans), nuts, seeds, fish and other seafood, eggs, poultry and/or red meat with fat removed.

Supplements

The only supplement that is recommended for all breastfeeding women is a 150-microgram iodine-only tablet. This is the same supplement recommended during pregnancy and should be continued until breastfeeding ends. Food sources of iodine should also be encouraged. These include bread, milk and milk products, eggs, cooked fish, some shellfish, and red or green seaweed. Choose iodised salt if using salt in home cooking.

Woman should seek advice from their doctor, midwife, or dietitian before taking supplements other than iodine. More specific information is available in Behind the Hype: Nutrition Supplements in Pregnancy and Breastfeeding

Food allergies

Breastfeeding women are encouraged to eat foods that are associated with allergies, unless they have a known allergy to the food themselves. Common foods linked to allergy are milk, eggs, fish, seafood, peanuts, nuts, sesame, soy, and cereals containing gluten. Research shows that avoiding these foods does not prevent allergies in infants⁷.

Fluid intake

Women are often thirsty during breastfeeding, as fluids are needed to produce breast milk. Drinking around 10 cups of fluid a day is recommended. Plain water is the best drink choice. Low-fat milk (green or yellow label) is also a good choice, and provides protein and calcium for breastfeeding women.

Caffeine

Caffeine is found in energy drinks, black tea, coffee, fermented beverages (kombucha) chocolate and some soft drinks (eg, cola). Energy drinks and soft drinks are also high in sugar and energy. It is advised to moderate caffeine intake while breastfeeding.

Alcohol

Drinking alcohol is not recommended for mothers who are breastfeeding.

Alcohol can delay milk let down and reduce milk production⁸. Alcohol passes to the baby through breast milk, this can affect growth and motor development. It can also make baby irritable, unsettled and less able to feed well^9,10. Women should be advised to avoid drinking alcohol in the first month of breastfeeding, particularly until breastfeeding is established. 

Women should be advised to only breastfeed when there is no alcohol in their system. Depending on a woman’s weight, it takes nearly two hours for her body to rid itself of one standard drink (100ml wine or 330ml can beer). If a woman drinks alcohol, she should wait for two hours or longer until breastfeeding again. It is also possible to plan ahead to express and store milk that doesn’t contain alcohol and then discard milk after drinking alcohol in order to maintain supply.

Also of note, kombucha contains low levels of alcohol. If the amount of alcohol exceeds 0.5% it must be declared on the label. Mothers should be encouraged to check kombucha labels and to refrigerate after opening to avoid further fermentation and alcohol production.

Colic

Foods that have been suggested to unsettle babies include cabbage, broccoli, onion, and garlic. However, there is not enough evidence to recommend excluding specific foods to reduce colic or wind in an infant⁶.

Effect of flavours from a mothers’ diet on breast milk

Some flavours from the mothers’ diet transfer to and flavour breastmilk¹¹. This has been shown to subsequently have a positive effect on children’s acceptance of these flavours eg, carrot, but it is not known if this is the case for all flavours. However, it indicates the importance of a mother’s diet during breastfeeding and potential to influence the healthiness of children’s diets¹¹.

Aim for a healthy weight

Breastfeeding can help a woman return to her pre-pregnancy weight over time. Combining healthy food and drink choices together with regular moderate-intensity physical activity will help to achieve and maintain a healthy body weight¹². This is in preference to restrictive eating plans or diets. Participating in physical activity will not negatively affect milk supply. However, timing exercise after breastfeeds may be more comfortable for mothers.

If women need more support to maintain a healthy weight, help can be sought from a doctor, dietitian, or community health provider.

In a nutshell

• Eat a variety of healthy foods to ensure nutrient needs are met and infants are exposed to a wide range of flavours, particularly from vegetables, through breast milk.
• Drink plenty of fluids each day (10 cups) and choose plain water over sweetened drinks.
• Aim for a healthy body weight by choosing healthy foods and drinks that are low in fat and sugar and by being physically active each day. Being active will not negatively affect milk supply.
• Iodine supplements are recommended while breastfeeding (this is the same iodine supplement recommended during pregnancy).
• There is no evidence to recommend avoiding any foods to alleviate or prevent colic-like symptoms in babies while breastfeeding.
• Avoiding alcohol while breastfeeding is the safest option for breastfeeding mothers and babies, as alcohol passes through to the baby in breast milk.

References

1. Horta BL, Victora CG (2013). Long-term effects of breastfeeding. Geneva: World Health Organization.
2. Horta BL, Loret de Mola C, Victora CG (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatrica,104:30-7.
3. Chowdhury R, Sinha B, Sankar MJ, et al. (2015). Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatrica,104:96-113.
4. Aune D, Norat T, Romundstad P, et al. (2014). Breastfeeding and the maternal risk of type 2 diabetes: A systematic review and dose–response meta-analysis of cohort studies. Nutrition, Metabolism and Cardiovascular Diseases, 24(2):107-15.
5. Davidove ME, Dorsey JW (2019). Breastfeeding: A Cornerstone of Healthy Sustainable Diets. Sustainability,11(18):4958.
6. Ministry of Health (2020). Eating and Activity Guidelines for New Zealand Adults. Wellington: Ministry of Health.
7. Joshi PA, Smith J, Vale S, et al. (2019). The Australasian Society of Clinical Immunology and Allergy infant feeding for allergy prevention guidelines. Medical Journal of Australia. 210(2):89-93.
8. Giglia RC (2010). Alcohol and lactation: An updated systematic review. Nutrition & Dietetics, 67(4):237-43.
   
9. NHMRC (2009). Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Canberra: National Health and Medical Research Council.
10. Ministry of Health (2010). Alcohol and Pregnancy. A practical guide for health professionals. Wellington: Ministry of Health.
11. Spahn JM, Callahan EH, Spill MK, et al. (2019). Influence of maternal diet on flavor transfer to amniotic fluid and breast milk and children’s responses: a systematic review. The American Journal of Clinical Nutrition,109(Supplement 1):1003S-26S.
12. National Institute for Health and Care Excellence (2010). Weight management before, during and after pregnancy. NICE Public Health Guidance. Manchester: National Institute for Health and Care Excellence.