Breastfeeding – the best diet for you and your baby (part 1) - How your diet affects your milk

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1. What’s in breast milk?

The composition of breast milk changes in the first few days after birth from colostrum, which is rich in protein and protective factors, to mature milk. It also changes during each feed from fore milk, which is more watery, to hind milk, which contains more calories and nutrients. It even varies with the time of day and with the weather, so your baby gets more fluids when it’s hot, and really does get just what he or she needs.

On average, breast milk contains about 70kcal per 100ml. It is 1.3% protein, 4.1% fat and 7.2% carbohydrate and has a range of vitamins and minerals. In addition to providing nutrition, breast milk contains growth factors, hormones and other special proteins, antibodies, white blood cells and nucleotides, which help protect against infection.

2. How your diet affects your milk

Some components of breast milk are affected by the food you eat. The protein and carbohydrate content doesn’t seem to vary, but studies have shown fat content can be altered. If you have a low-fat diet and low fat stores, the amount of fat in your breast milk is reduced. The levels of different fatty acids can also be altered. Women who eat more butter have higher levels of saturated fat in their breast milk, and women on macrobiotic diets have lower than average levels of saturated fat. In addition, women who consume more of the long-chain omega 3s DHA and EPA have more of these fatty acids in their milk. The breast milk of lacto-ovo-vegetarians contains more ALA (a short-chain omega 3) but less DHA (a long-chain omega 3) than that of meat-eaters. Vegans’ breast milk has even more ALA and less DHA than that of lacto-ovo-vegetarians. It is also known that three-month-old babies breastfed by vegan mothers have around a third the amount of DHA in their blood compared to babies of meat-eaters. There is no evidence of health or developmental problems caused by vegans’ lower DHA levels, but there hasn’t been much research into it. Some experts argue that long-chain omega 3s are vital in the diets of breastfeeding mothers, and including some in your diet or taking supplements should be considered.

There have been a small number of cases of vitamin B12 deficiency in babies of vegan mothers with low intakes of the vitamin and low levels in their breast milk. Deficiency results in megaloblastic anaemia and symptoms such as weakness, refusal to eat and delayed development. Most of the cases have involved babies who have been exclusively breastfed for up to 10 months to a year. A recent case, however, involved a five-month-old Italian boy who was admitted to hospital with severe growth and developmental problems and an enlarged liver and spleen. He was vitamin B12 and iron deficient, and although his mother had taken multivitamin and vitamin supplements during pregnancy, she had stopped when he was born. Mild vitamin B12 deficiency in breastfed babies can be treated by giving the mother a supplement, but the Italian boy needed injections as he was severely deficient. These raised the level of vitamin B12 in his blood, but seven months later he still showed developmental delays. The supplements this vegan woman took contained 2.5µg vitamin B12 and it may be that a higher dose would have given her son larger vitamin B12 stores at birth. Lacto-ovo-vegetarians usually have higher intakes than vegans, but levels of vitamin B12 in breast milk have been found to be lower among lacto-ovo-vegetarians than among meat-eaters, and it is important for all vegetarians to be vigilant about this while breastfeeding.

As milk is rich in calcium, you may worry about getting enough calcium for your body to make breast milk. However, it has been found that breast milk calcium levels are fairly stable, irrespective of a mother’s calcium intake. Research with macrobiotic women with very low calcium intakes found they had normal levels in their breast milk. Nevertheless, following pregnancy you will have less calcium in your body than normal, no matter how well you ate during pregnancy. Also, your body may be producing calcium-rich milk at the expense of your own needs. This could mean poor future bone health if you aren’t careful. Calcium requirements increase from 700mg to 1250mg per day for breastfeeding, so it’s a good idea to check you’re eating enough calcium-rich foods to meet these high requirements. If you’re not, then it’s best to take a supplement. Although calcium levels in breast milk are fairly stable, vitamin D levels are lower if mothers have lower levels, and this could affect calcium absorption. Vegetarians have been found to have lower vitamin D levels in winter and spring, and all breastfeeding women are advised to take a supplement.

The myth of poor-quality milk

Women sometimes believe their milk isn’t very good. They may even be told they have ‘poor-quality milk’. In reality, the composition of breast milk is unlikely to vary enough to affect your baby’s feeding pattern or immediate growth, unless you are severely malnourished. It is much more likely that your baby’s positioning and attachment while feeding need attention. If you are concerned about your milk supply and are thinking about giving your baby the odd bottle or switching to formula completely, don’t rush into it. Make sure you first talk to your midwife or health visitor or call one of the breastfeeding helplines . They should be able to offer you plenty of advice on establishing good breastfeeding.

3. Yummy – garlic milk

The foods, spices and drinks you consume while breastfeeding directly affect the flavour and odour of the milk you produce. You might think that garlic-flavoured milk would put a baby off feeding, but this doesn’t seem to be the case. It is known that garlic transfers into breast milk – the odour has been detected by scientists, who report that it is at its strongest two hours after garlic is eaten – but babies seem to like it. In fact, babies have been found to stay at the breast longer, suck more often and consume more milk when their mother has eaten garlic.

Another great advantage of flavoured breast milk is that it prepares babies for weaning and enjoying a varied diet in later life. Breastfed babies are less likely to become fussy eaters. A greater acceptance of different flavours is apparent right from the beginning. A number of studies have found that babies exposed to certain flavours while breastfeeding, including garlic and aniseed, are more likely to enjoy the taste later when they are weaned.

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