As an expectant mother you were probably bombarded with information about nutrition whilst you had a bun in the oven. You were likely also told - on repeat - about the benefits of breastfeeding your babe. But how much information did you receive about looking after yourself as a lactating mother? I appreciate that many medical professionals fear that telling expectant mothers that they should be prescriptive about their diet whilst breastfeeding may decrease breastfeeding rates. However, since we know that breast milk remains nutritious irrespective of maternal diet (12), I believe that it is important to share dietary advice with mothers. Not doing so puts mothers and their health and risk. Quite frankly, we deserve better.
Just Eat Healthily?
Whenever I asked medical professionals for advice about my diet when breastfeeding, the answer was always, "Just eat a balanced diet." To me this sounded vague and open to broad interpretation. Not once was I told by any medical professional that my body needed more of certain macro and micronutrients for as long as I was breastfeeding. This remained the case even when I collapsed at nine months postpartum and again six months later when I was admitted to A&E with heart palpitations and dizziness. It was only after I pressed for more investigations that I learned that the cause of my symptoms was a potassium deficiency. Also known as hypokalaemia, other symptoms of potassium deficiency include: constipation, muscle weakness and even paralysis (1). Important note: Before you rush to order a potassium supplement, or eat a dozen bananas, it is important to note that hyperkalemia (high potassium) is a dangerous condition which can also require medical attention (2).
A Balanced Breastfeeding Diet
Upon researching the recommended daily allowances for vitamins and minerals, I was shocked to learn that sometimes, the nutrient requirements of breastfeeding mothers are even greater than during pregnancy. Without this information, is it any wonder that breastfeeding mothers feel so exhausted so much of the time? Below is a summary of each of the key components of a balanced, healthy diet for lactating mamas:
Daily Calorie Intake
Breastfeeding uses between 500-700 calories per day (3) - no wonder you feel ravenous all the time! Non-lactating women are advised to consume between 1800-2400 calories per day (depending upon their level of activity). In addition to this, breastfeeding mothers are recommended to consume an additional 450 - 500 calories per day (4). Therefore, if you are relatively sedentary, you might aim to consume around 2250 calories a day. Conversely, if you are extremely active, you may aim for closer to 2900 calories a day. In order to ensure that you are getting enough macronutrients, aim to eat carbohydrates, protein and healthy fats with every meal. As far as possible, listen to your body and your appetite, too.
Iron, Vitamin D and Calcium
During pregnancy a woman's iron requirements increase significantly to 27mg/d, but this is not the case during lactation. In fact the RDA for iron in breastfeeding mothers is a third of that recommended for pregnant mothers at 9mg/d . Vitamin C supports iron absorption and it may surprise you to learn that breastfeeding mothers require significantly more vitamin C (120mg/d) than even pregnant mothers at 85mg/d. Fruits and vegetables are the best natural source of vitamin C (7) whilst iron is found naturally in beef, poultry, beans and nuts (12).
You may be aware that vitamin D supplementation is recommended for exclusively breastfed babies, but you may need supplementation too if you do not get at least 15 minutes of exposure to sunlight per day all year round. This is especially true for mothers with darker skin tones. Vitamin D and calcium both play a significant role in our bone health, as vitamin D aids the absorption of calcium in our bodies (5). As in pregnancy, vitamin D intake for breastfeeding mothers is recommended at 15μg per day - three times the recommended intake for other women (5). The flesh of fatty fish is the best natural source of vitamin D, with smaller amounts found in eggs, cheese and beef liver (8).
Calcium plays a significant role in the wellness of breastfeeding mothers for several reasons. Firstly, it is important to know that if there is insufficient calcium in a mother's diet to meet the demand crated by lactation, then it will be drawn from her teeth and bones (5). Secondly, we know that a breastfeeding mother's menstrual cycle affects the levels of calcium (and magnesium) in her body. This often contributes to a temporary drop in supply around the time that she gets her period each month. A supplement of 500 to 1000mg of calcium and magnesium in the few weeks leading up to a lactating mother's period may minimise a drop in her supply (8). The total recommended intake of calcium for breastfeeding mothers is 1000mg per day (5). This mineral is widely available in many foods - not just dairy - but also winter squash, edamame and leafy greens such as kale, bok choi and spinach (9).
When you first discovered that you were pregnant, one of the first recommendations that you likely received was to take a folic acid (folate) supplement, but did you know that for as long as you are breastfeeding, your requirement for folic acid remains 20% higher than other women at 500μg/d? Lactating mothers also require more vitamin B6 and vitamin b12 - essential for providing us with energy - than even pregnant women. No wonder so many of us feel exhausted all of the time! Natural sources of B vitamins include: salmon, poultry, chick peas, eggs, dark leafy greens, beans and peanuts (7).
Magnesium and Zinc
Like calcium, maternal deficiencies in magnesium and zinc during lactation are relatively common (5). Both minerals play a crucial role in immune function and disease prevention (10, 11). Zinc is also essential for cell building during periods of rapid growth such as pregnancy, infancy and childhood. Again, breastfeeding mothers require even more zinc than pregnant women at 12 mg/d. Rich sources of magnesium and zinc include plant foods like legumes, dark green leafy vegetables, nuts, seeds (10). Zinc is also found in beef and poultry (11).
I want to remind you that the information in this post is about you, mama. I also want to reiterate that your breast milk remains nutritious even if your diet is far from perfect. Your health on the other hand, may suffer. Wherever possible, it is recommended that we get the vitamins and minerals that we need from the food that we eat. However, that can be incredibly difficult if you spend your days sleep deprived and cluster feeding. For this reason, many mothers choose to take a prenatal or breastfeeding supplement for as long as they are lactating.
This information is designed to empower you to take better care of yourself as a nursing mother, not to replace medical advice. Please seek support form a medical professional if you have any health concerns, in the knowledge that you deserve advice and support to help you to feel happy and healthy. This blog post is adapted from my book, 'Self Care: The Breastfeeding Edition,' which is available here now.