Breastfeeding is widely recognized as the optimal way to nourish infants, offering numerous benefits for both the baby and the mother. A healthful breastfeeding diet is essentially the same as a nutritious diet when not breastfeeding. However, ensuring adequate nutrition during this period requires careful attention to dietary choices, especially when following a non-dairy diet. This comprehensive article explores the benefits and risks associated with non-dairy diets during breastfeeding, providing essential information for mothers seeking to make informed decisions about their nutritional needs and their baby's health.
Nutritional Needs During Breastfeeding
When breastfeeding, a person requires around 450 to 500 extra calories per day. A healthful breastfeeding diet is essentially the same as a nutritious diet when not breastfeeding. The main difference is that people who are breastfeeding need more calories. People who wish to lose weight after pregnancy may not need to increase their calorie intake while breastfeeding, but they should discuss this with their doctor. Specific nutrients, such as iron, calcium, potassium, and vitamins A and D, are particularly beneficial when breastfeeding. Eating a wide variety of foods is also essential, as this will expose the baby to different tastes and may result in them being more receptive to solid foods later on.
Key Food Groups for Breastfeeding Mothers
No single diet will be ideal for everyone who is breastfeeding. The goal should be to eat a healthful, varied diet. When breastfeeding, aim to include the following foods in each day’s meals:
- Fruits: Fruits are a rich source of many nutrients. They may also help relieve constipation, which some people experience after giving birth. Aim for about 2 cups of fruit per day, which should include a wide variety of different fruits, such as cantaloupe, honeydew melon, bananas, mangoes, apricots, prunes, oranges, and red or pink grapefruit.
- Vegetables: People who are exclusively breastfeeding should aim to eat 3 cups of vegetables a day. Those who are combining breastfeeding with formula-feeding should eat 2.5 cups of vegetables each day. Vegetables are rich in vitamins and antioxidants. Consuming a sufficient quantity will help the body to replenish the nutrients it needs to make milk. The USDA recommend the following vegetables due to their potassium and vitamin A content: spinach, cooked greens (such as kale and collards), carrots, sweet potatoes, pumpkin, tomatoes, and red sweet peppers.
- Grains: Grains offer vital nutrients, especially whole grains, such as brown rice and whole-wheat bread. People should aim to eat 8 ounces (oz) a day if they are exclusively breastfeeding, or 6 oz if they are also formula-feeding. Some grains, such as quinoa, are also high in protein, which is an essential nutrient to eat when breastfeeding. Fortified cereals provide added nutrients and are also a good option. It is best to stick to whole-grain cereals that do not contain added sugar.
- Protein: When breastfeeding, the body requires an extra 25 grams (g) of protein per day and at least 65 g per day in total. Experts recommend including some protein with every meal. The USDA recommend the following sources of protein: beans and peas, nuts and seeds, lean beef, pork, and lamb, oysters, crab, and mussels, salmon, herring, pollock, sardines, and trout. Seafood is rich in omega-3 fatty acids, which can support healthy brain development in the baby. Salmon, sardines, and trout are excellent choices because they are high in omega-3s but low in mercury. People who are breastfeeding should avoid other fish, such as albacore tuna, swordfish, shark, and king mackerel, which are high in mercury. Other forms of tuna are safe to eat.
- Dairy: Both pregnancy and breastfeeding can leach calcium from the bones. This puts people at risk of osteoporosis if they do not get enough calcium and vitamin D. Dairy products, such as cheese and milk, are excellent sources of calcium, and many have added vitamin D. People who are breastfeeding should aim for a minimum of 3 cups of dairy products each day. The following are good sources of vitamin D and calcium: milk, yogurt, and natural cheese. People who do not eat dairy can also get calcium from dark leafy greens, beans, and fortified orange juice. The National Academy of Sciences recommend that people who are breastfeeding should consume 1,000 milligrams (mg) of calcium a day. The sun is a primary source of vitamin D, but consuming mushrooms and oily fish can increase intake. Supplements may also be beneficial.
Navigating a Dairy-Free and Soy-Free Diet During Breastfeeding
Proper nutrition is crucial both for babies and for people who are breastfeeding. The following information is helpful for mothers on a vegan or vegetarian diet. While a dairy-free and soy-free diet might sound overwhelming, it’s manageable with the right resources and support. Cow’s milk protein is one of the most common reasons for food sensitivity in babies. The second most common is soy. What’s more, many babies with milk sensitivities also have soy sensitivities. If you are a breastfeeding or pumping mother who just learned their baby has an intolerance or sensitivity to milk, you may be wondering if a dairy-free and soy-free diet is feasible.
Foods and Drinks to Avoid
Eliminating dairy and soy from your diet can be a little confusing because of the way ingredients are listed on labels. Look at food label warnings. If a product contains milk or soy, it must be included in the ingredient list or state on the label as “may contain,” “processed in a facility that processes,” or “processed on equipment with.”
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- Dairy and Milk Products to Avoid: Milk products, including milk, milk solids, milk proteins, and hydrolyzed proteins; yogurt; cheese, including cottage cheese; sour cream; cream; ghee; custard; pudding; half and half; nonfat dry milk; whey products, including whey protein and whey powder; casein/caseinate; milk chocolate and most other chocolates; and butter products.
- Soy Products To Avoid: Soy products, including soy protein and soy protein isolate; soy milk; soy flour; soy yogurt; soy beans; soy nuts; soy caseinate; soy sauce and teriyaki sauce; vegetable protein, broth, gum, and starch; tofu; miso; and edamame. Soy oil and soy lecithin are generally considered acceptable.
Dairy-Free and Soy-Free Options
Here are some options you can incorporate into your breastfeeding diet:
- Drinks: Water, including seltzer waters; milk substitutes, such as rice, coconut, or almond milk; fruit and vegetable juice; soda; tea; coffee; and milk-free hot cocoa.
- Breakfasts, Lunches, and Dinners: Eggs; fruits and vegetables; non-breaded meat (check labels carefully); grains and starches, such as potatoes, rice, quinoa, and most pastas (ensure no soy fillers); beans, including hummus; natural peanut butter and sun butter; and chia seeds.
- Snacks: Salsa and guacamole; pretzels, popcorn, plain potato chips, corn chips; most cereals; gummies and hard candies; most sorbets; and specific brands of snacks, such as LaraBar snack bars, HyVee wheat crackers, Nabisco’s triscuits and Wheat Thins, Eat Smart veggie chips, and Keebler and HyVee animal crackers.
- Condiments: Ketchup, mustard, Miracle Whip, buttery spreads (a plant-based product that tastes like butter), and Hershey’s chocolate syrup.
- Baking Ingredients: Butter flavored Crisco, Guittard semi-sweet chocolate chips and Enjoy Life chocolate chips, and HyVee white cake mix.
Certain brands, such as Enjoy Life and Kinnikinnick, also make products for dairy- and soy-free diets. Kosher products that are labeled Parve or Pareve are certified dairy-free. This is indicated by a circled letter “U” (with no other symbols or letters) on the label. When eating out, be sure to remind your server about your dietary restrictions.
The Importance of Nutritional Supplements
In most cases, a well-balanced diet should provide all the nutrients that a person who is breastfeeding needs. However, nutritional demands increase when breastfeeding, so some people may need vitamin and mineral supplements. It is important to note that supplements cannot replace a healthful diet. People who are breastfeeding should speak with their doctor before taking any herbal or dietary supplements. People who have dietary restrictions or follow a vegan or vegetarian lifestyle should also be mindful of certain vitamins and minerals that may be missing from their diet. Anyone who is concerned about meeting all of their nutritional needs should speak to a dietician.
Key Nutrients for Vegan Breastfeeding Mothers
Although a vegan diet may have certain advantages and can be safe during lactation, the avoidance of animal-based foods in the diet increases risk of nutrient deficiencies. Mothers following a vegan diet may have decreased intake and breast milk content of essential nutrients such as iodine, DHA, vitamin B12, vitamin D, and choline. Children who consume breast milk that is deficient in these key nutrients are at risk of failure to thrive, anemia, delayed/regressed psychomotor development, hypothyroidism, and rickets. Lactating vegan mothers are also at risk for anemia and osteoporosis. It is important for breastfeeding mothers consuming vegan diets to be aware of key nutrients and a possible need for supplementation. It is recommended that vegan mothers consult their healthcare provider or a Registered Dietitian to optimize nutrient intake during pregnancy and while breastfeeding for their own health and that of their infants.
- Iodine: Iodine is a vital component of thyroid hormones thyroxine (T4) and triiodothyronine (T3). The mother’s thyroid hormone levels affect proper fetal growth and neurological development during pregnancy and after birth. Food sources of iodine include fish, shellfish, seaweed, and iodized table salt. Although breast milk contains iodine, concentrations can vary based on maternal iodine levels. If a pregnant or breastfeeding woman is deficient in iodine, the fetus or infant may be at risk for iodine deficiency and associated cognitive and psychomotor impairments.
- Recommendations: Ensuring adequate iodine intake through iodized salt or supplements is crucial.
- Iron: Iron is necessary to make hemoglobin, the component in red blood cells that carries oxygen throughout the body; it also supports neurological development during infancy and early childhood. Inadequate iron leads to fatigue, anemia, and impaired development. Meats, poultry, and seafood are high in heme iron, a form that is absorbed well. Vegan mothers and their infants have higher risk of iron deficiency and anemia.
- Recommendations: In mothers aged 19-50, the Recommended Dietary Allowance (RDA) is 27 mg during pregnancy and 9 mg during lactation. Iron needs can be met through the introduction of iron-rich foods, iron-fortified cereals, or iron supplement drops.
- Vitamin B12 (Cobalamin): Vitamin B12 plays an essential role in red blood cell formation, cell metabolism, nerve function, and the production of DNA. Food sources of vitamin B12 are primarily animal source foods, including poultry, meat, fish, and dairy products. Vitamin B12 is also added to some foods, such as fortified breakfast cereals or enriched soy/rice milk, and is available as an oral supplement. Vitamin B12 is transferred through the placenta to the fetus during pregnancy and through breast milk after birth.
- Recommendations: Vitamin B12 supplements are recommended for women who follow vegetarian or vegan diets and are pregnant or breastfeeding exclusively.
- Vitamin D: Vitamin D is needed to support healthy bone development and to prevent rickets, a condition that causes weak or deformed bones. Breast milk alone does not provide adequate vitamin D for infants.
- Recommendations: It is recommended that all breastfed infants receive vitamin D supplementation.
- Calcium: Calcium is a mineral that, along with vitamin D, is necessary for healthy bones and teeth. Calcium also plays an important role in blood clotting, helping muscles to contract, and regulating normal heart rhythms and nerve functions. Calcium deficiency in childhood may result in not reaching full potential adult height. Later in life, it can result in low bone mass or osteoporosis. Calcium must be obtained from diet.
- Recommendations: During pregnancy and lactation, adequate calcium intake is considered to be 1000 mg/day.
- Docosahexaenoic Acid (DHA): Docosahexaenoic acid (DHA) is an omega-3 fatty acid found in cold water fatty fish, including salmon and tuna. Omega-3 fatty acids are good for the cardiovascular system and are necessary for infant neurological development. Infants need DHA, especially during the first 6 months of life, for brain, eye, and nervous system development.
- Recommendations: Maternal supplementation with DHA has shown to increase breast milk DHA content. DHA is available as a supplement in two common forms: Fish oil capsules, which has both DHA and EPA (eicosapentaenoic acid), another omega-3 fatty acid, or DHA from algae, which has no EPA.
- Choline: Choline is an essential nutrient involved in many processes such as cell structure and messaging, fat transport and metabolism, DNA synthesis and nervous system maintenance. The liver can make small amounts of choline, but the rest is primarily obtained through diet. Rich food sources of choline include beef liver, eggs, and fish. Some plant-based food contain choline; however, unusually large quantities would need to be consumed to meet the daily requirement.
- Recommendations: Breastfeeding women are recommended to consume 550 mg of choline daily throughout the first year postpartum (100mg more than is recommended prior to pregnancy) in order to meet the demands of herself and her baby. Prenatal supplements typically do not contain substantial amounts of choline; thus, mothers may require an extra choline supplement.
Addressing Common Concerns and Misconceptions
Many people worry that they have to measure food portions, or that missing a few nutrients will affect their ability to make enough milk. However, people all around the world are able to produce milk with a wide variety of diets. The goal should be a well-rounded diet, not a perfect one.
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Hydration
It is crucial to drink plenty of water, especially in the first few weeks after the birth when some people are so overwhelmed and distracted that they forget to drink. The need for fluid also increases when breastfeeding. Not drinking enough fluids can lead to dehydration and may even affect milk supply. People who are breastfeeding can remind themselves to drink by keeping a bottle of water in each room in the house. They should also have a water cup within easy reach of the place they tend to breastfeed.
Foods to Limit or Avoid
The list of foods that a person should avoid during pregnancy is long. This may be why some people believe that they must also eat a restrictive diet when breastfeeding. In fact, there is no list of foods that people who are breastfeeding should avoid altogether. Instead, they should eat food that is healthful and pay attention to cues from their body. Breast milk comes from nutrients that pass into the blood. Many of the potentially dangerous ingredients that could cross the placenta during pregnancy do not get to the breastfeeding baby.
- Seafood High in Mercury: Limit consumption of seafood that may contain mercury.
- Caffeine: Pay attention to how caffeine affects the baby.
- Alcohol: Medical authorities and parenting guides often provide mixed or unclear advice regarding alcohol consumption when breastfeeding. The Centers for Disease Control and Prevention (CDC) recommend no more than one drink per day. They also suggest reducing the risk further by waiting at least 2 hours to breastfeed after drinking alcohol.
Foods That May Increase Milk Supply
The body of research on foods that increase breast milk supply is scant and mixed. Some anecdotal evidence suggests that, for some people, the following foods may support a higher production of milk: fenugreek seed, goat’s rue, oatmeal. Trying these remedies is safe. However, people wanting to use proven milk production strategies can try: Breastfeeding on demand. If the baby is also getting solids or formula, pump when the baby gets these foods. The production of breast milk occurs according to need, which means that supply decreases when demand does.
Practical Tips for Breastfeeding Mothers
The first weeks of breastfeeding can be demanding. People have to contend with recovering from birth, lack of sleep, and the emotional demands of caring for a newborn. For many, the most challenging part of eating a healthful meal is finding the time and energy to prepare food. Enlisting the assistance of a partner is a great way to share the burden. One partner can pump or breastfeed while the other prepares food. If a supportive partner is not available, a few easy-to-prepare meals can ensure adequate nutrition.
- Quick Meal Strategies: Consuming a morning smoothie to load up on fruits and vegetables. Preparing instant oatmeal as a filling, fiber-rich snack that may support a healthy milk supply. Snacking on nuts during the day. Buying pre-cut cheeses. Considering enrolling in a ready-meal service, or asking people to bring meals around a few times a week. Freeze any leftovers to thaw for a quick snack.
Breastfeeding and Allergy Prevention
Breastfeeding is the preferred method of infant feeding and its establishment is one of the primary goals for the infant. Allergic diseases are common in childhood, with increased morbidity. Food allergies are also associated with a strong negative impact on health-related quality of life and is a major public health problem. In addition, maternal exclusion of common allergens during pregnancy and/or lactation suggests that supplementation with regular cow’s milk formula during the first week of life should be avoided.
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The Role of Breast Milk
Breast milk contains many active immune factors, such as cytokines, inflammatory mediators, signaling molecules and soluble receptors, which may also reduce the risk of allergic disease. Exclusive breastfeeding is essential for at least the first 6 months of life, with continued complementary breastfeeding for the first two years of the child’s life as per WHO guidelines. Breastmilk is immunologically the most relevant and essential food for the development of the newborn and the consequent maturation of immuno-defensive mechanisms. It confers active and passive immunity, through maturation of the system and also provides bioactive components, like secretory IgA and IgG, with a proven prophylactic effect against food allergies.
Common Food Allergies in Infants
The most common form of food allergy in infants and young children under 3 years of age is sensitization to cow’s milk protein (casein or serum beta-lactoglobulin). The most common allergens are casein, alpha-lactalbumin, and beta-lactalbumin, the latter of which is extracted from breastmilk and is the trigger. It has a 50-65% chance of being converted into an offending antigen, altering the intestinal flora and the concentration of bioactive compounds in the body. The natural development of an infant’s gastrointestinal tract is essential for the metabolism of non-dairy foods, and its disruption can lead to future allergic manifestations.
Managing Allergic Symptoms
The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines differentiate according to the severity of symptoms and the presence of breastfeeding. In breastfed infants with mild or moderate symptoms, overt and covert products containing cow’s milk protein are removed from the mother’s diet for 3 to 6 days; if delayed onset of symptoms is suspected, calcium supplementation is recommended for 2 weeks; while in severe symptoms (severe anemia), the mother’s milk is expressed and the newborn is given an improved anti-allergy formula.
Breastfeeding and Gut Microbiome
The gut microbiome is an established homeostasis regulator, promoting baseline immune functionality and nutrient absorption for the whole body and an active medicinal target. Breastfeeding and vaginal birth favourably influence the development of the infant’s gut microflora and protect against the development of allergies, as a recent study has confirmed. The intestinal microflora of breastfed infants is characterised by an early dominance of Bifidobacterium, which may have a significant impact on developing immune tolerance.