For breastfeeding mothers suspecting their baby has a food allergy, navigating the world of elimination diets can feel overwhelming. August is National Breastfeeding Month, and it's essential to know how to safely manage potential allergens while continuing to provide the best nutrition for your baby. This article delves into the total elimination diet (TED) in the context of breastfeeding, providing guidelines and considerations for mothers and healthcare providers.
Understanding Elimination Diets
An elimination diet involves completely removing specific foods from your diet that are suspected of causing an allergic reaction in your baby through breast milk. When a baby is allergic to a food protein, their immune system mistakenly identifies it as a threat, triggering a defensive response. Common allergic reaction symptoms in babies include hives, rashes, vomiting, diarrhea or abnormal stools, congestion, and swelling of the face or tongue.
Starting an elimination diet ensures that the proteins from these foods won't be passed to the baby through breast milk. The goal is to identify and eliminate the specific food(s) causing the reaction, allowing you to continue breastfeeding comfortably and safely.
The Total Elimination Diet (TED): A More Restrictive Approach
For some families and babies, standard elimination diets may not provide fast enough results. If you've already tried removing common allergens like dairy, soy, and wheat, and your baby is still experiencing reactions, a total elimination diet (TED) might be considered.
TED involves removing literally everything from your diet except a small selection of foods. For example, a TED might consist of eating only lamb, olive oil, potatoes, bananas, lettuce, and green peppers for a period. This extreme restriction aims to quickly eliminate all potential trigger food proteins from your breast milk.
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Benefits of Elimination Diets
Fast Results
The most appealing aspect of elimination diets, particularly TED, is the potential for fast results. When you want to produce allergy-free breastmilk fast, elimination diets - with the right support and guidance - can get you there. You’ve tried removing dairy, soy, wheat, and still notice reactions on and off in your baby. You’re tired of seeing your little one in pain or suffering with a horrible rash, so you’re ready to cut all the foods. Limiting your diet so severely is extremely difficult - but may give you the result you’re looking for quickly. While it’s so boring (and honestly, so sad) eating the same thing for days, noticing your baby’s improvement makes it all worth it.
Pinpointing Triggers
Elimination diets are not meant to be followed forever. TED’s and elimination diets get us producing allergy-friendly breastmilk fast. Since most breastmilk is clear of food allergens within 24 hours, you should see improvement in your baby’s symptoms after 5 days in an elimination diet or TED, if you’ve effectively cut the right foods at the same time that are causing an issue for your baby. After the success of your TED or elimination diet, it’s time to start adding foods back in. This part feels scary because eventually you’ll find your baby’s trigger food and get a reaction. But when you find out which exact foods your baby reacts to, you find that knowledge diamond. That makes feeling pressed and confined by the elimination process worth it! Knowing the foods you both can eat is powerful information for your food allergy journey. Reintroducing foods back into your diet gives you information on what your baby can tolerate at this time. If your baby doesn’t react to chicken, then goodness, eat chicken! Elimination diets give you valuable information fast so you can move on and get back to more safe foods. Even though your heart breaks to see a reaction in your baby, TED and elimination diets help you learn how to best feed both of you. You stop the guessing game and feel more prepared and confident.
Potential Drawbacks of Elimination Diets
Nutritional Deficiencies
Elimination diets, especially TED, can be extremely restrictive and may lead to nutritional deficiencies in the mother's diet. It’s difficult to ensure breastfeeding parents get the proper nutrients they need. Important nutrients you, as a lactating parent, need to be healthy and feed your baby. Read more about all the nutrients found in the top 12 infant food allergies here - and make sure you’re getting what you need from other sources. Breastfeeding moms have higher caloric needs than non-breastfeeding women. The additional calories generally needed are similar to the recommended caloric intake during the second trimester, an additional 330-400 calories. Breastfeeding mothers should be consuming a diet that supports all energy and nutritional needs. Nutrients to consider in the maternal diet are folate/folic acid, iodine, choline, calcium, and vitamin D.
Mental and Emotional Strain
Elimination diets are tough and don’t work for every family. Personal factors range from having multiple children, job demands, other dietary restrictions, various health concerns, and on. Your mental health matters during this difficult time and it’s absolutely okay if an elimination diet isn’t the best choice for you. Sometimes parents find that once their baby feels better, they’re afraid to risk causing any harm or a new reaction - so they continue with TED or elimination diets. We do not recommend this for the health and safety of the parent and baby. As parents, you’re already dealing with sleepless nights, new schedules, and general anxieties. Navigating your baby’s food allergies doesn’t have to be so stressful. Having support during this time is so important, and you’re not alone.
Not Always Necessary
Dietary restrictions in lactating mothers of infants with suspected FA are usually not necessary. In exclusively breastfed infants with chronic symptoms of CMA dietary restrictions should only be considered in rare and specific circumstances. Dietary elimination of offending triggers must not be recommended in lactating mothers if the infant is thriving and remains asymptomatic.
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Steps to Take Before Starting an Elimination Diet
Keep a Food Diary
The best way to identify potential trigger foods is to keep a detailed food diary. Log all the foods you eat, along with any possible allergic reaction symptoms that baby develops after you eat those foods. Look for and note any patterns you see --- for example, does your baby consistently develop diarrhea after you consume cow's milk products?
Consult with Your Pediatrician
Once you think you've found the foods you should remove, talk to your pediatrician before starting an elimination diet. They can help you determine if an elimination diet is appropriate and guide you on the best approach. Be sure to share the symptoms your baby is having with her doctor if you havn’t already.
Consult with a Lactation Consultant and Dietician
Pur team of lactation consultants are available to help you identify possible food causes and develop and individualized elimination diet plan that works for you and your life style. We have developed a specialized method for identifying foods that cause your baby discomfort. A registered dietitian nutritionist can ensure your diet still has all the necessary nutrients.
Consider Allergy Testing
There are many foods that could be the cause of the onset of symptoms that could be an expression of both IgE- and non-IgE-mediated forms of allergy, so skin prick tests and serum-specific IgE assays may not always be helpful in diagnosis. Contact a pediatric allergist.
Implementing an Elimination Diet
Removing Common Allergens
Stop eating several of the most common allergens at once, as directed by your doctor. The foods most likely to cause allergic reactions in babies and young children are cow's milk, egg, peanut, different types of tree nuts (like almond, cashew and walnut), soy, wheat and sesame. The foods initially taken out of the mother’s diet in this situation are dairy, soy and egg products. These foods must remain out of the mother’s diet for 2 to 4 weeks to be able to see if the babies' symptoms improve. If the baby does not improve, a formula substitution may need to be made, or there may be a different problem present.
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Reintroducing Foods
Add the foods you removed back in, one at a time. If baby's symptoms do re-emerge after you add a food back in, you've likely found the problem food. Eliminate that food again and see if symptoms subside. If baby's symptoms don't improve after eliminating several common allergens, another food that you didn't eliminate could be the culprit (or baby's symptoms may not be allergy-related at all).
Be Vigilant About Hidden Allergens
Remember that allergens can sometimes show up in unexpected places. By law, any food containing the top allergens must be labeled with a clear warning that lists the allergen(s) it contains. Top allergens that must be clearly listed on labels include milk, egg, peanuts, tree nuts, soy, wheat, fish and shellfish. Elimination diets don't just involve avoiding foods that contain an allergen. Sometimes, medications and supplements contain common allergens as well. And if a medicine contains the allergen you're excluding, you'll need to avoid it.
Important Considerations
Breastfeeding and Food Allergies
If your baby has a food allergy, you can still safely breastfeed. You'll just need to start an elimination diet and stop eating the foods baby is allergic to. With a successful elimination diet, you won't pass the proteins that cause an allergic reaction to your baby, and baby won't experience allergic reaction symptoms. Breast milk is preferable for all infants, including those with CMA.
Timeframe for Improvement
Since most breastmilk is clear of food allergens within 24 hours, you should see improvement in your baby’s symptoms after 5 days in an elimination diet or TED.
Alternatives to Consider
If the baby does not improve, a formula substitution may need to be made, or there may be a different problem present. It is important to keep in mind that fussiness is a common infant symptom and is not a direct indicator of a food allergy.
Maintaining a Healthy Diet
Women who are breastfeeding can remain nourished while following alternative eating patterns. The goal is to always nourish the mother and child, without forcing supplementation or other products that are not part of a normal diet.
When to Reintroduce Foods
If the baby does improve, one type of food at a time will be introduced back into the mother's diet to see if infants' symptoms return. If symptoms return, the mother should avoid that food item to ensure the baby receives adequate nutrition.
Allergen-Free Meal Plan
Choosing meals and snacks from the below listed options will help eliminate the top 8 major allergens (dairy, soy, eggs, fish, shellfish, wheat, tree nuts, peanuts, and sesame) while helping you maintain an adequate nutrient intake.
Breakfast
- Option 1: Gluten free oatmeal made with water, banana, and sunflower seed butter
- Option 2: Plant-based yogurt alternative, berries, and chia seeds
- Option 3: Smoothie: Banana, berries, baby spinach, unsweetened plant-based milk alternative, ground flax seeds, and hemp seeds
- Option 4: Millet made with water and apple juice, mixed with unsweetened coconut flakes, dried fruit, pumpkin seeds
- Option 5: Gluten-free vegan pancakes with sliced banana, sunflower seeds, and a drizzle of maple syrup.
Lunch
- Option 1: Massaged kale salad with shredded carrots, garbanzo beans, and brown rice
- Option 2: Shredded chicken mixed with olive oil, chopped veggies of choice, salt and pepper; Wrapped up in corn tortillas with a hummus spread and a spinach salad on the side
- Option 3: Salad with colorful vegetables, sunflower seeds, grilled chicken, olive oil and balsamic vinegar
- Option 4: Spiced black beans and quinoa in bell pepper cups
- Option 5: Gluten free pasta tossed with olive-oil roasted veggies (such as tomatoes, yellow squash, and bell pepper) and chicken
Dinner
- Option 1: Grilled chicken, broccoli, seasoned potato salad made with olive oil
- Option 2: Roasted sweet potato topped with seasoned black beans, cilantro, and avocado
- Option 3: Corn tortillas, seasoned ground beef or ground turkey, corn and tomato salad, and asparagus
- Option 4: Stir fry chicken and vegetables with quinoa.
- Option 5: Spaghetti Squash topped with pasta sauce made with ground chicken
Snacks
- Option 1: Corn chips with black-bean salsa
- Option 2: Bell pepper or other veggies with hummus
- Option 3: Pumpkin or sunflower seeds and dried fruit
- Option 4: Apple or pear with sunflower seed butter
- Option 5: Gluten-free high-fiber cereal, unsweetened plant-based milk alternative, berries
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