Vegetarian Diet and Breastfeeding: Recommendations for Optimal Nutrition

Breastfeeding provides infants with crucial nutrients that support their growth and development. For mothers who follow vegetarian or vegan diets, ensuring that their breast milk provides complete nutrition is a common concern. This article examines the nutritional considerations for vegetarian and vegan mothers during lactation and offers recommendations for maintaining the nutritional quality of breast milk.

Nutritional Adequacy of Breast Milk from Vegetarian Mothers

The nutritional composition of breast milk is influenced by the mother's diet. Concerns about the nutritional adequacy of breast milk often arise when mothers follow vegetarian or vegan diets. Some milk banks even exclude vegan lactating women as milk donors due to these concerns. However, research indicates that vegetarian and vegan mothers can produce breast milk of comparable nutritional value to non-vegetarian mothers, provided they receive appropriate supplementation to meet their nutritional requirements.

A systematic review of thirteen publications found that vegetarian, vegan, and non-vegetarian mothers generally produce breast milk with similar nutritional value. Differences that do exist primarily relate to fatty acids and certain micronutrients, particularly vitamin B12. Adequate nourishment and nutrition significantly impact human milk composition, regardless of dietary choices.

General Breastfeeding Nutrition Tips

Breastfeeding mothers often have questions about what and how much to eat, and what to avoid. Here are some general tips:

• Eat a little more: Breastfeeding requires extra calories. Aim for nutrient-rich foods to fuel milk production. An additional 330 to 400 kilocalories (kcal) per day is recommended for well-nourished, breastfeeding mothers, compared with the amount they were consuming before pregnancy. The number of additional calories needed for a breastfeeding woman is also affected by her age, body mass index, activity level, and whether she is exclusively breastfeeding or both breastfeeding and formula feeding. If you have lost all your baby weight, you may need to eat an extra 500-600 calories per day. After your baby starts eating other foods at 6 months, you will be making less milk and you can cut back on your calorie intake.
• Focus on protein-rich foods: Include lean meat, eggs, dairy, beans, lentils, and low-mercury seafood.
• Eat a variety of foods: This changes the flavor of breast milk, which can help your baby accept new foods later.
• Consider a multivitamin: Your healthcare professional might suggest a daily multivitamin and mineral supplement. Continued use of a prenatal vitamin after giving birth may exceed the iron and folic acid needs of a breastfeeding mother. The recommended dietary allowances (RDAs) are the average amount of a vitamin or mineral that meets the daily nutrient needs of nearly all healthy people. Therefore, diet alone may not ensure adequate nutrition for breastfeeding women. In these cases, breastfeeding mothers may benefit from taking a multivitamin supplement.
• Stay hydrated: Drink when you're thirsty and choose water most of the time. Limit sugary drinks and caffeine. Many women find they are thirsty while breastfeeding; however, forcing yourself to drink fluids does not increase your supply.
• Choose iron, protein, and calcium-rich foods: Good sources of iron include lentils, beans, enriched cereals, leafy green vegetables, and peas. For protein, try soy products, meat substitutes, legumes, lentils, nuts, seeds, and whole grains. Good sources of calcium are dark green vegetables and calcium-enriched foods.
• **Dietary restrictions from pregnancy do not apply to breastfeeding moms.

Specific Nutritional Considerations for Vegetarian and Vegan Mothers

While vegetarian diets can be compatible with breastfeeding, it's essential to pay attention to certain nutrients that may be lacking in plant-based diets. If you avoid meat, make sure you eat other sources of iron and zinc such as dried beans, dried fruit, nuts, seeds and dairy. If you avoid all animal products (vegan diet) you will need to take a B12 supplement to make sure your baby does not develop a B12 deficiency.

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• Vitamin B12: This vitamin is primarily found in animal products and is crucial for red blood cell formation, cell metabolism, nerve function, and DNA production. Infants need vitamin B12 to support brain development and produce healthy red blood cells. Deficiency can lead to permanent brain damage. Breastfed infants of women who do not consume any animal products may have very limited amounts of vitamin B12. Low amounts of vitamin B12 can put infants at risk of neurological damage from vitamin B12 deficiency. Recommendations: Vitamin B12 supplements are recommended for women who follow vegetarian or vegan diets and are pregnant or breastfeeding exclusively. If you are already taking B12, and your levels are good, your milk will be an excellent source for your baby. You can ensure that they have adequate amounts of vitamin B12 by taking a daily B12 supplement and eating vegan foods that are high in B12. These include fermented soybean products, fortified nutritional yeast flakes, seaweed products and other foods fortified with vitamin B12.
• Vitamin D: Essential for healthy bone development and preventing rickets. Breast milk alone does not provide adequate vitamin D for infants. Vegan vitamin D drops for babies are commercially available online and at some health food stores. It is possible to increase the amount of vitamin D in your milk with safe exposure to the sun and by taking very high doses of vitamin D supplements (there are supplements for adults that are vegan). If you are not comfortable giving your baby non-vegan supplements, you can discuss the options with a health professional. Recommendations: All breastfed infants should receive vitamin D supplementation. If you don't eat enough foods fortified with vitamin D and you have limited sun exposure, you might need to take vitamin D supplements. Good sources of vitamin D-fortified foods are cow's milk and some cereals. Too little vitamin D can cause rickets, a softening and weakening of bones. Tell your healthcare professional if you're giving your baby a vitamin D supplement.
• Calcium: Necessary for healthy bones and teeth, blood clotting, muscle contraction, and nerve function. Breast milk calcium comes from increased maternal bone resorption (release of calcium from bones), increased calcium absorption in the intestines, and, to a lesser extent, dietary intake. Calcium content of breast milk for vegans and omnivores has been found to be similar, indicating that breastfed infants of vegan mothers likely receive adequate calcium. However, maternal deficiency of calcium coupled with bone adaptation to provide adequate calcium in milk may pose a risk for maternal bone health, including osteoporosis. Recommendations: During pregnancy and lactation, adequate calcium intake is considered to be 1000 mg/day. While nursing, your body needs at least 1000 mg of calcium per day. Calcium is available from dark leafy green vegetables, beans and tofu (there is calcium in regular tofu and even more in calcium-set tofu). You can also find foods with calcium added such as enriched orange juice, soymilk, and enriched soy products.
• Iodine: A vital component of thyroid hormones, essential for fetal growth and neurological development. 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. Breast milk from vegan and vegetarian mothers on average contained less iodine than the estimated requirement for infants 0 to 6 months old. The Dietary Guidelines for Americans recommend breastfeeding women consume 290 micrograms (mcg) of iodine daily throughout the first year after giving birth. Food sources of iodine include fish, shellfish, seaweed, and iodized table salt.
• DHA (Docosahexaenoic Acid): An omega-3 fatty acid crucial for infant neurological development, especially during the first 6 months of life. DHA-deficient infants also showed delayed maturation of visual acuity. Breast milk DHA levels were 0.15% for vegans vs. 0.33% for omnivores. Maternal supplementation with DHA has shown to increase breast milk DHA content. Recommendations: Consider DHA supplementation through fish oil capsules or DHA from algae. You can boost the DHA in your milk by eating fish 2-3 times per week. The best sources of DHA are: salmon, bluefish, bass, trout, flounder and tuna. Do not eat tile fish, swordfish, shark and king mackerel. They contain high levels of mercury.
• Choline: An essential nutrient involved in cell structure and messaging, fat transport and metabolism, DNA synthesis, and nervous system maintenance. 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. 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.

Foods and Drinks to Limit or Avoid

• Alcohol: There's no safe level of alcohol in breast milk. If you drink, avoid breastfeeding until the alcohol has completely cleared your breast milk, which takes at least two hours for one drink. Alcohol does not stay in your milk. It is removed as your blood alcohol levels go down. When you are sober, the alcohol is gone from your milk. If you are feeling the effects of alcohol and your breasts are full, you may need to “pump and dump."
• Caffeine: Limit to 2-3 cups (0.4 to 0.7 liters) of caffeinated drinks a day. Caffeine passes from the mother to infant in small amounts through breast milk. This usually does not adversely affect the infant when the mother consumes low to moderate amounts. Irritability, poor sleeping patterns, fussiness, and jitteriness have been reported in infants of mothers with very high intakes of caffeine. If an infant appears to be more fussy or irritable after the mother consumes high amounts of caffeine, she should consider decreasing her intake. Newborns may be more sensitive to caffeine than older babies.
• Fish: Avoid high-mercury seafood like shark, swordfish, and king mackerel. Most fish contain mercury that can pass from mother to infant through breast milk. If you eat fish caught by family or friends, check for fish advisories. Limit serving size. Mercury can be harmful to the brain and nervous system of any person exposed to too much over time. Thus, lower mercury fish are a good choice for everyone.
• Potential allergens: Some foods or drinks in your diet could cause your baby to become fussy, have a reaction, or have intolerance. If you think that something in your diet might be affecting your baby, avoid that food or drink for up to a week. The most common symptoms are green, mucus-like and blood-specked stools. Colic and reflux are not usually caused by food allergies. The most common foods that cause allergies are dairy products, soy products, wheat and eggs. Less common foods that cause allergies include fish, nuts, peanuts or corn. A baby could develop an allergy to any food you eat.

Other Important Considerations

• Iron: The iron found in human milk is usually sufficient for infants throughout the first four to six months, unless you have been anemic during your pregnancy. Dried beans and dark green leafy vegetables are especially good sources of iron. Iron absorption is improved by eating foods containing vitamin C along with foods containing iron. If you are concerned about your iron levels you can consult with your health professional or a dietician.
• Protein: The recommended intake of protein for nursing parents is 65 grams (2 oz) per day for the first six months, and 62 grams per day between six and twelve months.
• Listen to your body: Many women find they are thirsty while breastfeeding; however, forcing yourself to drink fluids does not increase your supply.

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