Eliminating For Two While Breastfeeding: Important Nutritional Information

Many breastfeeding parents with littles experiencing infant food allergy symptoms begin systematically removing foods from their diet. While navigating elimination diets, common questions pop up like whether this will impact the nutrient density of breast milk or what this means for YOUR health?

Free to Feed is here to guide parents navigating babies with food allergies. Today, we dig into nutrient deficiencies seen during elimination diets and what that means for baby and parents.

Breast Milk Changes Over Time To Fit Your Baby’s Needs

It’s important to note that breast milk is a complex fluid that consists of almost 200 recognized components that are continuously changing based on baby’s needs. [1] Composition of milk changes from beginning of the feed to the end, diurnally, and with progression of lactation.

Most remarkable of this change in composition is seen in the first week of lactation as parent transitions from yellow colostrum, high in carotenoids, β-carotene, and lutein, to traditional milk. [2] Baby’s phase of development as well as our nutrient intake, creates an ever-changing super-food.

Calories Are Important For Nursing & Parent’s Health

To ensure proper infant nutrition, the child must receive ample milk volume. Think of it like your own diet: eating only one bite of an apple gives you much fewer nutrients than if you ate the entire thing.

Milk production is dependent on lactation performance as well as maternal calorie intake. [1] A well-nourished lactating parent needs an increased daily energy intake of ~500 kcal. [3] During elimination diets, we should focus on calorie-dense safe foods to support lactation. Tracking calories can be a vital tool to ensure parents are consuming enough to support nursing a baby with food allergies.

Some Nutrients Are Unchanged & Some Suffer From Big Diet Changes

Interestingly, major ingredients of breastmilk like calcium have been reported to be unaffected by the diet. [4] This means that if a diet is lacking in specific nutrients that her body will pull it from the body's reserves in order to feed baby.

In the case of calcium, the typical daily loss through breast milk is 200-400mg. If this demand is not met, the body will demineralize the maternal skeleton to make nutritionally complete breast milk. [4] In other words: your body sacrifices itself to best feed your infant. Takes “sucking the life out of you” to a new level. Alternative calcium sources include green leafy vegetables, sardines, fortified orange juice, chia seeds, and rhubarb.

Conversely, concentrations of fatty acids, fat-soluble, and water-soluble vitamins are impacted by maternal diet. More specifically, maternal intake of B vitamins (except folate), vitamin A, C, D, E, K, choline, selenium, and iodine strongly affects breast milk concentrations. [5]

Below are natural, top 12 infant food allergy-free options we can eat to boost intake of these nutrients [6-7]. Supplementation of these nutrients may be necessary to reach target levels.

Fatty-Acids: olives/oil, avocado/oil, coconut/oil, seeds/oil, fish, seafood, cod liver oil, algae oil/seaweed

B Vitamins: Fish (tuna, salmon), mollusks (oysters, clams, scallops), pork, turkey, bison, nutritional yeast, sunflower seeds, millet, quinoa, potatoes, banana, winter squash, portabella mushrooms, spinach, avocado

Vitamin A: Fish (herring, salmon), sweet potato, spinach, pumpkin, carrots, cantaloupe, red bell pepper, mango, dried apricots, broccoli

Vitamin C: Kiwi, oranges, grapefruit, lemon), bell peppers, strawberries, tomatoes, cruciferous vegetables (Brussels sprouts, broccoli, cauliflower)

Vitamin D: Cod liver oil, fish (salmon, sardines), mushrooms, fortified orange juice

Vitamin E: Seeds, avocado, olives/oil, salmon

Vitamin K: Collard greens, spinach, kale, broccoli

Choline: Fish roe, mollusks (scallops, clams), red potatoes, quinoa, cruciferous vegetables (Brussels sprouts, broccoli, cauliflower), shiitake mushrooms

Selenium: Fish (tuna, halibut, sardines), shrimp, pork, turkey

Iodine: Seaweed, fish (cod, haddock, salmon, sardines), crustaceans (crab, lobster, shrimp), mollusks (oysters, clams, scallops)

How Bioavailability Plays a Role In Supplementation

The amount of nutrients absorbed by the infant is further influenced by the “bioavailability” of that nutrient. Bioavailability is the ability for a nutrient, vitamin, mineral, or similar to reach the circulatory system where the body can effectively utilize that molecule. Nutrients found in breastmilk have an extremely high bioavailability rate. [6]

Supplemental foods given to breastfed infants are shown to impact total nutrients absorbed. For instance, babies consuming foods such as formulas or cereals generally decrease their intake of breastmilk and thus decrease their nutrient and other specialized components intake because formula and cereal have less bioavailability. [7]

Thus, the intake of supplementary foods adds nutrients in a less bioavailable form, decreasing the bioavailability of nutrients from the breastmilk, and hence decreasing the intake of important factors from breastmilk. [8]

Remember You Have Options & You’re Not Alone

Elimination diet mamas have to be mindful of their calorie and nutrient intake. By filling their plates with nutrient-rich and calorie-dense foods, they can effectively reduce deficiencies that will impact their production rates and nutritional value of their breast milk as well as their own bodies. Healthy nutrient intake can be found and maintained through an elimination diet!

Schedule a one-on-one consultation to develop an elimination and reintroduction strategy that fits your life and journey.

Co-authored by: Taylor Silver, RD, Neha Misra, PhD & Trill Paullin, PhD

References

1. Eriksen, Kamilla G., et al. "Human milk composition and infant growth." Current opinion in clinical nutrition and metabolic care 21.3 (2018): 200-206.

2. Sinanoglou, Vassilia J., et al. "Factors affecting human colostrum fatty acid profile: A case study." PLoS One 12.4 (2017): e0175817.

3. Blincoe, Alana Juman. "The health benefits of breastfeeding for mothers." British Journal of Midwifery 13.6 (2005): 398-401.

4. Kovacs, Christopher S. "Calcium and bone metabolism in pregnancy and lactation." The Journal of Clinical Endocrinology & Metabolism 86.6 (2001): 2344-2348.

5. Allen, Lindsay H. "Multiple micronutrients in pregnancy and lactation: an overview." The American journal of clinical nutrition 81.5 (2005): 1206S-1212S.

6. https://ods.od.nih.gov/factsheets/Iodine-HealthProfessional

7. https://www.ars.usda.gov/ARSUSERFILES/80400535/DATA/IODINE/IODINE%20DATABASE_DOCUMENTATION.PDF

8. Zhu, Jing, and Kelly A. Dingess. "The functional power of the human milk proteome." Nutrients 11.8 (2019): 1834.

9. Fairweather-Tait, Susan J., and Birgit Teucher. "Iron and calcium bioavailability of fortified foods and dietary supplements." Nutrition reviews 60.11 (2002): 360-367.

10. Martin, Camilia R., Pei-Ra Ling, and George L. Blackburn. "Review of infant feeding: key features of breast milk and infant formula." Nutrients 8.5 (2016): 279.