Diet for breastfeeding

A ‘perfect’ diet is not required for breastfeeding. You don’t need to eat anything special while you’re breastfeeding. But it’s a good idea for you, just like everyone else, to eat a healthy diet. In general, your diet is important for your own health and energy levels, rather than affecting your breastmilk and your baby. Even in countries where food is scarce, mothers are able to breastfeed and their babies thrive. However, there are a few nutrients a baby needs that may be affected if the mother’s intake is too low, such as iodine and vitamin B12.

When you are breastfeeding, your body is able to partly compensate for the extra demand on nutrients by using them more efficiently and there is usually an increase in your appetite as well. You can obtain the extra energy and nutrients needed by eating slightly more of the same foods you would normally eat, using up some of your fat stores laid down while you were pregnant and by reducing the amount of energy you use.

For mothers eating a normal American diet, the most common nutrients of concern are iodine, iron and calcium. Talk to your medical adviser or a dietitian to find out if you have enough of these in your diet. Particularly in the case of iodine, you may be advised to take a supplement, as the amounts recommended for pregnant and breastfeeding mothers are hard to obtain from a normal American diet.

A healthy diet includes:

• At least 5 portions of a variety of fruit and vegetables a day, including fresh, frozen, tinned and dried fruit and vegetables, and no more than one 150ml glass of 100% unsweetened juice
  starchy foods, such as wholemeal bread, pasta, rice and potatoes
• Plenty of fiber from wholemeal bread and pasta, breakfast cereals, rice, pulses such as beans and lentils, and fruit and vegetables – after having a baby, some women have bowel problems and constipation, and fiber helps with both of these
• Protein, such as lean meat and chicken, fish, eggs, nuts, seeds, soya foods and pulses – at least 2 portions of fish a week is recommended, including some oily fish
• Dairy foods, such as milk, cheese and yogurt – these contain calcium and are a source of protein
• Non-dairy sources of calcium suitable for vegans include tofu, brown bread, pulses and dried fruit
• Drinking plenty of fluids – have a drink beside you when you settle down to breastfeed: water and skimmed or semi-skimmed milk are all good choices

Eating a healthy, balanced diet is an important part of maintaining good health, and can help you feel your best. This means eating a wide variety of foods in the right proportions, and consuming the right amount of food and drink to achieve and maintain a healthy body weight.

The following table shows the recommendations for food groups and average serve sizes. This is only a guide showing the relative numbers of serves of food types. You should use your common sense, your appetite and any changes in your body weight to determine what is right for you. If you have any concerns that you may not be getting the proper amount of nutrients, talk to your doctor or nutritionist about improving your diet or the possibility of taking supplements.

Small amounts of what you’re eating and drinking can pass to your baby through your breast milk. If you think a food you’re eating is affecting your baby and they’re unsettled, talk to your doctor or nutritionist.

Table 1. Balanced diet sample daily food patterns

Food Group	Serves per day			What is a serve?
	Women 19-50 years	Pregnant	Breastfeeding
Grain (cereal) foods, mostly wholegrain and/or high-fiber cereal varieties	6	8½	9	1 slice (40 g) bread ½ (40 g) medium roll or flat bread ½ cup (75–120 g) cooked rice, pasta, noodles, barley, buckwheat, semolina, polenta, bulgur, quinoa ½ cup (120 g) cooked porridge 2/3 cup (30 g) wheat cereal flakes ¼ cup (30 g) muesli 3 (35 g) crispbreads 1 (60 g) crumpet 1 small (35 g) English muffin or scone
Vegetables and legumes/beans	5	5	7½	About 75 g: ½ cup cooked green or orange vegetables ½ cup cooked dried or canned beans, peas, lentils 1 cup green leafy or raw salad vegetables ½ cup sweet corn ½ medium potato or other starchy vegetable (sweet potato, taro, cassava) 1 medium tomato
Fruit	2	2	2	About 150 g: 1 medium apple, banana, orange, pear 2 small apricots, kiwi fruit, plums 1 cup dried or canned fruit Occasionally: ½ cup (125 mL) fruit juice with no added sugar 30 g dried fruit (4 dried apricot halves, 1½ tbsp sultanas)
Milk, yogurt, cheese and/or alternatives (mostly reduced fat)	2½	2½	2½	1 cup (250 mL) fresh, UHT long-life, reconstituted powdered milk or buttermilk ½ cup (120 mL) evaporated milk 2 slices (40 g) or 4x3x2 cm cube (40 g) hard cheese ½ cup (120 g) ricotta cheese ¾ cup (200 g) yogurt 1 cup (250 mL) soy, rice or other cereal drink with at least 100 mg/100 mL calcium 100 g almonds with skin 60 g sardines, canned in water ½ cup (100 g) canned pink salmon with bones 100 g firm tofu (check label for calcium content)
Lean meats and poultry, fish, eggs, tofu, nuts and seeds, legumes/beans	2½	3½	2½	65 g cooked lean red meat such as beef, lamb, veal, pork or goat (90–100 g raw) 80 g cooked lean poultry (100 g raw) 100 g cooked fish fillet (115 g raw) 1 small can fish 2 large (120 g) eggs 1 cup (150 g) cooked or canned legumes/beans such as lentils, chickpeas or split peas 170 g tofu 30 g nuts, seeds, or nut or seed paste
Additional serves for taller or more active people. More from above food groups or unsaturated spreads and oils or discretionary choices*	0-2½	0-2½	0-2½	10 g poly/monounsaturated spread 7 g polyunsaturated oil such as olive, canola 10 g nuts or nut paste   Discretionary choices: 2 scoops (75 g) ice cream 2 slices (50–60 g) processed meats, salami, mettwurst 2 thin (50–70 g) sausages ½ snack-size packet (30 g) salty crackers or crisps 2-3 (35 g) sweet plain biscuits 1 (40 g) doughnut 1 slice (40 g) plain cake/muffin 5–6 (40 g) small lollies 1 tbsp (60 g) jam or honey ½ bar (25 g) chocolate 2 tbsp (40 g) cream 1 tbsp (20 g) butter 1 can (375 mL) soft-drink (sugar-sweetened) ¼ (60 g) commercial pie or pastie (individual size) 12 (60 g) hot chips

Footnote: * Discretionary foods only provide energy and very little nutrition, so are not good choices.

Healthy snack ideas for breastfeeding mums

The following snacks are quick and simple to make, and will give you energy and strength:

• fresh fruit
• sandwiches filled with salad, grated cheese, mashed salmon or cold meat
• yogurts and fromage frais
• hummus with bread or vegetable sticks
• ready-to-eat dried apricots, figs or prunes
• vegetable and bean soups
• fortified unsweetened breakfast cereals, muesli and other wholegrain cereals with milk
• milky drinks or a 150ml glass of 100% unsweetened fruit juice
• baked beans on toast or a baked potato.

Eating fish while breastfeeding

Eating fish is good for your and your baby’s health, but while you are breastfeeding you should have no more than 2 portions of oily fish a week. A portion is around 140g.

Oily fish includes fresh mackerel, sardines, trout and salmon.

All adults should also eat no more than 1 portion a week of shark, swordfish or marlin.

Peanuts and breastfeeding

Unless you’re allergic to peanuts, there’s no evidence to suggest you should avoid them (or any peanut based foods like peanut butter) while breastfeeding. If you’re worried about it, or concerned about your baby developing a food allergy, speak to your doctor.

If you’d like to eat peanuts or foods containing peanuts, such as peanut butter, while breastfeeding, you can do so as part of a healthy, balanced diet (unless, of course, you are allergic to them).

There’s no clear evidence that eating peanuts while breastfeeding affects your baby’s chances of developing a peanut allergy. If you have any questions or concerns, you can talk to your doctor, midwife or health visitor.

Mothers with medical conditions

Mothers may have conditions such as celiac disease, food allergies or another medical condition that requires a special diet. Provided these conditions are well managed, there should be no reason why these mothers cannot breastfeed. Breastfeeding may help to protect babies against also developing these conditions as they grow up. The diet can be well balanced and nutritionally complete for both the mother and her baby. If you are unsure if your diet is adequate, you can consult a dietitian for assessment and advice.

Food allergy or intolerance in baby

Some babies can be food-sensitive and react to traces of foods that come through their mother’s breastmilk. This can include allergies and food intolerances. The most common food allergies in babies are those to cow’s milk, eggs, peanuts and tree nuts. A baby can also have food intolerance (along with an allergy or alone) and react to a range of other foods in the mother’s diet. Since peanuts are one of the foods most likely to cause an allergic response in both children and adults, be sure to monitor your baby’s response when you eat foods containing peanuts, especially if there is a family history of food allergies.

However, there are many reasons a baby may be unsettled or have other symptoms that are like those of food intolerance. Seek professional advice to help you determine if your baby is food-sensitive. Each mother and baby pair is different. Even if you are sure that it is something in your diet, it can often be very difficult to identify which foods are causing problems. Avoiding a whole food group, such as dairy products, may make it more difficult for you to eat a balanced diet. A dietitian will be able to help you sort out what the problem foods are and ensure that your diet contains all the nutrients you need.

Cows’ milk allergy

Cows’ milk allergy is one of the most common childhood food allergies. While it’s more common when first infant formula milk is introduced or when your baby starts eating solids, it can happen while breastfeeding.

Symptoms include:

• skin reactions: such as a red itchy rash
• swelling: lips, face and around the eyes
• tummy ache, vomiting, colic, diarrhea or constipation
• runny or blocked nose
• eczema

Some babies are lactose intolerant (lactose is the natural sugar in milk). This means they can’t digest it – but this not an allergy and may only be temporary. Symptoms include:

• diarrhea
• vomiting
• tummy pain or rumbling
• wind

If you’re worried that your baby is showing signs of an allergic reaction, or intolerance, speak to your doctor. They’ll assess your baby and advise you on the best course of action.

Foods to eat while breastfeeding

The most important thing is to include a wide variety of fresh, healthy foods in your breastfeeding diet. If you think something you’re eating is affecting your baby through your breast milk, talk to your doctor or nutritionist.

Remember that you don’t need a special diet while you’re breastfeeding, just try to include a well-balanced, healthy variety of the following:

• Fruits and vegetables: Aim to eat at least 5 portions of fruit and veg a day. Fresh, frozen, tinned, dried or juiced can be part of your daily allowance – avoid anything with added salt or sugar.
• Starchy foods: Starchy foods are an important source of energy, certain vitamins and fiber. This includes bread, potatoes, breakfast cereals, rice, pasta and noodles. Go for wholemeal, instead of refined starchy (white) versions, as much as possible.
• Protein: Foods in this group include meat, fish, poultry, eggs, beans, pulses and nuts. Aim to have 2 portions of fish each week, make one of them an oily fish like salmon, sardines or mackerel. Shark, swordfish and marlin can contain more mercury than other types of fish, so avoid eating more than 1 portion per week.
• Dairy: Dairy includes milk, cheese and yogurt. It contains calcium and other essential nutrients. When possible, choose low-fat varieties, such as semi-skimmed, one per cent fat or skimmed milk, low-fat yogurt and reduced-fat hard cheese. If you prefer dairy-free alternatives, such as soy drinks and yogurts, go for the unsweetened, calcium-fortified versions.

Fish

It’s good to include 2 portions of fish per week, but when you are breastfeeding:

• Limit swordfish, marlin or shark to one portion a week. This is because of the high levels of mercury found in them
• Don’t eat more than 2 portions of oily fish a week (such as fresh tuna – tinned tuna is fine, salmon, trout, mackerel, herring, sardines, pilchards).

Calcium

Calcium is among the most important minerals in your diet. Your body stores of calcium (primarily from your bones) supply much of the calcium in your breast milk to meet your baby’s calcium needs. Studies show that women lose 3 to 5 percent of their bone mass when they are breastfeeding. After you finish breastfeeding, your body must replenish the calcium that was used to produce your milk. Making sure you consume the recommended amount of calcium in a normal diet—1,000 milligrams daily for all women ages eighteen to fifty and 1,300 milligrams for teenage mothers—helps ensure that your bones will remain strong after you have weaned your baby. The good news is that you recover the bone lost during breastfeeding within the six-month period after you wean your baby.

By consuming three servings of dairy products—8 ounces of milk is one serving—per day, you should receive the calcium you need. If you dislike milk, you can get the calcium you need from cheese and yogurt. If you are allergic to dairy products, try calcium-fortified juice, tofu, dark leafy greens such as spinach and kale, broccoli, or dried beans. You can also get calcium in fortified foods such as breakfast cereal. Contrary to popular myth, it is not necessary to drink milk to make milk.

If you do not routinely consume 1,000 milligrams of calcium in your diet, talk to your doctor or nutritionist about a dietary supplement of calcium. Avoid supplements made from crushed oyster shells, though, because of concern about lead from these sources. Consuming 1,000 milligrams of calcium daily—not only while breastfeeding but throughout life until you reach menopause—will decrease your risk of osteoporosis in later life.

Vitamin D

Everyone, including pregnant and breastfeeding women, should consider taking a daily supplement containing 10 mcg of vitamin D. If your baby is only having breast milk (no first infant formula top-ups), you should give them a daily vitamin D supplement of 8.5 to 10mcg.

Keep in mind, though, that your baby still needs vitamin D supplementation, even if you’re taking a supplement. Breast milk does not provide babies with enough vitamin D. Exclusively breastfed infants or those getting less than 32 ounces of vitamin D-fortified formula per day need 400 IU of vitamin D per day, because sunlight exposure can no longer be safely recommended as their primary source of vitamin D. Babies exclusively breastfed may develop a condition called rickets when adequate vitamin D is not provided. Make sure to talk to your baby’s doctor about the need for vitamin D supplementation.

Vitamin D is found in certain foods (including oily fish like salmon, sardines, and mackerel; red meat; and some breakfast cereals) but it’s hard to get enough from food alone. It’s sometimes referred to as the ‘sunshine vitamin’ as we get most of our vitamin D from sunlight (from late March to the end of September).

From late March/April to the end of September, the majority of people aged 5 years and above will probably get enough vitamin D from sunlight when they are outdoors. So you might choose not to take a vitamin D supplement during these months. However, exposure to sunlight it’s not the safest, given concerns about skin cancer. It’s also unreliable and depends a great deal on where you live. Instead, you should look to get vitamin D from foods such as salmon, mackerel, fortified milk or orange juice, and yogurt. Some ready-to-eat breakfast cereals are fortified with vitamin D.

You can get all the other vitamins and minerals you need by eating a varied and balanced diet.

Protein

Protein is another component of a healthy diet that demands your attention while you are breastfeeding. Protein builds, repairs, and maintains body tissues. You need 6 to 6½ ounces a day when you’re nursing. You can get it best by eating two or three servings of lean meat, poultry, or fish, usually about 3 ounces (the size of a deck of cards) in a serving. You can also get 1-ounce equivalents of protein from 1 egg, 1 tablespoon of peanut butter, nuts (12 almonds or 24 pistachios, for instance), or dried beans (¼ cup cooked). It’s also a good idea to include fish in your weekly diet as one source of protein, especially fatty fish such as salmon, tuna, and mackerel. These types of fish are rich sources of DHA (docosahexaenoic acid), an omega-3 fatty acid that is found in breast milk and contributes to growth and development of an infant’s brain and eyes. In addition, DHA content of milk declines with breastfeeding and can be replenished by eating fatty fish. As always, it’s best to vary your choices as much as possible, while keeping saturated fat intake to moderate levels. To do that, choose lean meats or low-fat varieties whenever possible.

Iron

Iron helps breastfeeding mothers (and everyone else) maintain their energy level, so be sure to get enough of this important mineral in your diet. Lean meats and dark leafy green vegetables are good sources of iron. Other sources of iron include fish, iron fortified cereals, and the dark meat in poultry.

When it comes to meeting your iron needs, it’s important to eat the best sources of iron and to pair them with the right foods. Iron from animal sources, for instance, is generally better absorbed than iron from plant sources. Tea may interfere with iron absorption, so you may want to avoid drinking tea when you eat iron-rich foods or take iron supplements. On the other hand, foods that are rich in vitamin C can enhance iron absorption. So consider pairing ground beef with spinach, or take your multivitamin/mineral supplement with a glass of orange juice.

Folic acid

Nursing mothers (along with all women of childbearing age) should get at least 400 micrograms of folate, or folic acid, daily toprevent birth defects in future children and ensure their babies’ continued normal development. Spinach and other green vegetables are excellent sources of folic acid, as are citrus fruits or juices, many kinds of beans, and meat or poultry liver. You can also get folic acid from breads, cereal, and grains, which are enriched with folate in the United States. All women in their reproductive years are encouraged to take a multivitamin supplement that provides 400 micrograms of folate daily.

Foods to avoid while breastfeeding

If your baby is sensitive to certain foods or drinks, you may need to avoid them. This is because traces of what you eat and drink can pass through to your breast milk. If you have any concerns, talk to your nutritionist or doctor.

Caffeine

Caffeine is a stimulant and can make your baby restless. Caffeine can reach your baby through your breast milk and may keep them awake. Caffeine occurs naturally in lots of foods and drinks, including coffee, tea and chocolate. It’s also added to some soft drinks and energy drinks, as well as some cold and flu remedies.

It’s wiser to cut caffeine out while breastfeeding as it’s a stimulant which can make your baby restless. If you do drink caffeine, try not to have more than 200mg a day. To give you an idea of what that looks like:

• 1 mug of filter coffee = 140mg
• 1 mug of instant coffee = 100mg
• 1 (250ml) can of energy drink = 80mg (larger cans may contain up to 160mg caffeine)
• 1 mug of tea = 75mg
• 1 (50g) plain chocolate bar = up to 50mg
• 1 cola drink (354mls): 40mg

Try decaffeinated tea and coffee, herbal teas, 100% fruit juice (but no more than one 150ml glass per day) or mineral water. Avoid energy drinks, which can be very high in caffeine.

Alcohol

Obviously, it’s better not to drink any alcohol while breastfeeding, but an occasional drink is unlikely to harm your baby. One or two units of alcohol, once or twice a week, should be fine.

If possible, allow two to three hours in between drinking and breastfeeding (you should only do this after breastfeeding is well established). This allows time for the alcohol to leave your breast milk. An alternative option is to express before drinking any alcohol, then your baby can be bottle fed and you can skip a feed. But if you do miss a feed, make sure your breasts don’t become uncomfortably full.

It’s very important that you never share a bed, or sleep on the sofa with your baby if you’ve been drinking. This is linked to the risk of sudden infant death syndrome (SIDS).

What is a unit of alcohol?

• a small glass of wine (125ml)
• half a pint of beer
• single measure of a spirit (25ml)

After drinking alcohol, how long should I wait to breastfeed?

On average, it takes about 2 to 3 hours for a glass of wine or beer to leave your system, so it’s best to wait a few hours to breastfeed. Obviously the more you drink, the longer it takes. If your baby is under 3 months old, it will take them longer to process the alcohol, as their liver is still developing.

If you express before drinking alcohol, your baby can be bottle-fed with your breast milk. If you need to miss a feed, don’t let your breasts become uncomfortably full as this can lead to mastitis. It’s best to express your breast milk rather than be uncomfortable.

What affects the content of my breastmilk?

Pregnant women usually pay close attention to their diet, since every food, beverage, and drug they ingest may make its way to their baby. Fortunately, this is not exactly the case with breastmilk.

Breastmilk is produced from the mammary glands in your breasts, not directly from the substances you ingest. These glands draw on the resources available in the form of nutrients from your diet and from your body’s stores of nutrients. If your diet contains insufficient calories or nutrients to fully sustain both you and your nursing child, your mammary glands will have “first shot” at your body’s available nutrients to produce highly nutritious breastmilk, leaving you to rely on whatever is left over. So a less-than-ideal diet will probably not affect your breastfeeding child, but it may leave your body at nutritional risk.

The mammary glands and cells that produce milk also help regulate how much of what you eat and drink actually reaches your baby. Moderate consumption of coffee, tea, caffeinated sodas, and an occasional glass of wine or other alcoholic beverage are fine when you are breastfeeding. However, some babies are more sensitive than others, so keep a close eye on your baby to see how she reacts. It is also reassuring to know that the drugs injected for epidural blocks and other types of regional anesthesia during childbirth do not pass into breast milk sufficiently to cause longterm harm, though they may make your baby a little sleepy at first. In cases when general anesthesia is used, your anesthesiologist or obstetrician should be informed in advance of your plans to breastfeed.

Most medications are safe to take during breastfeeding, but there are a few—including some nonprescription substances— that may be harmful to the baby. These are not always the same medications that are dangerous for pregnant women to take, so be sure to get approval for all medications from your doctor and your baby’s pediatrician. Excessive alcohol or any kind of recreational drug or medication that has not been approved by your pediatrician should not be indulged in, since enough of it could be passed on to your baby and cause serious harm.

Weight loss

It is normal to store extra fat during pregnancy to be used up while breastfeeding. Mothers vary in when they lose this extra weight – some in the early weeks, some later and some not until after they have stopped breastfeeding. It is important that you do lose this extra weight at some point, however, and not carry it through to another pregnancy or later life. If this happens, it makes it much harder to return to a healthy weight later on. Even though making breastmilk uses kilojoules, research is unclear whether breastfeeding actually increases weight loss after childbirth.

While breastfeeding, it is best to lose the extra weight gradually, using healthy eating principles and adding in some extra exercise. A loss of up to about half a kilo per week is safe for breastfeeding mothers. Don’t use crash or fad diets, where you lose weight quickly, either during pregnancy or breastfeeding. These diets don’t have a good balance of important nutrients needed for both you and your baby.

If you feel that you need to lose a lot of weight and more quickly, consult your medical adviser or a dietitian for advice on a balanced weight-reducing diet.

Some tips if you are trying to lose weight:

• Avoid shopping when you are hungry. Write a shopping list and stick to it. Don’t be tempted to buy high-fat or high-sugar snack foods or processed foods.
• Use smaller plates for your meals.
• Eat slowly. Don’t put more food on your fork until you’ve eaten the last mouthful. This gives you time to feel full.
• Don’t eat on the run – sit down at the table and relax.
• Choose snacks of wholegrain products, vegetables and fruits.
• Cut down on fat and calories intake by choosing low-fat or fat-free dairy products, cutting off all visible fat from meat before cooking and using only a small amount of oil during cooking.
• Choose foods that contain little or no added sugar. Note that foods labelled ‘low-fat’ are often very high in sugar. Foods with added fruit or fruit juice concentrate, but labelled ‘no added sugar’, can be just as high in calories as some others with added sugar. Check labels for energy (calories) content.
• Increase the amount of exercise you do.

Weight gain

Some breastfeeding mothers have the opposite problem and find that they lose too much weight, too quickly. In this case, try to increase the number of serves of food you eat across all food groups. Avoid the temptation to eat foods high in saturated fats or added sugar – the ‘discretionary choices’ listed in the table above. These foods might help you gain weight, but are not good sources of the extra nutrients you need. Try having frequent, small meals or at least have snacks between each regular meal. Consult your medical adviser or a dietitian if you are concerned about your weight loss.

Thirst

Making breastmilk uses extra fluid, so breastfeeding mothers are often more thirsty than usual. There is no one figure for how much you need to drink, as it depends on the weather conditions, your activity level and the foods you eat. Be guided by your thirst; don’t be tempted to ignore it because you are busy. Perhaps make it part of your breastfeeding routine to have a glass of water or a water bottle next to you each time you give your baby a feed. Carrying a water bottle with you when out and about also makes it easy to have a drink when you need it.

Special diets

Vegetarian

There are two types of vegetarian diets:

1. those that include some animal products, such as dairy products and/or eggs, and in some cases fish or some other animal products
2. those that do not contain any animal products (vegan)

The nutrients of most concern when animal products are not eaten or only in small amounts are protein, iron, calcium, vitamin B12 and omega-3 fatty acids. While breastfeeding, well-planned vegetarian diets are able to satisfy these needs, with the possible exception of vitamin B12 in a vegan diet. If you have followed a vegan diet for a long period of time prior to having your baby, it would be wise to have your vitamin B12 levels checked and you may require a vitamin B12 supplement. If you are unsure at all, check with your medical adviser or a dietitian regarding nutritional adequacy of your diet for both yourself and your baby.

Dairy-free diets

Some mothers follow dairy-free diets for either cultural reasons or because they or their babies have an intolerance to cow’s milk. Some cultural groups don’t traditionally eat dairy products and need to get their calcium from other foods. Dairy products primarily supply calcium in the Western diet, but they are also a valuable source of protein and some vitamins like A, B2 (riboflavin) and B12. When dairy products are avoided, consideration has to be given to replacing all of these from other sources in the diet. A dietitian is able to advise on this on an individual basis and take into account a mother’s cultural background.