The Motherwear Breastfeeding Blog

Which foods can boost your milk supply?

I was recently reading a great handout by Lisa Marasco on galactagogues (foods, herbs, and medications that increase milk supply), and thought I'd share some of the information on foods. 

I interviewed Lisa on hormonal causes of low milk supply when her book, The Breastfeeding Mother's Guide to Making More Milk, co-authored with Diana West, came out.  I also read Mother Food, which has great information on increasing milk supply using foods and herbs.

Before working to increase your milk supply, you need to first determine if it's actually in need of a boost.  There are many things that can make you think that it's low when it's not.  If it's truly a concern, galatctagogues shouldn't be your first step.  Feeding frequently and effectively, ensuring that the latch is good, breast compression, pumping after feedings, and skin to skin are at the top of the list.  A trained breastfeeding suppport person can help with all that.  Herbs and prescription medications would be the next things to explore with your health care provider.

So, which foods were listed on the handout as increasing milk supply?

• High fiber foods such as oats, usually eaten as oatmeal (the old fashioned kind, not instant), barley, brown rice, and beans
• Calcium-rich foods such as sesame, almonds, and dark green leafy vegetables
• Fruits such as apricots, dates, figs, and cooked green papaya
• Soups made from Torbangun or Mulunggay leaves

Last year I wrote about making lactation cookies, which contains oats, as well as brewer's yeast, another traditional galactagogue.  Whether or not they help with milk supply, there's really good!

Have any of you found that any of these foods helped your milk supply?

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here. 

A little research update.

New research about breastfeeding has been in the news quite a bit in the last few weeks.  Here's a sampling:

Breastfeeding leads to better academic achievement in high school and an increased likelihood of attending college

Women with multiple sclerosis who breastfed exclusively for at least two months appear less likely to experience a relapse within a year after their baby's birth

Women who breastfed were less likely when they were older to have developed high blood pressure, diabetes, high cholesterol and cardiovascular disease

Breastfeeding cuts women's risk of metabolic syndrome.

Mothers who drink an excessive amount of fructose-sweetened beverages (as high fructose corn syrup) during pregnancy or breastfeeding may be likelier to have children—at least sons—who are more prone to becoming overweight and developing type 2 diabetes

Hand expression and breast massage combined with breast pumping did a better job of stimulating milk production than breast pumping alone.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Donate breastmilk for breast cancer research.

Some of you probably remember posts I wrote last Fall about a research project I'm involved with at the University of Massachusetts.  (That project is ongoing, and if you are nursing and have had, or are expecting to have, a biopsy, please see the study website for information on how to participate.)

The same professor, Dr. Kathleen Arcaro (shown to the right at a visit to my breastfeeding group), is now recruiting for a separate, though related study. 

This study, funded by the Avon Foundation, involves research on the breastmilk of mothers who have nursed over time.  Dr. Arcaro is examining the DNA of these mothers' milk to identify changes in the functioning of genes in breast epithelial cells.  This will help to identify which genes' functions are being altered (or not altered) over time.  The future of cancer therapy is thought to lie in a field called "epigenetics," (great video about it here) which involves the restoration of normal DNA functioning, so understanding which genes are involved in the development of breast cancer is key.

This time, we're looking for mothers who:

• Are in our area (Western Massachusetts, but anywhere within reasonable driving distance to our area may be okay)
• Had and nursed a baby in your mid-20's
• Are now in your mid 30's or older, and are nursing or pumping
• Willing to provide a milk sample. 

Participants also fill out a questionnaire, and receive $25 in thanks.  If that sounds like you, please email me.  More information is available at Dr. Arcaro's website.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

CBS News shows why preemies need breastmilk.

This video (sorry about the ad that precedes it) does a great job of showing the value of breastmilk for preterm babies.  The statistics on NEC (necrotilizing enterocolitis) alone are dramatic, and that's just one of many problems preemies can have.  I wish that all NICUs were as on board with breastfeeding as UCSD Medical Center.

I've always had a lot of admiration for all of the nursing and pumping moms of preemies, as well as the breastmilk donors who come to their aid.  Here's proof that it's worth it.

Are you the mom of a preterm baby?  Feel free to tell your story in the comments section.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Pollutants are everywhere - including formula.

In 2003, newspapers around the country carried headlines like this one:

"Tests show babies get doses of toxins in moms' breast milk." (Boston Herald, May 22, 2003)

This was after researchers were able to identify perchlorate, a component of rocket fuel, in breastmilk.  And undoubtedly, some mothers switched to formula, thinking it was safer.  Recent research shows that we are very sensitive to the idea that our milk contains toxins.

Six years later - last week, in fact - the headlines look like this:

"Perchlorate found in infant formula -- CDC" (New York Times, April 3, 2009)

The CDC study found perchlorate in 15 brands of powdered infant formula, before mixed with water.  This isn't terribly surprising, since perchlorate has been found in cow's milk, which is used to make some formulas.

The truth is that pollutants are found everywhere in our environment, and neither breastmilk or formula is exempt.  But because biomonitoring studies generally look only at loads of pollutants in human milk, and not in formula, it creates a perception that breastmilk is more polluted than formula.  But in some cases, the levels in formula are significantly higher than in breastmilk (study).

As Dr. Jack Newman notes, "There are toxins in formula. Why would everything on earth be polluted, even the far reaches of the Arctic, but not formula?"

The good people who do biomonitoring studies aren't trying to scare people away from breastfeeding; they're trying to determine what things in our environment are ending up in our systems, so we can set policies to protect ourselves.  But if the results are not publicized with care, it can send an unintentional message about what is safe, and what is not.  I've read blog posts suggesting that formula was safer than breastmilk, and heard of moms who plan to wean because of fear about pollutants.

In February, I wrote a long post about this issue, pointing out that levels of some of the worst pollutants have been declining dramatically in the last 30 years, that there is no evidence that pollutants in breastmilk cause babies any harm, and that we can make choices - at both the personal and political levels - that reduce the levels of pollutants in our milk.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Miss any of these podcasts?

A couple of years ago, when Motherwear asked me to create podcasts for the blog, I almost said no.  I felt nervous about doing recordings, and wasn't sure what people would want to hear.

The president of Motherwear had me meet with the owners of a big yarn store in our area, who do a weekly radio show about knitting.  Their show is produced as a podcast and is very popular.  I went with them to the radio station to watch them record it.  It actually looked like fun, and I committed to giving it a try. 

The funny thing is that I really enjoy the process of putting these podcasts together.  I like reading the books, coming up with questions, and talking with authors.  I've had a chance to talk with people I might never have contacted.

Can you guess which one is the most frequently downloaded from the iTunes store?  A breastfeeding welcome here sticker goes to the first person to guess correctly (leave your guess as a comment).  And if you're feeling friendly, please go to our iTunes store and write a review! 

• Breastfeeding and early sexual abuse, with Penny Simkin
• African American moms and breastfeeding, with Kathi Barber
• How do other mammals do it? With Dia Michels
• What's the problem with those formula company bags? With Alison Stuebe
• Starting solid foods, with Ellyn Satter
• Breastfeeding in the movies, with Sarah Rubenstein Gillis
• Low milk supply: Could it be your hormones? With Lisa Marasco
• So, you want to work in breastfeeding support (just me)
  
• Nursing in public and the law, with Jake Marcus
• Making more milk, with Diana West
• Hathor the Cow Goddess, with Heather Cushman-Dowdee
• Postpartum depression and breastfeeding, with Kathleen Kendall-Tackett
• MilkShare, with Kelly Faulkner
• The Milk Memos, with Cate Colburn-Smith

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

"The Case Against Breastfeeding"

This month's edition of The Atlantic Monthly features an article by Hanna Rosin entitled "The Case Against Breastfeeding."  Thanks to many of you for emailing me about it!

There are several pieces to the argument she presents, and they roughly follow the perspective of one school of feminist thought (you can read about different feminist perspectives on breastfeeding here):

1) The evidence of better health outcomes for breastfed babies is "thin."
2) Women in some communities feel a lot of pressure to breastfeed.
3) Breastfeeding "keeps women down," and is "a serious time commitment that pretty much guarantees that you will not work in any meaningful way."

I'm going to tackle the first one here, though I have some strong feelings about the others, especially the third. Breastfeeding mothers can't do meaningful work?  It's going to be hard to break that news to the many, many breastfeeding mothers I meet who are working as doctors, teachers, professors, and nurses.  And of course this argument assumes that being a parent is not "meaningful work."

But back to the "thin" evidence for breastfeeding.  I'd like to point out a few things about her argument:

1) The author says that there are so many methodological problems in the research as to undermine the credibility of health claims.  As evidence of this, she points to a meta analysis published in...1984.

I wonder why she didn't cite the 2007 U.S. Department of Health and Human Services (AHRQ) meta analysis, "Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries," which reviewed over 9,000 abstracts, 43 preliminary studies, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies on breastfeeding. The analysis graded each study for methodological quality.  The report states,

"We found that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis."

And while this topic wasn't raised in the article at all, the study found: "For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer...Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression."

2) The article argues that breastfeeding provides limited protection against infection because "they never get into the blood." Right.  That's because the components in milk prevent the pathogens from getting into the baby's bloodstream to begin with.  The antibodies in breastmilk coat the lining of the baby's intestine and are pathogen-specific - blocking the bad bacteria and leaving the good bacteria alone, based on messages from the mother's immune system.  The bad bacteria can't get in to the baby's tissues, and leaves the baby's body in its poop.  This is a more efficient form of infection protection, says Dr. Lars Hanson, in The Immunobiology of Human Milk, because when a virus or bacteria does enter tissues, it requires an inflammatory response which involves symptoms of infection (fever, for example) and a higher energy requirement. 

3) But beyond this site-specific immune protection, there is the overall development of the baby's immune system.  Think of it this way: your baby's body is taking notes about what your milk fights in its system, and is remembering it for the next time it encounters that pathogen.  That's called active immunity.  It does this in part through memory T cells, through cytokines and chemokines, which do enter the baby's system through gut, and regulate activation of the immune system, and through other pathways. There are many more ways in which breastfeeding protects babies, but I don't have space for them here. 

I did find a couple of things to agree with in her article:  that there is irony in the fact that the movement to take back infant feeding from the medical establishment is now justified on the basis of medical research; and that women feel trapped between health recommendations and the reality of maternity leave policy in this country.

But all in all, I found this article to be a very selective reading of the research, with comments reflecting a highly specific experience of American motherhood, with a dollop of judgement on top.

If you're like me, this article raised some pretty strong feelings.  I'm going to encourage all of us to be respectful in our comments here.  However you view this article, try to address the arguments, not the person making them, please.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

New study: Breastfeeding reduces SIDS risk by 50%.

A study from Germany has found a reduction of 50% in the risk of SIDS for breastfed babies.  Past studies have also found a lower SIDS rate among breastfed babies, but the finding was lower - 36% in one study.

Medscape reports:

"This study shows that breastfeeding reduced the risk of sudden infant death syndrome by ~50% at all ages throughout infancy," the study authors write. "We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages."

"...Because breastfeeding rates are low in the socially deprived sections of our population, there should be special programs to encourage mothers of low socioeconomic status to breastfeed their infants not only for the established benefits of breastfeeding for the mother and infant but also to reduce the risk of SIDS in their infants."

Curious how breastfeeding and SIDS risk are related?  Dr. Sears has a good piece entitled "8 Reasons Breastfeeding Reduces SIDS."

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

I've been very excited about this book for a while, and am happy to be able to tell you more about it - and to offer a free copy to a lucky winner!

First, I want to share some past interviews I've done with the authors, which you can also find at our free iTunes store:

Diana West on basic milk supply issues:

Diana West answers readers' questions:

Lisa Marasco on maternal hormonal causes of low milk supply:

I really can't say enough good things about this book.  It's clear, readable, and most importantly, comprehensive.  There are a few features that I particularly want to highlight:

1) Diana and Lisa write about maternal hormonal causes of low milk supply in more detail than I've seen in any other breastfeeding book for moms.  There is also some hard-to-find information on some topics like gastric bypass, eating disorders, and vegan/vegetarian diets.

2) The chapter entitled "Planning for the future" made me shake my head and think "Of course!"  So many mothers who have had difficulty with milk supply are very motivated to try again, and this chapter tackles the process of planning for a new baby straight on.  Wonderful.

3)  The authors take seriously the feelings mothers have when they have a problem with milk supply.  They devote a chapter to "coping with milk supply," which I think mothers will find very helpful. 

If you'd like to win the copy, leave a comment below by March 9th, 2009.  U.S. addresses only, please.  Winner be chosen using random.org, and announced in the comments section. 

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

I was discouraged to see this recent study, which showed that as many as 93% of pregnant mothers would stop breastfeeding over concerns about toxins in their milk:

Of breastfeeding women, 78% to 93% of mothers reported that they would either discontinue breastfeeding sooner than intended or pump and discard their milk if they were told that they had "low" or "high" levels of phthalates in their milk, respectively.  African American women were significantly more likely than Caucasian women to report that they would immediately wean if told of phthalates in their milk.

This demonstrates, I think, a lot of fear about environmental toxins in breastmilk.  So I thought that this might be a good time to put out a few facts about this topic:

1) Levels of some toxins in breastmilk have been going down in recent years.  Dr. Kathleen Arcaro, environmental toxicologist at the University of Massachusetts said in an interview for this blog, "the good news is that the concentration of some lipophilic (fat-loving) environmental pollutants in breast milk is decreasing.  For instance the level of many pesticides (DDT and its metabolites) and polychlorinated biphenyls (PCBs) has greatly decreased over the last 30 years." 

2) Toxins are in the general environment, which means that they are in formula, too.  You obviously have to feed your baby something, and there's no reason to think that formula doesn't contain some contaminants as well.  Dr. Arcaro notes that "pollutants are widely distributed [i.e. in the air, in water] and therefore are in cow’s milk and formula."  Dr. Arcaro shared a study with me showing that one type of toxin (PAH) is found in the highest levels in formula and cow's milk, and lowest levels in breastmilk.  If some degree of exposure exists in all of our choices, wouldn't we want to choose the food that offers many health and developmental advantages?

3) Recent research found no adverse consequences of dioxins in breastmilk.  A recent study comparing the health and development of babies exposed to dioxins (nearly twenty years ago, when exposure to dioxins was more common) through breastmilk and those fed formula found no adverse health consequences for the breastfed babies, and significantly better developmental outcomes for those who were breastfed.  This confirms the findings of prior research.  The International Lactation Consultant Association states in their position paper (pdf) on this topic that, "with the exception of maternal poisoning, breast milk remains a safe, life-enhancing method to feed and nurture infants and young children."

4) Not everything in the environment or your diet makes it into your milk.  Our bodies have several systems that regulate what gets into our milk.  Some things we eat, for example, are destroyed in our digestive system, eliminated from our bodies, or held in our livers before they even enter our bloodstream, which is where they may transfer into milk.  And not everything that enters our bloodstream makes it into our milk, either.  Only substances that are small enough in molecular weight to squeeze in between our milk making cells, or fat-soluble enough to 'hitchhike' through the milk making cells, can make it into milk.  And once the level in our bloodstream declines, substances that make it into milk actually move backwards into our bloodstream.  Even when something harmful does make it into your milk, your baby's gut may destroy it or poop/pee it out before it can enter her bloodstream.  Of course, these systems are not foolproof, and some substances can pose a threat to your baby.  Much more on this topic can be found on Dr. Thomas Hale's website.

5) If you're concerned, you can make choices about products you use, and advocate for better regulation.  Dr. Arcaro points out that some recently identified substances in milk (and therefore in our fatty tissue) are from household and personal care products.  So, if you're concerned about this (and I'd again note the research above does not raise concerns), you can make some pretty simple choices about the detergents, cleaners, personal care products (soaps, shampoos, deodorant, lotions, etc.), and plastics you use, as well as the foods you eat.  You can also advocate for tighter regulation of substances like BPA.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Give away week: The Breastfeeding Mother's Guide to Making More Milk

I've been very excited about this book for a while, and am happy to be able to tell you more about it - and to offer a free copy to a lucky winner!

First, I want to share some past interviews I've done with the authors, which you can also find at our free iTunes store:

Diana West on basic milk supply issues:

Diana West answers readers' questions:

Lisa Marasco on maternal hormonal causes of low milk supply:

I really can't say enough good things about this book.  It's clear, readable, and most importantly, comprehensive.  There are a few features that I particularly want to highlight:

1) Diana and Lisa write about maternal hormonal causes of low milk supply in more detail than I've seen in any other breastfeeding book for moms.  There is also some hard-to-find information on some topics like gastric bypass, eating disorders, and vegan/vegetarian diets.

2) The chapter entitled "Planning for the future" made me shake my head and think "Of course!"  So many mothers who have had difficulty with milk supply are very motivated to try again, and this chapter tackles the process of planning for a new baby straight on.  Wonderful.

3)  The authors take seriously the feelings mothers have when they have a problem with milk supply.  They devote a chapter to "coping with milk supply," which I think mothers will find very helpful. 

If you'd like to win the copy, leave a comment below by March 9th, 2009.  U.S. addresses only, please.  Winner be chosen using random.org, and announced in the comments section. 

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.

Worried about environmental contaminants in breastmilk? Get the facts.

I was discouraged to see this recent study, which showed that as many as 93% of pregnant mothers would stop breastfeeding over concerns about toxins in their milk:

Of breastfeeding women, 78% to 93% of mothers reported that they would either discontinue breastfeeding sooner than intended or pump and discard their milk if they were told that they had "low" or "high" levels of phthalates in their milk, respectively.  African American women were significantly more likely than Caucasian women to report that they would immediately wean if told of phthalates in their milk.

This demonstrates, I think, a lot of fear about environmental toxins in breastmilk.  So I thought that this might be a good time to put out a few facts about this topic:

1) Levels of some toxins in breastmilk have been going down in recent years.  Dr. Kathleen Arcaro, environmental toxicologist at the University of Massachusetts said in an interview for this blog, "the good news is that the concentration of some lipophilic (fat-loving) environmental pollutants in breast milk is decreasing.  For instance the level of many pesticides (DDT and its metabolites) and polychlorinated biphenyls (PCBs) has greatly decreased over the last 30 years." 

2) Toxins are in the general environment, which means that they are in formula, too.  You obviously have to feed your baby something, and there's no reason to think that formula doesn't contain some contaminants as well.  Dr. Arcaro notes that "pollutants are widely distributed [i.e. in the air, in water] and therefore are in cow’s milk and formula."  Dr. Arcaro shared a study with me showing that one type of toxin (PAH) is found in the highest levels in formula and cow's milk, and lowest levels in breastmilk.  If some degree of exposure exists in all of our choices, wouldn't we want to choose the food that offers many health and developmental advantages?

3) Recent research found no adverse consequences of dioxins in breastmilk.  A recent study comparing the health and development of babies exposed to dioxins (nearly twenty years ago, when exposure to dioxins was more common) through breastmilk and those fed formula found no adverse health consequences for the breastfed babies, and significantly better developmental outcomes for those who were breastfed.  This confirms the findings of prior research.  The International Lactation Consultant Association states in their position paper (pdf) on this topic that, "with the exception of maternal poisoning, breast milk remains a safe, life-enhancing method to feed and nurture infants and young children."

4) Not everything in the environment or your diet makes it into your milk.  Our bodies have several systems that regulate what gets into our milk.  Some things we eat, for example, are destroyed in our digestive system, eliminated from our bodies, or held in our livers before they even enter our bloodstream, which is where they may transfer into milk.  And not everything that enters our bloodstream makes it into our milk, either.  Only substances that are small enough in molecular weight to squeeze in between our milk making cells, or fat-soluble enough to 'hitchhike' through the milk making cells, can make it into milk.  And once the level in our bloodstream declines, substances that make it into milk actually move backwards into our bloodstream.  Even when something harmful does make it into your milk, your baby's gut may destroy it or poop/pee it out before it can enter her bloodstream.  Of course, these systems are not foolproof, and some substances can pose a threat to your baby.  Much more on this topic can be found on Dr. Thomas Hale's website.

5) If you're concerned, you can make choices about products you use, and advocate for better regulation.  Dr. Arcaro points out that some recently identified substances in milk (and therefore in our fatty tissue) are from household and personal care products.  So, if you're concerned about this (and I'd again note the research above does not raise concerns), you can make some pretty simple choices about the detergents, cleaners, personal care products (soaps, shampoos, deodorant, lotions, etc.), and plastics you use, as well as the foods you eat.  You can also advocate for tighter regulation of substances like BPA.

Want to get email updates from the Motherwear Breastfeeding Blog?  Subscribe here.  Want an RSS feed? Subscribe here.  Want to subscribe to our breastfeeding podcasts on iTunes?  Click here.