Postpartum period is one of the most challenging times for any woman, with a lot of adjustments going on on both physical, emotional, intellectual and physiological level. And, if figuring out how to take care of your growing family wasn't hard enough, you also have to figure out how to care for your now changed body. Let's start with one of the most basic and commonly neglected issues - nutrition. Here is the list of general concepts and common questions, which you need to consider during this special period.
How many calories should I be eating? This is a more complex question, than it appears. The answer largely depends on your calorie intake while not pregnant, your activity level, whether you are exclusively nursing or supplementing with formula occasionally, etc. In general, to maintain good milk supply, most women need around 1800- 2200 calories a day. It is recommended to increase the calorie intake by about 300 calories from your baseline for the last 2 trimesters of pregnancy, and by 300-500 calories for exclusive breastfeeding. So, while breastfeeding, you should be eating similarly, or slightly more than you were eating while pregnant.
That being said, calorie counting is not the best approach to building a healthy diet regardless of your pregnancy or lactation status. While we all enjoyed the since class experiment of determining the caloric output of burning a peanut, it may hardly be considered an accurate representation of what happens to the food once it enters the body. Counting the calories, which represent the energy value of food, does not take into account the obvious fact that not all food is used as energy. This is intuitively obvious when you think about the nutritional value of one egg versus 2 cups of chopped broccoli or one slice of white bread. These foods have very different effect on your body, but contain the same number of calories. It also does not account for the work; your body needs to do, and energy it needs to spend, in order to digest the food and process the nutrients. In general, the less processed the food, the more energy it requires for digestion.
So, the better way of approaching your postpartum nutritional needs would be to eat when hungry, and focus on nutritional value and quality of food. With counting the nursing sessions, the dirty diapers and the baby weight gain, you have more than enough math in your life already.
- Can I diet while breastfeeding? In general, dieting is safe for breastfeeding mothers, as long as it is not taken to an extreme. It is best to wait until your milk supply is fully established (around 2 months postpartum) before giving any weight loss plans a go. Also, if you are calorie counting (which we are not fans of, but still), it is recommended you maintain your intake at about 1500 – 1800 calories a day and avoid sudden changes to keep your milk supply from dropping. In general, we think the best approach to dieting is making gradual small scale changes overtime. Instead of counting calories we recommend planning your meals and snacks in a way that will ensure you are eating real whole foods and avoiding refined highly processed foods. We also do not recommend restricting the intake of any specific food group, as this commonly results in unbalanced diet and subtle nutrient deficiencies.
- Are there any foods that I should avoid? There are no recommendations to avoid any specific foods for postpartum women or nursing mothers. So, you can eat anything you want, unless instructed other vice by your or your child’s doctor. However, do keep in mind, that certain foods (highly processed foods, refined carbohydrates, trans fats, fish high in mercury, etc) are not recommended for anyone, regardless of lactation status or even gender.
- What about alcohol? Excessive alcohol intake is harmful for anyone, whether they just had a baby or not, whether they are nursing or not. Of course, everyone defines excessive differently. We believe that the general guideline for moderate alcohol consumption of 7 or less drinks per week and 2 or less drinks per occasion also holds true for postpartum women. Things do, however, get more difficult when breastfeeding is added to the picture. While the “pump and dump” strategy is no longer recommended, it is best to wait about 2-3 hours after finishing the drink until nursing the baby. Alcohol level peaks in your bloodstream and milk about ½ - 1 hour after drinking, and the concentration will gradually decrease by the 2- and 3-hours mark. It is also best to postpone the drinking until your baby is at least 3 months of age, because their liver enzymes mature around that time and start to detoxify alcohol (even the small amounts that make it into your milk) much more efficiently. Additionally, it is worth noting that alcohol can decrease milk supply and slow the let down reflex for some moms, and cause sleep wake cycle disturbance in some infants. Considering all the above, we can not recommend regular or daily alcohol intake for nursing mothers (especially nursing mothers of very young infants), but believe the risks and benefits balance may allow for an occasional drink in the right setting.
- Should I continue taking prenatal vitamins? After you give birth and, especially, if you are nursing your baby, your body will need a constant supply of vitamins and minerals to replenish the nutrients used during pregnancy (hey, making a new human is not an easy feat!) and provide them in your milk to the baby. While it is theoretically possible to get all the nutrients from diet alone, we would still recommend maintaining on the prenatal multivitamin. Alternatively, if you are working with a nutritionist and know which vitamins and minerals you are at risk of being deficient at, you could pass on a multivitamin and take the regimen tailored for you. Of course, the financial burden of the prenatal multivitamin should not come at the expense of a healthy and balanced diet.
- Can I use Artificial sweeteners or consume foods and beverages that contain them? Artificial sweeteners are a heterogeneous group of substances, so the answer to this question will depend on the particular sweetener you are planning to consume. The question itself probably stems from the 2015 study that showed the certain nonnutritive sweeteners (NNS) ingested by the mother are excreted in breastmilk and, therefore, passed to the infant. As the effects of prolonged infant exposure to sweeteners in the study (particularly sucralose, ace-K, and saccharin) are not well understood, nursing mothers are encouraged to avoid or limit the use of these substances whenever possible. Safer sweeteners for breastfeeding mothers include Nutrasweet (aspartame) and Splenda (sucralose). Sorbitol and Stevia are in the grey zone, as there is little research available on their excretion in breast milk.
- Is Caffeine ok? Known as an ultimate mom fuel, caffeine is probably safe to use in moderation by most mothers. While individual tolerance to caffeine warries for both mothers and babies, a general guideline is consuming less than 500mg Caffeine per day. That is a combined amount for all the caffeine containing products, including coffee, tea, coke, hot cocoa, chocolate bars, etc. But please keep in mind that this is a very general guideline and caffeine metabolism can vary greatly from person to person. If you see that your baby is fussy, irritable and sleepless, trying to cut down on your caffeine intake and switch to decaffeinated beverages may be a difficult, but reasonable thing to do. It is also likely that your baby’s caffeine tolerance to change with age, so 2 venti lattes that used to interfere with their sleep as a newborn may not do much once they are 3-6 months of age.
Here, we provide a list of nutrients we believe to be especially important for new mother's, along with a list of foods you can find them in. We believe it's best to get most, if not all of your nutrients from real whole foods, but if you find that your diet is lacking one of the components listed below, it may be a good idea to supplement that specific substance.
- Water – the most essential and the most overlooked component of your diet. As busy as you are with this new baby, it’s easy to forget about drinking enough liquids. You know the story, you fill up the glass, then hear the baby fussing, and go off to feed, change and cuddle. But it’s important to remember, that water is essential to all your body’s functions. And, if you are breastfeeding, it is the main component of your milk. Make sure you get at least eight 8-ounce glasses of water a day, and up that to twelve if you are nursing.
- Protein -this is a building block for all your tissues and organs. Protein requirements increase in the postpartum period, as your body has quite a bit of healing to do. Nursing also increases your protein needs, because you become the sole provider of those building blocks for a rapidly growing human (well, nothing new here, that’s been the story throughout your pregnancy also). And while the individual need will vary depending on your age, weight and activity level, it is recommended to eat at least 70g of protein a day on average. This can be achieved by incorporating different plant and animal based foods in your diet. Think eggs, milk, meat and poultry, beans, tofu, etc. It may be especially beneficial for recovery to get the protein called collagen, which is found in the connective tissue of animals. So, bone broth, and all the hearty soups and stews you can make with it, are going to be very helpful in restoring the health of your abdominal wall muscles and helping tighten stretched out skin. If bone broth is not your thing, you can also use collagen powder, which can be added to smoothies or even coffee.
- Fiber – if you read any number of articles on what to expect from your postpartum recovery, you likely know that constipation is a common problem during this period. What’s more, having episiotomy and/or tears in your genital area, is not helping the situation either. A natural way to make bowel movements softer and, therefore, easier, is upping your fiber intake. The best way to do it is with fresh fruits and vegetables, whole grains, nuts and legumes, but if you feel like you are not getting enough, you can try supplementing with Psyllium Husk Fiber capsules.
- Omega 3 fatty acids – as we have figured out in recent years, not all fats are bad for you. In fact, fatty acids are essential nutrients for building cell membranes and synthesizing certain hormones. When talking about good fats, Omega 3 fatty acids, immediately come to mind. Their many benefits include improved cardiovascular health, memory and vision benefits and reduced risk of postpartum depression. DHA, a supplement commonly mentioned in connection with fetal cognitive and motor development, is also a type of Omega 3, commonly found in fatty fish such as salmon, tuna or herring. It is best to get your Omega 3’s from eating wild caught fish but taking a high-quality fish oil is also an option if you feel that your seafood intake is inadequate.
- Iron – it is widely known that Iron is a center component of Hemoglobin, an Oxygen-transporting molecule found inside our red blood cells. Blood loss, which inevitably happens during vaginal delivery or C-section, and later while your uterus is healing, may lower your hemoglobin levels quite a bit. You will need to make sure Iron is readily available for your body to make more Hemoglobin and red cells. We strongly advise you get this element from food, as Iron supplements are known to cause upset stomach and constipation, which you do not need any more of. Some foods that are high in Iron are meats (both red meat and poultry), liver, seafood and green vegetables such as spinach, broccoli, kale and string beans.
- Vitamin D –This fat-soluble vitamin has recently gained a lot of publicity as an anti-cancer and immune balancing nutrient. It has also been long recognized as a key factor in Calcium metabolism and bone health. Unfortunately, very few foods contain naturally occurring Vitamin D, with most of it being made inside our bodies during sun exposure. Vitamin D deficiency in childhood can lead to a condition known as Rickets. It was previously believed that Vitamin D is minimally secreted into breastmilk and therefore, supplementation was recommended for all breastfed babies. Recent studies, however, show that maternal supplementation with 4000-6400 IU of Vitamin D a day can adequately enrich breastmilk with this nutrient for healthy infant development.
- Calcium - is an essential element that makes up the matrix of your bones and teeth. Additionally, it is present in your muscles and intracellular fluid, playing important role in muscle contractions. We all know that milk is rich in calcium, to provide baby (either baby cow, or baby human) with adequate nutrients for bone mineralization, so it is important to make sure that your body has enough to share. Foods high in Calcium include dairy products, dark green leafy vegetables, nuts, seeds and beans. It is also important to make sure you are getting enough Vitamin D, as Calcium absorption from the gut is dependent on it.
- Magnesium – it participates in over 300 enzyme reactions in the body, so whatever function you can think about, it is very likely to be depending on magnesium to some degree. It is especially important for maintaining healthy sleep patterns and mood stability, both of which are vitally important when you have a new baby. In addition to it’s own benefits, Magnesium also aids in absorption of Potassium and Calcium. In addition to your typical healthy food list, which includes nuts, seeds, beans and leafy vegetables, high amounts of magnesium are also found in dark chocolate. So a chocolate craving might be just your body’s way of telling you to get your magnesium level up.
- Zinc – this is one of the less known dietary minerals, but still an important one. Zinc deficiency can negatively affect your immune system, cause loss or alteration of taste and contribute to skin problems, such as acne. Zinc is found in most animal-derived foods, such as eggs, meat and dairy, in shellfish, whole grains, legumes and, again, dark chocolate. Most vegetables, however, are low in zinc, so those on a vegetarian or vegan diet may need to consider supplementing. And, since we have mentioned acne earlier, topical zinc ointment is a great pregnancy and lactation safe treatment for those.
- Selenium – this microelement has a variety of functions, ranging from prevention of cancer and dementia to boosting your immune system and balancing your thyroid. Several recent studies on Selenium supplementation during pregnancy and postpartum period demonstrated its ability to reduce the risk of postpartum thyroiditis and postpartum depression. Brazil nuts are by far the best source of selenium, but if they are not your thing, you can opt for fish, such as tuna, cod or herring, Shiitake mushrooms or eggs.
- Probiotics – recently, the tiny inhabitants of your gut, or your microbiome, have been getting a lot of attention from doctors. It appears, that the bacteria in your bowel are producing nutritional compounds playing key role in your metabolic health and balancing your immune system. And during the early childhood, you share your microbiome with your baby, helping them form a strong community of bacteria for life. In order, to make sure you only pass the good ones to them, increase your intake of probiotic rich foods such as kombucha, yoghurt, sauerkraut and kefir. It’s also important to feed the bacteria you already have by making sure you consume enough dietary fiber. If you are not a fan of yoghurt, or if you believe the state of your microbiome to be very poor (such as after antibiotic treatment), probiotic supplements may be a way to go. It’s difficult to recommend a specific strain of bacteria to look for in a general purpose supplement, so we think variety is best. As far as the dosing, start with at least 15 billion colony forming units (CFUs).
- Choline – a nutrient that is crucially important for your infant’s central nervous system development, cognitive development and neural tube closure. Depletion of mother’s liver choline stores after pregnancy has been demonstrated in animal studies. Moreover, high amounts of choline are found in breast milk, making mom’s depletion of this key nutrient even more likely. And, if that was not enough, certain genetic variations can increase mother’s requirements in choline even farther. In order to replenish your choline stores and provide adequate levels in milk for your baby, make sure you are getting at least 550mg a day. Good sources of choline include pastured eggs, organ meats like liver, meat and dairy products, potatoes, beans, and soybeans. Additional bonus: it may help prevent or fight clogged ducts!
- Vitamin B12 – one of the main B vitamins that is used for DNA replication (which, as you might have guessed, occurs a lot during pregnancy). The most known symptoms of B12 deficiency include anemia and nerve disorders, but actual effects of this vitamin go much deeper. Low levels of B12 may contribute to fatigue, brain fog, depression, or thyroid dysfunction in the mother and poor brain growth, low weight gain and developmental delays in her baby. Since B12 is mostly found in animal derived foods, vegetarians and vegans are highest risk for deficiency and supplementation is recommended for them.
- Iodine – the mineral most know for it’s role in thyroid hormone production. The Iodine requirements significantly increase for pregnant and breastfeeding women, since it is preferentially transferred from the mother to the fetus and, afterwards, concentrated in the breast ducts of lactating women, to be secreted into breast milk. The recommended daily intake of Iodine for lactating women (290mg/day) is even higher than during pregnancy. Women living in certain geographical areas may be at especially high risk of Iodine deficiency. Depending on where you live and whether you use iodine fortified products (such as salt), Iodine supplementation may be needed to meet the minimum daily requirements.
- Vitamin E – a potent antioxidant and a miracle ingredient of most skin salves. Vitamin E can help with postpartum skin dryness, alleviate hair loss to a degree and possibly speed up scar healing. It is also excreted in breast milk and is beneficial to your baby’s immune system, blood cells, muscles and nerves. Vitamin E is mostly found in plant based foods, especially those that are rich in fats (since it’s a fat soluble vitamin) such as nuts, seeds, coconuts, avocado and mango.
Stay tuned for a list of great nursing-time snacks coming soon!