This fourth installment of our newsletter marks the completion of its first year since returning from a hiatus in 2019. We are so happy that you have joined us along the way. Our team of breastfeeding counselors always looks forward to creating new content that is valuable and relevant to families in the current landscape. As the United States, and the world, continue to navigate the COVID-19 pandemic, Breastfeeding USA remains available to support families throughout this trying time. Our warm line is open at (612) 293-6622. Additionally, we continue to support families locally and through social media.

In this edition of #MilkMemos, we cover nutrition as it relates to breastfeeding. We dive into nutrition specifics, the sometimes-mysterious world of galactogogues, the dynamic health effects of human milk, and several other topics. We know that breastfeeding contributes positively to physical, social, and emotional wellbeing. On the physiological side of things, breastfeeding at its core is nutrition. Sometimes called the "First Food," human milk sets the stage for lifelong health. Producing milk also improves metabolic outcomes for lactating parents. 

Unfortunately, there are many myths surrounding breastfeeding and nutrition. Inaccurate information can impact the plans of parents, including the decision to breastfeed at all. Some of the most misunderstood nutritional facts about human milk involve diet during lactation and the nutritional significance of human milk in a growing child’s diet. It’s important that people connect the long term improvements in health outcomes for parents and babies, as a result of breastfeeding. This kind of knowledge empowers individuals and families to prepare for breastfeeding and make the best decisions for their health and the health of their family. Our hope is that the information in this issue enhances some things you may have already learned about breastfeeding and nutrition, and perhaps answers questions you have been pondering. 

Warm regards,

Erika Costanzo

Breastfeeding Counselor

By Dana Saccomano, Breastfeeding Counselor

Galactogogues are substances commonly thought to increase milk supply. These include foods, such as oatmeal and brewer’s yeast, herbs, teas, and prescription medications. Unfortunately, the evidence to support that natural galactogogues (tinctures, teas, herbs, etc) increase milk supply is inconclusive. Pharmaceutical galactogogues, while effective in the correct circumstances, can carry the risk of severe adverse effects. Overall, there is little evidence to support that the general use of galactogogues improves common goals for achieving breastfeeding success, such as increased duration of breast/chestfeeding and improved weight gain. 

If low milk supply is a true concern, supported by low infant weight gain and inadequate diaper output, then seeking help from a lactation professional, as well as baby's healthcare provider, to address the underlying reasons for this should take priority over self-prescribing herbs and teas. They could very well do nothing for one's milk supply, and would certainly be less effective than correcting the baby’s latch or increasing the frequency of milk removal.

When considering the use of galactogogues, it is important to consider the benefits in light of the risks. Eating more oatmeal is probably not risky, but ingesting herbs or medications may be less safe. It is always best to check with your healthcare providers before taking any herbs, supplements, or medications. With or without galactogogues, frequent and effective milk removal remains the most effective way to support a healthy milk supply.

By Amy Beney, Breastfeeding Counselor 

Childhood obesity has been a public health concern since the government started tracking statistics in the 1980’s. There are many factors that contribute to childhood obesity including genetics, environment, socio-economics, lack of physical activity, medications, and sleep. There are also many protective factors against childhood obesity, one of which is breastfeeding. 

Several studies have looked at breastfed babies and their risk of developing obesity later in childhood. The conclusions of these studies have been mixed. One meta analysis of studies analyzed the association between breastfeeding duration and obesity. A total of 51 estimates included in the meta analysis were categorized 3 months, 3–5 months, 5–7 months and 7 months. The length of breastfeeding was associated with a decreased risk of childhood obesity. Children breastfed for 7 months were significantly less likely to be obese, while those breastfed for 3 months showed a 10% decrease in the risk of childhood obesity.(1)  The risk of childhood obesity was 22% lower in children that were breastfed 7 months compared with those who were never breastfed.(1)  

Although this meta analysis shows that there are protective benefits for breastfed babies against childhood obesity, other factors that contribute to obesity should also be considered. The exclusivity of breastfeeding directly from the breast, the exclusivity of pumping, or a mixture of both forms of providing human milk were not taken into consideration in the studies. More studies are needed to further understand the benefits of being breastfed to children as they grow. A myriad of benefits for breastfeeding mothers and babies have been well established and reach much farther in scope than protection against obesity alone.

Yan, Liu, Zhu, Huang, Wang. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health. 2014; 14: 1267.

By Erika Costanzo, Breastfeeding Counselor

Human milk is a dynamic, living substance. It is full of immune boosting antibodies and healthy bacteria, which are needed by infants and children in different amounts and formulations as they grow.  Human milk changes as the needs of the nursing child evolves. 

Human milk is composed of water, carbohydrates, fats, proteins, vitamins, minerals, antibodies, immune cells, stem cells, hormones, enzymes, growth factors, and hundreds of different beneficial bacteria. Scientists studying human milk are continuing to discover components we are not aware of yet. 

Early  milk, called colostrum, provides newborns with powerful immune protection and coats the digestive tract to guard against unwanted bacteria. Colostrum is thick and often golden in color, and helps babies pass meconium, those first sticky, tar-like stools. After a few days, the lactating parent's body begins to produce a transitional milk, which is thinner in texture, generally lighter in color, and higher in volume than the smaller amounts of colostrum that the baby needed right after birth. At about  two weeks postpartum, transitional milk continues to evolve into its final state, known as mature milk. This is the way we typically think of human milk, in its mature state. Human milk provides all of the nutrition that babies need for the first 6-12 months of life. As children transition to more solid foods and take in less milk, the volume produced decreases, but the concentration of immunological components increases, providing the concentrated protection that curious, exploring toddlers need. 

In addition to evolving as children grow older, human milk changes throughout the day, with higher serotonin levels in the evening when babies are preparing to sleep. Human milk also responds to the environment, producing immune factors that fight off bacteria the body detects, either from mom’s exposure or through the feedback mom’s body gets from baby’s saliva at the breast. During a growth spurt, when babies may feed more frequently, the volume and fat content of milk increases in order to help babies grow. There is also some interesting research focused on the differences in the milk the body produces for female and male babies.  

According to the Mayo Clinic, “there's no known age at which breast milk is considered to become nutritionally insignificant for a child” (Mayo Clinic, 2020).

For more information, here is a related article on our website: https://breastfeedingusa.org/content/article/breastfeeding-beyond-infancy

Reference: https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/extended-breastfeeding/art-20046962

By Erika Costanzo, Breastfeeding Counselor

In the United States we are fortunate to have several government and nonprofit programs that support the nutritional health of families in need. These assistance programs typically serve low income families, particularly those with children and older adults, with supplemental foods and nutrition education. The amount of food families receive is meant to increase their existing grocery amounts, not to provide everything needed. Though if families qualify for multiple programs, they may find they are able to meet most of their family’s food needs, especially with the use of education from these programs, to make their meals healthy and affordable. The United States Department of Agriculture (USDA) supports a number of nutrition programs, including the Supplemental Nutrition Assistance Program (SNAP), formerly called Food Stamps. This program may go by different names in different states. 

One of the great features of many public assistance programs is their collaboration with each other, which means that families get continuous care when these programs refer them to other services that they need. When it comes to public nutrition programs, there is one that also provides breastfeeding support: the USDA’s Supplemental Nutrition Program for Women, Infants, and Children, also known as WIC. This program serves income eligible families who are pregnant and postpartum  and have children from birth to age 5. The WIC Program is nationally funded, with some variations in the way each state administers benefits. Local WIC agencies are able to provide both nutrition and breastfeeding education/support. Many agencies employ Registered Dietitians (RDNs) and International Board Certified Lactation Consultants (IBCLCs) to serve their participants with expert knowledge. The WIC Program is also known for their award winning Breastfeeding Peer Counselor Program, which provides pregnant and new parents with the vital peer support that we at Breastfeeding USA know is so valuable for helping families thrive on their feeding journeys.

Co-Editors in Chief: Alaina Moon and Dana Saccomano

Editors: Dana Saccomano, Lauren Franzen, Alaina Moon

Writers: Erika Costanzo, Dana Saccomano, Amy Beney

Layout: Sara Strum