Ensuring Plentiful Breastmilk Supply Starts Before Baby is Born

by Dr. Kelly Brogan MD August 22, 2013

breastfeeding

By Dr. Kelly Brogan MD

There are few things more demoralizing than failing to feed your newborn despite your best efforts to breastfeed.

In my practice and among friends, I have found myself asking repeatedly, “What is going on here? What’s with the supply drama?”

Statistically, a full 50% of women are not able to meet their breastfeeding goals. There are many reasons for this, some of which include:

  • Aggressive promotion of formula-feeding in hospitals including supplementation in NICUs.
  • Limited lactation support and resources including insufficient family encouragement and shared community wisdom.
  • Workplace impediments to pumping, and unfinanced maternity leaves.
  • Pediatricians who overvalue growth charts and encourage supplementation.
  • Alcohol, nicotine.
  • Infrequent feeding.
  • Use of pacifiers.
  • Depression and anxiety.
  • Medications.

I’ve long been interested in what may be promoting insufficient supply on a physiologic level. I’ve come up with two interesting considerations – one environmental and one dietary:

Environmental pollutants — xenoestrogens

It is a meaningful concern that the modern woman’s breastmilk is a conduit for toxic substances. A recent study explored the relative significance of gestational versus lactational exposure to persistent organic pollutants and found that pregnancy was a more significant window of exposure, more directly correlated with adverse developmental outcomes.

Nonetheless, endocrine disruptors contribute to cumulative changes in thyroid function and estrogen load so that a woman’s hormonal milieu is skewed and her feedback loop between the brain (hypothalamus and pituitatry) and her glands may not be optimal. We know that synthetic estrogens in birth control can interfere with nursing, so it is hardly a leap to assume that environmental chemicals may be doing the same. These are most frequently found in plastics, pesticides, and cosmetics.

Insulin resistance and low milk supply

A fascinating study recently identified a potential biomarker gene expressed in the setting of insulin resistance and low milk supply. The significance of their hypothesis resonates with me because of how many women, of all body shapes and sizes, I see with early stage indication of insulin resistance that far precedes a diagnosis of diabetes and can also manifest as reactive hypoglycemia. Indicators of this state are high HemoglobinA1C, high or low fasting glucose and insulin, high triglycerides.

Clinically, these are the women who crave carbs and sweets, wake up without an appetite, or who can’t go more than two hours without eating (without risking relationships). Additionally, the study elucidates the complexity of breastmilk and inferiority of a one-size fits all, best-guess-at-nutrients formula. The researchers describe the 3 stages of breastfeeding as follows: “immune defense is the hallmark of the colostral stage, massive development of the protein synthesis infrastructure…the transitional stage, and massive synthesis of lipids…the mature stage”.

What to do BEFORE Baby is Born

Based on these theories, here are some things that women can do, preventatively, to help ensure a plentiful supply of breastmilk after baby is born:

  • Take chlorella:  based on a Japanese study where women who supplemented in pregnancy had lower levels of dioxins in their breastmilk and higher levels of IgA, and important indicator of immune performance. Other natural detox options are turmeric, cilantro, and garlic.
  • Avoid BPA, chlorine, pesticides, and parabens in some of the ways I detail here.
  • Adopt a low glycemic diet high in natural fats and proteins. The most important culprits are processed and artificial sugars and refined flour-containing foods (check labels…it’s everywhere).

As a staunch advocate for the impossible-to-replicate complexity of breastmilk, as well as the anti-inflammatory benefits to the mother, I look forward to sharing additional studies that further elucidate environmental drivers of this incredibly trying postpartum complication.

I also look forward to when some mechanical genius dramatically improves the operation of the annoying electric breastmilk pump!  

About The Author

Kelly Brogan MD

As an undergraduate at M.I.T., Dr. Kelly Brogan studied Cognitive Neuroscience and worked with Harvard undergraduates to create a public forum for the discussion of alternative medicine, directing conferences for the Hippocratic Society.

She attended Cornell Medical School where she was awarded the Rudin Scholarship for Psychiatric Oncology and began her work in Reproductive Psychiatry, which she went on to train in during her residency at NYU/Bellevue.

A strong interest in the interface of medicine and psychiatry led her to pursue a fellowship in Consultation Liaison/Psychosomatic Medicine at NYU/Bellevue/VA Hospital.  Since that time, she remains on faculty and has focused her efforts on her private practice where she cares for women across the life cycle including pregnancy and postpartum.

A passion for holistic living, environmental medicine, and nutrition are the bedrock of her functional medicine practice. She has published in the field of Psycho-Oncology, Women’s Health, Perinatal Mental Health, Alternative Medicine, and Infectious Disease.

She is Board Certified in Psychiatry, Psychosomatic Medicine, as well as Board Certified in Integrative and Holistic Medicine. You can learn more about her at www.kellybroganmd.com, and connect with her on FacebookTwitterand through her informative monthly newsletter

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Comments (28)

  1. Hi Dr. Brogan, I am blessed that I don’t have a supply problem. I have a 2 year old who is still nursing and getting about 75%-90% of her nutrition from me. I do know she has a milk allergy. She is vibrant, healthy, and energetic. Do you feel she is getting enough nutrition from me? The other foods she eats will be hard boiled eggs, nitrate free bacon, fruits and vegetables, and spoonfuls (yuck!) of homemade mayo. I have been really enjoying reading your posts!

    Reply
  2. Thank you so much for this information.My dil is breastfeeding her second child who is currently 8 months old. He has tried twice to stop breastfeeding. Her firstborn did the same thing, and she eventually dried up when he was 10 months old. She does not have most of those reasons you list at the beginning as she is a stay-at-home mom, home birth, no pediatrician, no drugs (legal or illegal:-), and supportive family. She is a very willing Momma, always available when the baby wants to eat. She does have allergies to the protein in milk and to berries, I think due to the formula they fed her when she was born as a premie triplet. She weighs about 100 pounds, very petite, and does not gain an excessive amount when pregnant. She is the first lactating mom I ever knew who had to make sure she ate before she fed the baby, and frequently says she has no more milk until several hours have passed. I always had an abundance of milk, so it has been hard to advise her at times!

    Reply
    • Hi Pat

      The best piece of advice I was given just before my baby (now toddler) was born was to eat loads of protein. I would eat twice as much as my husband for dinner and had substantial sized portions for breakfast and lunch. Your DIL may have an issue with eating lots if she is quite small (though I was a UK 8 and had no problems). I did find that the more protein I consumed the more milk the baby would take and then I’d be really hungry and could easily take on more food. I really can’t believe how much I used to it! All good quality food though, that’s obviously important too! :)

      Another important thing to keep an eye on is the other end – to make sure that as the baby starts solids and slowly starts to wean that she also reduces the amount of food (I didn’t until I realised I was gaining weight!). At the time of breastfeeding I didn’t consume any sugar and very little carbs, so I really do believe that protein is important for supply. Maybe Kelly knows what part of the protein makes it so successful…

      Best of luck for your DIL and for you as a grandparent! X

      Reply
  3. Hello!
    Sarah, it certainly sounds like she is getting what she needs. Keeping her dairy free other than breastmilk sounds like it is in her best interest.
    Pat – often, the carb content in the diet can help contribute to greater supply. I like carbs from resistant starches like potatoes, sweet potatoes, yucca, plantains, etc. Would also consider some known herbs and chlorella.

    Warmly,
    KB

    Reply
    • I agree! With my first I went back to work at 5 months and pumped till he was almost 1. I wound up breastfeeding for a total of 3 years. With my second I stayed home 10.5 months and pumped another 3 at work (might have gone longer but my pump gave up the ghost). I just weaned him earlier this year at almost 3.5. I think stress plays a huge part as I noticed when I was stressed pumping would be much more difficult. Not with the baby, though: he relaxed me right up!

      Reply
  4. mobimotherhood.org is also an invaluable website for support. There are many mothers doling out advice who aren’t on board with nutrition, but I have been pleasantly surprised by how many were actually turned to better nutrition (including myself!) because modern medicine is still so far in the dark about breastfeeding, there is no where else to find answers that will support lactation besides nutrition.

    Reply
  5. I am currently breast feeding a 9 month old and I am 9 weeks pregnant. It has been a struggle keeping my supply since I became pregnant. She nurses a lot! She likes the food I prepare and eats twice a day, sometimes three times if she wants to, only grassfed meats and free range chicken, roasted vegetables with coconut oil, and veggies that came out of my bone broth recipes ( simmered for over 24 hours) with the bone broths. She doesn’t tolerate eggs well yet.
    Any tips on boosting my supply that are safe? Thanks!

    Reply
  6. Anemia plays a part in low supply. Eat your liver or take liver tablets. Also take FCLO. Vitamin A defienciency plays a role in iron absorption. Drink enough water and think about adding trace mineral drops to it. Organic alfalfa pills are alsi helpful. These things helped me when my supply has gotten low. So far, I’m nursing baby #4.

    Reply
  7. I always thought that chlorella was actually not a great idea during pregnancy and breastfeeding because it is such a great detoxer for heavy metals etc and that all that stuff could then impact negatively on the baby on its way out of your system. Maybe I just got that wrong but my understanding was that you do that kind of heavy detoxing before conception, if possible. Can you clarify how that all works? Maybe it’s ok during pregnancy but not as much during breastfeeding? Or maybe it’s more of a dosing thing? I’m confused. Thanks!

    Reply
    • Absolutely a terrible idea to take chlorella while pregnant. It can and does detox heavy metals, and with nothing to bind it and remove it safely, (like calcium Bentonite clay does), you are mobilizing it in your bloodstream. Back to the research on this article.

      Reply
    • Tc, I was concerned as well about the adverse effect of detoxifying programs during pregnancy. Prior to my first pregnancy, I spent 6 months cleaning up my diet and using natural detoxifying methods. But once pregnant (and later when nursing), I strictly avoided anything that detoxifies.

      Otherwise, I find the rest of this post spot-on.

      Reply
  8. Thank you for that interesting article. I know this is a tangent, but what you wrote about insulin resistance got me to wondering if there’s a connection between insulin resistance and morning sickness during pregnancy. I have struggled with reactive hypoglycemia, and I was extremely nauseous during both my pregnancies.

    Reply
  9. “I also look forward to when some mechanical genius dramatically improves the operation of the annoying electric breastmilk pump!” Dr Brogan, I think this website — http://www.baileymed.com/ — sells less annoying electric pumps; a mother would be able to scan through a variety of products that might make it less of a headache for her to feed her child.

    Reply
  10. Hi all! Tc – This is a good question, and generally, yes, a “detox” is recommended 6 months prior to conception. With food-based enhancers of redox pathways, ie detox (curcumin, garlic, cilantro, chlorella), I have less concern about mobilization than I do with chelation, oral or IV. We don’t know the answer, but if binding up pesticides and toxins is happening, or excretion is enhanced, that seems preferable to dumping it into the fetus and breastmilk as we know to be happening.

    Warmly,
    KB

    Reply
    • I stumbled across traditional lifestyle while pregnant, and now my son is 3 months old. I am planning on having another (not for another year and a half at least) and will continue to breastfeed my son until he is no longer interested, likely into my next pregnancy. Will I have to wait until my *next* child is done breastfeeding to detox? I wish I had learned about this lifestyle before having children…ugh.

      Reply
  11. Kelly,

    I have heard mixed things about chlorella. As far as metals i heard it redistributes metals but they are not always pushed out of the body which can be dangerous. What do you think?

    Also do you have any suggestions for the insulin type you describe? That is me to a T. A life long battle with chocolate, lemonade, iced tea, etc. homeopathy has not helped. Gaps diet destroyed my metabolism. Eating raw milk and grains really helped me to feel hotter and normal however made me gain 30 lbs

    Reply
  12. I loved kellymom.com. What a great website. The other resource that I wouldn’t have been able to continue nursing after the first week or so without was The Nursing Mother’s Companion. That book told me how to get a latch better than hospital lactation consultant, doula, and grandmas. Still nursing at 12 months!

    Reply
  13. Thyroid issue and/or too much estrogen can also contribute to low milk supply. With my first son, my milk supply dropped around 3 months (AND I didn’t figure it out until around 5-6 months), and I never was able to bring it up again. With my 2nd son, I worked hard to balance my thyroid (definitely still in the learning stages on this one!), daily use natural progesterone cream to offset my estrogen in balance, and took Dr Christopher’s “Mother’s milk” supplement (the only herbal remedy that has really helped me). Even with these measures, I found I had to nurse every 2 hours around the clock to give him enough milk, but I did not have to supplement, and he is still nursing at 19 months. I will say though, that experiencing these milk supply issues–even with the help of a professional lactation consultant–has greatly humbled me, and I realize that there are not always hard and fast or “easy” answers.

    Reply
  14. Hello again – Here is another mechanistic study for those assessing the risk/benefits of chlorella. There isn’t much known about the way that it acts in the body. It is a source of multiple minerals, amino acids (notably cysteine), and vitamins. It may just help the body excrete more effectively by supporting cellular processes without a direct chelation effect like DMSA. http://www.ncbi.nlm.nih.gov/pubmed/22008543
    and
    http://www.ncbi.nlm.nih.gov/pubmed/20013055

    Be well,
    KB

    Reply
  15. I totally relate to the milk production problems as a result of insulin problems. I found a way to have a good suppy after having 2 scronny babies that constantly nursed….

    It is more common these days, so EVERYONE won’t consider me crazy, but one thing that helped boost my tremendously for my 3rd and 4th kids was placenta encapsulation. I don’t know the why, but I know it worked!

    Reply
  16. I think the fact that 50% of women can’t breastfeed is important information. Many women feel a great deal of guilty about their inability to breastfeed. It’s also important to work with your doctor to understand the underlying causes of low breast milk such as hormonal imbalances. Diet changes and supplements alone are not enough for most women. Kellymom looks like a great resource. Great post. Thanks.
    Chloe\’s last post: How to Buy Breast Actives: A Buyers Guide

    Reply
  17. Pingback: Guts, Bugs and Babies | Share Scents

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