Thursday, March 11, 2010

Breastfeeding and Maternal Diet



Breastfeeding and mothers nutrition
When looking at the maternal diet whilst breastfeeding I came across little documented evidence that confirms what to and what not to eat whilst breast feeding to avoid any ‘colicky’ symptoms in the child. Surprising given all the ‘old wives tales’ about you can’t eat this or that whilst breast feeding.

So, for the sake of all those rumours and hours of chatting mothers saying the ‘not so evidence-based’ anecdotes, I decided to put it all on my blog so others cannot be soooo confused!

In the early research days in an article by Evans et al., found that a number of foods, particularly chocolate and fruit, did seem to cause an increase in colicky symptoms, but cow’s milk showed no significant change in symptoms.  R. W. Evans, R. A. Allardyce, D. M. Fergusson, Brent Taylor (1981). Maternal diet and infantile colic in breast fed infants. The Lancet  317 (8234): 1340-2
However, another earlier article had written that their evidence showed that it was worthwhile for breast feeding mothers to exclude cow’s milk in their diet to avoid colicky symptoms. But, looking at the ages ranges in the experiment, it was highly likely that the colicky symptoms disappeared as a matter of time anyway. Jakobsson I, Lindberg T. (1978). Cow's milk as a cause of infantile colic in breast-fed infants. The Lancet  312  (8087) 437-439
Two of the most in-depth studies in 1995 and 1996 however, did seem to show a little more promise in identifying the ‘cursed’ foods. The study by Hill et al., (1996) took out all the previously said allergens in a diet and gave mothers a diet that was artificial colour-free, preservative-free, and additive-free and also randomized some to an active low allergen diet (milk-, egg-, wheat-, nut-free). 
For those that would like to know, the diet only allowed:
Rice, buckwheat, apple, pear, water, watery tea, watery coffee, potato, pumpkin, zucchini, marrow, lettuce, carrot, cauliflower, squash, lamb, beef, chicken, veal, turkey, fish, milk-free margarine, safflower oil, honey, sugar, salt and pepper.
Hill et al concluded that “a period of dietary modification with low allergen diet should be considered to avoid colicky symptoms”. Hill D J et al. (1995). A low allergen diet is a significant intervention in infantile colic: Results of a community-based study. J Allergy and Clinical Immunology 96 (6) 886-892
Lust et al. In 1996 came up with the research that colic was significant with the consumption of: Cabbage, cauliflower, broccoli, cow’s milk, onion and chocolate. They said that the occurrence of colicky symptoms may depend less on how often these item are consumed than whether they were consumed at all. Lust K D et al. (1996). Maternal intake of cruciferous vegetables and other food and colic symptoms in exclusively breast-fed infants.  J Am Diet Assoc  96 (1): 46-48

As to the reason why these foodstuffs cause the colicky symptoms the jury is still out. Some have come to say that the cruciferous veggies have a certain chemical that could irritate the intestines and cause gas, and others suggest that cow’s milk intolerance is immunologically mediated. Whether this is just a transient protein intolerance that improves after 6 weeks of age, in regards to the cow’s milk protein, is also still to be argued.