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By Sunitha Raman 
abstract from "Keeping Abreast" BMSG Newsletter Oct/Dec 97


Few of us would have missed the aggressive advertising by ANMUM, selling milk drinks for pregnant & breastfeeding mothers. This was especially so during World Breastfeeding Week. While the public talks they held were promoted and attended widely, and the information on the practical aspects of breastfeeding was accurate; the underlined implication was that breastfeeding mothers should take ANMUM 2 to ensure that their breastmilk contained enough nutrients.

This is a powerful message that we, at the BMSG(S) must straighten out and clarify.

ANMUM informs us that breastfeeding mothers need an extra 500 calories a day. An impressive food pyramid that consists of 5 - 7 servings of vegetables & fruits, 4 servings of milk & milk products, 3 servings of animal/vegetable proteins etc. If mothers cannot eat this amount of food, she can top up by drinking 2 glasses of ANMUM a day. Yet how many breastfeeding mothers do we know who are willing and CAPABLE of eating this amount of food?

THe BREASTFEEDING ANSWER BOOK by La Leche League International (LLLI) state that "Although it has been believed that a breastfeeding mother needs to consume an extra 500 calories a day to produce milk, recent studies indicate this recommendation is too high." Dr Ruth Laurence MD in her highly acclaimed book, "Breastfeeding: A Guide for the Medical Profession" says, "Most writings for the nursing mother regarding matenal diet during lactation set up complicated "rules' about dietary intake that fails to consider the mother's dietary stores and normal dietary preferences. Thus one barrier to breastfeeding for some women is the "diet rules" they see as too hard to follow or too restrictive".

The committee on Recommended Dietary Allowances of the Food & Nutrition Board (Washington DC 1980) says that "the diet of a lactating mother should supply somewhat more of each nutrient than that recommended for the non-pregnant female". In other words, a lactating mother should (from Breastfeeding Answer Book, LLLI) "follow a basic approach to good nutrition by eating a well balanced diet of foods, in as close to their natural state as possible. As is true for the rest of the family, the breastfeeding mother should eat fresh fruits and vegetables, whole grain breads and cereals as well as calcium rich and protein rich foods".

During pregnancy, the body prepares for lactation by storing up additional nutrients and energy. Most women store 2 to 4 k of extra tissue in preparation for lactation. One study (Illingworth 1986) showed that the breastfeeding mother's metabolism may be more efficient while breastfeeding, so her need for extra energy from foods may be reduced. Lactating mothers will usually note an increase in appetite and thirst indicative of how much their body requires. A breastfeeding mother's energy requirement could be met not only with her daily food intake, but also from the sotres laid down in her body during pregnancy. Also a less active mother with more fat stores (from a well nourished pregnancy) will need far fewer caloris than an active mother with fewer fat stores.

On another aspect of this issue (from Breastfeeding Answer Book, LLLI) "recent studies have shown that breastfeeding babies require far fewer calories than previously thought". In one study (Butte 1984), it was found that breastfed babies at 4mths consumed 25% fewer calories than formula fed babies of the same age. The weight gains of both being about the same, this suggests that breastfed babies use the calories they receive from breastmilk more efficiently!

Another common misconception is that for a breastfeeding mother to produce more milk, she needs to drink milk. This is not so. Dinking more milk will not make the mother produce more milk. Milk is just one of the many sources for mothers to get their extra nutrients. Also, a mother who is eating a varied healthy & balanced diet does not require routine vitamin & mineral supplements. Nutrients, especially vitamins are excreted out of the body when taken in excess.

This brings us to the next issue - that of calcium supplementation during breastfeeding. Until recently, it was believed that nursing mothers should increase their calcium intake by 400 to 800 mg per day (as is also mentioned in the ANMUM ad). But according to a recent study published in the New England Journal of Medicine, researchers found that increasing the calcium intakein women had no effect on the calcium concentration of breastmilk, and didnot alter the pattern of change of bone mineral density associated with lactation and weaning. Breastfeeding mothers, whether they received calcium supplements or not, lost 4 to 5% of their bone density. After weaning their baby, the calcium returned to their bones. Calcium supplementation, or the lack of it had no overall effect on total bone mass of the mother's body, or the calcium concentration of breastmilk. This suugests that breastfeeding mothers DO NOT need to consume extra calcium.

Mothers who come from familes with a history of allergy to cow's milk or who themselves are allergic to cow's milk should be especially careful. The protein in cow's milk passes into the mother's breastmilk and if the baby is sensitive to this, it can cause fussiness in the nursing baby.

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