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Keto Diet + Breastfeeding = ?

Over the years I have had many mothers ask me if low carb diets are safe while breastfeeding and recently several mothers have asked me if the keto diet is compatible. Many people find that a low carb or keto diet helps them to lose weight rapidly without being hungry all the time or experiencing cravings, and of course after having a baby, many women are looking for some kind of diet plan. A few weeks ago the IABLE came out with a parent handout about the keto diet in relation to breastfeeding, as well as making it the subject of their weekly #LACTFACT question.

They discuss a risk of low carb and keto diets called ketoacidosis. This can occur when the body is burning fat and produces an excess of blood ketones which causes the blood to become too acidic. This rare but life threatening illness is more likely to occur during breastfeeding because of the extra calories the body requires to make milk. This condition is fairly common among dairy cows during early lactation because the energy required to make large quantities of milk is often much more than the cow is physically able to eat. Cows suffering from this condition have to be given large quantities of intravenous glucose and steroids to save their lives.

In addition to the low but real risk of ketoacidosis (Google: lactating women ketoacidosis), a woman who starts on a low carb or keto diet is often restricting her daily calorie intake very rapidly and this can result in a decrease in milk production. Experts who study “blue zones” – areas of the world where populations live longer and are generally very healthy – have found that the typical diets in these areas consist of legumes, grains and vegetables and generally relatively low amounts of dairy, meat, and fat. Long term, these “blue zone” diets are probably more sustainable and balanced than low carb dieting.

The authors of the keto diet and breastfeeding handout recommend that women considering a low carb or keto diet while breastfeeding use caution. They suggest consultation with a dietician or physician before strictly eliminating carbohydrates or dramatically reducing calories. A diet with increased protein and fewer carbohydrates may be helpful for lessening hunger and cravings while losing weight, but completely eliminating carbohydrates while breastfeeding is probably not wise, particularly during exclusive breastfeeding.

Parallel Pumping Technique for Breastfeeding

Many breastfeeding mothers need to or choose to express breastmilk at some point during their breastfeeding journey. Many use breastpumps, though some prefer hand expression or milk collection devices to collect leaked milk. Many women pump while they are away from their babies for work or school, while others pump to increase their milk supply. Some choose to pump their milk and donate it to babies whose mothers can’t produce enough. Some mothers with babies who are born somewhat early, often called late preterm babies, use a technique called triple feeding to make sure their babies take in enough breastmilk while they wait for them to mature enough to be able to breastfeed exclusively. The three steps of triple feeding are: 1. Feed the baby at the breast. 2. Simultaneously pump both breasts with a double electric breastpump. 3. Feed some of this expressed breastmilk to baby via bottle. This cycle is generally repeated every 3 hours. Triple feeding is a lot of work and many women find it cumbersome or overwhelming.

Parallel pumping is a technique described in an article called Maternal Satisfaction With Parallel Pumping Technique by Kathleen McCue and Michelle Stulberger in a recent issue of Clinical Lactation. This technique aims to make triple feeding more manageable by combining two of the steps. The technique involves using a breastpump to pump one breast while simultaneously breastfeeding baby on the other. They recommend using a pumping bra to hold the pump in place, then latching baby to the other breast. Because the women in their study were pumping to maintain or increase milk supply for late preterm babies, they recommended using a hospital grade multi user breastpump. For mothers who want to use this technique for donating or for having some extra milk in the freezer, the regular double electric pump issued by insurance may be adequate.

Mothers who are triple feeding may want to use the parallel pumping technique every feeding. Others may only want to do this a few times a day, or only when they happen to need some extra milk. A blog post at The Leaky Boob.com explains the technique and has a few pictures.

According to the article Clinical Lactation, many mothers found this technique easier to manage and more efficient than triple feeding. In theory it may also increase milk production since women may experience a stronger let down reflex for the pump while they are also breastfeeding than they do when pumping alone. I hope that this technique will become more widely known and accepted as an alternative to triple feeding, and also for mothers who are pumping for other reasons.

Julia’s Way – A Resource for Breastfeeding and Down Syndrome

At our most recent Linn Benton Lincoln Breastfeeding Coalition meeting one of our members brought information to share about Julia’s Way. Julia’s Way is a non-profit organization dedicated to inspiring parents, medical professionals, and the general public to reimagine what’s possible for those living with Down syndrome through education, advocacy, and awareness. Their website has many resources for parents of children with Down syndrome and a particular focus is on breastfeeding. They have a helpful educational brochure available in 9 languages which is available here.

They also have a whole page of breastfeeding resources for families here.

At our meeting we watched their video called Nursing Down Syndrome.

This video is very inspirational and a wonderful resource for families who have or are expecting a baby with Down syndrome, as well as for all of the professionals who work with these families.

Julia’s Way is in the process of writing a book called Breastfeeding and Down Syndrome: A Comprehensive Guide for Mothers and Medical Professionals. It will be available as a free download on their website when it is released later in 2019.

Please browse the Julia’s Way website to learn more about this inspirational organization!

Rocio Badger – Breastfeeding Advocate of the Year

On January 3rd from 3-5pm at Good Samaritan Regional Medical Center, the Linn Benton Lincoln County Breastfeeding Coalition honored Rocio Badger, Maternity Care Coordinator with Samaritan Health Services with the coalition’s third annual “Breastfeeding Advocate of the Year” award.

Rocio Badger is very deserving of the breastfeeding advocate of the year recognition award. She connects all of her Spanish speaking clients with WIC and other local resources prenatally so they can make contact with the programs they need and get support and education about breastfeeding. She calls WIC when babies are born to translate and report the births of the new babies and to get moms connected with support. She helps the families she works with fill out paperwork for OHP and Social Security. Rocio is extremely dedicated to the families she serves and she is a true asset to our Hispanic community in Linn County.

Insurance Coverage for Breastfeeding Moms

Picture1Your health insurance plan must cover the cost of a breast pump. It may be either a rental unit or a new one you can keep depending on your insurance. Your plan may have guidelines on whether the covered pump is manual or electric, the length of the rental, and when you’ll receive it (before or after birth).
Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.
Contact your insurance plan with any questions about breastfeeding benefits for your individual plan.

Steps to take to get a breast pump from your insurance

  • Talk to your doctor while you are pregnant about wanting to get a pump after baby is born.
  • Insurance plans require a prescription from your doctor.
  • Your doctor will need to fax a prescription to a medical supply company.
  • The supply company will call when the pump is ready to be picked up.

Samaritan medical supply :

Corvallis  – 777 NW 9th St., Suite 200 Corvallis, OR 973330 Phone: 541-768-7500 Fax 1-866-539-0313

Lebanon – 325 Industrial Way Lebanon, OR 97355 Phone: 541-451-6364 Fax 541-451-6366

Call WIC at 541-967-3888 if you do not have insurance or need to borrow a breast pump until your insurance provided pump is available.

How to Apply for Lactation Consultant Licensure in Oregon

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Ready to take the step and get licensed?
2017 House Bill 2503 created a program and license for lactation consultants. The program was placed under the authority of the Health Licensing Office. Administrative rules for lactation consultant licensing, license renewal and continuing education were developed with a rules advisory committee.
Licenses will be issued beginning Jan. 2, 2018. Rules take effect on Dec. 1, 2017; and applicants can submit their applications beginning on Dec. 1.”
As of December 1, 2017, IBCLCs in Oregon can apply for state licensure as lactation consultants. These are the steps to follow to become licensed:
2. Fill in the form and attach payment and 2 forms of ID.
3. Mail or fax to:
Oregon Health Authority
Health Licensing Office – Lactation Consultant Program
1430 Tandem Ave. NE, Suite 180
Salem, OR 97301-2192
Fax: 503-370-9004
4. Request IBCLC Certification Verification Authorization by downloading this form: https://iblce.org/wp-content/uploads/2017/11/ibclc-certification-verification-form.pdf
5. Fill in your name and IBCLC ID number. The recipient to put in the middle of the form is:
Name: Sarah Bye
Title: Licensing Qualifications Specialist
Organization: Oregon Health Authority – Health Licensing Office
Email Address: sarah.e.bye@state.or.us
Then sign and date the form and fax it to the number on the bottom of the form: 703-560-7332
Licenses will be issued beginning January 2, 2018.
Good luck everyone!

Can Breastfeeding Prevent Type II Diabetes Mellitus?

I recently listened to an Academy of Breastfeeding Medicine podcast where Anne Eglash, MD and Karen Bodnar, MD discuss a fascinating study looking at the connection between lactation intensity and duration, and the likelihood that a woman who has experienced Gestational Diabetes Mellitus (GDM) will go on to develop Type 2 Diabetes Mellitus (DM). You can find the podcast here: https://themilkmob.org/podcasts/gut-inflammation-unpasteurized-breastmilk-risk-type-2-diabetes/
Their discussion of this topic begins at 18:20 of the podcast. You can find the study they are referring to here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193135/

The authors in the study report information already demonstrated by previous research including that 5-9% of pregnant women in the US develop GDM, and these women have a 7 times higher risk of developing DM than women who did not have GDM. Lactation improves glucose and lipid metabolism as well as insulin sensitivity. These have favorable metabolic effects that persist after weaning.

The authors wanted to confirm this connection that has often been assumed by looking to see if women who breastfed more exclusively and for longer would be less likely to develop DM within the 2 years after giving birth. They enrolled over 1000 pregnant women with GDM from 2008-2011. All the women were receiving care at a Kaiser Permanente clinic and hospital. After delivery they asked the women to keep track of how much they were breastfeeding, and if giving formula, how many ounces daily. They also did glucose tolerance testing on the mothers to look for DM.

They found that women who breastfed for at least 6-9 weeks had at 36-57% risk reduction for developing DM in the first 2 years after delivery when compared with women who did not breastfeed for that long. This result was independent of obesity and gestational glucose tolerance.

The authors hypothesize that the reduced risk of DM for mothers with GDM who breastfeed may be because of pancreatic β cells. These cells in the pancreas can compensate for insulin resistance. The hormone prolactin increases the mass and function of these cells during pregnancy, and there is some evidence from studies with mice that these effects continue into lactation. So prolactin may be causing an increase in the number, function and activity of pancreatic cells, helping the body to be able to produce more insulin.

Towards the end of the podcast, Drs Eglash and Bodnar discuss how more and more research is coming out demonstrating the crucial role insulin plays in lactation. They also talk about their experience with differences between women with Type I DM and Type II DM and lactation. The say that women with Type I DM tend to produce plenty of breastmilk, and this is probably because the insulin in their blood is not bound to proteins the way it is in women with Type II. They finish up by saying we have a lot more to learn about insulin and its role in lactation, and that they are very excited to learn about how prolactin affects the pancreas.

I found the podcast and the study fascinating because we all work with so many women with GDM. At WIC we are often working with pregnant mothers as they are finding out that they have GDM, and as they are making the decision of whether or not to breastfeed. Most mothers cite health reasons for the baby when saying they choose to breastfeed. Many research studies are beginning to show that mothers too benefit greatly from breastfeeding, with reduced risk of breast cancer, ovarian cancer, and osteoporosis. We are now seeing that breastfeeding reduces the risk of metabolic syndrome and also DM. This study showed reduced risk when mothers breastfed to 6-9 weeks, and they were only followed for two years. It would be exciting to see a study where mothers breastfed even longer, and were followed for 10+ years. Would a longer duration of breastfeeding have a longer term protective effect? I suspect so.

We can encourage mothers that while breastfeeding is the optimal food for their babies and the connection and bonding during breastfeeding are a wonderful part of the mother-baby relationship, breastfeeding has many health benefits for mothers as well. Benefits that will likely affect their health in a positive way decades into the future!