Dr. Sarah King, ND
The ability to grow and nurture our babies is truly a miraculous part of a woman’s body. Nature has ensured that if we give birth in the middle of nowhere, our breasts will provide baby with what it needs to survive. Studies have even shown that having an adequate milk supply for baby after birth is independent of the mother’s nutritional status and her body mass index (BMI)1. But how can we help baby to thrive rather than just survive? Are there differences in breast milk nutrient content among mothers? A new study recently looked at how maternal health, specifically obesity, can influence breast milk nutrients2.
Obesity in general is often associated with whole-body swelling. It’s one of the reasons why when we initially lose weight we lose “water weight”. The water is the result of a widespread inflammatory response in the body and secretion of inflammatory cytokines. Part of this is in response to diet quality where a higher dietary omega-6:omega-3 fatty acid (FA) ratio can result in an overall pro-inflammatory state. Many of our processed, packaged and fast-food choices in the Standard American Diet are full of omega-6 FAs. The importance of Omega-3 FA intake is that it suppresses these inflammatory cytokines such as interleukin-1b, tumor-necrosis factor (TNF) and interleukin-62. Increasing maternal Omega-3 FA intake has also been associated with a decreased obesity rate in her child by the age of three3.
This new study was designed to compare breastmilk from 42 women, using BMI and food diets (including supplements) to characterize the women into one of two subject groups: Lean and obese. Macro- and micronutrients were measured in each breastmilk sample as well as inflammatory cytokines and specific FA profiles.
Maternal inflammatory markers were shown to influence the pro-inflammatory components in her breastmilk, specifically the neuroprotective FA content2. This demonstrates how mom’s health both before and during pregnancy can influence certain nutritional aspects of her baby.
It’s important in nature for our offspring to survive. The calories required by babies for this are provided by more than 50% of the fat content in breastmilk1. These fats, specifically docosahexanoic acid (DHA), contribute to baby’s neurodevelopment including visual centres1. As expected, there were no significant differences found in the caloric content, fat, protein and lactose concentrations of the breastmilk between the two groups in this study2.
The differences they did find were in the content of fat-soluble vitamins and FA between the two groups. The breastmilk of lean control subjects showed significantly higher levels of Vitamin D, Vitamin A (a- and b-carotene) and the entire Omega-3 polyunsaturated fatty acid (PUFA) profile, including eicosapentaenoic acid (EPA), DHA, and alpha-lipoic acid (ALA)2. Breastmilk from subjects in the obese group contained significantly more trans-fatty acids (trans-7-hexadecenoic acid) and a relatively more pro-inflammatory composition2.
We already know many of the benefits of breastfeeding, but this new study illuminates that breastmilk quality can be improved for optimal neurodevelopment by focusing on mom’s health.
How does this affect mom?
If addressed early enough, optimizing maternal health may also decrease the need for interventions during labor, including Caesarean section procedures. In this study, 28% of the women classified as obese underwent a Caesarean section compared to 0% in the lean group2. In another study of 28 obese breastfeeding mothers in 2015, 68% of them had undergone a Caesarean section, some of which reported led to delayed breastfeeding4.
Breastfeeding might also influence maternal health later in life. In an observational study 16-20 years post birth, women who had breastfed for less than 6 months were found to have a higher BMI and fat mass % compared to those who breastfed longer, independent of pre-pregnancy weight, physical activity level and current caloric intake5.
The effects of being underweight on breastfeeding
On the opposite side of the spectrum, we know that being underweight isn’t the healthiest option either. Many underweight women can be categorized as “skinny fat”, where morphologically a woman may seem small or lean, but body composition tests may reveal that her body fat % (compared to muscle mass) is high enough to negatively impact her health. Studies of underweight lactating women showed decreased amounts of some nutrients in their breastmilk content, including carotenoids, responsible for visual development2.
Issues today in breastfeeding
There are new findings showing that regardless of the intention to breastfeed longer, obese women are less likely to continue breastfeeding 6-10 weeks post-birth4. The most common themes that arose with the women in this study included the impact of birthing complications, feeling uncomfortable with the lack of privacy in which to breastfeed and the underutilization of breastfeeding support4. Perception of low milk supply can also be a barrier for many women and a reason for cessation of exclusive breastfeeding.
Naturopathic approaches to care
From a “whole-body” naturopathic approach, how we treat our bodies is vital to our health and that of our offspring. What we put into our bodies not only counts as our daily fuel but gives us the building blocks for taking care of our bodies, for repairing damage and preventing future illness and inflammation. The mouth-pleasure associated with rich and wonderful treats (sweet, salty or savoury) is simply that: enjoyment for our senses and chemical signals to tell our brains we’re rewarded. We need to be reminded that life isn’t only about enjoying the pleasures of food and surviving until 60 or 70 years old, but giving our bodies what they need to thrive so we can be active and feel great at 70, 80 and 90 years old.
Supplementing with EPA and DHA during pregnancy and breastfeeding is a great way to help tip the balance to a more anti-inflammatory FA profile. Think of your body and womb as an incredible growing and nurturing vessel. The more we treat our bodies like the magical temples they are, the greater the foundations for health and wellness we can create and pass on to our next generation.
Through any health and wellness journey I suggest not going it alone (including breastfeeding and weight/health management). Seek support whether it be from a friend who has gone through this before, a healthcare provider, naturopathic doctor, midwife, doula, lactation consultant, support groups or any other positive resource that’s available.
Dr. Sarah King is a licensed Naturopathic Doctor, graduating from the Canadian College of Naturopathic Medicine in 2014. Prior to completing her medical studies, she attended Nipissing University where she received her Honors Bachelor of Science in Biology. Sarah has a passion for women’s health and is a birth doula in Durham and Toronto Region. She treats a wide variety of health conditions including menstrual disorders and hormone balancing, fertility, prenatal care, digestive concerns, skincare and mental health/anxiety. Outside the office Sarah is an avid runner with a love of the GTA’s best forest trails. She also continues to improve her yoga practice and teaches breath work as part of stress management counselling to her patients.
- Fraser, D. M., and Cooper, M.A. “Infant Feeding.” Myles Textbook for Midwives. 15th ed. Edinburgh: Churchill Livingstone, (2009), 785- Print.
- Panagos, P. G., Vishwanathan, R., Penfield-Cyr, A., Matthan, N.R., et al. “Breastmilk from Obese Mothers Has Pro-inflammatory Properties and Decreased Neuroprotective Factors.” J Perinatol Journal of Perinatology (2016): Epub doi: 10.1038/jp.2015.199
- Storck Lindholm, E., Strandvik, B., Altman, D., Moller, A. and Palme Kilander, C. “Different fatty acid pattern in breast milk of obese compared to normal-weight mothers” Prostaglandins, Leukotrienes and Essential Fatty Acids. (2013) 88: 211-217
- Keely, A., Lawton, J., Swanson, V., and Denison, FC. “Barriers to breast-feeding in obese women: A qualitative exploration.” Midwifery (2015); 31(5): 532-9.
- Wiklund, P., Leiting Xu, Lyytikäinen, A., Saltevo, J. et al. “Prolonged Breast-feeding Protects Mothers from Later-life Obesity and Related Cardio-metabolic Disorders.” Public Health Nutr. Public Health Nutrition 15.01 (2011): 67-74.