Dear all:

Kristen asked about micronutrients and mentioned calories and someone else mentioned a case of vitamin B12 CAUSED by breastfeeding.

So, first, IN GENERAL, I would agree that the mother who is not breastfeeding is at much greater risk of developing anemia because she is more likely to have premature return of her menses.  She would be at higher risk of IRON-deficiency anemia.  

This does not mean that women who are breastfeeding cannot become depleted in minerals and this depends on her overall diet.  Unless women are severely depleted in iron, the baby usually can consume enough during the first six months of life as long as the baby full term.   Premature deliveraty and premature clamping of the cord both reduce the iron stores that babies should be born with and those babies may need an additional source of iron sooner than babies who are born full term and have received the full benefit of allowing iron to pass through with cord blood after delivery.

Most (but not all) strict vegans know that they need an additional source of vitamin B12.  If a mother is depleted in vitamin B12 while breastfeeding, it will put her baby at higher risk of vitamin B12 deficiency.  The problem is NOT the BREASTFEEDING, the problem is the underlying cause of the vitamin B 12 deficiency.  It seems somewhat strange that this would not appear in the infant while breastfeeding and show up much later.  Sounds more like a hereditary condition that is manifesting a little later, but I'm not an expert in medical conditions that can lead to B12 deficiency.

In terms of other micronutrients, we know very well that vitamin A and iodine deficiencies (the first increases the risk of childhood mortality by 30%, the second is the biggest cause of irreversible mental retardation when it occurs during fetal development and can still cause cognitive delays when it occurs after birth) can change the composition of the milk and thus influence the infant's status in these nutrients.  Because these are unrelated to blood loss, pregnant and lactating women would be at slightly higher risk of deficiency.

In terms of calories, every I hear about the NEED for 500 extra calories, I keep remembering all the unhealthily eating overweight women I see (as distinct from the overweight women who are working hard to regulate their diet and exercise).  You store fat during pregnancy.  Kathleen Rasmussen just gave a talk on the implications of overweight and obesity for the New York Lactation Consultation Association.  Of the top of my head I remember her saying that about 60% of women in New York State go into pregnancy overweight and something over 25% are obese.  There were cases in the data set of women who had BMIs over 50 going into pregnancy.  This puts these women at higher risk of surgical delivery and breastfeeding problems for a variety of reasons from the biochemical to the mechanical.  The fact that they may have more trouble breastfeeding then puts them at higher risk of postpartum weight retention.  The 500 extra calories are what are burned --- and those calories are all part of the mix of activity, metabolism, fat stores,  and food ingestion that equilibrate a mother's weight and health.  Just because those calories are burned, doesn't necessarily mean that they need replacing.

The fact that women burn off 500 calories extra a day while they are lactating, does not necessarily mean that they need to EAT 500 MORE calories a day than they would have.  I have had overweight women ask me if they really do need to eat the 3500 or 4000 calories a day someone told them they needed to eat per day to make milk. They have been relieved when I tell them that you actually put yourself on a diet that maintains your milk supply and also enables you to lose weight during lactation -- and in fact it is desirable for most women who gained a healthy amount of weight or an excessive amount of weight to lose that weight after delivery.

We have a crisis of overweight and obesity that has escalated dramatically in the last 10 years and includes our children.  Over two out of five children in New York City are overweight; one in five are obese.  New York City actually has lower rates of overweight than the state of New York because we walk so much.  I can't remember whether Dr. Rasmussen said the difference was 5 pounds or 10 pounds for adults.  We need to look seriously into ensuring we are not contributing to patterns of behavior that will increase this epidemic.  

Best, Susan Burger

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