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Nutritional Needs in the Postpartum ~ Do I Need to Supplement?

Updated: Jun 15


To support and nourish both your baby and your own body during the weeks and months postpartum, there are some fundamentals to be aware of. Energy requirements need to be maintained at approximately 1,500 to 1,800 calories per day if you are exclusively breastfeeding your baby. Some parents notice that when they eat more calories, their milk production increases too. Three satisfying meals per day and a small snack after each day-time feed may be a reasonable suggestion to ensure your body is receiving enough without the need to count calories.


Depending on your baseline nutritional status, supplementation may be recommended.

Things to consider are:

  • Iron levels in the third trimester

  • Amount of red meat and animal protein in your diet

  • Iodine sources in your standard diet

  • Are you vegetarian or vegan?

  • Vitamin D levels throughout your pregnancy

  • Intake of essential fatty acids

  • Gut and absorption issues such as irritable bowel syndrome or Crohn’s disease

  • Presence of chronic stress

Supplementation

A well-balanced diet is critical for human development. You will want to ensure that you include dietary sources of the following key nutrients or supplement to ensure that both you and your baby remain nourished for optimal repair, growth, and development. Chronic stress is also important to consider as it can impede the absorption and assimilation of nutrients. Therefore it is important to assess whether heightened stress levels is a lived experience during your postpartum and to a supplement accordingly.


Following is a simple guide to help you assess whether diet is enough or supplementation might be needed:


Vitamin D

Reduced levels of vitamin D can cause rickets in severe cases as well as autoimmune disorders such as lupus and multiple sclerosis, type 1 and 2 diabetes, certain types of cancers and cardiovascular problems.


Factors that predispose to deficiency are following:

  • Use of sunscreen

  • Limited time outdoors in natural sunlight

  • Winter months

  • Darker skinned individuals

If you have deficient levels of vitamin D (see below) and are exclusively breastfeeding your baby, you will need to supplement to ensure you both are getting enough. Paediatric vitamin D drops can cause stool colour changes and in one baby I know seemed to cause the presence of mucous in the stools, indicating an immune response. Interestingly a study conducted in Sweden of 206 babies supplemented with daily vitamin D during the first year revealed an associated increase in allergies independent of family history (Back et al., 2009 as cited in Mohrbacher, 2020. P.296). So keep an eye on how your baby responds to direct supplementation.


Consider the following when deciding whether to supplement:

  • What were your levels toward the end of pregnancy?

  • Are you dark skinned?

  • What season are you in?

In Australia a vitamin D level above 75nmol/L is desirable. Most pregnant women I have worked with have had levels between 15 and 30nmol/L, usually assessed in the second trimester. A level of 30nmol/L or below is classified as moderate to severe deficiency, a level of 50nmol/L or below is classified as mild to moderate deficiency and levels of 75nmol/L or above are considered normal to optimal.


Toxicity of vitamin D is very rare. Consider a daily dose of between 2,000 and 5,000 IU or weekly doses between 14,000 and 50,000 IU. Be guided by your own specific biochemical, lifestyle and dietary needs. Multivitamin supplements usually only contain a standard 400IU dose which is not enough to address sub-optimal levels.


Iodine

Iodine is a critical nutrient for thyroid functioning as well as milk production. Iodine needs nearly double during the lactation period so you will want to ensure that you are getting enough in your diet or that you are supplementing. Iodine deficiency is on the rise in Australia and other countries. According to the World Health Organization (WHO) iodine deficiency leading to hypothyroidism is the leading cause of preventable brain damage worldwide. Amongst the most vulnerable are pregnant and lactating mothers and their babies.


Healthy sources of iodine:

  • Kelp is an excellent source of iodine. It is a seaweed readily found as a supplement or as flakes that can be sprinkled on food

  • Fish and seafood (Refer to EWG’s consumer guide to seafood to minimise intake of heavy metals such as mercury: https://www.ewg.org/consumer-guides/ewgs-consumer-guide-seafood)

  • Pregnancy multi-vitamin may or may not contain iodine

  • Iodized table salt *Please note that sea salt does not contain adequate levels of iodine

  • Eggs and dairy products

  • Other iodine fortified foods such as bread and baked goods

  • *Please note that organic flour and organic baked goods are not fortified with iodine


Protein

Intake of between 65g to 100g per day is required during lactation. Some studies have shown both a shorter duration and reduced milk production in women who had poor protein rich foods in their diet. Therefore, mothers who have vegetarian or vegan diets will need to pay close attention to ensure adequate non-animal sources of protein intake.


Calcium

Calcium is the most abundant mineral in the body and makes up 1.5-2% of total body weight, most of it is found in bones and teeth. Calcium adds hardness to bone, and it is required for muscles to function well. Breastfeeding women should obtain 1300mg of calcium from the diet throughout pregnancy and breastfeeding. If this is not possible, supplementation may be needed. If you eat dairy products and a nutrient-dense whole foods diet, supplementation can be avoided.


Taking too much supplemental calcium can have adverse effects too, therefore it is important to pay attention to your diet first, and only if required, add in a good quality supplementation that contains some calcium, vitamin D, and vitamin K2. Please note that iron and calcium compete for absorption and need to be taken at different times of the day.


Food that are high in calcium include (in order or most to least):


  • Gruyere cheese, mozzarella, cheddar, cottage cheese

  • Turnip greens, silver beet (chard), rhubarb, spinach, broccoli, mustard greens, kale, dandelion greens,

  • lambs’ quarters (wild greens)

  • Milk, yoghurt, rice-milk, soya milk, tofu, tempeh

  • Blackstrap molasses

  • Sardines (with bones), halibut, canned salmon (with bones)

  • Baked beans, sesame seeds, tahini, chickpeas, almonds (soaked), amaranth, buckwheat, oatmeal

Recommendations

  • Consume a diet rich in nutrient-dense whole and real food

  • Dairy products should be organic if possible

  • If vegetarian or vegan consume a diet rich in the above foods and ensure all nuts, seeds, and legumes are soaked and or sprouted prior to eating. You may also like to add the following:

  • Take 1 tablespoon of blackstrap molasses daily as it contains a good amount of calcium along with many other minerals

  • Eating a portion of fermented vegetables like sauerkraut daily will provide vitamin K2 needed for calcium absorption

  • Other foods high in vitamin K are turnip greens, broccoli, green tea, lettuce, asparagus, oats, cheeses, peaches, peas, milk, and green beans (many of these contain good levels of calcium too)

  • Ensure adequate vitamin D levels from sunlight or from supplementation if needed.


Zinc

The importance of optimal zinc levels in the diet cannot be under-estimated. It is involved in over two-hundred important processes in the body. During breastfeeding, zinc is required for the maintenance of the milk glands, and it assists with the process of involution of breast tissue during weaning. Studies show that mothers who are deficient in zinc are more likely to experience a lower production of milk.


The optimal daily intake for zinc is between 30-50mg per day. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists does not mention zinc in their pregnancy supplementation guidelines. Considering most people are consuming approximately only 10mg of zinc daily, it is a wonder we are not offering more education about this important trace-mineral. Although prenatal vitamin and mineral supplements contain zinc, they also contain other nutrients such as copper, calcium, and iron that can interfere with zincs’ absorption.


Great sources of zinc include (from highest to lowest):

  • Oysters, beef, wheat germ, turkey (dark meat), cheddar cheese, silver beet (chard), lima beans (soaked), Rolled oats, mustard greens, pumpkin seeds, tuna, kidney beans (soaked), ginger root, wild rice, peas, leeks, lentils, cashews, sunflower seeds, pecans, tahini, peanuts, whole wheat bread, human milk (varies depending on dietary intake), colostrum

Recommendations

  • Eat a nutrient-dense diet that includes meats, fish, seafood, legumes, grains, cheeses, nuts, and seeds (Pumpkin seeds are very high in zinc)

  • Soak legumes and nuts overnight before cooking and/or eating

  • If vegetarian, increase your intake of fermented vegetables, tempeh, soaked legumes, brown rice, nuts, and seeds

  • At times of immune system weakness such as mild colds, herpes outbreaks, skin conditions, supplement with 15mg of zinc daily

  • Zinc glycinate is believed to be the best absorbed form of zinc

  • Absorption of supplemental zinc is not great and may be increased by drinking a small amount of kefir or probiotic drink to aid absorption (apple cider vinegar would work too)

Vitamin B12

Vitamin B12 is a very important nutrient for nervous system development and milk supply is shown to be affected if levels are low. It is involved in many functions in the body including the synthesis of the myelin sheaths on nerve fibres that enable the speedy transmission of impulses. Without myelin, our responses would be over one-hundred times slower.


During lactation 2.8 micrograms per day is the minimum amount needed to avoid deficiency symptoms, however the optimal daily intake (ODI) has been listed to be between 100-500 micrograms per day.


Vitamin B12 needs stomach acid (Hydrochloric Acid (HCL)) to be absorbed, so if you know you have difficulty digesting protein, or if you have a vegan or vegetarian diet you may have some challenges absorbing B12 from food. Vitamin B12 absorbed better when taking omega 3 fatty acids.


Other factors that can impede absorption are the regular use of antacids such as Nexium, Mylanta or Gaviscon and ageing slows down production too. Vitamin B12 is excreted in the urine and is very safe to consume higher rather than lower amounts during lactation, especially if vegan or vegetarian.


The best sources of vitamin B12 are from animal sources and include:

  • Beef liver, lamb, lobster, salmon, clams, tuna, halibut, eggs, chicken, and cheese

  • Non-animal sources include:

  • Brewer’s yeast

  • Sea vegetables: Nori, wakame, kombu, arame, dulse

  • Micro-algae: Super blue green, chlorella, spirulina


Recommendations

If not vegan or vegetarian and eating a nutrient-dense diet that includes animal products, there is no need to supplement vitamin B12 unless you know you have difficulty digesting and absorbing protein or take regular antacids due to heartburn. You may consider the use of digestive enzymes that include HCl or consider using a small amount of apple cider vinegar in warm water prior to meals to stimulate the production of HCL. If you have a vegan or vegetarian diet, consider using a small amount of apple cider vinegar in warm water prior to meals to stimulate the production of HCL and include regular servings of seaweed and micro-algae in your diet.


Iron

Anemia is considered a risk factor for low milk production and delayed onset of milk production in the early postpartum. Consider your diet, get your levels checked and address any malabsorption issues that are underlying. Other factors to consider are the amount of blood lost during birth, your haemoglobin levels in third trimester as well as after birth, and your iron store levels (ferritin). Iron is a vital nutrient for your baby and can cause neurodevelopmental delays when deficient.


Consider the following recommendations to ensure adequate iron for both you and your baby:

  • Consume iron rich foods daily along with citrus or acidic condiments to aid absorption

  • Fortify sauces and soups with heme-sources of iron such as red meat etc

  • Avoid combining iron foods with dairy, calcium supplements, or antacids as these will block its’ absorption by the body

  • Use cast iron pans for cooking if available - this has shown to significantly increase iron content in foods

If vegan or vegetarian:

  • Become aware of the best sources

  • To increase the bio-availability consider soaking, fermenting, or sprouting.

  • Include seaweed, spirulina, chlorella, and other algae sources in your diet


The best form of supplemental iron is bisglycinate as it has shown to be better absorbed with less side effects like constipation. More common preparations are ferrous sulphate and ferrous fumerate both of which are twice as likely to cause uncomfortable side-effects and are less well absorbed. Desiccated liver supplementation is a good option for those wanting a highly bio-available food-based iron supplements.


Spirulina capsules - 1500mg daily is shown to be safe and effective throughout pregnancy and breastfeeding. This is an ideal option for those on vegan and vegetarian diets. Please note the colour of yours and your baby’s stools can change.


The recommended daily intake of iron almost doubles in pregnancy and lactation to 27mg per day and for those on a vegan or vegetarian diet the recommended daily intake increases 1.8 times that of the pregnancy/lactation needs.


Essential Fatty Acids

Omega 3 fatty acids are essential for healthy development and functioning. They are termed essential because the body cannot make them. Your baby needs these fatty acids to develop healthy eye function and a healthy brain and nervous system.


The bio-available form of Omega 3 fatty acids is known as EPA and DHA. During the final trimester of pregnancy, your baby accumulates approximately 67mg of DHA each day (if it is available). During the first couple of years of your baby’s life, her body and particularly his brain are developing at a rapid pace, and studies have shown improvements in cognitive development in the children of mothers who consumed DHA during the second half of their pregnancies.


Including 2-3 servings per week of fatty cold-water fish such as salmon, sardines, herring, fish eggs (roe) and trout will provide all the DHA you and your baby need during pregnancy and for your baby during the first 6 months of life.


Other sources include grass-fed meat and organ meats, eggs from pasture raised chickens or chickens that have been fed flax-meal, and dairy products from grass-fed animals. Algae is the highest vegan source of pre-formed EPA and DHA.


If you choose to supplement, you may consider the following choices:


  • Algae oil, chlorella, micro-algae such as blue green (these will also provide great levels of trace-minerals)

  • Cod liver oil

  • Fish oil that includes both EPA and DHA

  • *Choose a fish oil supplement that has been tested for heavy metals and PCB’s



Please note this information is intended as a guide only. Please consult your health care practitioners for individual and specific guidance.


References

Anaemia in Pregnancy: https://www1.racgp.org.au/ajgp/2019/march/anaemia-in-pregnancy

Bergner, P. (1997). The Healing Power of Minerals and Trace Minerals. p.64. Boulder, CO.

Better Health Channel on Iodine: https://www.betterhealth.vic.gov.au/health/healthyliving/iodine

Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001059.pub5/full

Environmental Working Group Guide to Seafood: https://www.ewg.org/consumer-guides/ewgs-consumer-guide-seafood

Health Direct: https://www.healthdirect.gov.au/iodine

Infant Development & Omega 3 Supplementation: https://pubmed.ncbi.nlm.nih.gov/17185423/

Maternal Thyroid influences on Foetal Brain Development: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819012/

Mohrbacher, N. (2020). Breastfeeding Answers - a Guide for Helping Families. 2nd Ed. pp. 412-13; 294-98

Marz, R.B. (2002). Medical Nutrition From Marz, 2nd Ed. pp.110-19; 120-24; 175-79;189-191; 220-205. Portland, Oregon

Maternal Vitamin D and adverse outcomes: https://pubmed.ncbi.nlm.nih.gov/23311886/

Nichols, L. (2018). Supplements. Real Food for Pregnancy, 1st Ed. Chapter 6. pp. 40-47; 98-100; 106-108. USA (Sourced at: www.realfoodforpregnancy.com/)

Nichols, L. (2018). Lab Tests. Real Food for Pregnancy, 1st Ed. Chapter 9. pp. 166-170. USA

(Find at: https://realfoodforpregnancy.com/)

Nichols, L. (2018). Foods that Build a Healthy Baby. Real Food for Pregnancy, 1st Ed. Chapter 3. p.50. USA

RANZCOG: Vitamin and Mineral Supplementation in Pregnancy /pdf. (Cut and paste in browser)

Siegel, D. (2020). Brain, Awareness, and Energy. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. p. 41. Guilford Press. New York.

Spirulina in Pregnancy: https://www.scirp.org/Journal/PaperInformation.aspx?PaperID=7364

Zinc and reproduction: effects of zinc deficiency on prenatal and early postnatal development: https://pubmed.ncbi.nlm.nih.gov/20803691/




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