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I have been working with a small team of anaesthetists for some time to develop guidelines so that breastfeeding mothers can have surgery, pain relief etc and continue to breastfeed as normal. The guideline also recommends support for the mother in terms of pumps, information and her baby nearby – not necessarily in that order.
As we begin World Breastfeeding Week 2020 I am proud to share this guideline and infographic
Again I wonder if this is a consequence of the Lockdown but more breastfeeding mums seem to have taken up running again or for the first time. We have all needed to take exercise in this strange world the past few months.
This is the information on glucosamine and chondroitin during breastfeeding – enjoy your running. Yes it is safe in breastfeeding : https://kellymom.com/bf/can-i-breastfeed/lifestyle/mom-exercise/
Glucosamine is either derived from shellfish or synthetically produced. The shellfish derived product should be avoided by anyone with a shellfish allergy.
It is most commonly used to treat osteoarthritis and joint pain or to prevent joint damage. A glucosamine derivative, N-acetylglucosamine, is a normal component of human breastmilk. Glucosamine occasionally causes stomach discomfort in adults but is generally well tolerated. There are no studies on levels in breastmilk but it is poorly absorbed and metabolised in the liver so levels absorbed by the breastfed baby are likely to be very low.
Chondroitin is a mixture of large glycosaminoglycans and disaccharide polymers, usually derived from shark or bovine cartilage. It is most commonly used to treat osteoarthritis because it acts as a flexible connecting material between the protein filaments in cartilage.
Chondroitin is poorly absorbed orally with a bioavailability of about 10%. Its molecular weight averages 50,000 Daltons so is unlikely to be absorbed by breastfed babies at all.
It is well tolerated in mothers with occasional gastrointestinal upset reported. Although no studies exist on the use of chondroitin sulphate supplements during breastfeeding, small amounts occur naturally in breastmilk. Mothers of preterm infants excrete greater amounts of chondroitin into breastmilk than mothers of fullterm infants.The use of chondroitin by a nursing mother is unlikely to adversely affect the breastfed infant.
Coppa GV, Gabrielli O, Zampini L et al. Glycosaminoglycan content in term and preterm milk during the first month of lactation. Neonatology. 2011;101:74-76. https://pubmed.ncbi.nlm.nih.gov/21934331/
Hale TW Medications and Mothers Milk
Apple cider vinegar seems the “in” thing for weight loss at the moment, sipped in water and sometimes sweetened with honey. As the pandemic loosens it’s hold it seems that more breastfeeding mothers than usual are looking for an answer to weight loss.
There is no research data on whether it is safe in breastfeeding. It certainly isn’t something I would advocate: not least because there is no evidence, that I found, that it’s effective for weight loss although culinary use is unlikely to be an issue. Back to less in, more out – healthy eating and exercise – sigh!
I would NOT advocate this for any breastfeeding mother – or anyone else for that matter
I found this link interesting https://www.health.harvard.edu/blog/apple-cider-vinegar-diet-does-it-really-work-2018042513703?fbclid=IwAR037-joCZ_XbvfuIv48c3cGekHN6e35U1kP618RLh5tnJ5A-42Q_A5ZL7c from Robert H. Shmerling, MD
Senior Faculty Editor, Harvard Health Publishing. His words not mine:
What is the apple cider vinegar diet?
Apple cider vinegar comes from apples that have been crushed, distilled, and then fermented. It can be consumed in small quantities or taken as a supplement. Its high levels of acetic acid, or perhaps other compounds, may be responsible for its supposed health benefits. Although recommendations for “dosing” vary, most are on the order of 1 to 2 teaspoons before or with meals.
What can the apple cider vinegar diet do for you?
For thousands of years, compounds containing vinegar have been used for their presumed healing properties. It was used to improve strength, for “detoxification,” as an antibiotic, and even as a treatment for scurvy. While no one is using apple cider vinegar as an antibiotic anymore (at least, no one should be), it has been touted more recently for weight loss. What’s the evidence?
Studies in obese rats and mice suggest that acetic acid can prevent fat deposition and improve their metabolism. The most widely quoted study of humans is a 2009 trial of 175 people who consumed a drink containing 0, 1, or 2 tablespoons of vinegar each day. After three months, those who consumed vinegar had modest weight loss (2 to 4 pounds) and lower triglyceride levels than those who drank no vinegar. Another small study found that vinegar consumption promoted feeling fuller after eating, but that it did so by causing nausea. Neither of these studies (and none I could find in a medical literature search) specifically studied apple cider vinegar. A more recent study randomly assigned 39 study subjects to follow a restricted calorie diet with apple cider vinegar or a restricted calorie diet without apple cider vinegar for 12 weeks. While both groups lost weight, the apple cider vinegar group lost more. As with many prior studies, this one was quite small and short-term.
In all, the scientific evidence that vinegar consumption (whether of the apple cider variety or not) is a reliable, long-term means of losing excess weight is not compelling. (On the other hand, a number of studies suggest that vinegar might prevent spikes in blood sugar in people with prediabetes and type 2 diabetes by blocking starch absorption — perhaps that’s a topic for another day.)
Is there a downside to the apple cider vinegar diet?
For many natural remedies, there seems to be little risk, so a common approach is “why not try it?” However, for diets with high vinegar content, a few warnings are in order:
- Vinegar should be diluted. Its high acidity can damage tooth enamel when sipped “straight” — consuming it as a component of vinaigrette salad dressing is a better way.
- It has been reported to cause or worsen low potassium levels. That’s particularly important for people taking medications that can lower potassium (such as common diuretics taken to treat high blood pressure).
- Vinegar can alter insulin levels. People with diabetes should be particularly cautious about a high vinegar diet.
If you are trying to lose weight, adding apple cider vinegar to your diet probably won’t do the trick. Of course, you’d never suspect that was the case by the way it’s been trending on Google health searches. But the popularity of diets frequently has little to do with actual evidence. If you read about a new diet (or other remedy) that sounds too good to be true, a healthy dose of skepticism is usually in order.“
Following on from the information on miscarriage I decided I needed to carry on talking about the hardest topics for mothers and think about the unthinkable – stillbirth, a baby born sleeping, and how to deal with the subsequent milk supply. I could fervently wish this never needed to be read but I hope that it provides information for mothers, families and professionals in this awful situation.
This is one of the chapters of the new book I am just finishing and about breastfeeding with a chronic condition. So many people told not to breastfeed or to stop for medication. Hope this changes some of those concepts. Any queries please feel free to email email@example.com
I’ve realised that the information I wrote long ago now, on loss of a pregnancy and breastfeeding is not very detailed so today I have written a more detailed factsheet. My heart goes out to everyone who has to go through the loss of a baby through miscarriage. We dont talk about it openly often enough considering how common it is .
Sending hopeful rainbows for the future
Constipation in the neonate is a topic apparently rarely discussed in medical sources and may be seen as the domain of the health visitor or midwife. However, many “constipated” babies may be seen by their GP and be the cause of concern for their parents.
This factsheet is designed to provide information for parents and their professionals on what is normal with regard to baby poo and where interventions are required be that referral to breastfeeding expert or medical treatment.
Turmeric is a supplement recommended for the relief of inflammation in many chronic conditions. It is, of course, a spice used in curries.
When taken as a supplement levels are significantly higher than those used for culinary purposes.
This is the information on compatibility with breastfeeding that I found in LactMed https://www.ncbi.nlm.nih.gov/books/NBK501846/ (the emphasis is my own) :
Summary of Use during Lactation
Turmeric (Curcuma longa) rhizome contains curcuminoids such as curcumin. No data exist on the excretion of any components of turmeric into breastmilk or on the safety and efficacy of turmeric in nursing mothers or infants. Turmeric is “generally recognized as safe” (GRAS) as a food ingredient by the U.S. Food and Drug Administration. Turmeric is generally well tolerated even in high doses, but gastrointestinal side effects such as nausea and diarrhea, and rare allergic reactions have been reported, and it may increase the risk of bleeding in patients taking warfarin and antiplatelet drugs.
Because of a lack of data, turmeric in amounts higher than those found in foods as a flavoring should probably be avoided during breastfeeding.
Turmeric has been used as a galactogogue in India; however, no scientific data support this use. In Thailand it is reportedly used as part of a topical herbal mixture to shorten the time to full lactation and also part of a topical herbal mixture used for breast engorgement. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production. In India turmeric is a component of a paste applied to the breasts for sore nipples. Contact dermatitis has been reported after contact of the skin with curcumin-containing products.
References from LactMed https://www.ncbi.nlm.nih.gov/books/NBK501846/
1.Sayed NZ, Deo R, Mukundan U. Herbal remedies used by Warlis of Dahanu to induce lactation in nursing mothers. Indian J Tradit Knowl. 2007;6:602-5.2.Chaudhuri RN, Ghosh BN, Chatterjee BN. Diet intake patterns of non-Bengali Muslim mothers during pregnancy and lactation. Indian J Public Health. 1989;33:82-3. [PubMed]3.Dhippayom T, Kongkaew C, Chaiyakunapruk N et al. Clinical effects of Thai herbal compress: A systematic review and meta-analysis. Evid Based Complement Alternat Med. 2015;2015:942378. [PMC free article] [PubMed]4.Ketsuwan S, Baiya N, Paritakul P et al. Effect of herbal compresses for maternal breast engorgement at postpartum: A randomized controlled trial. Breastfeed Med. 2018;13:361-5. [PubMed]5.Brodribb W. ABM Clinical Protocol #9: Use of galactogogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeed Med. 2018;13:307-14. [PubMed]6.Amuthavalluvan V, Devarapalli J. Indigenous knowledge and health seeking behavior among Kattunayakan: a tribe in transition. Glob J Human Soc Sci. 2011;11. http://socialscienceresearch.org/index.php/GJHSS/article/view/198/161.7.Chaudhari SP, Tam AY, Barr JA. Curcumin: A contact allergen. J Clin Aesthet Dermatol. 2015;8:43-8. [PMC free article] [PubMed]
Collagen seems to be another frequent supplement I get asked about . Collagen is found in connective tissue and can be used during exercise routines but also in the prevention and treatment of wrinkles as well as to strengthen hair I believe.
There are no studies on passage into breastmilk and it would therefore be unethical for me to comment.
Sorry – another of the increasing number of natural products which seem to be attracting attention during lockdown and as we emerge.
With the launch of a new beauty cream containing retinol advertised as reducing wrinkles, the questions about beauty products similar to it have increased. Or maybe we all just need something to cheer us up during Lockdown.
There is no research on the use of topical retinols and the best information I have sourced is “Because it is poorly absorbed after topical application, it is considered a low risk to the nursing infant” (Lactmed accessed June 2020 studies referenced below.)
Hale (Medications and Mother’s Milk accessed June 2020 states “Tretinoin is a retinoid derivative similar to Vitamin A. It is primarily used topically for acne and wrinkling and sometimes psoriasis. Used topically, tretinoin stimulates epithelial turnover and reduces cell cohesiveness. Blood concentrations measured 2-48 hours following application are essentially zero.
I have been unable to access the full papers and so would recommend caution
- Leachman SA, Reed BR. The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin. 2006;24:167-97. [PubMed]
- Zip C. Common sense dermatological drug suggestions for women who are breast-feeding. Skin Therapy Lett. 2002;7:5-7. [PubMed]
- Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II Lactation. J Am Acad Dermatol. 2014;70:417.e1-417.e10. [PubMed].
- Zbinden G. Investigation on the toxicity of tretinoin administered systemically to animals. Acta Derm Verereol Suppl(Stockh) 1975; 74:36-40.
- Lucek RW, Colburn WA. Clinical pharmacokinetics of the retinoids. Clin Pharmacokinet 1985; 10(1):38-62