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Fibromyalgia and Breastfeeding

Fibromyalgia is incredibly difficult to deal with when you have a baby. The most effective intervention is CBT. Please read this factsheet which is a chapter from my book Breastfeeding and chronic medical conditions available on amazon.

Breastfeeding and Fibromyalgis factsheet

Mirtazapine and Breastfeeding

With the developing COVID situation more mothers are struggling to sleep and being prescribed mirtazapine for anxiety and depression associated with poor sleep. This is the information I used in Breastfeeding and Medication.

For more information Mirtazapine and Breastfeeding Factsheet

or maybe buy the book

ADHD and Breastfeeding

Currently there seem to be many questions about treatment of ADHD and breastfeeding. I’m sharing the chapter from my book Breastfeeding and Chronic Medical Conditions which I hope helps

For more information :

Breastfeeding and ADHD factsheet

and maybe you would like to but the book available on Amazon

Depression and breastfeeding

The rise in the statistics on COVID seems to be exacerbating symptoms of depression for many, many people. I can totally identify with that because I am immunocompromised myself due to medication and have very much gone back into Shield mode.

Many of the queries I have had in the last week relate to mothers who need to begin, increase or change their antidepressant medication but are being advised to stop breastfeeding to do so. There is evidence that stopping breastfeeding in itself lowers mood – you have a baby who wants to be breastfed and is fighting the change, you loose oxytocin, you become engorged – it isnt as easy as “stop now” might sound.

This is the chapter on depression from my new book Breastfeeding and chronic medical conditions. I hope the chapter helps in itself but maybe you would like to buy it and learn more about how drugs get into milk.

I will of course answer any queries you have wendy@breastfeeding-and-medication.co.uk

More information: depression and breastfeeding factsheet

Bi polar disorder and breastfeeding

This is one section of the new book that I am currently working on and should hopefully be available in kindle format shortly

bipolar disorder and breastfeeding fact sheet

Colonoscopy and Endoscopy in breastfeeding women

I am so very tired of breastfeeding mothers who need colonoscopies and endoscopies being told that they need to interrupt breastfeeding. I am currently trying to engage with the national body to update national guidelines. Interestingly it is the same old story – we dont see breastfeeding women needing these examinations. So how come I do?

This is the evidence that I have put together and am desperate to share with clinicians.

colonoscopy and endoscopy in lactating women factsheet

Anaesthesia and breastfeeding

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

Guideline on anaesthesia and sedation in breastfeeding women 2020

Infographic guideline on anaesthesia and sedation in breastfeeding women

Glucosamine and chondroitin supplements during breastfeeding

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

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

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.

References

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

LactMed https://www.ncbi.nlm.nih.gov/books/NBK501922/

Apple Cider Vinegar and Breastfeeding

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.

So what?

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.

Stillbirth and Milk Supply

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.

stillbirth and milk supply factsheet