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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_A5ZL

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.

Dental Health and Breastfeeding

As with most professionals, my own included, dentistry seems to lack education on breastfeeding as part of undergraduate training if questions sent to this page exemplify a wider issue. I have tried to provide information for CPD inline with that written for other healthcare professionals.

I have developed this powerpoint presentation on the pharmacokinetics of drugs which dentists may use or prescribe for CPD information in an effort to break down the barriers of continuation of breastfeeding.

I am happy to answer individual questions or training. Please contact wendy@breastfeeding-and-medication.co.uk

In summary:

  • Breastfeeding mothers can have local anaesthetic injections with/without adrenaline and continue to breastfeed as normal
  • Breastfeeding mothers can take analgesics for dental pain and continue to breastfeed as normal
  • Breastfeeding mothers can have dental sedation for procedures and continue to breastfeed as normal.

Powerpoint training for dental practitioners on the pharmacokinetics of drugs they may use in breastfeeding women

In a report Public Health England have made recommendations on dental health and breastfeeding. Full information can be accessed at : www.gov.uk/government/publications/breastfeeding-and-dental-health/breastfeeding-and-dental-health#breastfeeding-and-dental-health

  • dental teams should continue to support and encourage mothers to breastfeed
  • not being breastfed is associated with an increased risk of infectious morbidity (for example gastroenteritis, respiratory infections, middle-ear infections)
  • breastfeeding up to 12 months of age is associated with a decreased risk of tooth decay

Delivering Better Oral Health (PHE, 2014 updated content 2017)4 recommends that:

  • breast milk is the only food or drink babies need for around the first 6 months of their life, first formula milk is the only suitable alternative to breast milk
  • bottle-fed babies should be introduced to drinking from a free-flow cup from the age of 6 months and bottle feeding should be discouraged from 12 months old
  • only breast or formula milk or cooled, boiled water should be given in bottles
  • only milk or water should be drunk between meals and adding sugar to foods or drinks should be avoided

Recent systematic reviews such as that by Tham and others (2015)6 included studies where children were breastfed beyond 12 months. When infants are no longer exclusively breast or formula fed, confounding factors, such as the consumption of potentially cariogenic drinks and foods and tooth brushing practices (with fluoride toothpaste), need to be taken into account when investigating the impact of infant feeding practices on caries development. Tham and others (2015) noted that several of the studies did not consider these factors and concluded that with regard to associations between breastfeeding over 12 months and dental caries “further research with careful control of pertinent confounding factors is needed to elucidate this issue and better inform infant feeding guidelines”. Good quality evidence on breastfeeding and oral health is an area with significant methodological challenges which have been outlined by Peres and others (2018)7.

Of course I would also have to highlight that dental procedures, including sedation, local and general anaesthetic and use of antibiotics and analgesics need not interrupt breastfeeding

Powerpoint training for dental practitioners on passage of drugs in breastmilk

See also:

A Guide To Supporting Breastfeeding For The Medical Profession, Amy Brown and Wendy Jones

The substance exposed infant

This is an adapted version of a training powerpoint I gave some time ago. I plan to record it over the next few weeks and will upload it to my You Tube channel.

But hope it helpsin the meantime. Happy to answer any questions wendy@breastfeeding-and-medication.co.uk

Breastfeeding and the substance exposed infant

Breastfeeding during baby immunisation

As a new mum I remember how hard I found it holding my babies whilst they had their immunisations and hearing them cry. I always breastfed them as soon as I could to comfort them. I recalled a paper which mentioned using sucrose to relieve the pain during painful procedures. I recall it being in the BMJ but have it may not have been but may have been Abad (1996).

No one ever suggested that I could breastfeed during the immunisation because my babies were born back in the 1980s when breastfeeding was far from the norm after 6 weeks.

However, this paper has looked data from 10 trials, with results for 1,066 babies, mostly between one and six months old, following their normal immunisation schedule. They found that babies who were breastfed before and during routine childhood immunisations cried on average for 38 seconds less and had lower pain scores compared to babies not breastfed. Thirty-eight seconds may not sound a lot but to a mum witnessing her baby’s distress it definitely matters.

The authors noted “There is good evidence that breastfeeding during blood tests reduces pain in new-born babies (up to 28 days old), but the evidence was unclear for older babies. There were no evidence reviews looking at whether breastfeeding might help during painful procedures in babies aged one month to one year” which made me sad. It suggests that we still don’t consider breastfeeding is the norm and is about so much more than nutrition.

They mention that The good practice in postoperative and procedural pain management guideline from the Association of Paediatric Anaesthetists of Great Britain and Ireland, published in 2012, recommends that breastfeeding (along with swaddling, pacifiers, and sugar) should be considered for babies being vaccinated.

None of the included studies reported any adverse effects such as choking, gagging, spitting or coughing. No studies reported on the acceptability of breastfeeding, from the mothers’ or healthcare professionals’ perspective. The studies didn’t report on the practicalities of breastfeeding in the immunisation clinics but surely this isnt impossible to arrange?

So next time your baby needs an immunisation or you as a professional need to immunise a baby maybe this is something to think about?

References

Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in new-born infants undergoing painful procedures. Cochrane Database Syst Rev. 2016 Jul 16;7(7):CD001069. doi: 10.1002/14651858.CD001069.pub5. PMID: 27420164; PMCID: PMC6457867. https://pubmed.ncbi.nlm.nih.gov/27420164/

Abad F, Díaz NM, Domenech E, Robayna M, Rico J. Oral sweet solution reduces pain-related behaviour in preterm infants. Acta Paediatr. 1996 Jul;85(7):854-8. doi: 10.1111/j.1651-2227.1996.tb14167.x. PMID: 8819554.

The good practice in postoperative and procedural pain management guideline from the Association of Paediatric Anaesthetists of Great Britain and Ireland

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1460-9592.2012.03838.x

Harrison D, Reszel J, Bueno M, et al. Breastfeeding for procedural pain in infants beyond the neonatal period. Cochrane Database Syst Rev. 2016;10:CD011248.

NHR Evidence Breastfeeding reduces crying during baby immunisation https://evidence.nihr.ac.uk/alert/breastfeeding-reduces-crying-during-baby-immunisation/

Opioids and breastfeeding

When paracetamol plus a non steroidal drug (ibuprofen, naproxen, diclofenac or celecoxib) are sufficiant to control pain opioid drugs may need to be used. They cause constipation so should be co prescribed with a stool softener). They are also addictive so should be used for the shortest possible time, in the lowest possible dose.

Codeine is not recomemnded for breastfeeding https://breastfeeding-and-medication.co.uk/thoughts/breastfeeding-and-codeine but one accidental dose or short term use, maybe overnight when no other pain relief is available does not mean that breastfeeding needs to be interrupted.

No breastfeeding mother should ever be asked to choose between adequate pain relief and breastfeeding

Opioids and breastfeeding factsheet

Scleratherpy and Breastfeeding

Another question not frequently asked but something I have been meaning to write for ages. Hope it helps for those who need to have this procedure.

Scleratherapy and Breastfeeding Factsheet

Aripiprazole and Breastfeeding

Aripiprazole seems to be being prescribed more frequently in pregnancy and therfore with newborns but it is becoming apparent from contacts that it can have a massive impact on breastfeeding. I may be seeing the unusual messages but it feels too much of a coincidence. I feel strongly that mums need to know how to watch for poor milk supply and understand the need to monitor their baby for milk intake if they are taking aripiprazole when breastfeeding.

Aripiprazole and Breastfeeding Factsheet

The Synacthen test and breastfeeding

Not a very frequently asked question but one which causes a lot of distress as many mothers are advised to interrupt or stop breastfeeding unnecessarily. Having tests is bad enough without trying to manage milk supply and a distressed baby.

Hope this information that breastfeeding can continue as normal after the test helps

The Synacthen test and breastfeeding factsheet

What do mothers want professionals to know about contraception and breastfeeding

Last year I asked on my facebook page for experience of using contraception whilst breastfeeding using a googledoc survey. I had just under 80 responses in 24 hours and here I have tried to analyse the results. Five mothers reported that their supply was affected by the use of contraception. Many more were unhappy with the information that was given before prescription of the contraceptive. Food for thought

Please see https://www.breastfeedingnetwork.org.uk/contraception/ 

for information on the contraceptives and 

https://www.breastfeedingnetwork.org.uk/ehc/ 

on emergency hormonal contraception which I wrote for BfN.

Contraception and breastfeeding. What mothers want doctors to know analysis

what do mothers want healthcare professionals to know about breast and nipple pain in lactation

I asked for feedback on this question 12 months ago about pain during breastfeeding and finally time to write it up. Reading it again makes me sad. The pain of breastfeeding for some people cannot be ignored. I hope that this facilitates a discussion amongst professionals who see breastfeeding women. It’s important for mothers, for partners and for babies and time we stopped ignoring it.

This is the data that I extracted

what do mothers want healthcare professionals to know about breast and nipple pain in lactation

Some links that may help everyonehttps://www.breastfeedingnetwork.org.uk/if-breastfeeding-hurts-05-may-2015/embed/#?secret=xbxHk33i2Fhttps://www.breastfeedingnetwork.org.uk/thrush-detailed/embed/#?secret=PiSWCix58w

A Guide To Supporting Breastfeeding For The Medical Profession, Amy Brown and Wendy Jones