New Risk for Low Milk Supply: Alcoholism in the Family, von Bunge, Mennella, MOBI

I would like to introduce you all to my new hero from the 19th century, a brilliant biochemist who laid the foundation of nutritional science and whose work is still relevant today, Gustav von Bunge (1844-1920). Please enjoy this biography, and be amazed that one man can achieve so much that is so meaningful!  


In 1907, towards the end of his life, von Bunge published a remarkable study (thankfully I am fluent in German) that links alcoholism in the family to low milk supply. In this study, von Bunge shows  results from a survey of more than 1600 women that spanned several European countries. Remarkably, he relates that in households where the father is an extremely heavy drinker, huge percentages of  daughters experience true low milk supply (40% compared to 3% in families with no heavy drinking). He also shows that low milk supply can be inherited, and that the granddaughters of heavy drinkers also tend to have problems.


In the decades that followed, von Bunge's correlation between alcoholism and low milk supply was not taken very seriously, and low milk supply was said, if anything, to be the result of the poverty and poor nutrition. Furthermore, von Bunge included in "low milk supply" not only those mothers who consistently had low secretion, but also those who did not breastfeed for more than nine months. The assumption was that if a mother weaned so "early" she must be struggling to make breastfeeding work. 

However, I recently felt compelled to take von Bunge's study more seriously when I saw a new study by Julie Mennella and Marta Yanina Pepino titled "Breastfeeding and Prolactin Levels in Lactating Women with a Family History of Alcoholism."


Briefly, Mennella and Yanina show that women with a family history of alcoholism have a "blunted"  prolactin response to the removal of milk from the breasts. Familial alcoholism is identified as a risk factor for breastfeeding problems. The mothers in this study, for instance, breastfeed more frequently than the "controls." This is probably an instinctive reaction: if you have less milk production per feed, more frequent feeding can make up the difference.
 
It took me a couple weeks, but I finally got up my courage to ask at our MOBI group if our mothers with low supply have alcoholism in their families. Unbelievably, nearly all of our mothers raised their hands. We conducted a spontaneous survey and found that the most common denominator was the maternal grandfather.


Is alcoholism in the family a risk factor for low milk supply? It appears to be so. More research is of course needed.


The good news is that this is the best of times to be aware of risk factors, because there is so much information and help available compared to only a decade ago. Having risk factors does not spell out failure. It does however signal the need to be prepared so that you can meet and overcome the problems when they arrise. See "Making More Milk," by Marasco and West, and my own book, "Mother Food," for starters.

Beer, Anemia, Lactation, Copper - and of course, Galactagogue

Last week, a mother wrote to say that she drinks a pint of Guinness beer every day to help with her anemia. Never having heard of beer as a remedy for anemia, I did a little internet searching.

An article called "Beer: it does a body good" on Prospectus News relates how Guinness beer has been wrongly promoted as a good source of iron in Ireland for pregnant women. Hm. Talk about a country standing behind its national product, regardless of medical truth or consequences for their vulnerable population. Read more.

Studies from Africa reporting on the medical condition called iron overload, point to people's high consumption of home-made beer. Read more. It turns out that materials used in brewing increases the iron content of some beer, but also that certain people of African descent carry a gene that predisposes them to iron overload. Read more.

So is Guinness different from other beers? Yes, not because it contains more iron than other beers, but because it contains more beta-glucan, an immune-boosting and lactation-boosting sugar that unfortunately is reduced to a minimum in normal commercial beer brewing. Beta-glucan is the secret ingredient that makes Guinness and similar dark stout beers special for breastfeeding mothers. To learn more, read The Best Beer for Breastfeeding and other related posts about beer and malt as a galactagogue on this site.

So what was going on with the mother who drinks Guinness for her anemia? 

That search lead me to a website describing something called "copper-deficiency anemia." Beer is actually a good source of copper. Read more.

I contacted the mother and she reports that she does indeed fit the description of copper-deficiency. She also finds that while Guinness makes her feel less fatigued by providing copper, it also supports her very fragile milk supply.

Could copper be crucially involved in milk supply? 

Something new to investigate... and after a quick search, there seems to be something to it. This study on rodents concludes: "lactation markedly enhances the avidity of the mammary gland for copper, diverting most of it from liver and kidney to that tissue" Here is the entire study. Any thoughts? I am reminded of all the copper-rich seafood traditionally recommended to increase lactation: oysters, octopus, eel, fish.

Good news: blackstrap molasses is an easily available and good source of both iron and copper, and this may be behind its use as a galactagogue -- two tablespoons a day. 1 Tablespoon mixed into very hot water with a bit of milk tastes a bit like coffee.

Suggestions for Iron Deficiency Anemia in Pregnant and Breastfeeding Mothers

I was low on iron during my first pregnancy. My ObGyn placed me on an iron supplement that slightly improved my  levels, but  lead to chronic constipation. It was my stool, more than anything, that was "iron enriched."

Through my studies and understanding of the passageways of toxins during pregnancy, I  adamantly believe that we want to avoid constipation at this time. When the intestine does not "move," toxins are not pushed out of the body and are available in the large intestine to be reabsorbed into the bloodstream where they can be delivered over the placenta (which does not filter them all out, unfortunately) to our growing baby.

The body naturally tries to eliminate toxins through the intestine and in the stool. When we slow down and stall the movement of the stool, we undermine this process. The baby becomes the receptacle for the toxins--not at all what we want to happen.


The good news is that time tested, iron-rich home remedies are safe for pregnant and breastfeeding mothers.

Remedy One: Pears in Red Wine


For a later birth, my Swiss midwife suggested this old and unusual remedy: take three slices of dried, organic pears and simmer them in a couple ounces of red wine. Eat the pear slices and drink the wine (which contains no alcohol because it  simmered off) throughout the day. This remedy worked like a charm for me during pregnancy, increasing my iron levels and "moving me along."



Remedy Two: Blackstrap Molasses

Many mothers have found relief for iron deficiency with blackstrap molasses, which also has a reputation as a galactagogue. This dark, bitter-sweet syrup is the mineral-rich "left over" from the refining process that removes sugar from its source, sugar cane. The white sugar we buy at the store has had all its original minerals removed, which are now found in blackstrap molasses. Buy organic molasses from a reliable source, as cheaper kinds may be stretched with corn syrup.

A teaspoon of molasses, added to a cup of hot water, drunk 2-3 times a day, provides a sweet hot drink that is traditionally used to abate anemia.

You'll want to avoid or limit your use of blackstrap molasses (and all sugar concentrations) if you have blood-sugar and insulin issues, and if you have problems with normal, very very slow weightloss after birth. Also, keep an eye on your baby's digestion/colic if you take any form of concentrated sugar. Some babies react sensitively to any amount of sugary food eaten by the mother.

Remedy Three: Raw Beet Root   

One of my favorite iron providers is the raw red beet root. I would cut the round red root into quarter-inch slices and leave it on the table as a snack. When my family ate this on a daily basis,  our iron levels went through the roof.

Now, beet root can taste sweet and yummy, but, depending on the soil and weather conditions it can also be tart and unpleasant, especially those beets that are bright red and yellow. I've had greatest success with the dark red, purplish vegetable.

Now, raw beet root has a puckering effect. What I discovered however is that if you slice the root as described above and then leave it to "breathe" for about 15 minutes, it exhumes whatever is in it that causes the pucker. It now tastes delicious, and the air-dried root also no longer stains. Once your children are used to it, they will grab for those slices as though they are cookies.

More on Iron Deficiency and Postpartum Anemia - Prevention

Each cell in the body, from the brain to the heart and the bones, requires oxygen to be healthy and function. The body transports oxygen to the cells by piggybacking oxygen on the iron in red blood cells. But what happens if there is not enough blood? Not enough iron to deliver the oxygen? If a person is anemic?

Low iron levels do not automatically spell anemia. There is a long, sliding grade from low iron levels to wholesale anemia as a condition requiring medical treatment. However, even a mild degree of iron deficiency can create undesirable symptoms. When the body is deprived of oxygen, cells turn down the volume on their energy use. An iron-deficient person may feel tired, look pale, and could come down with a cold or flu more frequently than other people. However, these symptoms come on slowly, and may go unnoticed.

Iron deficiency can stem from a range of causes. Any on-going internal bleeding, for instance, from an ulcer, from hemorrhoids, from cancer, or from other disease can lead to blood loss and iron deficiency. Lack of certain nutrients such as iron, vitamin B12, and folic acid can also lead to anemia. These nutrients may be lacking in one’s diet but can also result of an inability to absorb these nutrients from food.

Here is good news. Anemia has been decreasing in the US since the early 1990s. Less happily, however, the kind of anemia linked to too little iron is as widespread as ever, and this is important for women to know, for iron deficiency is found mainly among menstruating girls and pregnant women. Through menstruation, blood and iron is lost each month. In pregnancy, a woman’s body ‘donates’ its stores of iron to the baby.

Low iron levels can factor into common problems after birth, including low milk supply, fatigue, and depression. When a mother is depressed, she will naturally enjoy motherhood less, and be less responsive to her baby. The relationship to her newborn baby will suffer. Due to lowered immunity, iron-deficient mothers are more likely to have mastitis, or to come down with a cold or flu. Clearly, iron deficiency in the postpartum should be avoided.

It used to be that ObGyns would meticulously regulate a pregnant woman’s iron levels. The iron supplements they prescribed, however, often led to uncomfortable constipation and bloating. Now it is recognized that the benefits of iron supplementation are not worth the risks of gastrointestinal problems. Studies show that the highest risk for anemia in the postpartum is not low iron levels in pregnancy—except of course in cases where a woman had pre-existing iron deficiency and anemia—but rather by the quantity of blood lost during birth.

Additional risk factors for iron deficiency and anemia are low socioeconomic status and obesity, which often go hand in hand[i]. Here, a lifetime of poor diet and, possibly, inherited body metabolism, conspire to make motherhood a more tiring task—lack of iron and red blood cells makes life feel just that much harder. Clearly, preventing postpartum anemia in all women but especially disadvantaged mothers should be a high, medical priority.

Since anemia in the early postpartum is primarily due to bleeding during childbirth, finding a way to avoid bleeding would logically be the first line of defense. One study shows that although blood loss is greater in caesarian sections than vaginal birth, mothers who have had a c-section suffer less from anemia because they receive blood transfusions[ii]. What to do? Short of giving all mothers blood transfusions?

Talk to any midwife with years of experience, and she’ll have a story or two to tell about Shepherds purse. Traditional midwives like this life saving herb handy, as it is known to dramatically halt the flow of blood. Shepherd’s purse grows freely across the United States, and the aerial parts can be wild harvested, dried and processed into tea or tincture. It can be bought as a bulk herb, packaged in tea bags, as tincture and in capsules.

Every pregnant woman should consider preparing for birth with Shepherd’s purse. Be sure to research the appropriate dosage of the particular form you choose, whether capsule, tincture, tea.

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[i] Nead, KG. Halterman, JS. Kaczorowski, JM. "Overweight Children and Adolescents: A Risk Group for Iron Deficiency" Pediatrics 2004;114;104-108

[ii] Bergmann, RL. Richter, R. Bergmann, K. Dudenhausen, J. "Prevalence and risk factors for early postpartum anemia European Journal of Obstetrics and Gynecology and Reproductive" Biology 150 (2010) 126-131

Low Milk Supply, Anemia, and Galactagogues

Anemia can be an important co-factor in low milk supply and depression after birth. In this article published by MOBI Motherhood Intl, Cheryl Renfree Scott, PhD, RN, IBCLC, reviews studies that highlight the relationship between iron deficiency, low milk supply, short duration of breastfeeding, and fatigue and depression in the new mother. Specific iron supplements and dietary measures can help prevent and abate anemia. read more

I will talk about lactogenic foods and herbs used to provide iron in my next post.

Special Diets for Special Times - origin of lactogenic diet

In the United States, foods are divided into groups according to kind: fat, starch, protein, fruit or vegetable. The food groups are then arranged within a pyramid to indicate which ones the government advises eating the most of (lower on the pyramid) or the least (toward the top of the pyramid). This grouping changes from time to time, to catch up with what nutritionists are learning about how the body needs and uses food. 

Peoples around the world in traditional societies think quite differently than we do about food. Their knowledge has not been reached by observing food molecules beneath a microscope, or by studying lab rats, or by statistically analyzing the effects of foods on large groups of people. Rather, highly observant and intuitive individuals analyzed different people’s reactions to the foods they ate. In understanding their observations, these early doctors developed complex systems that encompassed all the subtleties they observed. 

Traditional Perceptions of Food

Traditional approaches to diet, such as Ayurveda from India and Traditional Chinese Medicine (TCM), describe foods in terms of their thermal properties: whether they make the body hotter or colder where hot means strong and active, and cold means slow, weak or fatigued. Depending on a person’s unique constitution—whether they tend naturally to be hot or cool, energetic or lethargic—foods are given to create a balance. Hotter people are given cooling foods, and cooler persons are given warming foods. It's all about balance.

Special Diets for Special Times

In unique life cycles, such as pregnancy and breastfeeding, specific diets are implemented. After birth, all women are said to be on the cooler side. Their bodies are slowed down, they are convalescing. They are in a phase of restoration; the body’s organs such as the heart, liver and kidneys are recovering from the larger quantity of blood they processed during pregnancy, returning to their normal size and function. In this cooler, postpartum phase, women eat foods that are said to be gently warming. They are also said to do several very specific things:

• Promote the lochial flow (for good detoxification and healing of the womb·)
• Reduce sexual drive (so the mother can better focus on her baby).
• Build blood and restore strength (especially after blood loss through birth).
• Detoxify the mother (pregnancy and birth are said to have left her ‘polluted’).
• Build the mother’s health (many of these foods and herbs are strong immune boosters and anti-inflammatories that are used in the treatment of chronic illness and severe disease)
• Strengthen the mother’s digestion (many of the herbs aid in digestion, and also support the liver and the kidneys.)
• Build and increase milk supply.

The latter, in particular, is the overriding goal of every traditional postpartum diet. That is why they are based on so-called ‘lactogenic’ foods, or foods believed to support an abundant milk supply (Goldsmith, 1994). These foods and herbs are also called galactagogues.

No Such Dietary Guidelines in the West

In the United State, England and in Europe, we do not usually think of mothers needing special dietary assistance to help with any of these biological processes. We certainly never think of women requiring nutritional or herbal aids for milk production. Yet, even in the West, we can find traditional foods and herbs recorded in early historic herbals. I'll talk more about this in later blog articles.

In general, we in the West have lost the knowledge of what it is like to be nourished by good, whole foods. We have become dulled to how food affects us--how the right kinds can enrich our lives, help emotional balance and mental clarity, and impart vigor and good sleep. We are also insensitive as to how the wrong kinds of food can dull us, trigger depression and aggression, lead to tired, compulsive thinking, and to a host of other problems and losses in the quality of our lives.

A Unique Learning Opportunity

The postpartum period, with a focus on a lactogenic diet, enables mothers to experience the effects of food in ways that are unprecedented in the lives of most western people. We feel directly how different foods affect our vigor, mood, and milk supply. If our baby has digestive issues such as colic (commonly diagnosed now as reflux) we can see how the right food choices help soothe and balance our baby.

This is a unique time for women to experience just how profoundly food choices can affect her life.

Bibliography

Goldsmith, Judith. Childbirth Wisdom: From the World's Oldest Societies. Brookline, Mass: East West Health Books, 1990