From alcohol to sushi, caffeine to spicy food, get the final word on what you can and can't eat when you're breastfeeding.

By Kate Silver and Marra Francis, M.D.
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If you are what you eat, then so is your nursing baby. You want to give him only the best nutrition and avoid foods that may cause harm. But with so much conflicting information out there, it's not uncommon for new moms to swear off entire food groups out of fear.

Good news: The list of foods to avoid while breastfeeding isn't as long as you may have thought. Why? Because the mammary glands that produce your milk and your milk-producing cells help regulate how much of what you eat and drink actually reaches your baby through your milk.

Read on to get the verdict on alcohol, caffeine and other foods that were taboo during pregnancy before you start scratching anything off the menu while you're nursing.

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Spicy Food

Verdict: Safe

Nursing moms don't need to be scared of spicy foods, says Paula Meier, Ph.D, director for clinical research and lactation in the Neonatal Intensive Care Unit at Rush University Medical Center in Chicago, and president of the International Society for Research in Human Milk and Lactation.

By the time the baby is breastfeeding, Dr. Meier says, she is accustomed to the flavors Mom eats. "If a mother has eaten a whole array of different foods during pregnancy, that changes the taste and smell of amniotic fluid that the baby is exposed to and is smelling in utero," she says. "And, basically, the breastfeeding is the next step going from the amniotic fluid into the breast milk."

In fact, some items that mothers choose to avoid while breastfeeding, such as spices and spicy foods, are actually enticing to babies. In the early '90s, researchers Julie Mennella and Gary Beauchamp performed a study in which mothers breastfeeding their babies were given a garlic pill while others were given a placebo. The babies nursed longer, sucked harder, and drank more garlic-scented milk than those who had no garlic exposure.

Moms will restrict their diet if they suspect a correlation between something they ate and the child's behavior — gassy, cranky, etc. But while that cause-and-effect might seem enough for a mom, Dr. Meier says she would want to see more direct evidence before making any diagnosis.

"To truly say that a baby had something that was milk-related, I would want to see issues with the stools not being normal. It's very, very rare that a baby would have something that would truly be a contraindication to the mother's breastfeeding."

Alcohol

Verdict: Safe in Moderation

Once your baby is born, the rules on alcohol change! Having one to two alcoholic drinks a week—the equivalent of a 12-ounce beer, 4-ounce glass of wine, or 1 ounce of hard liquor—is safe according to experts. While alcohol does pass through breast milk, it's usually in tiny amounts. 

In terms of timing, keep this advice in mind: As soon as you don't feel the effects of alcohol any more, it's safe to feed, says Liz Pevytoe, a registered nurse, certified lactation consultant, and founder of askthelactationconsultant.com.

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Caffeine

Verdict: Safe in Moderation

Consuming coffee, tea, and caffeinated sodas in moderation is fine when you are breastfeeding, according to HealthyChildren.org. Breast milk usually contains less than 1 percent of the caffeine ingested by the mom. And if you drink no more than three cups of coffee spread throughout the day, there is little to no caffeine detected in the baby’s urine. 

However, if you feel that your infant becomes more fussy or irritable when you consume excessive amounts of caffeine (usually more than five caffeinated beverages per day), consider decreasing your intake or waiting to reintroduce caffeine until your infant is older.

Studies have shown that by three to six months of age, most infants’ sleep wasn’t adversely affected by maternal caffeine consumption.

"Based on the clinical evidence avail­able, I advise my patients to wait until their infant is at least three months old to reintroduce caffeine into their diet and then watch their baby for any signs of discomfort or restlessness," says Alicia C. Simpson MS RD IBCLC LD in an excerpt from her book, Boost Your Breast Milk: An All-In-One Guide for Nursing Mothers to Build a Healthy Milk Supply. "For moms who work outside the home, I suggest that you always label any pumped milk that you have expressed after consum­ing caffeine to ensure that the infant is not given this milk right before naptime or bedtime."

While coffee, tea, chocolate, and soda are obvious sources of caffeine, there are also significant amounts of caffeine in coffee- and chocolate-flavored foods and beverages. Even decaffeinated coffee has some caffeine in it, so keep this in mind if your baby is es­pecially sensitive to it.

Sushi

Verdict: Safe in Moderation

For moms who have been waiting patiently for forty weeks to eat sushi, you can rest assured that sushi not containing high-mercury fish is considered safe for breastfeeding mothers. This is due to the fact that the Listeria bacteria, which can be found in undercooked foods, is not transmitted readily through breast milk, according to Simpson.

However, if you choose to eat one of these low-mercury sushi options while breastfeeding, keep in mind that no more than two to three servings (a maximum of twelve ounces) of low-mercury fish should be eaten in a week. Fish that tend to contain low levels of mercury include salmon, flounder, tilapia, trout, pollock, and catfish.

High-Mercury Fish

Verdict: Avoid It

When cooked in a healthy manner (such as baking or broiling), fish can be a nutrient-rich component of your diet. However, due to a wide array of factors, most fish and other seafood also contain unhealthy chemicals, particularly mercury. In the body, mercury can accumu­late and quickly rise to dangerous levels. High levels of mercury prin­cipally affect the central nervous system, causing neurological de­fects.

For this reason, the US Food and Drug Administration (FDA), Environmental Protection Agency (EPA), and WHO have all cau­tioned against the consumption of high-mercury foods for pregnant women, nursing mothers, and chil­dren. As mercury is considered by the WHO to be one of the top ten chemicals of major public health concern, there are also specific guidelines set forth by the EPA for healthy adults based on weight and gender.

On the list to avoid: tuna, shark, swordfish, mackerel, and tilefish all tend to have higher levels of mercury and should always be skipped while breastfeeding.

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