What Not to Eat While Breastfeeding

By OBGYN Dr. Kenosha Gleaton

If you have chosen to breastfeed your baby, you’ve likely heard a lot of different stories, opinions, and “facts'' about what you can and can’t eat. Luckily, the list of foods to avoid isn’t as long or strict as you might think. Let’s see what the research has to say. 

Benefits of breastfeeding

If you have the ability to breastfeed, it is a beautiful way to nourish and bond with your child after giving birth. Not only does breastfeeding have positive effects on your infant’s health, but it can benefit maternal health as well. Breast milk changes to adapt to your baby’s changing nutritional needs, contains antibodies that help the immune system fight off certain illnesses, and has even been linked to reducing the risk of sudden infant death syndrome and other health problems. [1] Additionally, breastfeeding may reduce the risk of breast and ovarian cancer. [1] That being said, not everyone can or chooses to nurse, and that’s okay! The most important thing is prioritizing a happy and healthy baby and mother. If you are nursing, there are some things you need to know about the nutritional demands. 

Breastfeeding nutritional needs

Dietary needs change during pregnancy and while breastfeeding to adequately support the health of both mom and baby. It’s important that breastfeeding mothers increase their caloric intake by 330 to 500 kilocalories a day, although this number can be impacted by age, activity level, and extent of breastfeeding. [1-2] It’s recommended that these additional calories come from healthy food sources including vegetables, fruits, whole grains, legumes, fish, and other food groups. Not only is the composition of breastmilk impacted by dietary choices, but the production of milk is also influenced by diet and hydration. [3] 

Water intake while breastfeeding

Not only is it recommended to increase caloric intake through a balanced diet, it’s also important to stay hydrated while breastfeeding. A good rule of thumb is to drink a glass of water every time you breastfeed. This may sound like a lot, but breastmilk is about 90% water, and you’re losing about 25 ounces of water in breastmilk alone every day. [4] Water is also necessary for helping dissolve and transporting all the important nutrients you’re getting in your postnatal vitamins and balanced diet. If you’re having trouble staying hydrated or want to drink something besides water while supporting hydration, consider trying breastfeeding safe Magnesium Plus drink mix or Hydration & Energy Electrolyte Drink Mix. 

Vitamins and supplements 

Specific vitamins and minerals are recommended in higher daily amounts for those breastfeeding or newly postpartum. A few examples include iodine and choline, of which the recommended dietary allowances (RDAs) increase to 290 mcg and 550 mg while lactating. [2] These nutrients can be consumed through a diet rich in dairy products, eggs, meat, seafood, beans, and lentils. There are also postnatal vitamins that are formulated to supplement a postpartum diet with some of the necessary vitamins and minerals needed for the health and development of mom and baby. 

What foods to avoid while breastfeeding

Now let’s talk about what foods you shouldn’t eat while breastfeeding. Most of these foods and beverages just need to be limited or managed and don’t necessarily have to be removed from the diet completely. The main exception to this would be if your baby has a severe food allergy, which only occurs in two to three percent of exclusively breastfed children. [5] So, what foods do you need to limit and why? 

Seafood

If you’re a seafood lover, don’t fret. You can still have seafood while breastfeeding, there are actually a lot of very important nutrients in fish, such as omega-3s, iodine, and vitamin D. [6] It is recommended that you limit your weekly intake depending on the kind of seafood you like to eat. [2,7] Most fish contain some mercury which is fine in small amounts, but it can build up over time and be passed through breast milk. High amounts of mercury may have negative effects on the brain and nervous system of yourself and your child. [2] The U.S. Food and Drug Administration has compiled a list of what types of fish are the best choices during pregnancy and breastfeeding as well as what choices to avoid. [7] 

Fish with the highest mercury content that should be avoided include king mackerel, marlin, orange roughy, shark, swordfish, tilefish (Gulf of Mexico), and bigeye tuna. Some of the better choices include crab, shrimp, tilapia, canned tuna, trout, salmon, lobster, and more. See the full list here. The FDA recommends that those pregnant and breastfeeding eat a variety of fish and limit consumption to one to three servings a week depending on the type of fish. [7]

Alcohol

There are a lot of misconceptions about alcohol consumption during breastfeeding. The way alcohol enters and leaves the bloodstream is very similar to how it interacts with breast milk. Levels of alcohol are highest in milk about 30 to 60 minutes after consumption, but can be delayed if consumed with food. [8] Alcohol levels will begin to decrease within a few hours after consumption has stopped. Breastfeeding after consuming alcohol can result in a decreased milk intake and may disrupt the infant’s sleep patterns or cause agitation. [8] Data shows that nursing prior to consuming alcohol and waiting 2 to 2.5 hours per drink to nurse again may help to reduce amounts of alcohol in breastmilk and is unlikely to cause any health problems. [8] There is some evidence that consumption of more than two drinks a day may lead to early cessation of breastfeeding, excessive sedation, fluid retention, and abnormal hormone levels in breastfed infants. [8] You should speak to your healthcare provider directly about your alcohol use when determining how to move forward with breastfeeding or pumping. 

Caffeine

Caffeine consumption is another hotly debated topic when breastfeeding. Most of the data we have suggests that caffeine consumption is safe in low to moderate amounts. [2] About 300 milligrams or less per day (about two to three cups of coffee) haven’t been shown to adversely affect the health of mom or baby. [2] However, extremely high amounts of caffeine (10 cups of coffee worth) have been linked to irritability, poor sleeping patterns, and jitteriness in infants. [2,9] Intake of more than roughly four cups of coffee a day may decrease iron concentrations in breastmilk. [9] It’s also important to note that preterm and young newborns metabolize caffeine slowly, so lower intake levels are recommended. The bottom line is that if you stick to one or two cups of coffee a day, research suggests you are unlikely to cause any negative health effects. [2,9]  Still, it's best to discuss your caffeine intake with your healthcare provider.

Are there any foods I should prioritize while breastfeeding?

In general, a balanced diet full of fruits, vegetables, whole grains, legumes, protein, water, and if approved by your healthcare provider, a postnatal vitamin, will give you all the nutrients you need for postpartum life. [3] If you are vegan or vegetarian, you may be at risk of vitamin B12 deficiency or iron-deficiency anemia. [2] In order to make up for these potential deficiencies, you may benefit from taking specific supplements. A diet high in vitamins and minerals has also been shown to enhance breast milk quality and maintain healthy hair, skin, and nails. [10-11] Some important nutrients to look out for include: [12-15]

• Omega-3: Helpful for neurological development and mood boosting. Can be found in fish (preferably the low-mercury options), plant oils, and nuts.
• Vitamin C: A helpful immune booster for both mom and baby. Vitamin C is found in citrus, bell peppers, berries, tomatoes, and vegetables.
• Vitamin D: Another vitamin found in fatty fish, fish oils, and some dairy products. Taking vitamin D while breastfeeding is helpful for the immune system and building strong bones. 
• Iodine: Supports neurological development and ensures adequate thyroid levels. Iodine can be found in fish, dairy products, and iodized salt.
• Choline: Choline supports cognition and memory in infants and can be found in vegetables, fruits, and whole grains.

Key takeaways

• Breastfeeding has positive effects on maternal and infant health.
• It’s recommended that breastfeeding moms eat additional calories, up to 500 a day, depending on how often they are breastfeeding, their age, body size, and physical activity level.
• Water intake should also be prioritized while breastfeeding to replenish water lost through breastmilk. 
• There are rarely any foods that should be avoided while breastfeeding unless your child has an allergy. It is recommended to limit consumption of caffeine, alcohol, and fish. 
• Fish does have a lot of nutritional benefits, but only fish with lower mercury levels should be consumed one to three times a week. 
• Caffeine and alcohol have not reportedly caused negative health effects when consumed in small amounts, although breastfeeding should be well established before use. 
• Speak to your healthcare provider for specific recommendations on postnatal vitamins and breastfeeding nutrition. 

References:

1. Breastfeeding Your Baby. ACOG. Updated May 2021. URL.
2. Maternal Diet. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. CDC. Last reviewed May 17 2022. URL. 
3. Marshall NE, Abrams B, Barbour LA, et al. The importance of nutrition in pregnancy and lactation: lifelong consequences. Am J Obstet Gynecol. 2022;226(5):607-632. doi:10.1016/j.ajog.2021.12.035
4. Montgomery KS. Nutrition Column An Update on Water Needs during Pregnancy and Beyond. J Perinat Educ. 2002;11(3):40-42. doi:10.1624/105812402X88830
5. New Mother's Guide to Breastfeeding, 2nd Edition. American Academy of Pediatrics. November 2009. 
6. Tørris C, Småstuen MC, Molin M. Nutrients in Fish and Possible Associations with Cardiovascular Disease Risk Factors in Metabolic Syndrome. Nutrients. 2018;10(7):952. Published 2018 Jul 23. doi:10.3390/nu10070952
7. ADVICE ABOUT EATING FISH. FDA. Revised October 2021. URL. 
8. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Alcohol. [Updated 2022 Jan 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501469/
9. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Caffeine. [Updated 2022 Jun 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501467/
10. Bravi F, Wiens F, Decarli A, Dal Pont A, Agostoni C, Ferraroni M. Impact of maternal nutrition on breast-milk composition: a systematic review. Am J Clin Nutr. 2016;104(3):646-662. doi:10.3945/ajcn.115.120881
11. Draelos ZD. An Oral Supplement and the Nutrition-Skin Connection. J Clin Aesthet Dermatol. 2019;12(7):13-16.
12. Korsmo HW, Jiang X, Caudill MA. Choline: Exploring the Growing Science on Its Benefits for Moms and Babies. Nutrients. 2019;11(8):1823. Published 2019 Aug 7. doi:10.3390/nu11081823
13. Azizi F, Smyth P. Breastfeeding and maternal and infant iodine nutrition. Clin Endocrinol (Oxf). 2009;70(5):803-809. doi:10.1111/j.1365-2265.2008.03442.x
14. Aghajafari F, Letourneau N, Mahinpey N, Cosic N, Giesbrecht G. Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review. Nutrients. 2018;10(4):478. Published 2018 Apr 12. doi:10.3390/nu10040478
15. Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients. 2017;9(11):1211. Published 2017 Nov 3. doi:10.3390/nu9111211