Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
5 Jul

Dear Mark: Nursing and the Primal Eating Plan

nursingbabyI’ve received the question numerous times, and last month several readers raised the issue in my “Ask Me Anything” post. For all the innumerable benefits of the Primal Blueprint diet, there are a handful of situations that oblige a few modest accommodations. In the past I’ve suggested Primally-minded adaptations for endurance athletes. Today I’ll take up the question of nursing. Do the long-term, intensive demands of breastfeeding require modification of the typical Primal diet? What special considerations are there for nursing mothers? And what about specific scenarios readers have mentioned: ketones, reflux, ammonia-scented urine? There’s a lot of Primal ground to cover today, so let’s jump right in. But first a reminder that I’m not a doctor and that everything on this site should be viewed as my opinion and not medical advice.

First, a little background. Nature made the nursing process extremely efficient, which is great for baby and potentially not so great for the mother. The body not only prioritizes nutrient intake for breastmilk but in fact scavenges the mother’s stores, leaching calcium from the mother’s bones, for instance. Even under starvation conditions, the body still produces breastmilk with a remarkably nutrient dense profile. As comforting and ingenious as this phenomenon might be, it’s important for mothers to nourish their own health and wellbeing during these months. Although a shortchanged day here and there won’t do much, over time deficiencies can develop – especially if you’re practicing extended breastfeeding. As a result, research suggests that breastmilk displays a remarkably stable nutrient profile regardless of the mother’s food intake. Nonetheless, some nutrient levels are more dependent upon dietary intake because the body simply doesn’t store these in any substantial volume. As a result, optimal nutrition is crucial both for the baby’s development and the nursing mother’s overall health.

In keeping with these substantial needs, the more nutrient dense a nursing mother’s diet can be, the better. Of course, there are those additional 500-700 calories required for breastmilk production. (I remember Carrie being ravenous during those early months of nursing.) Yet specific nutrient needs escalate throughout the exclusive nursing duration as well. With only the basic RDA intake, women can stand to lose substantial bone, muscle and other organ stores.

For a comprehensive breakdown of nutritional secretion in breastmilk as well as RDA comparisons, check out this book from The National Academies Press. The report, for example, illustrates how an average nursing woman who eats only the basic RDA for protein can expect to lose approximately 20% of her lean tissue to cover the nursing related shortage. The most common deficiencies for nursing women are zinc and calcium. Additional “at risk” nutrients include magnesium, thiamine, vitamin E, vitamin D, B6 (especially if mothers have used oral contraceptives prior to conception), and iron (if/after menstruation resumes during nursing). Other nutrients like folate are of concern because the body keeps no ready stores and excretes any excess. In considering ample dietary intake, it’s important to realize that absorption efficiencies vary nutrient by nutrient. Protein absorption, for example, comes in at around 70%. Zinc absorption has been measured at approximately 20% in the general population, but some research suggests a higher absorption rate in nursing mothers.

Now for the carb controversy. When it comes to low carb diets and breastfeeding, the conventional message sounds very familiar: back away or risk great peril. There’s little research on this topic, but rest assured there’s no support for the anti-low carb alarmism. In the absence of modern confirmation, reason and evolutionary precedent can lend context. Prehistorical mothers always breastfed, of course, and there’s no reason to believe their diet was consistently or substantially different than anyone else’s of their time.

Given the impetus toward nutrient density, carb-based foods (like grains) remain relatively poor and unnecessary choices. The nursing mother has greater energy expenditure than she did before; however, her body’s natural metabolism and conversion abilities function just as well if not better. Additional clean protein sources and natural, intact fats not only provide excellent nutritional value for their volume; they offer satiation, a feeling hard to come by in those early post-partum months.

That said, I’m not one to suggest a no- or very low- carb diet during exclusive breastfeeding. Although I know there are plenty of mothers who have successfully done very low carb diets throughout their nursing duration, I generally suggest staying in the moderate carb range (100-150 grams/day) for a number of reasons. Although the presence of ketones, some of which can potentially be passed through breastmilk, might throw off the taste of a mother’s milk, I haven’t read anything to suggest that they compromise the health of the baby. The real issue, I think, with going extremely low carb is nutritional. It’s just flat out difficult to obtain fully rounded nutrition from very low carb diets. Cutting carbs too low generally means doing away with not just sugars and grains but antioxidant rich vegetables and fruits. With the increased needs for vitamins and minerals during nursing, I wouldn’t suggest giving up or cutting back on their best sources. It’s infinitely better, I believe, to get the full scope of nutrition for you and your baby. And though I believe wise supplementation has an important role for modern living, I don’t see supplements as stand-ins for a nutritionally comprehensive diet. A quality multivitamin and mineral supplement as well as additional omega-3 can offer a little extra assurance, but it can’t take the place of a solid diet itself.

Second, I tend to think that weight loss should be pursued carefully and selectively during breastfeeding. If a nursing mother is carrying a substantial amount of excess weight, it’s a reasonable choice to wisely – and Primally – diet once her milk supply is fully established (at very least six weeks but more conservatively twelve weeks’ time). Even in these circumstances, experts generally recommend not going below 1800 calories/day for the sake of maintaining adequate nutritional intake for the baby and basic needs of the mother. I would suggest a bit more as a rule of thumb. Nursing is a time to go a little slower on weight loss, especially because rapid loss can potentially release built up environmental toxins from fat stores. If extra weight is modest or simply pregnancy related, I recommend letting time take its course. Target your eating with healthy Primal fare, but I wouldn’t suggest restricting your caloric or carb intake for quick fat loss. The caloric demands of nursing itself, the moderation of a Primal diet plan and as much regular activity as possible will consistently and safely chip away at the remaining excess pounds.

Finally, to those final specific questions about Primal nursing…. A lot of babies have reflux, and it can sometimes be related to food sensitivities. If it’s a significant or ongoing problem, it’s worth eliminating certain food groups for a couple weeks at a time to see if it makes any difference. Although gluten and dairy get the most attention and warrant initial test runs, you might want to consider doing the same test runs with nuts, nightshades, eggs, citrus and any remaining soy in your diet. Readers might have other tips for sensitivities they’ve discovered. As for the ammonia-scented urine, it’s likely an issue of dehydration. Try adding a couple extra nursing rounds for a few days. The baby won’t take as much in but will get more of the watery foremilk to fill his/her fluid needs. Also, be sure to drink plenty of water yourself during these times. Nursing requires additional water intake, and it can be easy to skimp when you’re balancing the many responsibilities of early parenthood.

Thanks for reading, everyone. Be sure to weigh in with your thoughts, tips and additional inquiries about nursing while Primal. Keep those questions coming, and have a great week!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Finally, I’ve had some questions answered! I’ve been wanting to go low carb while breastfeeding my 12 month old becuase I need to lose weight due to an enlarged heart from the pregnancy. But I’ve been worried the low carbs will affect milk supply, even though my little boy eats mainly primal, he still drinks heaps. I have noticed that when I do give him some bread, his nappies are much messier, and the poo is sticky. When he eats pure primal, I don’t even need to wipe his bottom because it comes out so clean. Has anyone else noticed this?

    Karen wrote on July 16th, 2010
    • Yes, Karen – my son has eaten real food since birth, and his poops are exactly the same way.

      After a week of vacation with my parents (who try to eat healthy, but believe the Food Pyramid over me), my father commented that ds got “my” bathroom woes. Yes, I remember the painful bm’s for years as a child, and yes, ds was experiencing them after a week of insufficient nutrients. And yes, they went away entirely after getting back home and on a “primal” diet again.

      MamaGrok wrote on July 17th, 2010
  2. I’ve been bf’ing for 12 years w/ no more than 3 months off. I’ve been trying to eat the Weston Price way (called primal here) for 3 years, finally succeeding in the last year as I was finally able to kick the sugar addiction.

    Yes, there was absolutely calcium leached from the skeleton – but it was from my children’s! My first child had cavities before she was two, and each child got worse to the point that my fourth lost his front teeth all the way to the gumline as he turned two.

    None of the were allowed to eat sugar, juices, all that stuff. But we followed the Food Pyramid until dc#4 was born. When I changed them to primal diets, all the cavities stopped at once in the oldest three, even though they were different ages.

    The fourth wasn’t so lucky – he was eating almost no solid foods! The only possible explanation (no, it was NOT genetic decay) was that my milk was not the nutrient-dense food source it needed to be. Sure enough, when he weaned at 2 onto a primal diet, his decay stopped and the already horribly decayed teeth became stable and pain-free. He’s 3 and his teeth only ever hurt if we spend time at Grandma’s or it’s a holiday and eating is somewhat compromised. We go back to primal eating and his teeth are happy again.

    The solution, though, is NOT to stop breastfeeding earlier, but to get mamas on better diets. My 5th is nursing from a superbly fed mama, and I fully expect her to end the trend of progressively worse teeth with each child. Price saw a similar trend – large families would have worse and worse health in each child b/c the mother’s nutritional stores were being depleted. He only saw this in modernized families, though – the tribal people on their native diets could have child after child (about every 3 years) and never lose vitality, b/c they always kept the mother well-nourished. In fact, women started a special nutritional program 6 months before marriage that continued until her fertile times were over. Pregnant & nursing women had priority on the most nutrient-dense foods, like roe & organ meats.

    Yes, nursing requires superb nutrition on the part of the mother or someone will suffer – but of course, never as much as if on a diet of HFCS & powdered cow’s milk (formula).

    BTW, I shoot for less than 50gm carbohydrates a day, but I eat tons of veggies. I don’t see how going really low carb means not enough veggies? I eat leftover greens w/ bkfst, big salads for lunch & dinner, and usually a potato and another colorful veggie w/ dinner. But only the potato really jumps up the carb count. The other veggies add very little. And I eat only some berries for fruit about once/day, also adding just a few gm. What am I missing there?

    Lastly, ITA w/ the lactation consultant comments at the top of the comments above, and never force water. I drink only to thirst, which is far less than it used to be when I was eating tons of grains & sugar & processed oils, few or no veggies & fresh fruit, no broth, & doing chronic cardio.

    MamaGrok wrote on July 17th, 2010
  3. I’m just reading this so am so late to post. Have only just started PB a week ago. I had questions about how it would affect nursing so finding this post today was perfect. I’ve lost 7 lbs in 8 days and feel great. I’ve made the decision to have my baby eat primal as well and it is so comforting to see other parents making the same decision since I always feel like a fish out of water at mommy groups when they pull little cheerios and crackers out. I feel so proud of what I’m giving to my daughter by starting her out primal. I cannot even imagine what it would feel like to grow up that was as I grew up eating very processed foods. Thanks, Mark, and Mamas for sharing. It is inspiring.

    Kristen wrote on September 21st, 2010
  4. I’m a nursing mom of a toddler. We have eaten a mostly WAPF diet but are transitioning away from grains and dairy. Even though he eats mainly food and nurses less and less, I find I am hungry all the time. Even with whole milk. Even with lots of fat. I wonder if the carbs just do a number on my blood sugar and I’m really curious to see how longterm addition of more meat eating affects me. Thank you for all the great information here!

    Koko wrote on December 29th, 2010
    • Hi Koko– I submitted a comment before I read your comment. I basically feel the same way (we started with WAPF too, primal just seemed like the next step). I feel like I am hungry all the time. Did you ever get over it by eating more meat? Like you, I’m just wondering if this is my body getting used to less carbs from the occasional grains …

      Jacqueline wrote on May 20th, 2012
  5. Thank you so much! This is awesome. I have been on a Paleo/Primal type diet now for a month and have lost 7 lbs. I wish i had known this stuff when i was nursing. I nursed all my three children for between 15 and 18 months (each one was fed longer, and longer :) If we are blessed with another child, I will continue this diet through the pregnancy and breastfeeding.

    Natalia wrote on June 2nd, 2011
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  11. Has anyone had the opposite results of what seems to be the norm here? I’m nursing my 6 month old and have been Primal for 3 weeks now…with very little weight loss! The only cheat I have (daily) is 10-20 organic dark chocolate covered almonds. I’m surprised and dissapointed to go from wheat/sugar/processed food diet to Priamal without results! I do feel great mentally on this diet though. And I feel great about going grain free and eating organic etc, so I will keep going!
    Any comments or suggestions?
    Thanks all.

    Jenny wrote on February 15th, 2012
    • I am currently nursing my second child (3 months old now) and the weight isn’t coming off very quickly. I’m guessing that our bodies are just not ready to give up that extra weight yet. I’m eating primally about 95% of the time – white rice or some dark chocolate pieces about once a month is my only real deviation. I went primal about 9 months after my first child was born and before that, I couldn’t lose any weight. After going primal at that point, I finally started losing weight and it came off fast. So since I’m still eating primally, and did throughout my pregnancy, I gained less weight this time and have less to lose now (only 15 more pounds to go). I had a rough delivery with hemorrhaging and I’m thinking that might be why my body needs more time before giving up the extra weight.

      Did you have a similar experience with birthing? Any complications? I wonder if there would be a correlation if a study was ever done….

      Amanda wrote on February 15th, 2012
      • Thanks Amanda,
        I did have a rough C-section. She was lodged in my pelvis and they had to reef on her and I pretty hard to get her out. Recovery has been a little longer than expected, I think due to the trauma.
        I’m going to chose to believe that my body isn’t quite ready yet to let go. I didn’t gain much weight during pregnancy and was at pre-preg weight (due to post partum Hyperthyroid) when I started primal. I have about 50lbs to lose still. This weight has been on my body for 5-10yrs. It’s really stuck on there I guess! :) Like I said, I feel great about eating primarily regardless of the weight. I’m pretty confident it will come off in time. Also, there could posibly be an issue with Hypothyroid now. Seeing some Docs to figure it all out.

        Jenny wrote on February 15th, 2012
      • I’m not really losing weight either… :( not sure why

        jc wrote on July 12th, 2012
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    Joanne Slackman wrote on April 20th, 2012
  13. I just wanted to share that I just started to go primal in an effort to lose weight. My baby is 7 months old and I am 90% still exclusively breastfeeding. I fortunately have a Pediatrician that is focused on the holistic well being of both mother and child although she takes a vegetarian stance. My first son 8 years ago had terrible colic. He would cry for hours on end. This one did too until we figured out the culprit. Milk. As soon as I got off of milk all problems went away. Now I can have a little in my coffee here and there with no side effects. I’m hoping to reach my weight loss goals with primal soon as I have been following various programs in the last 4-5 years (since I put on a substantial amount of weight 40lbs). Nothing has worked. I’ll keep you informed of my progress.

    Carol Anne Schmidt wrote on May 19th, 2012
  14. Hi all! I’m still nursing my 11 1/2 month old on demand and since I started this about two weeks ago (we basically already ate primal in our house with a focus on grassfed beef, fish, raw dairy, veggies and some fruit, but over the last two weeks have completely rid ourselves of lingering grains (quinoa and buckwheat) and refined sugar (no more morning coffee.) I’ve noticed I’m losing weight fast, probably too much weight for me. I am 5’7″ and was 124 at a check up two weeks ago and I can feel I’ve probably lost another 3 or 4 pounds … I walk about 5 hours a week with the baby, do yoga and squats and swim … any suggestions to increase my calories? Would more carbs be a good idea? (I LOVE POTATOES AND BANANAS, basically love starchy sides, but I don’t want to overdue it.) Thanks!!

    Jacqueline wrote on May 20th, 2012
  15. Awesome job! I am breastfeeding my 15 month old son, and primal eating has definately done us no harm. Mama and baby are healthy, supply is abundant and we are boththriving.

    I have to commend you for writing such a thoughtful article. There is bad breastfeeding information everywhere, especially in regards to nutrition. Many women give up breastfeeding and result to formula because of this epidemic of misinformation. Kudos for staying up to date and keeping even the littlest of Groks in mind :)

    Whitney wrote on July 5th, 2012
  16. Great post! I though I had read this a few months ago but it felt new to me. I’m an extended-BF’d my almost 3yo.

    I was diagnosed with Hashimoto’s Thyroiditis about a year ago. Then I come to find a few weeks back that I am Vit. D deficient. I am on no medication for the thyroid because I was told I am in the “normal” range. I had many hypothyroid symptoms but was told medication won’t help. When I did try levothyroxine, it caused anxiety, excessive sweating and insomnia! So I’m off that now and trying some selenium supplements.

    I went mostly (90%) primal/paleo since last April. I will say, I feel great. A lot of my hypothyroid symptoms seem to be gone.

    But the major issue? Weight loss. I’m considered obese at 219 pounds, 5’5″. I do feel like my body is changing, but not much. I’ve considered restricting carbs but notice when I do, I get moody and crave junk. So it makes me think, I need the extra carbs.

    Would it be correct to say that because of the female body being SO efficient at making sure breast milk– that the body will even HOLD ON to any extra weight in response to any attempt at weight loss? I’m so frustrated by this. I thought I’d post the question. It’s probably my faulty thyroid, I realize but here it is!

    TillyMonstar wrote on September 11th, 2012
  17. I’m so grateful for this article and this website.

    My two month old is allergic to pretty much everything right now…

    If I eat meat and veggies he’s okay. If I eat nuts, eggs, potatoes, or pretty much anything else he breaks out in hives and his face starts swelling up and he gets sick to his stomach…

    I am struggling with milk supply issues at the moment, but I think I’m also figuring out what I can eat and how much more I need to eat to get the calories needed, so I’m hoping that will resolves itself in the next few days.

    Cam wrote on January 27th, 2013
  18. I have a 3.5 month old who is exclusively breastfed. I’ve always tried to east healthy and exercised up until the day I delivered naturally. My husband encouraged me to eat paleo after he had so much success with it. Since he cooks, I was eating about 50% paleo during pregnancy and after delivery but I still ate too mucg wheat and dairy. My baby had a lot of reflux and painful gas so I cut out all of the wheat and only eat trace amounts of dairy.

    Here’s the bottom line: My milk is incredibly rich. Our healthy newborn started at 7.1 lbs and now weighs 18 lbs at 3.5 months (this is above the 95th percentile). Since my milk is very rich while eating now 80% paleo, I’ve had zero supply issues and the baby has much less gas. She doesn’t need 34 oz of milk like my vegetarian or SAD diet friends. She takes in 28 oz per day of milk that looks like butter when I pump and store it in the fridge.

    Take you vitamins, eat paleo, strength train, take walks outside, breastfeed and enjoy seeing you baby thrive.

    Amy wrote on January 28th, 2013
    • And forgive my two spelling errors. One-handed typing while nursing!

      Amy wrote on January 28th, 2013
  19. Breastfeeding mothers tend to lose bone density but this is minimised by weight-bearing exercise like… er… carrying your baby around! Those baby carriers are not just nice for baby, they’re beneficial to mothers too.

    Vicky wrote on April 3rd, 2013
  20. I just wanted to say that my husband and I started the Paleo diet right after our baby was born. It was his idea because he had some weight to lose and really wanted to get the junk out of his diet and start eating whole foods. I was a little nervous about starting it, but I can now say that my son is 4 months old and I’ve lost all 40 pregnancy pounds (at 3 months) and am still going strong with breastfeeding. I plan to do extended breastfeeding til at least 2 years. I eat lots of fatty meats and nuts to keep my energy up and drink tons and tons of water. It’s the protein and water that really keep up your supply. We are now getting ready to start introducing solids to our baby and I’m so excited to have him be on Paleo too!

    Brooke wrote on April 10th, 2013
  21. Just wondering if any of you could offer advice? My wife’s milk supply was extremely low and our Lil boy was a big baby eating a lot. Whether she could have done anything different or not she gave up breast feeding at 11 months and her supply is gone now.

    Our son is now 15 months. I am trying to make sure all his solid foods are primal foods. My question is this, should I continue feeding him formula?

    I don’t believe he is ready to get all his nutrition from solids. Should I do raw goat’s milk, or some other alternative? I would appreciate the feedback. Thanks.

    Ryan wrote on July 31st, 2013
  22. I didn’t read all the comments to see if someone else pointed it out, but ammonia scented “urine” could just be stinky build up in cloth diapers. Cloth diapers sometimes need a more thorough deep cleaning and sunshine, but this isn’t the place to get into that! As a new mom, ammonia-scented diapers can certainly add to the worry of “Oh jeesh, what did I eat (or not eat!) that caused THAT?!”

    Jennifer L. wrote on October 15th, 2013
  23. Great article here and great comments from the readers. One question I have for all the readers, and Mark, is whether they have seen a change in the baby’s weight gain because of primal eating? My daughter, currently 10 months old, experienced a slowdown in weight gain around the same time that I started primal eating. I’m wondering if others have had the same issue. I’m also wondering if other primal babies are scoring low on the growth charts since they are not eating grains and other filler foods.

    Many thanks!

    Laura wrote on October 17th, 2013
  24. Hi,
    I have to thank you for increasing awareness about this issue. I was a new mother with worries about my supply when I got my diagnosis for Celiac disease. Now I feel much better and my toddler has continued extended nursing (with an increase in supply) as a result of going off the standard American diet and towards a whole foods, paleo diet. I also never thought I would take cod liver oil daily, but it isn’t so bad. Based on my experience, I would encourage new mothers to be concerned with their own energy level/nutrition and not just food quantity for weight loss/milk supply. The body will tell you if you listen.

    Margo wrote on December 2nd, 2013
  25. My kiddo had tongue tie. I suffered for a month with black & blue (BLEEDING!) nipples before I finally broke down and had him snipped. It changed the entire breastfeeding experience! Before I’d only been hanging on because I was stubborn. Once my chest healed up breastfeeding was a JOY! If/when I have another baby I’m going to have them check for tongue tie right away and have it taken care of asap rather than suffering the way I did. The pain almost made me stop breastfeeding… only my determination that MY BABY WOULD EAT BREASTMILK kept me going through 12 sessions of agony every day.

    Katie wrote on July 7th, 2010

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