Divine Mamahood

There's Sugar, Then There's Sugar - Understanding the difference between sucrose and fruit sugar February 02, 2013 00:00

All sugar is not created equal. 

Understanding the difference between refined white and brown sugar and the natural sugars found in fresh, cooked, or dried fruits and vegetables is essential to making healthy food choices for you and your children.

How Refined Sugar Hurts Your Body

Refined sugar, scientifically known as sucrose, is composed of fructose and glucose molecules.  When you eat something containing this kind of sugar, like a candy bar or soda, you feel an instant rush.  Why?  Because of how the body metabolizes sucrose. 

When you consume sucrose, your body instantly releases insulin to combat the rapid rise in glucose levels.  Insulin's job is to help cells absorb the glucose and store it as fat for when your body needs energy later.  Because the sucrose  is introducing pure glucose into the body, the amount of insulin produced is overwhelming.  Your liver and muscles can store some of it, but much of it will get converted into fat, your body's energy storage facility.

While that burst of energy provided by refined sugar might be good for someone performing incredibly strenuous activity, like a firefighter running up several flights of stairs or an athlete preparing for a race, for most of us it just starts a vicious cycle of insulin resistance and sugar cravings.  Insulin resistance causes cells to say, “Whoa, no more glucose.”  Since the cells aren't opening their doors, the body actually produces more insulin to try to stabilize glucose levels. 

The bottom line is that high insulin levels build fat.  That's why refined carbohydrates and table sugar, as well as high fructose corn syrup, make you fat even when they are fat free.  Of course, this type of insulin regulation disorder can eventually cause Type 2 Diabetes and possibly affect heart function.

It doesn't stop there.  Insulin plays an important role in regulating brain function.  An inability to properly process insulin can potentially lead to psychological disorders like depression, anxiety, and memory loss.  Did you ever eat a pint of ice cream because you were depressed, only to have it make you feel even more depressed?  I'm not saying that the results are that instant, but the long-term correlation is there and being studied more thoroughly by mental health researchers.

Sucrose and Breastfeeding

While many nursing mothers crave sugar, it's better to grab an apple than a slice of cake.  When your blood sugar spikes as a result of eating something filled with sucrose, your nursing baby's blood sugar will spike, too.  Babies are not well-equipped to manage blood sugar spikes, and the unstable insulin production can interrupt the development of healthy physical and cognitive function.

The high levels of sugar in the breast milk can also cause early tooth decay, according to the Australian Breastfeeding Association.  This is especially true for babies nursed longer than twelve months.  Breast milk with high sugar content also increases the risk of thrush, a yeast infection caused by the high acid levels present in sugar.

Why is Natural Sugar Better?

The natural sugars found in fruits and vegetables have a different chemical makeup.  Fruit sugar is simply fructose, which must be broken down into sucrose and glucogen by the pancreas before it can be used as energy or stored in the fat cells.  This is why natural sugars rank lower on the glycemic index than sucrose.  It takes your body time to turn natural sugar into glucogen to be used by your cells, so  insulin doesn't have to rush in to balance suddenly high glucose levels.

When you consume healthy amounts of natural sugars from fruits, your body doesn't need to spike its insulin production.  Just as high levels of insulin are directly related to weight gain, low levels of insulin help keep you lean.

Furthermore, it's widely recognized among the medical community that eating lots of fruits and vegetables keeps your heart healthy, your blood pressure and cholesterol down, and your mind clear.  Not only is fructose a healthier form of sugar, the fruits and vegetables also provide essential vitamins, minerals, and fiber that a spoonful of sugar will definitely not give you.

Satisfying the Sweet Tooth

Even' the healthiest people want to indulge in a little something sweet once in a while, and in fact those cravings are your body's way of telling you it needs energy!  But don't fuel it with calories that aren't just empty, but potentially dangerous to your health.  Instead, appease your sugar craving with healthy alternatives like dates, dried cherries, dried apricots, coconut, nut butters, and a nearly unlimited variety of fresh fruits and vegetables. 

 

Once you switch to these healthier alternatives, you'll start to notice that sucrose-based desserts like ice cream, candy bars, and cookies taste sickly sweet.  Instead, you'll crave apples and almond butter, and your body will thank you for it.

 

 

 

 RESOURCES:

Turner, Joel.  Sugar's Negative Effect on Our Brains.  Kale University. 17 May 2012.http://kaleuniversity.org/6231-sugars-negative-effect-on-our-brains/

Griffin, Sharon.  The Effects of Sugar on Breastfed Babies.  Livestrong.  28 March 2011.http://www.livestrong.com/article/69073-effects-sugar-breastfed-babies/

Ketterer C, Tschritter O, Preissl H, Heni M, Häring HU, Fritsche A. Insulin sensitivity of the human brain. Diabetes Res Clin Pract. 2011 Aug;93 Suppl 1:S47-51. doi: 10.1016/S0168-8227(11)70013-4. Review. PubMed PMID: 21864751. http://www.ncbi.nlm.nih.gov/pubmed/21864751

National Institute of Mental Health:  Diabetes and Depression. PsychCentral.http://psychcentral.com/lib/2008/diabetes-and-depression/all/1/

Effect of Fruit and Vegetables on Insulin Resistance.  NIH Clinical Trial.http://clinicaltrialsfeeds.org/clinical-trials/show/NCT00874341

 

 


Medications and Breastfeeding Mothers January 22, 2013 16:25

Below are some of my favorite go-to resources for research on Medication Use for Breastfeeding Mothers. 

First, it's important to know how medications are categorized to better decipher the literature.  Below are the Lactation Risk Categories.

L1 SAFEST:
Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.
L2 SAFER:
Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.
L3 MODERATELY SAFE:
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.
L4 POSSIBLY HAZARDOUS:
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
L5 CONTRAINDICATED:
Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Online Drug Databases and Resources

Breastfeeding Pharmacology – Dr. Hale, Professor of Pediatrics, is a renowned Breastfeeding Pharmacologist and the author of Medications and Mothers' Milk

LactMed from the National Library of Medicine-

A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.

Here's a shortcut to the massive database - just enter the medication in question below:

 

Drugs in Pregnancy and Breastfeeding– Perinatology.com – has a great list of scholarly and professional resources

Breastfeeding and Maternal Medication- great PDF file with detailed information and summary of research from the World Health Organization

Summary of Antidepressant Use in Breastfeeding Mothers- a keynote address by Thomas Hale, PhD at the LLL of Illinois Area Conference, Bloomingdale, IL, October 23, 2002 - summarized by KellyMom.com

Help Lines

 

Mother Risk(phone 416-813-6780) - at The Hospital for Sick Children in Toronto, Ontario, Canada. Call or visit their website for evidence-based information about the safety or risk of drugs, chemicals and disease during pregnancy and lactation.

Breastfeeding and Human Lactation Study Center at The University of Rochester in Rochester, NY, USA. This center maintains a database of drugs and medications and provides free information to physicians and lactation consultants on their use and effects during breastfeeding. Ruth A. Lawrence, MD is the Director of the center.

Drugline (phone 0844 412 4665) at The Breastfeeding Network, Paisley, Scotland. Call the Drugline for information on taking prescription drugs while breastfeeding, or visit their website for handouts on drugs and breastfeeding.

Herbs

Like traditional medications, herbs also have risk categories:

source: The Nursing Mother’s Herbal by Sheila Humphrey, BSc, RN, IBCLC

A
No contraindications, side effects, drug interactions, or pregnancy-related safety issues have been identified. Generally considered safe when used appropriately.
B
May notbe appropriate for self-use by some individuals or dyads, or may cause adverse effects if misused. Seek reliable safety and dose information.
C
Moderate potential for toxicity, mainly dose related. Seek an expert herbalist as well as a lactation consultant before using. Consider safer herbs.
D
Use only with the supervision of a knowledgeable physician. Consult with a lactation specialist before use. These herbs are used to make prescription medications. The pharmaceutical forms may be safer in most instances, but not always. Do not use these herbs without the guidance of a supervising physician. Consider using safer herbs.
E
Avoid. Toxic plant with no justifiable medical use.

It is possible for anyone (mother or baby) to have an allergic reaction to just about anything. Watch your baby closely for any adverse reactions if you take any herb or medication.

Keep in mind that most herbal treatments have not been thoroughly researched, particularly in regard to lactation. “Natural” substances are not automatically safe! Herbs are drugs, so it is necessary to use caution when using them.

Here are some suggestions for nursing moms when considering herbal remedies, from Ruth A. Lawrence, MD (author of Breastfeeding: A Guide for the Medical Profession):

  • Avoid the pharmacologically active herbal teas. Drink any herbal teas only in moderation.
  • Limit intake of any herbal preparation that combines several active ingredients.
  • Always check the label. Even vitamins and simple echinacea may contain herbs that should not be used by breastfeeding mothers.
  • Use only reliable brands that have ingredients and concentrations clearly marked on the label, as well as the expiration date and the name of the manufacturer and distributor.
  • Be sure to check with your physician before taking any natural remedy, since it could interact with other medications you take or need.

    Source:Herbs and Breastfeeding by Ruth A. Lawrence, MD

Other Herbal references:

Herbal Galactagogues from wildroots.com

National Institutes of Health: Office of Dietary Supplements

The information presented here is not intended to diagnose health problems or to take the place of professional medical care. If you have persistent medical problems, or if you have further questions, please consult your doctor or member of your health care team.


How Medications Affect Breastmilk January 20, 2013 21:26

At the pharmacy, I get a lot of questions about medications while breastfeeding.  While it is always safest to avoid medications while breastfeeding, sometimes mothers are left without a choice if their condition puts their own health at risk.  Although many medications are safe to use when you're breastfeeding, most drugs will get into your milk to some degree and may even affect your milk supply. To be safe, check with your child's doctor before taking any kind of medication, even over-the-counter drugs.  The mechanism of how drugs enter breast milk is described below in addition to some general guidelines that I follow when counseling my patients.

Transfer of drugs into breast milk is influenced by protein binding, lipid solubility and ionization

This sounds pretty scientific but basically this means that nearly all drugs transfer into breast milk to some extent.

Notable exceptions are heparin and insulin which are too large to cross biological membranes. The infant almost invariably receives no benefit from this form of exposure and is considered to be an 'innocent bystander'.

Drug transfer from maternal plasma to milk is, with rare exceptions, by passive diffusion across biological membranes. Transfer is greatest in the presence of low maternal plasma protein binding and high lipid solubility.

In addition, milk is slightly more acidic than plasma (pH of milk is approximately 7.2 and plasma is 7.4) allowing weakly basic drugs to transfer more readily into breast milk and become trapped secondary to ionization.

What you should know is that milk composition varies within and between feeds and this may also affect transfer of drugs into breast milk. For example, milk at the end of a feed (hindmilk) contains considerably more fat than foremilk and may concentrate fat-soluble drugs.

As a general rule, maternal use of topical preparations such as creams, nasal sprays or inhalers would be expected to carry less risk to a breastfed infant than systemically administered drugs.

This is due to lower maternal concentrations and therefore lower transfer into breast milk.

However, the risk to the infant must be considered in relation to the toxicity of the drug used, the dosage regimen and the area of application. For example, use of corticosteroids nasal sprays or inhalers in standard doses would be considered compatible with breastfeeding.

Infants have lower drug clearance (elimination) than adults

Drug clearance in the infant is a particularly important consideration and premature infants have a severely limited ability to clear drugs.

Within a few days of delivery, term infants have kidney filtration rates approximately one-third of adult values after adjusting for difference in body surface area, and premature infants have even more impaired clearance.

Generally, adult kidney filtration rates (adjusted for the difference in surface area) are attained by five to six months of age.

Minimize risk to the breastfed infant by reducing drug exposure

The overall risk of a drug to a breastfed infant depends on the concentration in the infant's blood and the effects of the drug in the infant. If, after assessment of the risks and benefits, the decision is made to breastfeed while the mother is using a drug, the infant should be monitored for adverse effects such as failure to thrive, irritability and sedation.

However, it is difficult to identify adverse reactions occurring in neonates. 

Feeding immediately prior to a dose may help to minimize infant exposure as concentrations in milk are likely to be lowest towards the end of a dosing interval.  Or,it may be reasonable to reduce infant exposure by alternating breast and bottle-feeding. For drugs that are not considered safe in breastfeeding, breast milk may be expressed and discarded for the treatment duration. Breastfeeding may be resumed after the drug has been eliminated from the maternal blood stream. A period of approximately four half-lives (the time it takes for half of the drug to clear the body) will reduce maternal concentrations to around 10% of steady-state (full) concentrations.

Atkinson HC, Begg EJ, Darlow BA. Drugs in human milk. Clinical pharmacokinetic considerations. Clinical Pharmacokinetics 1988;14:217-40.

Bennett PN and the WHO Working Group, editors. Drugs and human lactation. 2nd edition. Amsterdam: Elsevier, 1997.

Infantrisk.com

 


Breastfeeding Aids: Herbs and Milk Supply January 05, 2013 00:10

Mothers who are nursing for the first time are often concerned about the amount of milk they produce. Some mothers worry that they don’t produce enough to satisfy their baby while others wonder what to do with all their extra milk.  In addition to including lactogenic (milk-producing foods) in a well-balanced diet, sometimes the use of herbs can also help to boost and maintain an abundant milk supply.  A lot of mothers worry about taking supplements that might harm their infant. Simple remedies available at home or at most health food stores can help put these worries to rest.

 

Mothers need only look as far as the kitchen sink to help keep their milk flowing.  It is easy to become dehydrated when breastfeeding a hungry newborn. A nursing mother needs to be aware of her thirst and consciously drink water throughout the day to replace the liquid the baby draws from her. Simply staying hydrated will help milk production.

Nursing mothers have used herbs for centuries and they are usually considered safe alternatives that can help nursing mothers keep up their milk production. As always, consult a health care professional before taking any new supplement. Using the wrong herbs or using herbs in the wrong way can cause undesirable side effects.

Galactagogues are herbs that are used to increase the milk supply. These herbal remedies may come in a liquid tincture, tea or pill form. Mothers may need to take these natural aids for up to two weeks to see an affect.

Relaxing with a cup of warm tea can be soothing and help ease milk letdown. Chamomile tea is said to have a calming affect while red raspberry tea can stimulate milk production. Fenugreek is perhaps the most well known galactagogue. It is taken alone or in combination with other herbs to increase milk supply. Taking Fenugreek can result in a slight maple odor in the urine. Caraway, Blessed Thistle, and Brewer’s yeast can also be used to boost milk supply. Aniseed can aid in milk production and promote healthy digestion.

If herbs don’t seem to increase milk production, try using a breast pump for 5-10 minutes after the baby is finished feeding. This additional stimulation will help mothers produce more milk. Mothers can save the pumped milk, store it in the freezer, and have plenty of milk for their baby when return to work.

Mothers who have an overabundance of milk or choose to stop breastfeeding may also seek an herbal aid. Sage is the herb of choice for mothers who wish to decrease or stop their milk supply. Taking sage is reported to help dry up a mother’s milk. Sage can be drunk in tea form or consumed in a liquid tincture available from health food stores.

Most nursing mothers will find they have sufficient milk to feed their new babies. For those who feel they need a little help, natural remedies can provide safe, attainable answers. 


Pregnancy to Childbirth to Motherhood and so on - The Importance of Self-Care During Times of Transition December 30, 2012 22:00

Any major life change is bound to stir up some feelings of insecurity and fear for us. Ironically, this often occurs even when we’re transitioning into a much better situation than the one that we’re leaving behind. Familiarity has a way of bringing us a degree of comfort even when it’s unsatisfying. New situations, on the other hand, require many personal adjustments – even when they may promise us greater happiness. They may involve us with life changes that we can’t even foresee as the onset.

For this reason, it’s crucial that we provide ourselves with adequate self-care during times of personal upheaval. Sometimes our inner equilibrium can be disrupted in such a subtle way that we don’t even recognize it. If all of our time is filled with frantic activity, this disturbing influence, gone unrecognized, can strongly affect our mood and energy level. We may find ourselves feeling irritable, angry or depressed for no reason that we can discern.

We feel emotionally sapped because some parts of us aren’t being fed – even though we’re excited about the changes that we’re making in our lives. This can be prevented if we allow ourselves some down time during this busy transition. This means time during which we let go of the concerns of the outer world and pay attention to our inner life. Many of us will do this instinctively when we’re feeling stressed. There’s a wide array of things that people use to help create sacred space, forms of sensory input that help us to shift our focus away from the world and back to our innermost thoughts and emotions.

These can include music, painting, yoga, nature walks, time spent with pets and/or plants, pleasure drives with no destination, etc. Each of us will have to find methods that resonate with us personally. What’s crucial, however, is that we preserve time for our sacred space once we’ve discovered our preferred ways of creating it. In the results-driven culture that we live in, it can be easy to slip into the habit of thinking that such forms of rejuvenation are “indulgences”.

On the contrary, self-care is as necessary to our well-being as exercise or nutrition. Without it, we’re bound to start feeling unable to function, or to be nearly as productive as usual, anyway. What’s more – and this is particularly true when we’re in the midst of major life changes – we’ll lose much of our capacity to enjoy the fruits of our labors.

Any sort of transition in our lives can leave us feeling displaced for a period of time. It’s important that we find certain touchstones that can be emotionally nurturing for us as we strive to get settled into our new situations. Self-awareness becomes even more crucial when the demands of the outside world press upon us insistently. Knowing what will bring us mental refreshment and emotional rejuvenation – and giving such activities high priority – is the essence of good self-care during such times. It can steer us clear of potential burnout, and help us to focus upon the excitement that we feel about the adventure we’re embarked upon rather than the short-term discomfort that it may bring.


Returning to Work or School while Breastfeeding Your Baby - Some tips for Success December 28, 2012 21:23

Congratulations on your decision to provide the best possible nutrition and protection for your baby after returning to work or school! Here are some tips to help you succeed.

Combining breastfeeding with work or school is challenging, but well worth it. The health and immunity benefits your little one gets from your breast milk cannot be matched by formula. And sitting down to cuddle and nurse after a busy day is a wonderful way to de-stress and reconnect with your baby.

Two keys to success are planning and being organized. Below are tips that other mothers have found helpful, as well as information about the federal law to support breastfeeding mothers at work.

What should you do before you deliver?

Before you begin maternity leave:

 

  • Find out how much time you will be able to take off from work or school after you deliver. 
  • Take as much family leave as you can to have more time with your baby.  Research your options for returning to work or school.  Can you work/study part-time for a while?  Can you telecommute or use distance learning? Is there a more flexible work or school schedule you can try? 
  • Talk with your supervisor. Will he/she be supportive? You may want to point out the company advantages of having breastfeeding employees: 
    • »  Less time lost from work because breastfed babies tend to stay healthier than their formula fed counterparts.
    • »  Fewer health expenses for the baby and lower overall health care 
         costs. 
    • »  Higher employee satisfaction, morale and productivity and lower staff 
          turnover. 
    • »  Major recruitment incentive for new employees. 
    • »  Reputation as a company concerned for the welfare of working 
          mothers and children. 
  • When making arrangements for childcare, choose a provider that supports your wishes to provide pumped breast milk to the baby while you are away and allows you to nurse your baby as soon as you return. 
  • Be aware of the laws regarding employees who are breastfeeding. On March 23, 2010, as part of the Patient Protection and Affordable Care Act, a federal law amending Section 7 of the Fair Labor Standards Act (FLSA) (29 U.S.C. 207) was passed. This law mandates break times for breastfeeding mothers to express milk.
  • Find out where you will be expressing milk for your baby. Does the room have an electrical outlet? Is there a refrigerator nearby? If not, you may want to purchase a pump with rechargeable battery back-up and an insulated cooler with ice packs (blue ice). Is there a sink available to wash breast pump parts between pumping sessions?
  • If not, is there a microwave handy to steam clean the parts? If not, you may want to purchase wipes you can use to clean the parts.

What should you do before you return to work or school? 

  • Learn how to manually express breast milk, even if you plan to use a breast pump.
  • Become familiar with your breast pump. Practice setting up your pump and putting the parts together. Try it out. Adjust the settings so that the speed and suction are as close as possible to how your baby nurses.
  • About two or three weeks before returning to work or school, begin pumping once each morning about an hour after you have nursed your baby. (Prolactin levels are highest in the morning.) You may not get any milk during the first couple days, but you are sending a message to your body to begin increasing your milk supply.
  • Gradually add two or three more pumping sessions between feedings. Once you start to get milk, store it in the freezer for emergencies. Store expressed or pumped milk in small amounts, two to four ounces. 
  • Introduce the bottle to your baby two or three weeks before you go back to work or school. It may be easier to have someone else offer the bottle, since your baby links you with breastfeeding. Try to use the newborn-sized nipple for as long as you breastfeed, but you may have to experiment to find one your baby likes. 
  • Consider buying a “hands-free” nursing bra that allows you to use your hands while you are pumping milk.
  • It may be helpful to schedule a practice day. Set your alarm for the time you will be getting up when you’re working or attending class. Take your baby to childcare for at least part of the day. Breastfeed and pump at the times you expect to during work or school. At the end of the day, see if your baby drank as much as you pumped.
  • The evening before your first day back, pack the diaper bag and your pump bag. (See packing lists below.) Include an extra blouse or sweater that you can leave at work in case of a milk leak that soaks through breast pads.

What should you do when you return to work or school?

  • Be prepared. Your first day back at work or school may be very emotional. Try to start on a Wednesday or Thursday. Easing back into the work or academic world by starting with a shortened week will be less stressful. 
  • Breastfeed your baby when you wake up, then give him/her a “top-off” when you get to childcare.
  • Your baby will need at least two to three bottles while you are away, so you will need to pump at least two to three times during the eight or nine hours you are at work or school. (If you have a longer work day or longer commute, you will need to pump more milk.) This is the milk that will be given to your baby the next day at childcare. 
  • You may have an easier time having a let-down reflex if you look at a picture of your baby or have a piece of clothing handy that smells like your baby. Pack these in your pump bag. 
  • Clean pump parts that come into contact with you or your milk. Read the instructions that came with your breast pump. Between pumping sessions you may: 
    • »  rinse with cool water, then wash with warm soapy water and leave out to air dry, 
    • »  wipe with a sanitizing wipe sold by pump manufacturers, 
    • »  rinse parts well and store in the fridge or your cooler, and 
    • »  alternate options above throughout the day. For example, rinse and store in fridge after the morning pump session and wash in warm soapy water after the lunchtime pumping session. 
  • Some women prefer to purchase several extra sets of pump parts so they do not need to clean parts while at work or school and just put everything in the dishwasher at night. 
  • Breastfeed again as soon as you and your baby are back together. You can discuss your baby’s day with your childcare provider during this time. Let the mothering hormones that are released during breastfeeding help you relax and bond. 

1 Bridges CB, Frank DI, Curtin J. Employer attitudes toward breastfeeding in the workplace. J Hum Lact. 1997;13(3):215-219 

Resources 

Books

  • Working without Weaning: A Working Mother’s Guide to Breastfeeding (2006) by Kirsten Berggren 
  • Milk Memos: How Real Moms Learned to Mix Business with Babies-and How You Can Too (2007) by Cate Colburn-Smith and Andrea Serrette 

Websites 

  • www.workandpump.com
    Has many helpful tips for managing the transition back to work 
  • www.usbreastfeeding.org
    Has information on new legislation that relates to breastfeeding 

The information presented here is not intended to diagnose health problems or to take the place of professional medical care. If you have persistent medical problems, or if you have further questions, please consult your doctor or member of your health care team. 

 


Over-the-Counter Medication Use While Breastfeeding December 20, 2012 22:20

Working as a pharmacist, it is not uncommon for me to get several questions throughout the day from breastfeeding women about the use of over-the-counter medications.  Most medications can be detected in breast milk in small amounts (about 1% to 2% of maternal intake), but  very few are contraindicated while breastfeeding.  Adverse reactions from drug passage into breast milk is more likely in nursing infants <2 months old. 

In general, the safest thing to do when an over-the-counter medication may be needed is to try nonpharmacologic symptom management first. If all else fails, then medications can definitely be considered to use, it’s just important to know which ones are safest while breastfeeding. As always, nursing mothers should consult a health care professional before starting any medication.

A drug’s characteristics determine how much of it will be transferred into the breast milk. These include the molecular weight of the drug, the proportion of drug that is bound to plasma and milk proteins, the solubility of the drug in lipids and in water, the proportion of the drug that is ionized or nonionized, the pH of the drug, and the half-life of the drug. The lower the molecular weight, the easier the drug passes into the milk. Low protein binding drugs will more readily pass through to breast milk. Lipid soluble drugs rapidly accumulate in the breast milk. Drugs that are weak bases would be more likely to cross the membranes from plasma into breast milk. The longer the half-life of the drug, the greater the accumulation will be in the mother, in the breast milk, and in the infant.  Aside from potential adverse effects in the infant, some drugs may decrease milk production.

According to the American Academy of Pediatrics Committee on Drugs, to minimize a nursing infant’s exposure to maternal drug, breastfeeding women take oral medications immediately after nursing or just before the infant’s longest sleep period.  As a pharmacist, I recommend single ingredient products at the lowest dose possible. Try to avoid using extra strength, maximum strength, or long-acting formulations. In addition, avoid alcohol-containing formulations when possible or avoid frequent or high doses of alcohol-containing formulations. Breastfeeding women should also be sure to watch for any possible side effects that may occur.  As a last resort, breastfeeding may be withheld during the period of drug therapy if the drug is contraindicated.

 

Analgesics

Many OTC options for analgesics are available. Acetaminophen is routinely used for fever and pain in infants, and levels excreted into breast milk are expected to be less than the dose given to infants.

Of the NSAIDs, ibuprofen is considered the drug of choice for breast-feeding women and is used routinely in infants. While ibuprofen is excreted into breast milk, the concentration and subsequent transfer to the infant are very low.Naproxen should be used cautiously in breast-feeding women due to its long half-life. Alternative therapeutic options are recommended; if aspirin is taken, the mother should avoid breast-feeding for one to two hours after the dose.

 Allergy, Cold, and Cough Preparations

Antihistamines: All OTC antihistamines are known to be excreted in breast milk, and their sedating effects may also be seen in infants. While it is known that diphenhydramine is excreted into breast milk, the concentration and infant transfer are unknown. Clemastine is a long-acting antihistamine that should be used cautiously due to its association with significant effects on infants, including irritability, refusal to feed, and neck stiffness. All of the sedating antihistamines have the possibility of causing sedation in the infant and/or decreasing milk supply, especially when taken in conjunction with a decongestant, and should be used with caution.

Currently, the only nonsedating OTC antihistamine that is available is loratadine, which is excreted in breast milk. However, concentrations in the infant are low and considered safe. Due to its nonsedating effect, loratadine is the preferred antihistamine.

Decongestants: The two OTC oral decongestants available are pseudoephedrine and phenylephrine. Due to new regulations regarding the sale of pseudoephedrine, many cough and cold preparations have reformulated their products to contain phenylephrine. 

Phenylephrine, an ingredient in pediatric cough and cold preparations, is considered safe. While excretion into breast milk is unknown, it is unlikely to be excreted into breast milk in large quantities due to its poor bioavailability. The effect of phenyl­ ephrine on milk production and supply is also unknown; therefore, this medication should be used with caution in women with limited milk production.  Pseudoephedrine is excreted in breast milk and has been shown to decrease milk production and possibly cause irritability in infants. Nasal decongestants are an alternative to systemic decongestants. Most OTC products contain either oxymetazoline or phenylephrine. Excretion in breast milk of oxymetazoline is unknown. However, due to their local activity and minimal systemic absorption, nasal decongestants may have a low concentration in breast milk and are preferred over systemic oral decongestants.

Cough Medications:Dextromethorphan is a common cough suppressant used in cough and cold preparations. Although dextromethorphan has not been studied in breast-feeding, expected concentrations in breast milk would be low. Guaifenesin is used as an expectorant in many formulations of cough and cold products. Cough preparations may also contain alcohol. While alcohol is considered compatible with breastfeeding by the AAP, lactating mothers should choose alcohol-free or low-content alcohol products. 



Gastrointestinal Medications

Gastrointestinal medications include agents used for the treatment of diarrhea, constipation, and flatulence. Loperamide, which is used for the treatment of diarrhea, is generally considered compatible with breast-feeding due to minimal oral absorption.Docusate is a common OTC stool softener. It is minimally absorbed orally, and minimal transfer to breast milk would be expected. As a precaution, mothers who take docusate should watch for loose stools in the infant. Other OTC medications for the treatment of constipation are the stimulant laxatives bisacodyl and senna and the bulk-forming laxative psyllium. Bisacodyl has not been studied in breast-feeding; however, due to its minimal systemic absorption, it would not be expected to cause adverse effects in the breast-fed infant and is considered compatible. Senna, a strong laxative, is compatible with breast-feeding. Although older reports indicated an increased incidence of loose stools in infants who were exposed to senna, newer reports have not shown this adverse effect with current senna products.  Psyllium is not absorbed systemically and, therefore, does not enter breast milk. It is considered compatible with breast-feeding. Simethicone, used for the treatment of intestinal gas, is commonly used in infants. The drug is not absorbed systemically and thus would not pass into breast milk. Simethicone is considered compatible with breast-feeding.

Below are some great online resources regarding medications and breast milk and from where the information above is referenced. 

Online Resources:

Motherisk. http://www.motherisk.org/index.jsp. Offers consumers answers to questions about morning sickness and the risk or safety of medications, disease, chemical exposure, and more. Provides teratogen information for healthcare professionals and updates on Motherisk’s continuing reproductive research.

Perinatology.com. http://www.perinatology.com/. Provides teratogen information for healthcare professionals, links to clinical guidelines, and more.

Organization of Teratology Information Specialists (OTIS). http://www.otispregnancy.org/. Provides medical consultation on prenatal exposures for consumers and healthcare professionals.

OBfocus. http://www.obfocus.com/. Provides information for healthcare professionals and consumers on pregnancy and lactation related issues, including drug exposure. Provides a list of resources on high-risk pregnancy.

LactMed. http://toxnet.nlm.nih.gov/. Drug and Lactation Database by U.S. Library of Medicine. Provides information on drugs and other chemicals that breastfeeding mothers may be exposed to. 

                                                     

 

 

 

 

 

       




Breastfeeding your baby: Safe Storage of Breast Milk for Full-term Babies December 14, 2012 10:07

If you have to be separated from your baby for an unplanned event or because you are returning to work or school, you can express and store your breast milk.  By following these simple guidelines, you can safely provide your baby with high-quality nutrition and protection from illnesses. 

Some nutrients and health properties of human milk change with storage, but properly stored breast milk is still better than formula for your baby’s nutritional needs and protection from illness.

How do you safely prepare to store your breast milk?

 

Wash your hands with soap and warm water or use an alcohol-based hand sanitizer. Hands that are clean during pumping or expressing will decrease bacteria growth during storage and keep protein levels in the breast milk high.

If you are using a breast pump to express your milk, make sure all pump parts are clean and sterilized. Wash all parts in warm, soapy water and rinse well. Sterilize parts before first use and then once a day using any one of the following methods:

»» Use the top shelf of dishwasher, (if recommended by pumpmanufacturer)

 

»» Boil in water on high heat on the stove for 10 minutes »» Use a sterilizing machine in the microwave

»» Use a specially-designed sterilizing bag that goes in the microwave »» Use a counter-top sterilizer

 

Use glass bottles or BPA-free plastic bottles made from polypropylene. BPA-free, polypropylene plastic bags designed for human milk storage can also be used. They should be sturdy, sealed well, and stored in an area where there is no risk of damage to the bag. Steel bottles and plastic bottles made from polyethylene are not recommended since both can cause a decrease in the quality of stored milk. 

You do not need to sterilize bottles for your breast milk. Wash them in hot, soapy water and rinse, or wash them in the dishwasher.

How do you safely store your breast milk?

 

After you have manually expressed or pumped your breast milk, label the container with the date so you can use the oldest milk first. If you are planning to freeze the milk, leave space at the top of the container to allow room for the breast milk to expand during freezing.

The chart below is a guide for how long breast milk can be safely stored.

    

                       

Reference: Proper Handling and Storage of Human Milk @ cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm

You can add small amounts of cooled breast milk to the same refrigerated container throughout the day, but avoid adding warm milk to already cooled milk.

How do you safely thaw breast milk?

 

You can thaw your breast milk in the refrigerator overnight, under warm running water, or in a pan or bowl of warm water.

Defrosting frozen milk in the microwave is unsafe because the milk heats unevenly and can cause “hot spots.” In addition, microwaving breast milk decreases its anti-infective quality.

Expressed milk separates into layers. This is normal. Simply swirl the warmed milk to remix it. Do not shake breast milk. This may damage the proteins.

Breast milk that has been frozen and thawed for 24 hours in the refrigerator, should not be left out at room temperature for more than a few hours.

If your baby does not finish the entire bottle of expressed milk, discard the leftover milk after 1-2 hours.

Sources

 

Academy of Breastfeeding Medicine Protocol #8: Human Milk Storage Information for Home Use for Full-Term Infants. (Original Protocol March 2004; Revision #1 March 2010)

 

cdc.gov/breastfeeding/recommendations/ handling_breastmilk.htm

 

Books

 

The Nursing Mother’s Companion 6th ed. byKathleen Huggins (2010)

 

The Ultimate Breastfeeding Book of Answers Revised and Updated: The most comprehensive problem-solving guide to breastfeeding by JackNewman MD and Theresa Pittman (2006)

 

The information presented here is not intended to diagnose health problems or to take the place of professional medical care.

 


The Top Thirteen Health Benefits of Breastfeeding Your Baby December 07, 2012 22:44

Breastfeeding is not an option for all mothers, but there is now an impressive body of evidence suggesting that those women who can breastfeed will reap substantial health benefits. Some of these apply to the development of the baby, while others influence the health of the mother. Read on to discover thirteen fascinating and profoundly important reasons why breastfeeding is a smart choice.

 

1) It reduces your risk of developing certain cancers:

Cancer research has shown that mothers who do not breastfeed or who only breastfeed for a short period of time (i.e. less than three months) are a shocking 11% more likely to suffer from breast cancer at some stage in their lives. Further studies have also connected breastfeeding to a reduced risk of developing ovarian and endometrial cancers.

 


2) It is linked to higher intelligence:

Recent studies have revealed that children who were breastfed as babies are, on average, more likely to score higher on IQ tests and more likely to get better grades in school.

 

3) It can help you become slimmer:

There are a couple of reasons why breastfeeding can help you to get in shape. Firstly, it burns around 500 extra calories each day, and this will help you to lose weight. Secondly, when you lactate this causes your uterus to shrink more rapidly, and the quicker your uterus returns to its normal size then the easier it is to cultivate a slimmer figure.

 

4) It makes your baby less likely to suffer from digestive difficulties:

Breastfeeding your baby reduces its risk of developing a range of intestinal problems, including Crohn’s disease, ulcerative colitis and diarrhea. It is not entirely clear why this correlation exists, but a large body of research has established that there is a significant connection.

 

5) It reduces your risk of developing osteoporosis:

As a result of an overwhelming number of studies, it is now almost universally agreed that women who do not breastfeed their babies are around four times more likely to develop osteoporosis (i.e. brittle bones) in older age.

 

6) It boosts your baby’s immune system:

Breast milk helps to promote a strong and healthy immune system in your body, and this means that your baby is less likely to contract serious illnesses. This is because breast milk is a source of lymphocytes and macrophages, which produce antibodies that protect us from bacteria and viruses.

 

7) It reduces your baby’s chance of developing breast cancer:

A study conducted in the mid-nineties proved that female children who were not breastfed were as much as 25% more likely to develop some form of breast cancer during their adult lives.

 

8) It makes your child less likely to develop arthritis at a young age:

According to studies aimed at discovering how we might prevent arthritis, children who are breastfed appear to be around 60% less likely to develop arthritis during their childhood or teenage years.

 

9) It reduces your baby’s risk of suffering from diabetes:

Research conducted in Finland has found that drinking dairy products (instead of breast milk) at a young age raises the risk of ending up with type one diabetes. This is because cow’s milk antibodies are linked to a greater chance of developing diabetes.

 

10) It can help with insomnia:

The chemicals in breast milk can help to encourage your baby to fall asleep. This, in turn, can also help you to feel more relaxed and able to sleep.

 

11) It makes your child less likely to develop asthma:

Studies on respiratory health show that children who were breastfed as babies are much less likely to suffer from the wheezing and chest discomfort that are experienced by sufferers of asthma.

 

12) It promotes your child’s dental health:

When babies suckle in order to breastfeed, this tones and strengthens their facial muscles. Orthodontic studies show that this toning and strengthening improves jaw alignment, which in turns makes those children less likely to need braces or other orthodontic work in later life.

 

13) It helps to create and maintain a body between you and your baby:

When you breastfeed your baby, your endocrine system responds by releasing a hormone called oxytocin. This is the same hormone that is often called the ‘cuddle hormone’ because of its ability to increase emotional intimacy between romantic partners. In the context of breastfeeding, it improves milk ejection and promotes happy and relaxed feelings during the feeding process. In addition, babies it comforting to be cuddled, and being cradled in your arms during breastfeeding helps to soothe them.

 

As is obvious from these impressive health benefits, breastfeeding can boost the health of both you and your baby. However, note that you should never breastfeed if you have a serious bacterial or viral infection, and you should always speak to your doctor to make sure whether you are taking any medications that could harm your baby if they are transferred via breast milk.


How to Evaluate the Early Signs of Postpartum Depression November 26, 2012 13:09

 

The room is dark. The clock says 3am. You relish this brief moment of rest. And then, the baby cries again. You cringe, desperately hoping she’ll stop. But the crying gets louder. Your man merely grunts and rolls away from the sound. Suddenly, a wave of emotion hits you in the gut, and your whole body begins to spasm with impending tears. Postpartum depression is real, overwhelming, and terrifying. Here is a brief guide on how to cope with the initial onset of postpartum depression.

When does postpartum depression start, and how long does it last?

Immediately after pregnancy, all women experience hormonal fluctuations. Some women (but not all) experience mood changes as a result of these hormonal shifts, and the mood changes can vary from minor “baby blues” to full postpartum depression. The onset of these symptoms can start within the week after delivery, or they could emerge any time within six weeks. For some, the symptoms might last for a few days. For others, it can last weeks or months.

So it’s important to know that every woman experiences hormonal changes. You are not alone. It’s also important to recognize that the “baby blues” are common for many women (estimates say 50-90% of women experience these minor mood changes), and they will fade away when your hormones stabilize.

It’s also important to be aware of more severe symptoms of postpartum depression, which affects 20-25% of women. Be honest with your doctor and pediatrician about the symptoms you are experiencing, and be open and willing to get help, if needed.

The Early Signs of Postpartum Depression

Women experience a wide variety of mood changes during the postpartum hormonal-adjustment period. Many women feel unhappy, weepy, anxious, and have sudden shifts from happy to sad. More often than not, these feelings come without clear or adequate reasons. Often, the smallest thing can initiate a mood swing. However, some symptoms should be viewed as red-flags, and you should get help immediately.




 How to Know if You’re in Danger

It is important to regularly do a self-check on yourself. Here are some questions to ask:

1. How long has your depression lasted? (Concern: Your depression lasts longer than a week.) 

2. How are you sleeping? (Concern: You have trouble sl

eeping when baby is sleeping.)

3. How is your appetite? (Concern: You have very little interest in food.)

4. How are your interests? (Concern: You have lost interest in yourself and your family.)

5. How is your hope? (Concern: You have very little hope; you only see a bleak future.)

6. How is your confidence? (Concern: You feel helpless, without any control.)

7. How is your desire to press on? (Concern: You have suicidal thoughts or urges.)

8. How do you see your baby? (Concern: You wish the baby had never come.)

9. How am I caring for my baby? (Concern: You are not taking care of the baby; you have thoughts of harming the baby.)

10. How is my mental state? (Concern: You are experiencing weird thoughts, extreme fears, hallucinations, etc.)

If you are experiencing any of these “concern” symptoms, call your doctor and get help immediately. Don’t hesitate. Even if you feel you might be over-exaggerating, it doesn’t hurt to talk to someone. If anything, talking out your symptoms will put your fears to rest. And the good news is that help is just around the corner. There are well trained counselors and doctors who will quickly come to your side and support you through this experience. And often, you might be encouraged to join a mother’s group with women facing the same feelings as you. This kind of support (even if it’s the last thing you thought you’d need) can drastically soothe your feelings of panic and give you the tools and encouragement needed to get through this postpartum period. Help is close at hand. You just have to ask.

 Tips and Tricks to Cope With the Initial Onset

Step One: First recognize and accept your problem. In this case, you are experiencing a form of postpartum depression. As discussed above, you first need to accept that mood changes are normal and common during the postpartum period, and it is due to hormonal changes. Do a self-evaluation (perhaps regularly) to see where you are at in the depression spectrum. If in the danger zone, the first step is to get immediate help.

Step Two: During the postpartum period, you will often think negatively. Unfortunately, negative thoughts fuel negative behaviors and moods. So when you are feeling overwhelmed, take a moment to step back and evaluate your thoughts. Write them down if you can. “I feel like I’m doing everything wrong.” This is a thought. It’s a negative thought. Take a moment to step outside yourself and evaluate this thought. Is it accurate? In most cases, negative thoughts are extreme and overly-critical. If you can, try to come up with a positive thought as a rebuttal. “I may feel like I’m doing everything wrong …BUT, I am showered and dressed, and the baby has a clean diaper. That counts for something.” It may be simple. It may seem ridiculous. It may take time to really believe the statement. But these positive thoughts can and do dampen the fire of your negative emotions.

In Conclusion

All women experience hormonal changes after pregnancy. And 50-90% of women experience a mild case of “baby blues” that can last for a few days or so after delivery. In 20-25% of cases, women experience a more intense hormonal reaction called postpartum depression, which can vary from mild to extreme. It’s important that you regularly do a self-check to see if your symptoms are warning that professional help is needed. If you see these red flags, be quick to ask for assistance. Otherwise, for the day-to-day coping of postpartum depression, you can practice evaluating your thoughts. Positive thoughts can dampen your negative thoughts. And practicing positive “rebuttal” thoughts can pave the way for a greater sense of control and self-validation as you navigate through this (sometimes brutal) postpartum period.


Living Mindfully Through Breastfeeding November 21, 2012 00:00


 

 

 

 

 

 

 

 

 

 

 

 

 

As many concepts related to parenting, green living is an ideal that often gets tossed out the window once the baby arrives. Staying sane on only an hour of sleep while taking care of a demanding infant and remembering basics like getting your teeth brushed on a daily basis can be hard enough, much less living mindfully and in an environmentally friendly manner. However, incorporating green living into your daily life as a parent can start with something as simple as how you feed your infant.

One of the most ways a new mother can live mindfully and be green at the same time is to breastfeed her baby. While of course this is not possible for all mothers, nursing can be an incredible way to foster emotional bonding between a mother and child and may offer important health benefits such as increased immunity. Breast milk is also free, which can substantially lower overall costs compared to purchasing baby bottles and formula. According to the website KidSource.com, the yearly cost of baby formula can range between $1275.00 and over $3000.00, compared to the potential cost of a yearly breastpump rental, which costs less than $500.00 a year.

The creation of baby bottles, nipples, and formula containers has an environmental cost as well as a financial one, since natural and energy resources must be used to manufacture and distribute these items. Such objects are also less likely to be recycled and may take up to 400 years to disintegrate once left in a landfill. Moreover, there may be an environmental risk to using bottles and nipples, as plastic baby bottles and some nipples may contain biphenyl-A (BPA), which a chemical commonly used in the production of plastic items. BPA is also found in the metal lining of several types of infant formula cans, including Enfamil and Similac. The U.S. Environmental Working Group (EWG) has shown that exposure to BPA, even in low doses, may result in early puberty, cancer, behavior and brain disorders. According to MomsandPOPsProject.org, infants who are bottle-fed are the highest population group to face high levels of BPA exposure, which can be reduced through the simple act of breastfeeding.

Many parents think that using filtered water to mix their baby formula is a healthier choice than tap water and in many instances that may be true. However, water is also used to manufacture the bottles, formula and nipples used to feed these babies and this water may not be filtered. This increases the potential risk for contamination of cadmium, aluminum, lead, pesticide and other hazardous chemicals. Dangers with the water used to mix baby formula often continue at home as well. The hot water that parents frequently use to make baby formula in order to warm the formula before feeding it to their baby can also dissolve potential contaminants into the water faster than cold water, which only increases the overall risk of the infant’s exposure to potential chemical contamination.

For all the environmental, health and financial reasons to breastfeed your baby, there is no denying that there is an environmental risk in breastmilk as well. Pollutants that the mother is exposed to or ingests through what she eats or drinks can pass into the breastmilk, including heavy metals, pesticides and persistent organic pollutants (POPs). POPs can include a variety of chemicals, including DDT and other bioactive substances that can pose a health risk to humans. While this may make parents despair that nothing is safe for babies, not even human milk, the U.S. National Institutes of Health concludes that there is little evidence that the chemical agents in breastmilk are strongly linked to morbidity in infants and any potential health risk is lower than any potential health benefit to breastfeeding.

Not all mothers can breastfeed and if this is true for you, consult with your pediatrician about the best type of baby formula to use. If you do use baby formula, look for baby bottles, nipples and formula marked “BPA Free” and remember to clean and recycle the items when you are done with them. Moms who can nurse should consider doing so, due in no small part to the emotional, physical and environmental benefits. But don’t forget that nursing comes with a responsibility as well and carries a risk that may be reduced by eating organic foods whenever possible, choosing meat and dairy items marked “Hormone Free” and consuming a healthy diet. Doing so is a good choice for your mind and body, not to mention your baby and the environment.