Letters to
LLLI:
Dietary Choices and DHA Supplementation
From: LEAVEN, Vol. 34 No.
5, October-NOvember 1998, p. 102-103
We provide articles
from our publications from previous years for reference for our Leaders and
members. Readers are cautioned to remember that research and medical information
change over time
Dear LLLI,
Much is being said about
breastfeeding in the news these days. As a Leader I try to pay attention
when I hear or read about new information. Occasionally a mother will
come to me with questions about something she read or heard in the media.
Recently a mother who
follows a vegan diet (no meat, fish, dairy products or eggs) asked me
about an article on DHA (docosahexaenoic acid) supplementation.
She worried that because
she does not consume eggs or fish her breast milk might be low in DHA.
She referred to an article in Pediatrics (January 1998) that
states that "DHA is an important building block, essential to infant
brain and eye development." It also says that American mothers
typically have low breast milk DHA levels.
THE WOMANLY ART OF BREASTFEEDING,
page 339, states that "human milk contains significant amounts
of DHA and AA, which are long-chain polyunsaturated fatty acids derived
from linoleic and linolenic acid. These fats are important to the process
of myelination, the development of the sheath around nerve fibers that
enables them to send messages. This process is critical during baby's
first year and the presence of these particular fats in baby's diet
may be important." However, nothing is said about levels of DHA
in a vegan mother's milk.
As a Leader I tell mothers
that LLL believes in good nutrition from a well-balanced diet of foods
as close to their natural state as possible. However, since my family
is vegan, I wondered about DHA supplementation myself. There is so much
information in the media today and many mothers, at least in my area,
have adopted a vegan diet. I'd like to be able to support these mothers
with LLL information that responds to statements like those in popular
press articles on DHA. A mother who has eliminated foods from her diet
due to allergy might have similar questions.
Please help me find answers
for mothers with such concerns.
Sincerely,
Jessica Rigney
Petersburg, Illinois, USA
Dear Jessica,
Thank you for your interest
in this matter. When mothers are anxious about issues that may present
unique problems, it is essential for Leaders to seek sufficient information
to fully address their concerns. Usually a Leader can put the mother
at ease once this information is gathered from LLL resources. By offering
information, making suggestions and discussing options, a Leader can
help a mother sort out her problems so she can make up her own mind.
It is particularly important to be sensitive to the concerns of mothers
who come from varied backgrounds.
Articles in the popular press
often contain information that calls attention to an isolated aspect
of a research study. These articles may cause alarm where none was initially
intended, especially when they attempt to address a complex, controversial
issue, for example, dietary supplementation. In order to sort fact from
supposition or opinion, it becomes important to consult the original
medical research to put popular media reports into perspective.
Breastfeeding is recommended
for all infants throughout the world under ordinary circumstances, even
if the maternal diet is not perfect. Particular problems may exist for
preterm infants born with low fat reserves due in part to an insufficient
intrauterine supply of fatty acids like DHA. However, international
organizations have been impressed by the strong evidence that mothers
are able to produce milk of sufficient quantity and quality to support
growth and promote the health of infants in a wide variety of situations.
At the present time there
are very few specific recommendations for improving the nutritional
status of lactating women. Some suggestions have been made to improve
nutrient intakes of women with eating patterns that excessively restrict
food intake or a diet providing a poor source of one or more nutrients
considered by many nutrition authorities to be important for good health.
For example, THE WOMANLY ART OF BREASTFEEDING (1997 edition, page 226)
states that, "A mother who is on a vegan or macrobiotic diet that
includes no animal protein may need to take a vitamin B12 supplement
in order to avoid a vitamin B12 deficiency in her baby." However,
it does not mention concerns about low levels of certain fatty acids
in the breast milk of vegan mothers because there does not appear to
be universal agreement that such concerns are valid.
The dietary long-chain fatty
acid, docosahexaenoic acid (DHA), has been the focus of several research
studies that have found it positively associated with the neurological
and visual development of preterm and, to some extent, full-term breastfed
infants.
Levels of DHA in breast milk
vary with maternal intake. Mothers with diets high in fish consumption
have elevated breast milk levels of DHA, while lactating mothers with
omnivorous diets have intermediate levels. Vegan mothers, who consume
no animal products and therefore no DHA, do have low levels of DHA in
their breast milk, probably due to maternal synthesis of DHA from another
dietary fat, alpha-linolenic acid (ALA). The amount of DHA in breast
milk appears to depend on a complex interaction of maternal fat stores,
synthesis from ALA and consumption of dietary DHA. What significance
does this hold for nursing mothers?
One recent preliminary study
found that maternal DHA supplements increased DHA levels in breast milk,
yet the authors confirmed that recommendations regarding supplementation
of the diet of lactating women must await further studies. This study
found no evidence that maternal diets low in particular fatty acids
(e.g., vegan diets) are deficient or pose problems for nursing infants.
While some researchers have
reported that pregnant and lactating mothers are deficient in long-chain
polyunsaturated fatty acids (LCPUFAs) and therefore have increased dietary
requirements, there have been no reports of clinical conditions related
to lowered LCPUFA levels in these women. Many other investigators suggest
that before supplements are recommended, further research needs to determine
the biochemical and physiological consequences of varying levels of
breast milk DHA on infant development. For example, populations of mothers
who consume large amounts of fish should be studied to see if there
are any problems in their breastfed infants related to the higher levels
of DHA in their breast milk.
Breastfeeding is recommended
world-wide for healthy, full-term infants when at all possible. There
is no clear consensus that DHA supplements are needed or advised for
lactating women; instead, human milk is recommended as an appropriate
source of DHA. Neither the United Nations Food and Agriculture Organization
nor the World Health Organization has recommended DHA supplements for
nursing mothers. The American Academy of Pediatrics and the Food and
Drug Administration (US) do not recommend DHA supplementation either.
Nutrition and Breastfeeding
(No. 159) also reminds mothers that "before eliminating any
important food from your diet, be sure to talk to a doctor or nutritionist
about alternative foods or a vitamin mineral supplement." The choice
to take any dietary supplement is ultimately up to the mother and her
health care provider.
THE WOMANLY ART OF BREASTFEEDING
emphasizes that although dietary supplements do not substitute for nutritious
foods, lactating women may need to take certain supplements to avoid
deficiencies in themselves and their infants. La Leche League's basic
approach to good nutrition for all nursing mothers is to continue to
recommend eating a well-balanced and varied diet of foods in as close
to their natural state as possible, supplementing only when essential
nutrients are not, for some reason, present in the mother's diet. A
Leader can recommend the mother seek the advice of a nutritionist or
health care provider if she has questions about supplements.
Sincerely,
Marty O'Donnell, PhD
US Western Division Professional Liaison Resource Advisor
Park Ridge, Illinois, USA
Ed. Note: See also Wolk,
M. The vegetarian breastfeeding mother. LEAVEN Jun/Jul 1997; 69.
Special thanks to Laure Marchand
Lucas, International Division Administrator of Professional Liaison
Resources, and Dr. E.A.M. de Deckere of the Unilever Nutrition Center
in the Netherlands for their contributions to this article. Laure, a
family physician and IBCLC, co-leads a Group in Paris, France.
References
Joint Food and Agriculture
Organization (FAO)/ Health Organization (WHO) Expert Consultation. Fats
and oils in human nutrition. FAO Food and Nutrition Paper 57 1994.
Horwood, L., Fergusson, D.
Breastfeeding and later cognitive and academic outcomes. Pediatrics
Jan 1998; 101:e9.
Makrides, M., Neumann, M.,
Gibson, R. Effect of maternal docosahexaenoic acid (DHA) supplementation
on breast milk composition. European journal of Clinical Nutrition
1996; 50:352-57.
Mohrbacher, N. Nutrition
and Breastfeeding. LLLI, Jan 1994. Publication No. 159a.
Mohrbacher, N., Stock J.
BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997.
National Academy of Sciences
Nutrition During Lactation Washington, D.C.: National Academy
Press, 1991.
THE WOMANLY ART OF BREASTFEEDING
6th ed. Schaumburg, Illinois; LLLI. 1997.
Page last edited Sun Oct 14 09:32:08 UTC 2007.
