The uncertainty of uncertainty — Diet, Pregnancy & Breastfeeding
By: Philip Marais
Tags: Diet, Children, Health, Breastfeeding, Parenting

The uncertainty of uncertainty — Diet, Pregnancy & Breastfeeding

I recently became a father for the first time, along with my wife, who became a mother for the first time.

I hold very strong opinions about diet, and specifically sugar and vegetable/seed oils in the diet. In fact, a dietician responded to one of my previous articles on sugar, labeling it overly alarmist, and reflecting back on it, I tend to agree that the narrative may very well be overly alarmist.

That said, here is the story of how Jana (my wife) and I, managed, debated, and sometimes shouted about, her diet throughout her pregnancy and throughout the challenges of breastfeeding and milk volume.

The diet strategy through pregnancy

When we discovered that Jana was pregnant, we both knew that the single modifiable risk factor for our child’s future health, would be Jana’s health throughout her pregnancy, and her diet would be a major determinant of both her and the child’s (future) metabolic health.

It is for that reason that our approach was a diet consisting of whole foods, low in carbohydrates and as far as possible, free from refined seed/vegetable oils, limited sugar, and limited flour and other refined carbohydrates.

The nuances of food aversion and hormonal changes notwithstanding, we settled on a diet that consisted primarily of beef steak, bacon, peas, eggs, and full-fat dairy, and probably, most importantly, carb-clever (vanilla) ice cream from Woolworths.

Don’t get me wrong, it wasn’t all whole foods and strict adherence all of the time. There were a few desserts, a few potatoes, a few slices of bread, and high fructose fruit indulgences scattered in between, but by far the majority of our routine, was a low carbohydrate, whole foods diet.

The exercise philosophy

About halfway through the pregnancy, Jana shared the following thoughts with me.

Childbirth is a major physical challenge, hugely demanding of your endurance and fitness, and that you cannot prepare for it, by lying on the couch, much the same as you cannot prepare for running a marathon, by watching television.

Her philosophy was that she had to be as fit as possible at the time of the birth, in order to give our child and herself, the best possible chance of a healthy, normal delivery and a healthy infant.

We went to the gym 3–4 days a week, and we were religious about it. Jana’s workout consisted mainly of strength training, squats, lunges, deadlift, leg press (for as long as the belly allowed) and walking.

By the time we were at 7 months, Jana was in great shape, in great health and feeling very positive.

The birth

Our daughter was born on 13 January, via emergency c-section. Having had to endure a c-section was extraordinarily disappointing for both Jana and me, and the nuances around how and why that happened is an extremely long story, and to be honest, still a fairly painful one.

In short, we had an emergency c-section, for a baby that was experiencing zero fetal distress, to a mother who had experienced zero complications or risks during the pregnancy.

The c-section, as opposed to a natural birth, our first choice by some margin, is a product of the risks that clinicians in the South African medical sector have to deal with, in an environment where 80/100 mothers and infants are metabolically, at suboptimal health.

Infant health

At birth, I performed the traditional cutting of the cord and looked on as the pediatrician inspected and assessed my infant daughter.

You do not have to be a doctor or medical professional to recognise healthy human tissue when you see it.

The baby’s cord was so neat and clean, it looked like it was wrapped in a very high-quality rubber conduit, the kind you would expect to see in an Apple factory.

The baby was a healthy weight, lean and muscular in appearance, and strong.

When I saw the baby, and Jana later held the baby and breastfed for the first time, it was conclusive, that Jana’s healthy diet had resulted in a healthy baby.

There lingers no doubt about that, with either of us.

The challenges of breastfeeding

Returning home with the child, Jana reverted to her pre-birth diet, wich at this point was quite limited in carbohydrates, mostly beef, bacon, eggs, and full-fat dairy.

Breastfeeding is neither easy nor simple. It can be quite painful. More unnervingly for us, we had some serious doubts over the breastmilk volume because it felt as though the child always wanted to feed, but Jana’s breasts were always empty.

I put some time into thinking and reading about the physiology of lactation, and it occurred to me, that the breast tissue should be extremely insulin sensitive, and given that it is in a highly anabolic state, should respond well, in terms of milk production, if we added some good quality carbohydrates to her diet, and also, utilised some strategic sugar spikes to drive small insulin peaks and therefore, milk production.

Oats for breakfast and sweets after dinner had an immediate impact on milk volume. Every time we reverted back to a lower carbohydrate version of the diet, breastmilk volume appeared to decrease.

And still, we were concerned that there wasn’t enough milk. Even after we consulted a breastfeeding specialist and near-perfected Jana’s breastfeeding technique and latch, we still had concerns.

Considering commercial infant formula as a top-up

We considered the formula, a number of times. We researched all of the available infant formulas, and I genuinely mean, all of them. When I say research, I mean, 100+ hours of scientific journal articles and professional opinions. I an obsessive scientist, after all.

Every single available infant formula uses vegetable/seed oils as a fat source and highly hydrolysed (skim) milk poweder as a protein source, and lactose and sugar as the carbohydrate source.

It is not easy to explain my absolute phobia of vegetable/seeds oils. I shall write a comprehensive, more technical communication about seed oils in infant formula at another time.

The kind of fats your child consumes determines the quality of the tissue of every single one of their organs. Their digestive system, the brain, the immunity, muscle, eyes…

Why?

Because every part of her body is made up of cells. Hundreds of billions of them.

Every cell has a membrane around it, and every cellular substructure, called organelles, has a membrane around it.

Every membrane consists of a highly specific combination of proteins, and fats, in a near 50:50 ratio.

That means that fats are one of two KEY building blocks in every cell, every organelle, of every fiber of her very being.

One should not, and cannot, take lightly, the impact of building-block-quality, for all of her fast-expanding cell population.

What it amounts to is that infant formula, without any exceptions that I could find, is essentially children’s doughnuts. Doughnuts, because I consider it the single most poisonous processed modern food ever concocted. Vegetable/seed oil fried flour, with sugar on top.

If you don’t think that a person should live on Krispy Kreme exclusively, then you ought to not entertain the idea that any child on earth should consume infant formula throughout the period of their lives, where their growth and cellular expansion, is at its maximum.

The membranes of the cells in our body, for the most part, do not consist of a majority n-6-PUFAs, the kind you find in vegetable oils. It is incomprehensible to think that we should make it the biggest source of fats in the diets of any person, let alone infants.

No person should consume polyunsaturated fatty acids, at any appreciable volume. Ever. At least not in my opinion.

More on that topic in a different article, at a different time.

What to do?

At this point, we remained concerned about milk volume, but not milk quality, as Jana’s diet is still really good. This anxiety is both driven by, and compounded by the fact that Jana (pediatrician in private practice), is anxious to return to work, at least on a flexible basis, and the ability to express milk for the infant when the nanny looks after her, is critical, and milk volume is an important determinant.

I read in an article, that breastfeeding and milk volume, can often be a self-fulfilling prophecy.

Researchers have found that ineffective feeding practices may actually cause an insufficiency of breast milk. A mother’s lack of confidence in the efficacy of the lactation process can lead to a self-fulfilling prophecy whereby milk flow and transfer to the baby is undermined. The mother may then interpret this as representing insufficient milk, making her highly likely to resort to formula, with the result that her milk volume actually diminishes. [123]

That statement resonated with me for a day or two.

I addition, we also realised that Jana’s breastmilk volume appears to respond, significantly, to the presence and absence of potatoes in her diet, more so than total calories, but we cannot be certain of this just yet.

Sanity checks for preserving sanity

We had to remind ourselves of a few facts.

The baby was picking up weight, and growing in length. These are good signs of sufficient milk & nutrient supply. The baby has a number of wet and poo diapers per day, signs of regular hydration and nutrition. Babies cry randomly, for reasons known, unknown and unknowable. Once you have taken care of all the high probability items, feeding, diaper change, winding, temperature adjustment, swaddling, soothing, there is little else to do. It is unlikely that you have done anything to make them cry, and it is improbable that there is anything you can do to make them stop. Assuming you have taken care of the above, the baby will fall asleep before she dies, or before you die. The battle is with your own mind, not with the baby. (I use noise-canceling earphones and a fine selection of metal, and I find it makes me patient and compassionate when comforting the baby.) Babies are random. Sometimes they sleep longer, sometimes shorter. Sometimes they have growth spurts where they feed every 2 hours, other times they sleep so long, you go check if they are still breathing. When she is screaming and pulling out my chest hair, I have to actively remind myself that she is not being deliberate, because my mind jumps to the conclusion that she is being evil. It is the strangest internal battle. Every significant relationship takes time to evolve. As the baby grows and becomes more and more interactive, so will our relationship. For me there is little poetry or romanticism in ‘holding my child for the first time’. I find the magic and the poetry in the internal conversations, the discipline required to get up when you are (still) tired, to commit to my support role of diet design and cooking, and my responsibility of bathing our daughter, every day between 17:00 and 18:00.

Our latest diet approach

Currently, we have the following routine. I get up early to cook breakfast and lunch for Jana. (Typically, I do a 21:3 fasting window, nowadays for convenience of not having to make breakfast/lunch for me, more than anything else)

Breakfast: 100g Oats for breakfast + sweetener + full-cream milk. [14g Protein, 63g Carbs, 10g Fat, 391KCal] Lunch: 4-egg cheese-omelet, ±25g Cheddar, ±75g Gouda, 15g butter (for cooking) [53g Protein, 8g Carbs, 64g Fat, 808KCal] Dinner: Lean(ish) Protein (200–300g steak/pork) & Potato (one large ±150g). [63g Protein, 24g Carbs, 30g Fat, 619KCal]

This gives us 1800KCal per day for Jana’s diet, which was the recommended target I found in an article on breastfeeding and milk volume.

Breastfeeding, as though our daughter’s life depends on it, because it does

We have shifted our attitude from, “what do we do if there isn’t enough milk?”, to “we are breastfeeding, what do we need to do to make it work!”.

Breastfeeding with confidence and intent.

Focussing on every latch as though the breastfeeding specialist is looking over our shoulder.

Confidence and intent.

There are many things we don’t know, and I am sure we will learn still. Milk volume takes time and requires patience. That doesn’t mean that you should be passive about it.

Our daughter is growing like a weed, Jana has built up 4x80–100ml frozen breast milk portions, and we aren’t at 6 weeks postpartum yet.

Jana’s diet seems to be doing the trick for milk volume.

Confidence and intent.