Iron & the Breastfed Baby

My dear mommy readers, as I always like to share with you my personal experiences with my Kyra, and whatever I have learned from each experience, I feel compelled to be writing this post today of all days. Most of the mommies who are part of the facebook breastfeeding groups I am in, already know this as I have posted about this particular event in our lives, but for those of you who don’t, here goes.

Since the day my Kyra was born, her nutrition, health and development have become an obsession of mine. Most of the new mothers out there can surely relate, as it is a lot of pressure to be responsible for the wellbeing of someone else other than us. And even though proper nutrition starts from conception, most of us, myself included don’t really feel the heat until that little bundle of joy is in our arms. So, to give my angel the best possible start I could from a nutritional aspect, I chose to breastfeed. This decision did not come without its share of difficulties and took a lot of support from a whole lot of people, but thank God it worked out eventually and was for the very best. I truly, truly believe in the amazing benefits of breastmilk, and that it is indeed the perfect food for babies, but as I got more involved in the world of baby nutrition, I realized that after 6 months it might not be the perfect food anymore. Wait! Really??? No, bear with me here.

According to all major health authorities, WHO (World Health Organization), AAP (American Academy of Pediatrics and the Australian as well), UNICEF and others, babies should be breastfed for the first 6 months of life, and then around the 6 months mark, given complementary foods along with the continuation of breastfeeding up until 2 years or more. The rule also applies to formula fed babies, as all babies should rely solely on milk for the first 6 months of life. But what happens after 6 months and why do they all recommend babies to start eating solids?

 

Food pyramid

My plate is the updated version of the food pyramid, with new recommendations to increase the fruit & vegetable portions to make up half of our overall food intake.

myplate

Well, for the first 6 months of life, breast milk is ideally the perfect food for all babies, but then after that, babies’ nutritional needs increase and complementary feeding is necessary so that babies can receive all the proper nutrients for them to develop properly. So what is it that babies need that breast milk lacks after 6 months? Iron deficiency seems to be the most common type of deficiency in babies, which can cause IDA “Iron Deficiency Anemia” and impact a growing baby’s brain development and his motor and cognitive skills. Vitamin D deficiency comes next, with about around 40% of babies being deficient in the U.S alone according to recent statistics. But what exactly are the nutrients that babies need to get from other sources than breast milk and what are the daily-recommended dosages for each? If any of you have ever wondered like I did, here is a simplified table for you:

 

Nutrient Age Daily-recommended dosage Age Daily-recommended dosage Sources
Iron 0 to 6 months/Around 6 till 12 months 0.27mg/11mg 1 to 3 years 7mg Meat, poultry, beans, dark leafy greens, etc.
Calcium 0 to 12 months Needs met by breastmilk/formula Once cow’s milk is introduced (after weaning) for toddlers 500mg Yogurt, cheese, salmon, broccoli, tofu, etc.
Zinc 7 to 12 months 3mg 1 to 3 years 3mg Zinc is present in iron, chicken, turkey, yogurt, cheddar cheese, etc.
Vitamin K 0 to 12 months N/A 1 year + N/A Shot of vitamin K usually given at birth
Vitamins A & E 6 months + N/A 1 year + N/A Variety of foods from the food pyramid
Vitamin D 0 to 12months 200-400IU 1 year + 400-1000IU Sun/Variety of foods from the food pyramid
Vitamins C & B 6 months till 12 months N/A 1 year + N/A Citrus foods, tomatoes, strawberries, bananas, beans, eggs, meats, etc.

Now to some of you this table may look like Chinese, well the numbers did to me as well when I first got started on this research. An easy way to find out “how much” exactly to feed baby of each food is to keep your phone handy, and Google “how much iron (or vitamin X) does a teaspoon of X food have” which is what I did and still do lots of times. I always “triedddd” to give my baby at least a whole plate of food throughout the day with enough iron and vitamins, always adding vitamin C along with the iron for better absorption and avoiding calcium for a couple hours of an iron rich meal, since it inhibits the proper absorption of iron. But, alas, my baby wouldn’t eat much. I would spend all this time making food for her, letting her self feed, trying to spoon feed her, doing pretty much anything you could think of so she would eat at least enough to get all the nutrients that my milk didn’t have, but NOPE, she would feed most of it to the dogs one way or another.

I don’t believe in force-feeding, to me, overriding your baby’s basic instincts of fullness is simply not right, and I really believe that babies need to have a say in how much they eat, simply because they know when they’re full and when they’re hungry (exclusively breastfed babies in particular), so the option of shoving food down her throat was not an option. So as I ran out of tricks to get her to increase her solid intake, I patiently awaited her first birthday, and decided that I would test her iron levels. Should all be well, then I could finally relax and know that even the little food she’s having along with my milk would be enough. Should her levels be inadequate, I would do whatever was necessary to ensure that she gets the proper nutrition for her cognitive skills and brain development, even if it meant giving her supplements.

After a terrible first failed attempt at testing, we mustered up the courage to try again, and finally got her tested about a week ago. 2 days later the doctor calls with happy news, her iron levels were fine, her vitamin D as well (I had started her on vitamin D supplements since she was 2 months as in Dubai we are indoors most of the time and in Lebanon as well she is not exposed enough to the sun when we go there) and all was fine, except…her red blood cells looked small he said. I had no idea what that meant, but I was determined to find out. After ruling out “beta-thalassemia” the only logical explanation for such a healthy, smart, happy baby would be iron deficiency. But the doctor said her levels were fine!!! Well, they weren’t, what the doctor was looking at was her serum iron levels, what he needed to be looking for was the ferritin. Ferritin is the amount of iron storage available in the body, and when the iron in the body drops, it gets its storage from the bone marrow and ferritin. She was not found to be anemic, but iron deficient and in need of supplementation according to a pediatric hematologist and her doctor in Lebanon.

How could this be? How could have Mother Nature failed me like that? Breastmilk is supposed to be the optimal food for babies, the perfect food, but it was not! I thought of all the mothers I had encouraged to breastfeed, and on the endless hours I spent talking about the wonders of breast milk, when it was actually imperfect…or was it? I then thought, that if God had created humans with the ability to produce milk and feed their infants, if life on this planet was sustained for millions of years because of this milk, then there was no way that it could be imperfect. There is no way that the iron deficit in breast milk was just an accidental flaw. There has to be more to it. And so, after digging deeper into the world of science, it seems that the low amount of iron and other nutrients found in breastmilk, is really not an accident but an evolutionary necessity. And the reason why breastmilk is as such, and how come babies have survived without any supplements according to researchers is the following 3 hypotheses, none of them has been proven 100%, but they do seem to make a lot of sense to me so here is an excerpt from an article I found on the topic:

“Why would breast milk have evolved to be deficient in iron, putting babies at risk for iron deficiency?

What did the cave babies do before iron supplementation?  This fascinated me. 

We must remember that breast milk evolved over the last 2-2.5 million years to enhance infant survival (and also not put the mother at risk) in the context of the conditions of the time.  In the developed world, there have been major changes in living conditions over just the last several hundred years, and evolution simply doesn’t happen that quickly.  Researchers have proposed 3 hypotheses that could help explain why breast milk is low in iron:

Hypothesis 1.  Babies used to get their iron from soil.  Not too long ago in the history of the world, most people ate and slept on the ground, including babies.  We all know that babies put everything in their mouths, and I doubt if cave babies were any different, especially as they became more mobile around 6 months of age.  Iron in soil can be absorbed by humans [8].  Most other mammals are similarly exposed to soil and also have low concentrations of iron in their breast milk [9].  It is possible that breast milk evolved to have low iron concentrations because babies consumed plenty of iron through their environment (and why drain mom of iron if baby doesn’t need it?).

Hypothesis 2.  Until recently in human history, the umbilical cord was not immediately clamped.  In much of the modern world, it is common practice to clamp and cut the umbilical cord immediately after the birth of a child.  Research has found that waiting just 2-3 minutes after birth before clamping the cord allows up to 50% more blood volume to pulse from the placenta to the newborn [10].  A 2-minute delay has been shown to result in higher total body iron and plasma ferritin (reflecting iron storage) at 6 months of age, equating to about an extra month’s worth of iron stores [11, 12].  Certainly other mammals do not rush to clamp the cord immediately after birth and therefore also get that extra dose of iron to the baby before cutting her off from mom’s supply.

Hypothesis 3.  Breast milk may have evolved to have low iron as a mechanism for protecting infants from infection. Bacteria require iron to survive and reproduce, and many infections in young infants begin in the GI tract.  What little iron is present in breast milk is bound to an iron-binding protein called lactoferrin.  This limits the amount of free iron in a breastfed baby’s GI tract, which might also limit the growth of harmful bacteria.  Older infants consuming iron-rich foods have more mature GI tracts that would be more resistant to infection.  Although this hypothesis sounds plausible and is explained as if it is fact on sites like kellymom.com, there is actually not much hard data on it.  Human milk inhibits the growth of E. coli in culture, but this effect is lost if enough iron is added to the culture to overwhelm the binding capacity of lactoferrin [13].  However, this has only been shown in culture (in a petri dish) and in animals.  Studies in real live babies have shown mixed results, some finding no effect of iron supplementation on rates of infectious disease and some finding a small effect [14].  A 2002 review of 28 different randomized trials found an overall 11% increase in diarrhea in kids given iron supplements, but this small effect was not associated with iron-fortified foods, only iron drops [15].  In a randomized trial of 4- to 9-month-old infants in Honduras and Sweden, Dewey et al. [16] found that in infants that initially had iron-deficiency anemia, supplementation helped – it reduced the incidence of diarrhea.  However, in infants that were not anemic, iron supplementation increased their incidence of diarrhea.  This implies that too much iron can increase GI infections in infants, providing some support for the hypothesis that low iron in breast milk protects infants from infection.

Beyond these hypotheses, I have found no evidence that babies were breastfed exclusively much longer than 6 months throughout human history.  Most 6-month-old babies are interested in eating because they are interested in putting EVERYTHING in their mouths.  Given every mother’s interest in doing the best thing for her baby, I can imagine that babies have been given some of the best food available throughout human history, and in many cultures, that would be iron-rich meat (maybe initially pre-chewed by mom?).  What about the babies that didn’t get enough iron in their diets?  Before iron supplementation and awareness of the importance of dietary iron, babies probably were more likely to suffer from iron deficiency during the tender transition from breast milk to solid foods, and they probably suffered the consequences.”

This article made a lot of sense to me, and again this is my personal opinion, but to me, if you take into consideration these few facts and look at breast milk from an evolutionary standpoint, it actually makes a lot of sense. And so, to those of you who may think that breast milk is not actually perfect, but is lacking in a certain area, think again. Everything happens for a reason, and it’s not some cosmic accident that breast milk is low on iron and a few other nutrients. It has evolved this way to accompany our babies’ natural development beyond infancy, and give them a proper nutritional balance.

And even though some other nutrients are also low in breast milk, and babies do need them, and get them from other sources, I believe it’s because they would receive them in all cases (be it the sun or food after 6 months) and too much of anything is simply not beneficial. So, sorry Formula (yes even the iron fortified artificial milk formulas), you lose again! Human milk is still and will always be the perfect food for human babies.

So as it will take foreverrrrrr to talk about all of the complexities of breast milk and infant and child nutrition, I will end this post with this thought. Food is REALLY important for your baby, especially a breastfed baby, because it is the way nature intended it to be, but keep in mind that after 6 months, breast milk should still provide 75% of baby’s nutrition and this only goes to show that it is still of a very high nutritional value to your older baby. The composition of breast milk changes to meet the changing needs of babies as they get older (higher fat and protein content for example for older babies who spend less time on the breast) and in some cases, babies have thrived on breast milk alone for more than 6 months. Whether said babies developed any deficiencies is subjective to each case, but it is fairly easy to take a routine test around baby’s first birthday to assess whether or not baby has any deficiencies whatsoever. If you feel your baby is not eating enough, or if baby eats fine but your mommy instincts tell you that there is a need to test, then by all means please do. In our case, Kyra ate too little, and my mommy instincts made me feel uneasy regarding this subject, but thankfully a short course of iron supplements will hopefully resolve the little deficiency she has.

I hope you got some information from this post, as I have tried to gather a little info from various sources. Should you be interested to read more on the subject & a few other breastfeeding facts, please feel free to explore the links below. Wish you and your babies all the best, and I’ll see you all on my next post hopefully. 🙂

 

http://scienceofmom.com/2011/10/12/why-is-breast-milk-so-low-in-iron/

http://www.parenting.com/article/the-5-nutrients-all-babies-need

http://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/iron-deficiency/art-20045634?pg=2

http://www.llli.org/nb/lvaprmay98p21nb.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528681/

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

https://thelactationlearningstation.wordpress.com/2012/04/23/benefits-of-breast-feeding-after-6-months/

http://www.llli.org/nb/lvaprmay98p21nb.html

http://www.aappublications.org/content/early/2010/10/05/aapnews.20101005-1

https://www.cdph.ca.gov/programs/wicworks/Documents/Therapeutic%20Formula/WIC-TF-AAP-Chapter1-NutritionalNeeds.pdf

This link has a list of iron rich foods and the iron found in them in milligrams per serving

https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

2 thoughts on “Iron & the Breastfed Baby

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