Breastfeeding and Low Carb

I had this question while I was pregnant and never really got an answer so I thought I would document my experience here for anyone interested.
A little background, I was diagnosed with gestational diabetes at 28-29 weeks pregnant with baby #3 (age 44yo). I began eating low carb after googling but still ended up on insulin at night for my stubborn fasting levels.
Babybwas born just before 38 weeks with no complications. My blood glucose levels were on the lower side of the scale for diagnosis, fasting between 5.1 and 5.6mmol and post meals (2 hrs) usually high 5s into the 6s, but 7s and 8s after more carbs.

I have continued low carb eating (still including a couple of slices of homemade sourdough rye or spelt bread and a piece or so of fruit per day) and the rest of what I eat is eggs, meat, dairy and vegetables, I usually avoiding the carby ones except for the odd meal where I have chickpeas or lentils in a curry (no rice).
So far, I have no problem with my milk supply in relation to what I am eating.
But I never had a supply problem with my previous 2 babies either.
Where I have had a problem with supply this time though was because baby didn't open his mouth much so couldn't latch well. I also ended up with a lump in one breast which blocked the supply on one side for a number of days. I alleviated this with self-expression and eventually hired a breast pump andd pumped after feeds and 2 hourly. Now I have the opposite problem: a 3.5 week old baby and over 130ml per breast waiting to be drained when he could get by on 70- 80mls per feed. So I'm now in oversupply mode and must watch out once again for lumps that could become mastitis. Such a balancing act..
But I felt better seeing how much milk I was making so I could be confident he was getting enough despite my low carb eating.

Weight gain ✔ (They're pretty good at following things up here. They came 2 days after we checked out of hospital and then 5 days after that, and I've had a 2 week appointment as well. Weight gain in a positive direction, more than expected actually.)
Vitamin supplements ✔
Iodised salt ✔ all over my meat and pretty much everything I eat.
Breast milk storage bags - saw them in the chemist but didn't grab them. Still tossing up whether to be a milk station for a while to make a stash or just get some sleep while I can.
Have that special teat and bottle that Medela does and did start using it early when I was worried bubs was sleeping through feeds. I would have cringed much more with baby #1 but by baby #3 you get over that, don't you? I can't imagine how busy you must have been with twins but you do whatever you have to to survive, don't you?
Thanks for the advice! Got any magic tricks for nappy rash?

Hotpepper20000 said:

A few tricks I have learned after many years being nanny to help with diaper rash.
If you baby is prone to rashes do not use the premoistened wipes you can buy. Like pampers.
A soft cloth and warm water with a bit of baby bath soap. I would have a small bucket with warm water with a drop of bath soap in it while changing the babe.
Also if there is a a rash a present it’s important to wait a minute or two after cleaning the baby, before putting the diaper back on and let the area dry completely before putting any cream or the diaper on again.

Click to expand...

We have one small area of broken skin and I'll take him to a doctor if it doesn't heal in the next day or so. Do you think soap will sting that area?? I've started rinsing it with breastmilk on cotton balls and I have 4 or 5 different creams. Hopefully it's not thrush. Trying for more nudey time to.let it dry. Just hard now it's getting colder.

ringi said:

See https://www.dietdoctor.com/low-carb/when-breastfeeding

Click to expand...

I did see that article. The woman who ended up ill was apparently starving herself while breastfeeding though. I'm not super low carb I don't think. Not really sure how to measure but I haven't had any ketones show up on recent dip sticks. Even just 2 slices of homemade sourdough with a tablesp of sultanas or half a banana and gulps of milk throughout the day (on top of 3 egg cheesey buttery omlettes, mince and yoghurt and for dinner, tongue soup plus pistachio nuts as a snack) is all fairly nutrient dense. I'm not undereating so I don't think it will affect me But it is worth warning people for sure!

Edit: I just tested for ketones again now after eating ox tongue soup with carrot and onion around 12 hours ago then 3 egg omlette with boconncini cheese around 5 hours ago. There are trace ketones (0.5mmol) and that's probably only because I'm breastfeeding. So now I have my sourdough spelt with half a banana and that should bump me back out of ketosis. I guess if you have severe insulin resistance and higher blood glucose levels, you'd have to monitor closely. I'm pretty sure after doing a ketone dip stick test yesterday and finding nothing that the amount of carbs I'm having must be enough to keep my ketone levels pretty low. My blood glucose levels were also normal this morning as well (4.9 after a 7 hour fast - but not a well rested one as I was up 4 times with baby). If you have higher blood glucose levels and are using insulin, I can imagine this balancing act between ketones and blood glucose levels would be more complicated.

Edit again: Just thought I'd test again an hour after eating the carbs above. My husband added a few sultanas to the bread so those plus half a banana have given me a spike of 9.3 mmol blood glucose. Checked again for ketones and they appear negative. Will check again in an hour to see where my blood glucose is left after those few carbs. I didn't expect to be in the 9s with just those so maybe the low carb eating is making me more insulin resistant / glucose intolerant.

So the question is: is it better to wake up with a blood glucose level of 4.9mmol, like I did this morning and find ketones, trace or possibly higher levels; or not have any ketones but instead an increased blood glucose level (we'll see how far that 9.3 mmol spike comes down at the 2 hour mark), while breastfeeding?

Next time I'll try the sourdough without the fruit, or vice versa. Didn't seem like much of a carb load but I guess any small amount of carbs that keeps your ketones from rising too much above 0.5 to 2 mmol is probably a safe bet. Thoughts anyone?
Final edit: another 50 mins later (around the 2 hour mark) my blood glucose is 6.2 mmol. I guess that is okay, except I'm hungry again so I will eat now. But low carb should make that okay.

And I've just read this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867828/

AloeSvea said:

I thought I would put in a quote from one of the above references, just to make it easier for women wanting to have a quick feed, as it were, reading this thread, of the important information re breastfeeding, and safety issues, on LCHF/Keto, with Dr Andreas Eenfeld's summary

From https://www.dietdoctor.com/breastfeeding-low-carb-diet-dangerous
"My recommendation
Although these cases appear extremely rare – a handful of published ones in modern history, of which all seem to have ended well, with the woman recovering rapidly – they are worth taking seriously.

In my opinion, it’s a good idea to be watchful if you choose to breastfeed on a low-carbohydrate diet. Perhaps the best alternative is to go for a slightly more liberal low-carb programme.

Bearing in mind that breastfeeding consumes carbohydrates, it may be unnecessary to aim for less than 50 g carbohydrate a day. This would, in theory, correspond to a strict LCHF diet for non-breastfeeding people. Although the risk of negative consequences of a very strict LCHF diet while breastfeeding is probably minimal, it’s an unnecessary risk to take.

So how do you recognize early symptoms of ketoacidosis while breastfeeding on low carb, in the highly unlikely event that it should happen? You’ll get abnormally thirsty, headache and nausea and generally feel weak and sick. In that case you should significantly increase the amount of carbs and fluid you ingest – and seek medical attention immediately if you should keep feeling worse instead of better.

The most important thing is, regardless, to get enough food and nutrition overall when breastfeeding. If you’re finding it hard to keep down anything of nutritional value (for example, because of some illness), you should contact medical professionals for advice."

Click to expand...

Yes, and there is a letter somewhere on their site from the one documented case of lactation ketoacidosis (from breastfeeding) and the woman says she had hardly eaten anything at all in the lead up to her ketoacidosis so she was starving and breastfeeding.
I've been breastfeeding while eating low carb (plenty of fat & protein) for a month now and I have an oversupply of breastmilk
Baby was weighed today at his 4 week check up and he weighs 4.35kg. He was 3.1kg at birth and 2.95kg at 5 days old when we left the hospital. So he has put on more weight than average. His blood sugar was apparently fine at birth. I asked if he is putting on more weight because I had gestational diabetes but the nurse said unlikely and usually women with gestational diabetes have trouble making breastmilk. I'm not sure how true that is because that hasn't been my experience anywyay. Oh, and I have already lost pretty much all of the baby weight by 4.5 weeks postpartum (10kg) and the last 2 times (this was baby #3) it took about a year to get down to 2 kg above pre-baby weight (I never lost those last 2kg before falling pregnant again each time.)

wiflib said:

I think you are doing a brilliant job (FWIW, I’m a retired Midwife).

Humans have been feeding their babies whilst eating a low carb diet for millennia and you are very clued up about it so in my opinion, having good control over your blood sugars should come first.

Have you ever thought of donating your milk? Human Milk For Human Babies has a good network.

Click to expand...

I have thought about it but having 3 kids to deal with makes breastfeeding one seem too time-consuming at times. Not to mention my almost 3 year old still hangs out for tastes or expressed left overs (he's forgotten how to suck) so if I did end up pumping more out he'd be the first in line and most of it wouldn't make it out the door.

If I only had one baby and he weaned early, I probably would have been one to donate, but I've been breastfeeding on and off for over 4.5 years already and may go another couple of years with my newest addition. I think I'll be over it before I would have the energy to donate unfortunately. Not to mention the mastitis that threatens when I pump and they get over full. I weaned my second last time I had it.

Donating is good idea for those who are able though.

wiflib said:

I love that the three year old still wants mummy milk, the idea that it wouldn’t make it out the door has made me chuckle, clever children you have there.

Click to expand...

I briefly tandem fed my 1st and 2nd when my first was around 20 months right up till she was well into her 3rd year. We had breaks for months each time I was more than 12 weeks pregnant because it hurt me too much. Each child gave me challenges that nearly made me quit or I actually did supplement with formula for a couple of months because of my 2nd's severe tongue and upper lip ties which made it unbearable for me by the time he was 4 months old and I ended up going to the emergency dep asking for help to feed my baby - turned out I had thrush and a bacterial infection... so I hired a pump for a couple of months then ended up having his ties treated at 6 months old, then we went back to breastfeeding till he was over 2 years old when I fell pregnant again.
My 1st, who is 4.5yo now even had a short session on the boob just after my latest baby #3 was born, she asked to try, but she has also forgotten how to suck properly. Then when I gave her expressed milk leftovers, after the 2nd or 3rd time she said it made her want to vomit... haha So she is definitely done now.
Breastfeeding is **** hard! Most women need way more support than they can access, which is why so many quit early in the game. I've only had my husband for support and even with him at first had arguments about how often I was doing it. I pushed through infections when I think a more sane person would have given up for their own mental health.
I've decided that donating is setting the bar too high for me. I already feel like I deserve a medal for managing to feed my own 3 kids. Even this new baby of mine is a struggle to feed because he doesn't open his mouth wide or stay latched.
I'm sure some women breastfeed effortlessly, but the only part that was relatively effortless for me was the fact that I had a good supply each time.

Cocosilk said:

I briefly tandem fed my 1st and 2nd when my first was around 20 months right up till she was well into her 3rd year. We had breaks for months each time I was more than 12 weeks pregnant because it hurt me too much. Each child gave me challenges that nearly made me quit or I actually did supplement with formula for a couple of months because of my 2nd's severe tongue and upper lip ties which made it unbearable for me by the time he was 4 months old and I ended up going to the emergency dep asking for help to feed my baby - turned out I had thrush and a bacterial infection... so I hired a pump for a couple of months then ended up having his ties treated at 6 months old, then we went back to breastfeeding till he was over 2 years old when I fell pregnant again.
My 1st, who is 4.5yo now even had a short session on the boob just after my latest baby #3 was born, she asked to try, but she has also forgotten how to suck properly. Then when I gave her expressed milk leftovers, after the 2nd or 3rd time she said it made her want to vomit... haha So she is definitely done now.
Breastfeeding is **** hard! Most women need way more support than they can access, which is why so many quit early in the game. I've only had my husband for support and even with him at first had arguments about how often I was doing it. I pushed through infections when I think a more sane person would have given up for their own mental health.
I've decided that donating is setting the bar too high for me. I already feel like I deserve a medal for managing to feed my own 3 kids. Even this new baby of mine is a struggle to feed because he doesn't open his mouth wide or stay latched.
I'm sure some women breastfeed effortlessly, but the only part that was relatively effortless for me was the fact that I had a good supply each time.

Click to expand...

Oh thanks kitedoc! That was the medal I was hoping for