Articles published on this blog are my opinion only, and may not necessarily reflect the views of any organisations with which I am associated. Please be aware that articles posted on this blog are not intended as a substitute for professional medical advice. If you have a medical problem relating to breastfeeding, please seek further advice from a Lactation Consultant (IBCLC) or trained Breastfeeding Counsellor.

Monday, 18 July 2011

Am I a food martyr? - Breastfeeding the allergic baby and making dietary sacrifices

"You never really understand a person until you consider things from his point of view [...] until you climb into his skin and walk around in it."
~ Atticus, To Kill A Mockingbird - Harper Lee

When I support a mother to breastfeed, I am trying to see the world from her perspective; to appreciate the challenges she might be facing, and if she wishes, offer her ideas and information so that she might choose a pathway through her breastfeeding journey which works for her and her baby. There are however, some obstacles to breastfeeding I struggle to imagine what they would really be like to experience.

For just over a year now, I have observed a friend of mine breastfeeding a baby with multiple allergies, almost unable to fathom what it would mean to face something like this myself. Before I continue, I must point out that "Food sensitivities in breastfed babies are not nearly as common as many breastfeeding mothers have been led to think" (1). If you are concerned that your breastfed baby may have a food sensitivity, this article on Kellymom is essential reading, and contact an appropriately qualified breastfeeding specialist (UK telephone helplines are listed on the right).

Along with everyone else, I greatly admired what I perceived to be a deed of heroic undertaking when my friend eliminated a long list of everyday foods from her diet in order to continue breastfeeding her baby. She insisted that she wasn't doing anything extraordinary, but I thought she was just being modest, doubting that I would be capable of such sacrifices myself. And I told her so. And one day she finally turned around and challenged me to live for a week on her diet... and I heard myself accepting.

I admit I panicked a bit as the agreed week drew closer. Wheat, dairy, eggs, soya, meat, nuts and nightshades (includes tomatoes, potatoes, red peppers, aubergines, chilli, paprika and cayenne) were strictly off the menu, so I found myself wondering what on earth I was going to eat. And I very nearly wimped out of it: I am still breastfeeding two babies myself and I didn't really know what I was doing meddling with my food intake - perhaps the whole idea had been a bit rash? However, curiosity got the better of me... and a promise is a promise after all.

Why was I bothering to do this? I was asked. If I was in that situation, wouldn't it be easier to just give my baby some kind of hypoallergenic formula? I simply wanted to understand how to better support mothers like my friend. Support is key to a successful breastfeeding relationship. Supporting a breastfeeding mother of an allergic baby means first and foremost respecting that she is a breastfeeding mother, and that her baby is breastfeeding. She shouldn't have to endlessly justify herself for eliminating foods from her diet and continuing her breastfeeding relationship. The breastfeeding itself isn't actually the problem: it is certain foods in the mother's diet that the baby cannot tolerate. Eliminating those foods eliminates the problem. If the mother switches to infant formula, there is a long list of ingredients to check, and there are absolutely no guarantees that the baby will tolerate that either. Even if it did, not breastfeeding places the mother and baby at much greater risk of developing other short and long-term health problems. Why introduce so many other risks for the sake of a chance that it might solve just one problem?

The week got off to a bad start. Life with four children is rather hectic, so I ended up diving almost completely unprepared into my first day. No preliminary research, no recipes, practically no idea what I was in for. Would the breastfeeding mother of an allergic baby realistically have time for a huge amount of preparation before starting an elimination diet?

After the initial shock of the first couple of days, I realised that eliminating that long list of foods from my diet wasn't the painful experience I'd expected it to be. Although rarely included on my usual shopping list, alternative foods are actually plentiful and delicious. I found that the real challenge for the mother of an allergic infant is that there is a lot to learn, and fast. And everything she learns, she learns as she goes.

It's a steep learning curve, and lack of time is an issue. It takes time for a mother to inform herself about making changes to her diet. Potential vitamin deficiencies need to be looked into - I decided that taking a vitamin supplement would be a wise move for me, especially since I was learning about a new diet as I muddled along, and I wasn't confident I had every vitamin and nutrient covered. Finding alternative foods and figuring out ingredient substitutions which work well in recipes can be a tricky and time-consuming business at first, and can require quite a bit of experimentation and creative thinking, especially if she's eliminating a lot of foods from her diet. It takes time to become fluent in ingredient-speak, to become conversant in all the different words for an ingredient you have to avoid, all the different ways manufacturers sneak different forms of these ingredients into their products. It takes time to find a range of products she can eat, recipes she can work with, to cook from scratch if necessary. And, as I learnt from one or two catastrophic culinary experiments, there is far less room to make mistakes on a diet like this - she can't just order a takeaway if she messes up an evening meal. And would a new mother realistically have time to indulge in culinary experimentation? Being the mother of a new baby is demanding at the best of times, but add in parents who are already exhausted from caring for a baby who has been unusually fussy and unhappy for some time, as well as all the things a mother needs to know in order to successfully navigate her way through breastfeeding a baby with food allergies, and it is very easy to see how starting out can be daunting.

Support is vital to breastfeeding mothers of  babies with food sensitivities - they simply have different needs to other breastfeeding dyads. 

There are a number of ways that relatives, friends and breastfeeding supporters can make life easier for breastfeeding mothers of allergic babies, especially during the first few weeks while they adjust to their new eating habits. The mother might need:

  • help with researching information about eliminating foods from her diet, especially with picking out the information that is relevant and useful to her. Useful organisations and websites include:
Kellymom's article Dairy and other Food Sensitivities in Breastfed Babies - a goldmine of information and links
Botanical food family list from the Calgary Allergy Network - don't forget to check out the rest of this informative site too
Living Without - a magazine for people with allergies and food sensitivities - articles, research reports and recipes for all sorts of food allergies
Pig in the Kitchen - great blog by a family catering for children with multiple food allergies
The Vegan Society - plenty of ideas for those avoiding meat, fish, dairy or eggs
Coeliac UK - information for those avoiding gluten - information for those avoiding wheat
Eggless Cooking - ideas for those avoiding eggs
Go Dairy Free - information for those avoiding dairy
How To Do A No Nightshades Diet
Tomatoes are Evil - hilariously obsessive anti-tomato website

We know they're in there...
Image credit: Tomatoes are Evil
  • extra pairs of eyes to read food labels, which is a time-consuming job. Arm yourself with a list of the ingredients she has to eliminate from her diet and check ingredients lists in the supermarket for her, making notes of the foods she can eat. Even better: go shopping for her!
  • help with looking for recipe ideas. Offer to find her some quick and easy recipes which are safe for her to eat.
  • help with cooking. Make her something she is able to eat: a meal, a tasty treat, or a nutritious snack. Remember the takeaway isn't an option, so make her a meal she can freeze, just in case an experiment with new ingredients doesn't go to plan.
  • to get out of the house occasionally. Why not invite her to your house for lunch or dinner and make a meal which caters for her dietary requirements? Make sure you eat the same meal as your guest. Or find a restaurant or cafe which would be prepared to cater for her dietary requirements, and invite her to eat out with you. Make sure she can take the baby with her and that the establishment is positive about breastfeeding.
  • company. Two heads are better than one! Offer to accompany her on her special diet for a few days and see what new foods and recipes you come up with together. You'll end up with a much better understanding of what everyday life must be like for her.
I have been struck not so much by the hardship of making dietary 'sacrifices', but by the realisation that this journey can be a lonely one. Every mealtime is a reminder that the mother has stepped away from the crowd, that she is flying solo at a time when it is natural to desire to connect with others sharing similar experiences. In the UK, where in 2005 just 22% of infants were exclusively breastfed at 6 weeks of age (2), breastfeeding has been the road less travelled for a number of years. So if when she breastfeeds, a mother is already treading the road less travelled, breastfeeding a baby with food intolerances is a journey even fewer mothers have taken. I was lucky: my friend guided me through many of the problems I encountered, so I wasn't completely alone. In reality though, it's hard to find the much-needed community of mothers who can share their experiences of breastfeeding an allergic baby and make the path easier to tread for those that follow. After a week or so of trawling the internet, I found just one online forum: Breastfeeding babies with food allergies/intolerances/sensitivities, hosted by the Australian Breastfeeding Association. The triumphs of getting together with other people to pool ideas can be enormous: imagine our delight when we created a proper birthday cake for my friend's baby's first birthday!

The great news is that once the initial hard work is done, it really pays off. I noticed that once I'd tracked down alternative foods, it was simply a matter of getting into good habits: managing my food shopping differently, paying extra attention to food labels, changing my store of basic ingredients, and changing the recipes I use regularly. It's worth remembering that the baby may not outgrow his need for a special allergy diet once weaning starts and he grows older, which means that the mother has got a wonderful head start on knowing which foods are safe for him to eat, and she's already in the habit of being able to provide for his dietary requirements. 

The rewards are great: the immediate reward is a much happier, healthy baby. I am amazed at the difference my friend's dietary changes made to her baby. Changing my diet had some unexpectedly positive effects for me too: by mid-week, I realised I didn't actually miss many of the foods I wasn't allowed to eat; in fact, I was surprised to discover how much better I felt and how much more energy I seemed to have. By the end of the week, I decided that some of the alternative foods I'd discovered were here to stay.

My friend was right. This 'restricted' diet wasn't such a huge sacrifice after all. And so my perspective on the issue has changed completely: if I had a baby who couldn't tolerate some of the foods in my diet, of course I'd be motivated to make changes to my eating habits and carry on breastfeeding! Eliminating foods isn't martyrdom or a mark of supreme alpha mummy dedication. It is simply adaptation. It is accepting that, in a society which all too often decries breastfeeding as "The Problem" and touts infant formula as "The Solution", for every breastfeeding problem there is a breastfeeding solution. The truth is not that cutting foods out of your diet is hard; it is that we mothers are far more resilient and resourceful than we give ourselves credit for. Biology isn't stupid. If it encounters an obstacle it changes, adapts in order to survive. Examples of this are everywhere in nature - so why do we react with so much surprise when this same behaviour is displayed within a breastfeeding dyad?

Recipe: An extra-special birthday cake

This cake is adapted from a recipe I found here, and is wheat-free, gluten-free, egg-free, soya-free, nut-free, nightshade-free and vegan.

Dry ingredients:
120g polenta (granules, not the ready-made stuff)
150g rice flour
150g light muscovado sugar
3 teaspoons baking powder
Wet ingredients:
Juice & rind of 1.5 lemons
200ml olive oil
150ml warm water
150ml coconut cream

Mix all of the dry ingredients together in a bowl, then beat in all of the wet ingredients using a fork. The resulting mixture will be quite sloppy & should almost fill the cake tin. Bake at 180 degrees C for about 45 minutes, or until the top of the cake is cracked, and when the centre of the cake is tested with a skewer, it comes out clean.

To make a gorgeous chocolate cake, the lemon rind and juice can be substituted with about 50g cocoa (look for cocoa which is made from 100% ground cocoa beans).

The recipe also makes very nice cupcakes... mmm...

Last edited: 21/07/11

(1) Bonyata, K (2011) Dairy and Other Food Sentitivities in Breastfed Babies
(2) NHS Information Centre (2007) Infant Feeding Survey 2005