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Breast Feeding and the Elimination Diet

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In our lactation-counseling practice, we employ a method called the elimination diet for breastfeeding mothers who suspect that food sensitivities cause their baby's colic in their own diet. Developed by William G. Crook, M.D., this diet has several variations depending on the severity of symptoms. Our preferred method involves eating the least allergenic food from each food group.

It is important to note that this diet may need to be followed for up to two weeks as it takes time for the offending foods to completely exit both the mother's and baby's systems. However, we have found that following our recommended variation yields the quickest and most effective relief for both mother and baby.

Mothers can pinpoint the culprit behind their baby's discomfort by cutting out potential allergens such as dairy, soy, wheat, and eggs. Although the diet can be challenging at first, it is worth it to see the improvement in the baby's symptoms. Plus, mothers may discover new, delicious foods they wouldn't have tried otherwise.

We understand that embarking on an elimination diet while breastfeeding can be daunting, but we are here to support and guide mothers every step of the way. We recommend keeping a food journal to track progress and making meal plans ahead of time to avoid feeling overwhelmed. With dedication and patience, mothers can successfully identify and eliminate problem foods, resulting in a happier and healthier baby.

Step 1 of the Elimination Diet

During the initial two weeks of the elimination diet, we recommend consuming only range-fed turkey and lamb, baked or boiled potatoes and sweet potatoes (seasoned with salt and pepper only), rice and millet as your only grain, and cooked green and yellow squash as your vegetable. For fruit, stick to pears and diluted pear juice. Additionally, it is advised to switch to a rice-based beverage as a substitute for milk in cereal or cooking rather than soy beverages. To ensure adequate calcium intake, we recommend taking a calcium supplement. Rice-based products, such as rice beverage, rice-based frozen dessert, rice pasta, rice flour, and millet, can be found at nutrition stores.

Step 2 of the Elimination Diet

After two weeks, or once the colic has subsided, it is recommended to gradually add other foods to your diet, one at a time, every four days. We suggest starting with less commonly allergenic foods, such as sunflower seeds, carrots, beets, salmon, oats, grapes, California avocados, and peaches. It is important to wait before adding wheat, beef, eggs, nuts, and corn. It is advised to avoid dairy products, soy products, peanuts, shellfish, coffee, tea, colas, and other beverages containing caffeine, chocolate, gas-producing vegetables (such as broccoli, cauliflower, cabbage, onions, and green peppers), tomatoes, and citrus fruits for a longer period of time. Cooked vegetables and fruits may be tolerated sooner than raw ones.

Step 3 of the Elimination Diet

Maintaining a record of the foods you consume is crucial during the elimination diet. It is recommended to also note any problem behaviors that occur. Try to link your baby's fussy spells with what you have eaten in the past day or so. This will give you a better understanding of what may be causing your baby's discomfort and help you stay objective, which can be difficult when you are sleep-deprived. This is especially important if your baby continues to be fussy beyond four months of age. By keeping a detailed record, you can pinpoint which foods to avoid in the future and ensure your baby's comfort.

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It is important to note that while following the elimination diet, it may feel like limited food options are available. However, it is still possible to maintain a nutritious diet by consuming more of the "safe" types of food until you determine what your baby can tolerate. Colicky babies tend to respond quickly to changes in their mother's diet, often within one or two days. For older babies who are experiencing night waking, it may take longer to see results.

Mothers may find that when they alter their diet, their baby's sleep may initially improve for a few nights, only to worsen again for a few days or a week before improving once more. It is important to understand this pattern to avoid becoming discouraged and giving up prematurely. At this stage, it is recommended to mainly eliminate proteins, such as dairy, beef, eggs, chicken, shellfish, soy, corn, wheat, and peanuts (as well as any other foods that have been observed to cause discomfort for the baby). Research has shown that some foreign proteins may pass into a mother's milk more readily than others, and some babies may be more sensitive to these proteins than others.

Allergies and Breastfeeding

The effects of maternal food restrictions during breastfeeding on the development of food allergies in babies have produced mixed results in research studies. Surprisingly, a study presented at the 1996 meeting of the American Academy of Allergy, Asthma, and Immunology found that the children of breastfeeding mothers who avoided allergenic foods had a higher incidence of food allergies.

Currently, some scientific evidence suggests that consuming cow's-milk products during breastfeeding may cause colicky symptoms in a baby. Therefore, it would be wise for breastfeeding mothers with a family history of cow's-milk allergies to eliminate dairy products from their diet, at least for the first year. Seeking nutritional advice from a doctor or nutritionist before embarking on a restrictive diet is strongly advised. Otherwise, both the mother and baby may be at risk of developing nutritional deficiencies.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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