Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
A dilemma that I hear all of the time, both from my patients, but honestly, even in conversations with other physicians is what about GLP medications and breastfeeding? Is it safe to do that? It’s probably not, right? And the reality is we actually have some really compelling data that has developed over the last couple of years and the answer becomes very nuanced as it may actually make sense to resume GLP medications for the mother who is breastfeeding, but let’s talk about what that information actually looks like because if you are a patient, I want you to feel confident listening to this episode that you understand what are the risks, what are the benefits so that you can bring that in to your own healthcare practitioner and have a great conversation about your body, your needs, your health conditions, and what that means for breastfeeding. Now, very commonly, we in the setting of trying to conceive during pregnancy, during breastfeeding, these are not always times that we have a lot of data for what is happening for women with many different medications or different healthcare interventions.

And so we have to use the information that we have and make a risk versus benefits conversation. But there can always be some risk in that unknown, and a lot of physicians are very cautious when they make these decisions. So if you’re having frustrating conversations with your healthcare team, I want you to know that as long as they’re open-minded and engaging in these conversations, this is groundbreaking territory and they may not yet feel comfortable. Now, what I will say is that I prescribe GLP medications every single day, and these are medications that have been incredibly life-changing for so many patients across so many changes of life, including breastfeeding. And so if you are breastfeeding, if you’ve had a conversation with your physician and they’ve said something to you like, “Absolutely not. If you are breastfeeding, if you are producing breast milk at any fashion, you cannot be on a GLP medication,” then I want you to know I’m happy to support you as your obesity medicine physician.

I see patients in Virginia, in Tennessee, and Illinois. We’ll have all the information for my clinic in the show notes, but I would be so happy to be a resource for you if you are struggling to find someone to prescribe in this breastfeeding situation. But let’s dive in and talk about who this is for, who this is for not, and what does the data actually show us so we can feel confident in making the decision that is best for the patient that is there, whether that’s you or if you are a healthcare provider listening, what is the evidence for the patient that’s sitting there in front of you? Now, I think one thing I really want to be clear with is over the last couple of years, we have seen the GLP medications become incredibly popular. We know that these medications are life-changing for so many individuals, and we see that they are used in patients with diabetes, in patients with obesity.

A lot of those patients with obesity are seeing the complications of it. They might have pre-diabetes or high blood pressure, high cholesterol. Maybe they during pregnancy had gestational diabetes, even if they haven’t dealt with that outside of the pregnancy setting. That is very different than the patient who gained weight during pregnancy, now they’re a month or two postpartum and they’re ready to lose 20 or 30 pounds. I am not necessarily thinking about the GLP medications, or shouldn’t even say it that way. I’m not thinking about the GLP medications for the person who has a cosmetic weight loss goal. But what I see very frequently in my clinic is that women, particularly in their late 20s through their 30s, during those childbearing years, that they’re told that they have to stop the GLP medication to try to conceive. Then they become pregnant, which may take many months or years even.

So there’s this whole period of time where they don’t have access to that medication potentially. And that’s another topic for another conversation, but I do often treat patients in that setting as well of trying to conceive. But a lot of times women have been stopped on their GLP medication for trying to conceive. Then if they become pregnant, they’ve stopped for the nine months of pregnancy, now they’re breastfeeding and we have recommendations that breastfeeding is excellent. And the American Academy of Pediatricians says that we should aim to breastfeed for two years, so six months of exclusively breast milk if that’s possible, followed by continued breastfeeding alongside other food as that is being introduced. So now we have women who are breastfeeding and being told, “Okay, you cannot be on your GLP medication.” Well, if that woman, let’s say, breastfeeds for two years, at this point, if she’s thinking about having other children, then that sets back the timeline another couple of years, another two, three years.

And so if you’re looking at someone that wants to have maybe two or three children, all of a sudden they’re talking about five years or eight years that they are being told that they do not have access to this medication. And if we’re talking about this, someone that does not have evidence of metabolic disease, someone who has 20 or 30 pounds of excess weight on their body, well, okay, maybe there’s other interventions that we can consider, but what about that person that does have type two diabetes, that does have chronic obesity, that does have pre-diabetes or gestational diabetes? Does it make sense for us to withhold care for many years when that could be life-changing and health changing for that person to be on a GLP medication? So the conversation becomes a lot more nuanced and can be a really big difference between are we actually treating the patient in front of us versus are we feeling afraid of these medications?

And so I want us to go through the data to help to understand, well, should we be afraid of this medication? Now, when we think about GLPs being avoided, when we look back a couple of years, and I even have an episode on this before, we didn’t have that much data about breastfeeding and GLP medications, but that has evolved a lot over the last couple of years. So let’s dive into what that data actually looks like. So first I want to talk about semaglutide. So this is the medication brand name Ozempic, brand name Wegovy. This is a once a week GLP injection. And what has been thought is that this is actually a pretty large as the peptide and it’s pretty large. So it’s though that theoretically, because of the size of this peptide, that it would not be able to be transmitted in breast milk.

Now, there was a study, it was a very small study. It was looking at eight breastfeeding women who were taking weekly injections between 0.25 milligrams and one milligram every week, and they were breastfeeding their infants ranged, I forget the exact, from four months to 23 months old. So some were just a few months postpartum, some of them were almost two years postpartum, but these eight women were measured to see both when immediately after the semaglutide was taken, excuse me, immediately before the semaglutide injection was taken, then 12 hours after the injection and 24 hours after the injection, they provided a milk sample and then those milk samples were analyzed to see was semaglutide detectable? And the answer in all of those was no, the semaglutide was completely undetectable. Now it doesn’t mean that, okay, absolutely it couldn’t be transmitted in breast milk, but both with the size of this peptide molecule as well as this data, it helps us feel pretty reassured that, oh, actually semaglutide is pretty unlikely or maybe even impossible, but pretty unlikely to be transmitted in breast milk.

Now, what if it is? What if in these eight women there was something about them where it wasn’t able to be transmitted, but it could be in somebody else? Now, one thing that’s really important here is these medications, there’s a big reason that they are injectables. Now, semaglutide has been made into an oral version, and we’ll talk a little bit about what that looks like, but it is incredibly difficult for these medications to be taken orally. So for example, the top dose of semaglutide in Wegovy form is 2.4 milligrams. They actually did release a higher dose of 7.2 milligrams. But we think about that 2.4 milligram dose, for example, they made an oral version of this medication. What is considered an equivalent dose of medication is a 25 milligram dose taken every single day. So this is not only 10 times higher, this is like 70 times higher.

This is 10 times higher, but taken every single day rather than once a week. So the dose is 70 times higher when taken by mouth. There’s also a technology called the SNAC technology. This is a technology that helps to neutralize the stomach environment in order to increase the absorption of that Wegovy tablet. And that has to be taken fasting, first thing in the morning, within you have 30 minutes that you can’t take other medications, other beverages, other foods. It has to be this totally fasted state in order to improve and actually get the absorption that would make it equivalent to that 2.4 milligram dose. So we know that if we were to take a very small dose, let’s say 2.4 milligram pill, which doesn’t exist, but roll with me here, that if you were to take that very small pill, that it would be entirely broken down in the stomach, especially if it didn’t have that SNAC technology that would increase the absorption.

So let’s say even a teeny tiny amount did get into the breast milk. Well, theoretically, that amount is not going to impact the infant because their stomach is going to break it down. Basically, our body recognizes it like protein and breaks it down as if it is a food. And so the effect of that medication is likely to be very small, probably nothing, but very, very, very small if there is any sort of effect. So we’re getting kind of theoretical here, but really no evidence that semaglutide is transmitting in breast milk with the information that we have. Now, recently, earlier this year in 2026, there was a study also on tirzepatide. So this is the generic name of Zepbound and Mounjaro, and it was a study of 11 lactating women who were taking doses of 2.5 or five milligrams of tirzepatide. And they collected the samples looking at what was the amount after they took these injections, what was the amount that was detected in the breast milk?

And the women provided a total of 171 breast milk samples, and in 164 of 171 of those samples, so 96% of those samples, there was no detectable zepbound or tirzepatide. In the remaining samples, so in seven of those 171 samples, there was some breast milk or some tirzepatide detected in that breast milk, but it was less than 0.02% of the maternal administered dose. And the last measurable concentration was five days after dosing. So even though it may have been present in the breast milk for seven of these 171 samples, so about 4% of the samples, the amount was less than 0.02% of the maternal administered dose. Now, the exact same thing is true for tirzepatide, that it is a peptide that if we were to take it in a pill version, which doesn’t exist for the tirzepatide medication, but if we were to take it in a pill version, our body would see this peptide, it would recognize it basically like food, like protein, and it would break it down.

So that 0.02% of the maternal administered dose becomes this very, very small amount of tirzepatide that is detected in the breast milk, and in theory, that would get broken down. Now with this information available to us, what does that mean in terms of making a decision? So we have a little bit more data for the semaglutide medication, so Ozempic, Wegovy. We still have data, but maybe it’s transmitted in breast milk for the tirzepatide medication, Zepbound and Mounjaro. But what do we have to say about the patient that is sitting in front of us? Now, what is their health history? Have they taken this medication before, any of these medications before? How were they doing on it? What was their health? What was their weight before starting it? What is the reason to start it right now? Where are they at in their breastfeeding journey? So someone who is six weeks postpartum versus three months postpartum versus two years postpartum is going to look incredibly different.

Now, even if this medication is transmitted into breast milk, one of the big arguments that people will make is, well, what does it do in terms of affecting breast milk supply? And I think this is an incredibly valid question. We do know that breastfeeding is this metabolic time where our body is revved up and burning a lot of energy. And if you have ever breastfed before, you will know how thirsty and how hungry you feel. I so distinctly remember the feeling of breastfeeding my three children and feeling just hungry and so, so thirsty all of the time. I mean, I had just armfuls of… I would go to work every morning and it was like my water and my Gatorade and my tea and another water bottle. It was just so many beverages and so, so much food. And so this is this time where metabolically our bodies are very active and metabolically a breastfeeding mother is going to need adequate nourishment.

We do know that if someone is taking too high of a dose of GLP medication, or I shouldn’t even say that, but if they’re taking GLP medication, it will drive down appetites. How these medications work is that they decrease the appetite. But the question becomes, can we find a balance where we are decreasing the metabolic disease, but still allowing an appetite that allows us to nourish our body? Now, very early on in the breastfeeding journey, certainly the first six weeks, but honestly even up to the first 12 weeks, our body is still really regulating breast milk supply. The body is adapting to how much breast milk does my baby need? And that will predominantly depend on how often breastfeeding or emptying the breast occurs. So that can be pumping, expressing in any capacity, but how often are the breast relieved of breast milk? So how often is that breast milk expressed as well as how much of it?

So there’s a very supply and demand thing that is happening. So we want to make sure that breastfeeding is still happening at a regular interval, that there’s still adequate amount of breast milk that is being removed from the breast in order to establish it. So I would absolutely never prescribe to someone breastfeeding in the first six weeks. And then honestly, it’s about the three-month period of time that we start to feel a lot more comfortable that that breastfeeding relationship has been established, that there is supply that has been fully established at that point or to the extent that it’s going to be. So from there, as we’re thinking about, okay, well, could we introduce a GLP medication? We want to be incredibly mindful of are we adequately hydrating? Are we adequately nourishing the body in a way that will keep up supply and what are your goals for doing that?

A lot of times we talk about breastfeeding and the benefits for the baby, which of course there are plenty, but there are also breastfeeding benefits for the mother. Breastfeeding can be an incredible metabolic reset helping to process through fat stores. But what is also true is that if we have insulin resistance, things like prediabetes, diabetes, if you had gestational diabetes, those are all signs of insulin resistance. If you have insulin resistance, your body may not be able to tap into burning your fat stores in the same way as a woman who did not have insulin resistance. So is it even possible that giving a low dose of the GLP medications could be an effective way of helping women also to metabolically tap into releasing those fat stores in a way that improves breastfeeding? Now that is an incredibly hypothetical thing, but it is true that insulin resistance, it can make it much more challenging to breastfeed or to have an adequate milk supply.

And so we have to be thinking about that side of things as well. So if we’ve established milk supply, we’re starting obviously at the introductory dose of these medications and then we’re monitoring the patient really closely. Is she still getting plenty of liquid and getting those fluids? Is she still adequately nourishing her body? Is she able to make food choices more in line with her goals? Is she still keeping up with regularly emptying the breast?This can be an incredibly challenging time for the woman, for example, who has maybe a three-month or 12-week maternity leave. This may also align with the time that she is going back to work, and so she’s not able to breastfeed on demand. Maybe there’s other challenges in her workday that make it difficult to be able to pump on the schedule that she would like to. There’s a lot of other changes that can be happening at that time, but can we be checking in regularly with our patients to see, okay, how are you doing?

How is the breastfeeding going? Are you still getting similar volumes if you’re pumping? How is your baby’s growth going? Maybe we’re more concerned for the premature infant, the infant that’s really struggled with growth, but a child who’s growing really well along their curve and we’re tracking and checking in with the mother regularly, it may be appropriate for us to consider medication in this scenario. So it is not a simple yes, it is not a simple no, but it is absolutely appropriate in the right patient to be able to use a GLP medication while breastfeeding. Now, this conversation continues to evolve. We talked really in depth today about semaglutide and tirzepatide in injectable form. I do not recommend the oral medications, both that snack technology, which helps with the absorption of the Wegovy pill, the Foundayo medication, which is a very small molecule. This medication can be transmitted in breast milk.

This is the orforglipron medication. It’s not been studied in humans, but it was seen in rodent breast milk and it did freely transmit, so we are not talking about the orals. We are just talking about injectable semaglutide, so brand name Ozempic Wegovy, injectable tirzepatide, brand name Mounjaro Zepbound. It may be appropriate in the right patient and really help support them in not just their weight goals, but their overall health goals. Again, I am so happy to be the person that helps you with this if you are near me. I see patients in person in Charlottesville, Virginia and throughout the states of Illinois and Tennessee and the rest of Virginia by telemedicine. If you’re interested in learning more, visit www.sarahstombaughmd.com. You can learn more about my weight loss program there. Thank you so much for joining us for this week’s episode. We’ll see you all next time.