Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 56. 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: Hi everyone. Thank you so much for joining me today. We are talking about a topic that is near and dear to my heart and I honestly cannot believe I have not shared it with you, which is weight loss during breastfeeding and how we can support our healthy weight in order to bring back our health after pregnancy, make sure that we nourish our own bodies, nourish our babies, and support our health along the way. I'm really excited to share this. I actually was a guest on a friend's podcast. Dr. Kerry Reller has the Get Healthy Tampa Bay podcast. It is a great podcast if you are looking for general health tips. She is also a family medicine physician and has a variety of health related topics on her podcast, so I highly recommend it. And we were talking about weight loss during breastfeeding, and many of my listeners know I am the mother to young children. My children right now are five, three and one, and breastfeeding has been really important to me. And if you are listening to this episode and you're like, Dr. Stombaugh, I am a 50-year-old woman, or I'm a man, I don't even care about this topic. I want to invite you to share this episode with someone who would care about this topic. So maybe your daughter, maybe a family friend, maybe a colleague, someone who has breastfed, is breastfeeding, someone who is pregnant maybe and intends to breastfeed. It is so important that we are able to support women so that they feel like they have all of the advice that they need to thrive during that postpartum period. There's a lot of advice about pregnancy, lots of forums about where you can ask all your pregnancy questions, and as we transition into that postpartum period, a lot of women feel like they don't have great support to be able to meet their breastfeeding goals or meet their other health goals. And so I want to address one aspect of that today. Of course, we're talking about it from a weight loss standpoint, but we are going to be talking about things like how to nourish your body, how to increase your breast milk supply, how to make sure that you are supporting your weight in order to lose weight at a rate that allows you to continue breastfeeding at a way that is okay with your body. Because there are so many people who come into my clinic, there is this idea that during breastfeeding, the weight just falls off and certainly some people have that experience, but what is frustrating for people who do not have that experience is that they think they are the exception. They don't realize that many, many women struggle with weight gain during breastfeeding. Women who gained the appropriate amount of weight during pregnancy had a healthy delivery and then they start to notice that after delivery their weight is ticking up and up and up. And so it makes it even more challenging because they've gained additional weight that now they're trying to lose. Wherever you're at in this stage, if you know someone who is, I would love for you to be able to share this with them. Let's dive in. Breastfeeding is such a interesting time in our body's physiology. It has a lot of demands on our body that we often loop into pregnancy as if pregnancy and breastfeeding are the same state, but we have our own specific needs during breastfeeding that we need to make sure to address. So during breastfeeding, your body is making milk, and in order to do that, it requires that you have a lot of extra fluid. It requires that you have extra calories, extra nourishment to be able to make that adequate supply for your child. And we talk about that. We have this prolactin drive. So prolactin, the hormone that creates breast milk also drives intense hunger and intense thirst. And so it's very common for women who are breastfeeding, especially early on that they just feel sort of ravenously hungry all of the time. So let's talk about how we can address that. I want to say first and foremost, you should be listening to the signals that your body is telling you. If your body is feeling ravenously hungry all the time, I want you to be able to acknowledge that by making sure that you are drinking plenty and making sure that you are eating plenty. One of the traps though, that a lot of women fall into is that they are so busy, they're at home, they have a newborn, they may not have a lot of support and they don't know how to take care of a newborn while also preparing a meal that is going to meet their needs. And so I will encourage you or encourage whomever you're sharing this with to look at what are the resources that are available for you. Do you have someone who can help prepare meals for you, whether that's a significant other, whether that's someone who is coming to provide care for you and for your baby, someone who is going to help create those nourishing meals because I can guarantee that the breastfeeding mother is unlikely to starve, but she is likely to grab whatever is in sight. And so that might mean kids' foods. That might mean granola bars, that might mean goldfish crackers. That might mean whatever random frozen entree is in the freezer, she will grab anything that she can eat quickly when we can eat real foods, foods that have lots of protein, lots of healthy fats, lots of fiber in them that can support our health goals as mothers, as well as support a breastfeeding relationship. We talk about insulin resistance a lot, and pregnancy is a very insulin resistant stage, and a lot of times that carries over into breastfeeding when insulin resistance means is that our body has seen over and over again these increased levels of insulin in response to the foods that we eat. So when we have increased flour in our food, when we have sugars in our food, our body responds to that by releasing insulin, which is our energy storage hormone. So when we eat these processed carbohydrates, honestly, when we eat any carbohydrate, our body is going to release insulin in response to that to be able to store away that energy for later. And this is a very important thing that happens, and it's actually really important in terms of promoting our baby's growth. And so that insulin, it's a growth factor. So in adults that's often meaning that it's growing our fat stores, but in children it's also growing our bodies, and so we need that as one of our growth hormones in order to promote our body being able to grow height and grow weight and grow appropriately. So pregnancy is this naturally insulin resistant state, and that carries over into breastfeeding. What happens when we're insulin resistant is that our body tends to crave more carbohydrates and it tends to crave more processed carbohydrates. And especially when we're hungry, those carbohydrates are really quick hit of energy, and so we eat them and we feel that surge of blood sugar that makes us feel energetic. We feel that really quickly. And so it's such a desirable thing for mothers of young children and honestly for anybody to feel that surge of energy that comes from a quick hit of carbohydrate, particularly those processed carbohydrates, and there's nothing, when we're talking about sugars and we're talking about flowers, there's nothing in that slows down the digestion like fiber. There's nothing in that provides long-term satiety. So protein and fats help promote long-term satiety. And so a lot of times what we find is that in that breastfeeding state, you're still somewhat insulin resistant from the pregnancy state. Your body is still adapting to that. You have excess weight on your body that's promoting that insulin resistance, and now if you don't have adequate nutrition support available to you and you're sort of grabbing whatever is available, those quick granola bars or sugary yogurts and that type of thing, that makes it really hard to also promote weight loss because you are in a state constantly where you are giving your body energy and your energy goes up quickly, your energy goes down quickly and usually an hour or two later you're feeling hungry again. So I say all of that to say, making sure that you can get really great nutritional support with lots of protein, lots of fat, lots of fiber-filled foods, really whole foods, honestly, just real foods is going to be one of the best things that you can do. And if you're the mother of a newborn and you've been in that state and you're like, how am I supposed to do that with a newborn? Like I said, that might be engaging the help of someone else who can support you in that way and have foods that are delicious, that are nutrient dense, that are going to help to fuel your body and also to help tame that ravenous hunger that you have because the protein, the fat, the fiber, those are the things that are going to help you feel satiety that fullness as well as stay full for longer. And that's going to be really probably one of the most important things you can do in your weight loss journey while breastfeeding. The other thing is to make sure that you're drinking plenty of fluids, so your body is making breast milk and you have that in addition to all of your regular fluid needs. And so for a lot of women, this might mean that they are drinking honestly up to a gallon of water per day. And if you're breastfeeding twins, for example, maybe even that you're drinking more, so you need to be drinking enough fluids in order to cover all of your basic needs. Then in addition to your breastfeeding needs, so like I said, for a lot of women that ends up being up to a gallon, I often recommend to include electrolytes in that. So that can be something like a little bit of diluted Gatorade powder. I often recommend a little bit of diluted Gatorade powder and then some sprinkles of sea salt as well to help bump up the sodium content of it because you want to make sure that you are having plenty of those electrolytes both for your own needs as well as for the needs of your breast milk so that your baby can have those. A lot of women are feeling very thirsty, and so it's easy to respond to that, but particularly in times where the middle of the night, for example, to have a glass of water on your bedside as you're transitioning back to work, if that's something that you're doing to make sure that you are prepared with those fluids right next to you. My colleagues in my office used to laugh at me because I would have literally three or four different containers. I would have all of my different fluids for the day just ready and my desk because as a busy primary care physician at the time, it was hard for me to carve out time to be able to stop and go to the kitchen in the office and fill up a drink or make coffee or make tea. And if I didn't have all of the beverages that I was planning on drinking throughout the day just there and available, then I found that I did not do an adequate job of getting myself hydrated. And so I just had them all. I brought them with me every day, almost a gallon of liquid that I drink throughout the day, which is wild to think about, and I would just have them sitting next to me on my desk. And so I want you to think about not just making sure that you're drinking enough, but what are the things that you can do that are going to make it really easy for you? Having cups that you enjoy, mugs that you enjoy, having your beverages convenient, especially like I talked about as you transition back to work, if you're traveling other times where you may struggle with getting enough fluid, making sure that you have a plan for those times. The other thing that I often find is that women are really antsy to lose weight. And so they go about weight loss in the ways that they've done maybe previously, sort of all in lots of dieting, restricting certain foods, being really aggressive in the gym. And as they do that, they find that their breast milk supply really plummets. And so they're like, oh my gosh, I just can't lose weight while I'm breastfeeding. It doesn't even work for me. I will do anything in order to make sure that I protect my breast milk supply. And I totally get that. And what I want to offer is that making slow and meaningful changes will add up really significantly over time. There's this rush of getting your body back, which I honestly do not think is a healthy mindset for anybody who's just had a baby. And honestly, long-term learning to see how your body has evolved and changed and how you can support and embrace that is a much healthier mindset than always looking back to some past that may not ever be your future reality. And so when we think about how that applies to our weight loss journey, I want you to think about what was your weight when you started pregnancy and what was that weight gain trajectory over time? And so did you gain that weight over one month? Nope, over six months? Nope. You gained that weight over nine months, and the weight loss process is often likely to mirror that as well. Some women may lose weight faster, some women may take longer, but it's common that it is going to take the majority of a year in order to lose that weight. And the reason that I'm saying a year is that I don't recommend to any of my patients that they are actively focused on weight loss at all during the first three months or the first 12 weeks after having their baby during that time. There's a lot of healthy habits that you can work towards, like making sure you're having plenty of fluid, making sure that you're eating real food. All of that is really valuable and is going to support you in your weight loss journey. But I don't recommend doing anything during that period of time in order to try to lose weight. And the reason why is that during those first six to 12 weeks, our breast milk supply is regulating and our bodies and are learning how much food that our baby or our babies need. And so you don't want to do anything, especially in that first six weeks that's going to impact that. And so really after you move beyond that first 12 weeks, that first three months or so, then you can start to make little changes in order to support your weight loss journey, recognizing that it's okay if your weight loss ends up taking nine months. So that's where I get a year from three months of making sure that you're supporting yourself, eating nourishing real food, having plenty of fluids, but nothing really intentional, and then the following nine months that you are starting to make more of a concerted effort if that is a goal for you, and that by that one year mark, you can absolutely find that your weight has come off. Unfortunately, there are some women who are the exception to that, and we'll talk about that a little bit, but I want to give you some tricks to be able to successfully lose weight during that time. So one of the things that we have to be really intentional about is how often our babies are eating and then how often we are feeding them or how often we are pumping is going to drive what our breast milk supply looks like. And so you might be wondering, what does this have to do with my weight loss? Well, let me tell you. We know that breastfeeding is a supply and demand thing. So the more that your baby drinks, the more that your body will make. And so you need to feed every so often, maybe every one hour, some breastfeeding women feel like they are just feeding their baby around the clock or maybe your baby someone who eats every two hours or every three hours. But whatever it is, depending on how much milk you produce, depending on how much is being held in your breast and how much your baby takes in a single serving is going to depend on how much milk your body is being told that it should make. So if your baby is breastfeeding every two hours and every two hours, it ends up taking about two, two and a half ounces. Your baby is getting about 24 to 30 ounces of breast milk per day. And that's really about the average that a breastfed baby takes about one ounce to one and a quarter of ounces of breast milk every hour. So if they're breastfeeding every hour, maybe they're having smaller volumes. If they have longer stretches like they're feeding every three hours, maybe they're taking three, four, rarely, maybe five ounces of breast milk at a time, but they are going to be eating regularly and your body is going match your supply to what the baby is demanding for you. There can be reasons that struggles. So for example, if your baby is not able to adequately take breast milk, maybe they have a tongue tie, for example, and they have a difficult time latching, that can be a reason that the baby's not taking as much milk, and even if they need it, your body's not getting the signal to make as much as they need. So there's a lot of things that you may need to work with with a lactation consultant or a breastfeeding medicine physician in order to make sure that you optimize that for yourself and for your baby. But one of the things we find happens is that women either are going back to work and they're now transitioning from feeding directly at their breast to feeding using a pump to empty their breast. Or as babies start to sleep longer, women may be going longer and longer periods of time without emptying their breast. And so you need to be mindful of how often you are breastfeeding your baby because if you stop emptying your breast as often your body is going to get the signal that it doesn't need to make as much milk and your breast milk supply is going to start going down. And what often happens with that is that we as women will do absolutely anything we can in order to increase our breast milk supply. A lot of times we find that if we've eaten more like we've gone to a party or we've had some sort of special occasion a day where we've eaten more food, we see this short-term bump in our breast milk supply, and then we start applying that in the long term. And so women who are noticing that they have a low breast milk supply start eating more and more and more in order to help promote their supply. And so my advice to you if you're finding yourself in that situation is get in right away to see a lactation consultant, to see a breastfeeding medicine physician and see if there are things that you can do in terms of everyone's going to kill me for saying this, but waking up in the middle of the night, for example, to do an extra pumping session. So if your baby starts sleeping through the night and they are sleeping from eight o'clock at night until six o'clock in the morning, that's wonderful. And as a mother of a young baby, you were so grateful for when moments like that happen. But it's unlikely that your body is able to tolerate 10 hours without the breast being emptied. And so if you are going 10 hours without emptying your breast, your body starts to get this signal to make less breast milk. And so that may mean you need to empty your breast by pumping in the middle of the night or something like that. And so if you're noticing you're having supply issues, absolutely reach out to someone who can support you in that. And as you're making dietary changes or exercise changes, I want you to be really mindful of how that is affecting your breast milk supply. And so if you are starting to an exercise program or if you're trying to make adjustments within the foods that you eat, if you notice that your breast milk supply is decreasing, then you should reverse that right away. So we do know that you can make temporary changes that may decrease the supply. Usually if we're talking about two or three days, your body is going to be able to regain that. And so having a really mindful awareness of how much milk your baby is taking, how engorged the breasts are, if the breasts feel like they're really full and paying attention to is my body making less breast milk as I am engaging in dieting, as I'm engaging in exercising, and making sure that you are not decreasing your breast milk supply if that is not your goal. And so my goal for you is that you will over time start to see that small changes are adding up. So I recommend, like I said, plenty of fluid eating real foods, making sure that you're getting plenty of protein, that you're getting plenty of fat, that you are getting plenty of fiber in the foods that you eat, that the foods that you have handy available to grab when you need a quick snack, that that is something that is going to meet your health needs, as well as helping support your breastfeeding journey. So not just whatever is right there and ready, but what is something that you enjoy, something that's going to support your weight loss and something that's going to help you to get the energy that you need to be able to successfully breastfeed. Making sure that as you start exercising, that is going to mean a bump in the fluids that you take, making sure that you're mindful to pay attention to your breast milk supply as you're exercising, as you're making nutrition changes so that you can backtrack those or make different adjustments as you need to promote your breast milk supply. And then the most important thing is there's no amount of food. There's no amount of M&Ms, there's no amount of lactation cookies. There's no amount of pink drink from Starbucks that is going to reverse your breast milk supply if you are not emptying your breast enough. And so if you find that you're having supply issues, make sure that you get the support that you need with a physician, particularly a breastfeeding medicine physician. Honestly, I didn't even know that was a thing until five years ago. It's amazing. A lot of times women physicians who are pediatricians, family medicine physicians or OB/GYNs can go on to get additional certification as a breastfeeding medicine physician. That is one of the most experienced type of people that you could have in your life supporting you. So seek support from someone like that. Seek support from an experienced lactation consultant. Make sure that you have the support you need medically, the support that you need broadly within your family, within your work environment to get the adequate nutrition, get the adequate fluids that you need, and I promise you, the weight will come off. There are some women who find that no matter what they do, their weight will not come off until they finish their breastfeeding journey. And I am going to reassure you, if you are someone who feels like that is the case for you, that is okay. We are talking about a short period of time in your whole life. Make sure that you are making choices that align with your goals, foods that fuel your body. And as long as you're doing that, you will find that your weight is going to come off eventually. You may just be someone that you have to wait till the breastfeeding journey is over. And if that's the case, that is normal physiology as well. But I would love to support you if you feel like you're doing all of this and you are struggling. You're like, oh my gosh, why is this not working for me? Dr. Stombaugh says, I need to eat healthy foods. I need to have real food available, but I don't even know how to manage that in my hectic schedule. I would love to work with you. If you live in Illinois or in Virginia where I am licensed to practice medicine, pop on over to my website. It's www.sarahstambaughmd.com. It's S-A-R-A-H-S-T-O-M-B-A-U-G-H-M-D.com. I see patients for weight loss consultations. We will make a personalized plan for you to support you in whatever stage of life that you are in, whether that is breastfeeding, whether you are a 50-year-old woman or man or someone for whom this doesn't apply at all. I can help you make a plan that's going to work best for you and your body. So please reach out if I can support you. I can't wait to see you all soon. Take care. Bye-Bye.