Wednesday, April 25, 2012

Dieting While Breastfeeding

There happens to be a popular mommy blogger currently promoting a dietary supplement company called Xyngular. In the interest of full disclosure, these are not products I would ever endorse or recommend to anyone. But specifically, I'm very bothered by her refusal to tell her followers point blank that it should not be taken by nursing mothers.

How do I know this? I'm an International Board Certified Lactation Consultant (IBCLC). My area of expertise is breastfeeding and I spent years studying everything related to human lactation before sitting for (and passing with flying colors) my certification exam five years ago.

I found this information on Xyng's website about the xyng pills:
Now, as a lactation consultant, I often deal with situations where medications are labeled "if you are pregnant or breastfeeding, consult a doctor before use".   Those are often (not always, but often) CYA statements simply meaning there isn't yet specific research proving whether that particular medication is harmful or not. Many, many, many medications are okay for use by breastfeeding moms. However, an unequivocal "Not for use" is usually a hint that the manufacturer knows the medication is truly not okay for use during breastfeeding.

So let's take a look at the ingredient list for the xyng pills to find out why this might be the case:
Setting aside the proprietary blend, which may have problems of its own, there are 90mg of caffeine in one pill.  That's about the same as a cup of coffee.  And the directions suggest up to two per day, so you're up to 180mg of caffeine from that alone. EDIT: A reader requested I look into the 1,3-dimethylpentylamine that is present in the proprietary blend of this product. I am currently using the 2008 edition of Medications and Mother's Milk and did not find information on this in there (update again: I now have the latest, 2012, edition and it's not in there either). I turned to the internet and looked up general information on 1,3-dimethylpentylamine. What I found on WebMD would be enough for me to suggest a nursing mother not take this drug. To begin with, it has been added to the prohibited substances list of the World Anti-Doping Agency. It has also been removed from military stores due to reports of life-threatening side effects. Reading further, I found it has stimulant effects similar to pseudoephedrine. Two big red flags here. First, more stimulants. Second, pseudoephedrine is generally not acceptable for use by most breastfeeding mothers. It carries a very serious risk of drastically reducing milk supply, sometimes with as little as one dose. I would be very concerned that 1,3-dimethylpentylamine might also reduce milk supply. Thank you for pointing this out to me so I could do a more thorough explanation.

Then there are their core 4 products: Accelerate, Flush, Lean and Cheat.

Again, from their website, the Accelerate label:
We can't see specific amounts here, but guarana extract and kola nut extract both contain caffeine, oolong tea generally contains caffeine and green tea extract may or may not have caffeine. Judging by the name and the ingredients, it's a fairly safe assumption that there is quite a bit of caffeine in this product. Once again, we're seeing a suggestion to take up to two pills a day.  Does this add up to another two cups of coffee? It's impossible to know for sure. You'll notice this product also says that it is not to be used by nursing women. Also, like the xyng, it has chromium picolinate, which is often touted as a weight loss product, but doesn't actually have adequate supportive evidence that it's effective.

Here's the label for Flush:
These are mostly herbal laxatives that aren't really a big problem in and of themselves, but I wouldn't recommend a nursing mother take laxatives on a regular basis because I would be concerned about her nutrient absorption and dehydration. And once again, we see the direction not to take it if you are nursing.

Cheat's main ingredient is Konnyaku (or Konjac) root, which I'm having difficulty finding specific information on related to breastfeeding, but the company states that it eliminates 25% of the calories you've eaten and that's unlikely to be wise for breastfeeding mothers (see below). As with the other products, this one specifically says it it not to be used by breastfeeding women.

Lean is the only product in the lineup I don't have a specific concern about. It's a protein drink and while I'd prefer my clients to eat whole foods, there is nothing here that specifically stands out as a big red flag for me. This is also the only main product that doesn't specifically carry that "not for use if you are pregnant or nursing" warning, which reinforces the idea that the warning is there for a reason on the other products.

The other product they produce is Super Fruit Global Blend. This product has an 18 page information sheet with all the ingredients and honestly, they mostly seem harmless. However, once again, green tea shows up, which likely means even more caffeine.

If it's not clear already, my main concern with the products themselves is the amount of caffeine.  Caffeine does transfer into breastmilk.  The quantities are relatively small, but babies (especially young babies) take much longer to clear what caffeine they get out of their system.  According to Medications and Mother's Milk (our main resource for information about medications as they relate to breastfeeding), the half-life of caffeine for an adult is 3-7 hours.  A half-life is the time it takes to eliminate one half of the amount out of your system.  50% is gone after one half-life, then another 25% (so 75% total) after the 2nd half-life, etc...  It takes about 5 half-lives to effectively remove a medication from your system.  This means adults take about 15-35 hours to eliminate a dose of caffeine from their system.  However, for a baby under 3 months old, the half-life of caffeine is 65-130 hours.  That means it takes them 13.5-27 days to eliminate caffeine from their system.   This usually isn't a problem in moderation, but if a mom is taking in large amounts of caffeine, we can start to see unusual fussiness and less sleeping in baby as the amount of caffeine in their system builds up.   There is also some evidence that ingestion of high levels of caffeine over a period of time may reduce the iron content of mom's milk.  If you would like more information about caffeine and breastfeeding, there is a more thorough explanation at KellyMom.com.

My other concern is calorie intake. I am having difficulty finding specific directions from the manufacturer on how to use these products, but as a general guideline, I recommend my clients not consume fewer than about 1800 calories per day. Doing so poses the risk of a reduced milk supply. This could obviously be dangerous to the baby, especially if mom is not aware her supply has been reduced and thinks she is only dealing with an irritable baby without realizing baby is irritable because s/he is hungry. In addition to this, according to Breastfeeding and Human Lactation (4th edition, Riordan, pp500):
The mother who chooses to diet while lactating should be encouraged to avoid crash or fad diets that promise marked, rapid weight loss. Fat-soluble environmental contaminants and toxins stored in body fat are released into the milk in larger quantities when caloric intake is severely restricted.
As the manufacturer repeatedly states, the Xyngular line of products is not appropriate for breastfeeding mothers.  Taking these products while breastfeeding poses risks that clearly outweigh the possible benefits.  If you would like to know more about safely losing weight while breastfeeding, I suggest you visit the weight loss page at KellyMom.

21 comments:

Stephanie said...

Thank you for stating what MckMama refuses to communicate on her blog and Facebook page regarding Xyng and related products. I find her sales tactics irresponsible and reprehensibly self-serving, especially when the health of a nursing mother and her child are at stake. I hope that more people who are educated about this matter will speak up in MckMama's comment section and spread the word that these products are not intended for pregnant and/or lactating women.

Lisette said...

Very informative! I hope anyone thinking of jumping on mckmamas bandwagon finds your site first.

Stephanie, she is deleting any comment questioning the safety or ingredients in these Xyng products.

Again, thank your for such a well written and informative piece. It is making me so sad that she is promoting these products to ANYONE, but nursing mothers especially. I understand how frustrating it can be to carry that extra weight and not have the calories fly off like some breastfeeding mothers do.

My child just now weaned at 2.5 years and I am now working hard to finally lose that weight. My supply tanked anytime I exercised. It was a no brainer for me to put my baby first and just wait.

Amy said...

I have to say: I am not so much a fan of the blogger that you have described here. Not because of the other numerous moral tangles in which she is involved but because of THIS specific issue. I was aghast to see her, a self proclaimed BFing advocate, telling women to take these drugs and essentially give them to their babies. I don't care what people do to themselves but it is absolutely (in my book) out of the question to expose a baby or child to these unneeded dangers. ugh.

Marti Kubena said...

I don't follow that blog - but as usual, I am appreciative of your scientific approach to blogging. I've recently stopped reading several blogs because I just can't stomach the pseudo-science drivel that comes out of these people, knowing that so many of their readers are absorbing every word as truth.

Anonymous said...

Please consider submitting this to BlogHer for their health section. Word needs to get out this stuff is dangerous!

Anonymous said...

great post! I can't believe MckMama was deleting all those post on her facebook page. People would ask questions or say something like "no you should not take this when breastfeeding!" and literally 2 mintues later the comment was deleted. McKamama doesn't want anyone to see these comments that people are writing so she is deleting them.

Really wrong and messed up :(

Anonymous said...

Please look at the dimethylamylamine and the last ingredient of the blend, w hu h is another "mine" drug. Ive looked at both and they are stimulants which are actually banned for use in many sitiations. They an also produce a positive drug test. These ingredients concern me more than the caffeine as people have reported horrible side effects. These pills are poor not for only babies but adults as well.

http://drugfreesportrec.blogspot.com/2011/03/methylhexaneamine-1-3-dimethylamylamine.html

The Hills said...

Thank you for the tip on the DMAA, I am going to update the post now.

Amy said...

http://en.wikipedia.org/wiki/Phenethylamine

I'm so sorry about my last comment. I was typing from my iPad and not paying attention to the autocorrect.

Please look at the phenethylamine as well. Both of these are a stimulant and unfortunately, the DMAA is posing as a natural substance.

I am a RN who works in OB so I love my lactation ladies. Y'all have the patience of Job. Have you ever found that they ladies with the "best breasts" have no interest in nursing and it's the no/low intervention mommies that will pull back their gowns and I'll want to cry? :) that's when I'm so thankful for you all!

The more I spent time looking up these two ingredients the more concerned and honestly, just plain flabbergasted, I became. The Internet is filled with articles on their uses and dangers, especially the DMAA.

Thanks for doing this.

Amy

Amy said...

http://www.nytimes.com/2012/02/03/business/army-studies-workout-supplements-after-2-deaths.html

Sorry to keep coming back and back but I'm really concerned about this supplement and those who are following without looking further into the ingredients.

The army has pulled anything with DMAA from the shelves until studies are completed this summer. Two deaths have been linked to its usage.

The Hills said...

From the link you posted about phenethylamine (this one is also not in my edition of the book), it says "however, orally ingested phenethylamine is usually inactive because of extensive first-pass metabolism by monoamine oxidase (MAO) into phenylacetic acid, preventing significant concentrations from reaching the brain." I am not a pharmacologist, but from what I know, I believe this means the oral bioavailability (the amount that gets into your system when you ingest it orally) is low. The small amounts that make it into mother's system and then into her milk, would also be "diluted" out (for lack of a better word) by baby's digestion and further reduce the amount that actually make it into baby's system. (this action is why things like insulin are usually compatible with breastfeeding: the insulin baby gets is digested in their stomach rather than affecting their blood sugar levels). Also, your link lists the half-life as extremely short, only 5-10 minutes. Things that clear the mother's system quickly are usually better for baby because you can "nurse around" them. Apparently this has an action similar to amphetamines, which are categorized as L3 (on a scale of L1 to L5 with L1 being the safest, this is comparable to a category C for pregnancy) in clinical doses. The babies should be watched for insomnia, irritability and poor weight gain, but there are several studies in the literature with no side effects for the babies. Things like adderall would fall into this category of drugs and it would require a thorough risk/benefit analysis and careful monitoring by a mother's doctor and her lactation consultant to decide whether this type of drug was appropriate for her or not.

To sum up, this one is more of a gray area and there are plenty of other things that are definite concerns without needing to specifically incriminate this one.

Thanks for the work you do with new mommies!!! It can definitely be a challenge ;-) The counseling skills we have to learn are almost as important as the scientific knowledge some days!

Anonymous said...

Do you have any information on the safety of green coffee bean extract and calcium pyruvate when breastfeeding? I have so many friends who are taking it after seeing these supplements promoted on Dr. Oz, but I'm highly skeptical of most things not regulated by the FDA especially when it comes to nursing. Thank you!

The Hills said...

I cannot find a lot of information on either of these (this is the trouble with herbal things sometimes...there isn't a lot of peer reviewed evidence to go off of), but according to what I could find, green coffee bean extract is not particularly concerning. It's about 10% caffeine by weight and a daily dose equates to about 20% of the caffeine in one cup of coffee. If a mother was complaining of an irritable or sleepless baby, I would suggest she avoid caffeine completely, but small amounts of caffeine are usually okay for most mothers of healthy, full-term babies. The calcium pyruvate, I looked up on webmd. There was nothing here to reassure me that it's definitely okay, but also nothing particularly concerning. If a client asked me my opinion on either of these, I would suggest she discuss them with her doctor to be sure there is nothing in her medical history to contraindicate their use, but I would not be very worried about breastfeeding specifically.

Anonymous said...

Thank you so much for this blog post! I was going to ask my ped's lactation nurse about these products and you saved me a phone call :)

I do have a follow up question, I hope you don't think I'm being stubborn or trying to put my baby at risk or being horribly selfish... but does your answer change at all based on the age of the baby? The reason I ask, is that I have an EXTREMELY difficult time losing weight while breastfeeding (I console myself by saying the trade-off is having plenty of milk!) When my 3rd baby was 4 months old, I was running 4 miles every morning 5 days a week and had given up ALL sugar and was eating very healthy, but did not lose a single pound. Very frustrating.

My 4th is now 6 months old and I have hit that same plateu. I am over weight, clinically, though not hugely obsese (I am 35 lbs over my pre-baby weight, and at least 15 lbs over a healthy weight for my height). He is my last baby and I would really like to nurse him into toddlerhood, but I am also at a point where (after hating how my body looks through 8 pregnancies!) I am anxious to get back to a good (and healthy) weight. I went to my PCP and he said "stop breastfeeding so I can put you on a diet pill." Um, no.

My question to you is - would you consider taking any type of supplement like this once baby is over a year old? Breastmilk would be a smaller part of his caloric intake, and also he would get less of the caffeine because he's drinking less milk. I am trying to balance out wanting to keep nursing and possibly weaning sooner (after one year, though) because of wanting to lose weight.

The Hills said...

Older babies do process caffeine more efficiently than younger babies (much closer to the time frame it takes adults to process it). However, the calorie restriction, purported rapid loss and 1,3-dimethypentylamine would still be serious concerns. As a lactation consultant, I would not be comfortable with one of my clients taking it at any point in lactation. As a mother who has nursed 3 babies into toddler-hood, I would not be comfortable taking it myself.

While there are a lot of stories that breastfeeding helps women lose weight, the evidence is not clear that this is actually the case and there are plenty of women who report their bodies "hold on" to about 10 pounds of the baby weight while breastfeeding and then they lose it rather easily once the baby weans. So keep in mind that this may happen for you too. It is also fairly common for breastfeeding mothers of older babies to slowly lose some weight as their baby's intake decreases and mom's appetite decreases.

I would suggest you talk to your and your baby's doctor and give it a little time. Your body goes through a lot of changes in the postpartum year and it's difficult to know where your weight will be in 6 months, even if it was difficult to lose weight after previous pregnancies. It's very possible that the combination of an older baby, healthy diet and moderate exercise will start up a sort of secondary postpartum weight loss.

Anonymous said...

I have a question similar to a previous poster. I was going to start taking these products after reading the blog that is being discussed. I was told that it was fine to take while breastfeeding, I was not comfortable with that so I was researching when I stumbled on your blog. My daughter is over 2.5 years old, and nurses anywhere from 3-4 times per day. Would these products still be a problem or should I avoid them until she weans?

The Hills said...

I have a nursing toddler as well and I wouldn't take them. In particular, the 1,3-dimethylpentylamine is quite concerning. It is more commonly known as 1,3-dimethylamylamine, or DMAA, if you are trying to do research on it. In addition to that, the purported rapid weight loss would be a concern. Lastly, I'm not entirely sure of this point, but from what I can find the manufacturer recommends an extremely low calorie diet (I believe this is during a jump start phase, but I'm not sure), this could possibly impact milk supply.

Recently, this blogger has been mentioning Axion specifically as an ideal supplement for pregnant or nursing moms. This is still misleading. Axion is a combination multi-vitamin/probiotic and its formula is much closer to a regular multi-vitamin than a prenatal vitamin. Axion does not include as much folic acid as is recommended to prevent neural tube defects during early pregnancy. It also doesn't appear to include iron at all. For a mom wanting a similar product--a multivitamin made from whole foods--there are other options readily available such as the MegaFood brand, which does include a "Baby and Me" product for pregnant and nursing moms (I would recommend choosing the Herb Free version unless otherwise directed by a physician or midwife). The Axion supplement facts are available online. If you print them out and take them to the store, you'll see there are quite a few discrepancies between Axion and prenatal vitamins. It may not be harmful as long as you add in other vitamins along with it, but it certainly isn't ideal.

Anonymous said...

Hey Thanx u for such a informative post.... I was actually thinking of trying the green coffee extract and am nursing my son who's 1 year old.. Although he's feeding quite less ...he just feeds when he wants to doze off.... So will it effect him in any way? I wanna lose some weight for a wedding coming up and am desperate...also do think these are effective? If not do u know any other that are effective and safe during breast feeding

The Hills said...

I can't really say any more than what I've already posted in the comments above. It is impossible for me to say for certain if a specific drug will affect a certain mom or baby, especially when I haven't done a full exam and obtained a full medical history on both of them. The question would be better suited for your doctor or pediatrician or a lactation consultant you have worked with previously. I also can't make any comments about whether green coffee extract works at all, that is outside my area of expertise. I personally am not a fan of any weight loss supplements, but professionally, it's just outside my realm.

Ellie said...

I'm curious to know your thoughts on this article just posted to Fox News today, 4/12/13. It's titled "Supplement ingredient DMAA is illegal, dangerous, FDA says." Thanks!

http://www.foxnews.com/health/2013/04/12/supplement-ingredient-dmaa-is-illegal-dangerous-fda-says/?intcmp=HPBucket

The Hills said...

Personally? I think it's a total scam that xyngular has changed their labeling to remove 1,3-dimethylpentylamine and only list geranium root now. To keep the discussion to breastfeeding, it wasn't safe for breastfeeding moms when I wrote this post and it's not safe for them now.

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