Ep. 138 – Iron Supplementation and Breastfeeding

Transcript:

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Ep 138 – Iron Supplementation and Breastfeeding

This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way. So join us for another episode.

Welcome to the Milk Minute podcast, friends. Hey ho. We’re back. We’re back. And we’re getting pumped up with iron today. Yeah. Today we are gonna talk about iron supplementation and breastfeeding. Some of you might be like, what, what?

Why does, why are those related? And some of you might be like, oh yeah, my pediatrician mentioned supplementing with iron one time, like six months ago. Yeah. And then never brought it up again and never double checked to see if I was doing it. And then others of you are doing it dutifully and every single day, and you’re wondering why you seem to be the only one that got the memo.

Yeah, so lots of mixed messages around that and I’m hoping we can demystify that a little bit today. Yes. Let’s break through the mist, but first we wanna remind you that Maureen and I both do lactation consults and those links are always in the show notes.

So please stop struggling at home or just, you know, if you like, for example, I take some insurance, so if everything is going perfectly fine, but you wonder if things could be better and your insurance will pay for it, why not? So check out the links in the show notes and we look forward to working with you if that’s something that you need to do.

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You guys. Breastfeeding for busy moms. My little breastfeeding clinic isn’t so little anymore. I’m so excited that not only can people book with you in person here or virtually, but they can book with the other i b CLCs in your clinic. We also do accept some insurance directly. A lot of insurance will actually pre-approve you for a certain amount of visits, even prenatally.

So please head on over to breastfeeding for busy. Dot com and check out the services tab to see if your insurance is approved. Book with me or one of my IBCLCs, and we would love to work with you. You can do prenatal consults. What else can they do, Heather? Well, I often work with people who have supply issues.

We’ve got pumping, troubleshooting. We’ve got preparing to go back to work, weaning, starting solids. We really cover the entire journey. So if you’re struggling, stop struggling and just schedule with me or somebody on my team at breastfeeding for busy. Dot com. Dot com.

Okay. Before we talk about iron today, we have a question. This question is from Caitlin B in our Facebook group and. Caitlin says, I will be starting my breastfeeding journey with baby number two in January, and I’m trying to order my new breast pump. I ordered previously the Medela. She put lump in style

She meant pump in style, style, the older boxy version, like that old girl, and ended up switching to a spectra, which breast pumps are your favorite and get the most out during your sessions. I do love the Spectra. S one or two. They’re the same thing. It’s one of my favorite pumps cuz it’s affordable and it’s often covered by insurance.

And I think it works really well. I have to warn you against the new Medela pumping style that is like cylindrical. Mm-hmm. . It is not the same. It is not the same as the old one. We do not like her, the old pumping style advanced. That boxy one is great. If you wanna keep using that or like get a new one of that.

I also like the Motif Luna, which is very similar to the Spectra. Mm-hmm. And if you have to go hands free, I like the Spectra S two that plugs into the wall cuz it’s cheaper. And then you can use the money you save to get an LV stride, which can go mobile. Yeah, we love those. Okay, hopefully that helps. And if you want more information, we have like, I don’t know, four or five pump review episodes from all the stuff that I put on my boobs.

So tell you about it, . All right, so iron supplementation. Let’s start with the basics. Why do we need iron? , yeah. Iron. Well, one of the things we needed for, there are many I’m sure, but the main one is that iron is necessary for us to make hemoglobin right? And hemoglobin is that little bit in your blood that carries oxygen in the red blood cells to all the parts of your body.

So If you don’t have enough iron, you don’t have enough hemoglobin, we don’t have enough oxygenation in all of our cells. It also supports proper neurological development during infancy and early childhood, so that is kind of like the big star why we care about it in infancy. And also if you’re 28 weeks pregnant and you just had your blood drawn to get your hemoglobin level.

The reason is we want to know how much iron and hemoglobin you have right now at your worst, because 28 weeks is the most hemo dilute that you will be in your pregnancy, which is why you are probably out of breath all the time because hemoglobin carries the oxygen. Your body. So 28 weeks, you’re often huffing and puffing and you’re like, God, the baby’s not even that big yet.

What’s wrong with me? That’s what’s wrong with you. Yeah, it’s no big deal. U anemic , but like normal, anemic . Yeah, just like a little hema diluted, anemic. Yeah. And we’re not gonna get too deep into like the labs and whether you should look at ferritin or hemoglobin or hematocrit, that’s all something to talk to your doctor about

But we are gonna talk about breast milk. Human milk and whether or not it is a good source of iron because a lot of people are told that breast milk doesn’t have any iron and that babies have to have supplementation unless they are using an iron fortified formula. Mm-hmm. , it’s not a. Not really a true statement, but it’s very complicated.

So I’m gonna try to lay it all out plainly for you guys today. Relationship status with iron. It’s complicated. Yeah. Okay, so I’m just gonna start out by telling you breast milk has about 0.4 milligrams of iron per. So small amount. Mm-hmm. , I do have to be honest about that. . And according to the CDC, most newborns have sufficient irons stored in their bodies for about the first six months of life, depending on their gestational age.

Maternal iron status, timing of umbilical cord clamping. Factors like that. And by the age of six months, infants require an external source of iron apart from human milk. They state that human milk contains just a little bit of iron, and therefore, parents of infants receiving only human milk should talk to their infants care provider about using supplements before six months of age, and then possibly after six months of.

It is most commonly recommended that you use like a daily supplement, like those poly vial drops or whatever, rather than fortifying baby’s diet with really good sources of iron. Frankly, I understand, right. In this country the average diet is not great and you know, doctors have like 10 minutes to counsel patients and they may not trust their patients to offer a well-rounded diet with lots of iron sources.

They may not have the nutritional training to know what those are. It’s not a great situation for parents or doctors. Yeah, that’s true. And also though, I will say that you should be able to write a prescription for it so people don’t have to go out and spend money on it themselves. Absolutely. Like nobody handed me a prescription for iron drops.

Mm-hmm. , you know what I mean? It’s like, go get it. And it’s like, okay, which one? Well, we can’t recommend a certain brand. Okay, well how much is it? Well, it’s not cheap. Okay, well, can my insurance pay for it? No, but it is recommended. Oh my God, America. Yeah. And a lot of doctors recommend this starting at four.

And I’ve certainly heard earlier recommendations, but I haven’t seen any research to actually back that up. Now I always wanna look at. Other health organizations have to say, not just American ones of the AAP pretty much agrees with the CDC, but the W H O, the World Health Organization has an interesting statement.

They had really long publication about this, but it kind of boiled down to the W H O recommends daily supplementation of iron in infants between six and 23 months of age in areas where anemia, Is at about 40% of the childhood population or higher. So what they’re saying is it should be based on the individual population and their average levels of anemia.

Ooh, did you look us up? Oh no, I didn’t. I do that. Look that up. In the United States, 5% of toddlers between the ages of 12 and 36 months have anemia and iron deficiency is the cause of anemia and 40% of those children. So yes, we are that group. Yeah. Well, only 5% of toddlers are anemic. Yes. But 40% of those anemia cases are from iron deficiency.

But what the W H O said is, They recommend supplementation in populations where 40% of the children are anemic. Hmm. So interesting. Anyway, I just wanted to throw that out there because I think that’s an important consideration to make. But I wanna dig deeper into all this, right. Does breast milk carry sufficient or insufficient iron for.

because a lot of people say, well, there’s not very much in it. So it’s simply just not enough for baby. However, the sort of counter-argument to that is that while human milk doesn’t have a lot of iron, the iron that it has is more easily absorbed than other sources of iron for baby at that time. So anemia is not common in breastfed babies.

It’s not like an overwhelming phenomenon that we’re dealing with. And between 50 to 70% of the iron in human milk is actually absorbed by the. . Yeah. Which is, it’s hard to absorb iron orally, guys. Yeah. And let me just compare numbers for you, . So compared to straight cow’s milk an infant would absorb about 10% of the iron in that iron fortified infant cereals, they would absorb between four and 10%.

Of the iron in, in that iron fortified cow’s milk formula, they would absorb somewhere between three to 12% of the iron it contains. And then for the soy iron fortified formula, it’s more like one to 7%. Oh, so. There’s actually a very big difference in those numbers, statistically significant. Right. And there’s also just like a different way that we absorb different types of iron.

So there’s like the heme iron from meats, like red meats, and then there’s mm-hmm , also iron that you can get from leafy greens. But it’s harder for our bodies to kind of break that down and process it and absorb it. So it kind of makes sense that everybody’s a little. So like one to 7%. Right. It’s like, okay.

That kind of depends on the kid, obviously. Yeah. But you know, overall, considering all of that, the consensus from research is that exclusively breastfed infants do have enough iron for at least the first six months and some studies. Have evidence supporting that they have enough iron for beyond that healthy full term.

Infants who are breastfed exclusively for periods of six to nine months have been shown to maintain normal hemoglobin values and normal iron stores. One of these studies, which is a little bit old from 95, the researchers concluded that babies who were exclusively breastfed for seven. Not given any supplements or iron fortified foods had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months.

Well, that makes sense to me because they’re replacing, you know, cereal with a breastfeed. Mm-hmm. . And we don’t absorb as much iron from the cereal Right. As we do with the breast milk. So, yeah. And in that study, the researchers found, found no cases of anemia in the first year in the exclusively breastfed baby category.

And not every study that I saw in this had exactly the same conclusion. They also didn’t have the same like exclusion criteria for who was in it. And you know, this kind of thing gets a little bit complicated when. Human milk is like not the only factor that can influence iron. So as usual, recommendations from pediatric associations for iron fortified foods are often based on formula fed babies and their needs for them.

You know, and just the kind of. Overall number of how much iron is in human milk without considering how much we absorb. Well, it kind of makes sense to me that at some point you’re gonna kind of need to move to solid foods that have iron in it, and you can start kind of like breaking it down in different ways as our gut matures.

As our body matures. Yeah. And you know, maybe. This is like just how everything else that we’ve researched on this podcast seems to kind of always go in this one direction where it’s like maybe they need to be a little depleted in order to crave the next thing that they need. It’s really hard to say. But, you know, I did, I did wanna mention.

Anemia is not common in breastfed infants. However, there are babies that are like more at risk for it. And there are some kids that like go to the ER for a broken arm. Yeah. And then they find out they’re anemic when they get there. Yeah. And you’re like, oh, are you symptomatic? Are you just, yeah. Right. is it, is it subclinical as you follow?

Does the, does the number show that you’re anemic, but you, your baby still crawls at like a hundred miles an hour and they don’t seem tired and they’re fine. Right. And screening protocols are kind of different in the United States, like per state . Yeah. You know, I know my doctor routinely screens at age.

but when my son was younger it was like nine months, you know, that was like seven years ago or something. And other states have different protocols of when we screen typically at some time in the first 24 months. But maybe babies who are at higher risk should be screened earlier rather than they should.

So babies that are at higher risk would be premature infants because babies get the majority of their iron stores from, you know, their mother in the last trimester of p. Hmm. So if we’re not in the uterus for the last few months, they’re going to deplete their iron stores more quickly. And I wonder if you deliver it like that 28 week mark when you’re the most hemo dilute that you’re going to be in pregnancy.

If that contributes to It does because the mother’s level of iron anemia is a contributing factor to whether or not baby will be anemic. Yeah. Small for gestational age slash low birth weight babies. So babies less than 3000 grams or six and a half pounds tend to be at greater. Babies aren’t mothers who are anemic, like I just said, , and then babies who are fed cow’s milk during the first year of life, like I said before, right?

We don’t absorb as much iron from cows milk. And reminder, the recommendation is not to give your baby cow’s milk in the first year of life. Why don’t you remind us why Heather? Because if you give your baby cow’s milk in the first year of life, they don’t absorb as much of the iron in it. And then you have a baby that’s chronically anemic and then their brain doesn’t develop.

Right? And I don’t know if any of you saw that heart wrenching Laura Engel’s like Little House on the Prairie Movie back in the day. What the heck was it called? Something about like, oh, the Lord’s Prayer, I think, where she has a little brother that’s born and there’s a lactation issue and the mom can’t breastfeed, so they end up giving the baby cow’s milk and he basically just slowly dies.

Oh my gosh. Over the course of a year. And I’m like, why is this for children? Everyone’s crying. They say The Lord’s turn. Watch these things in like 1996. I have no idea on vhs. Come on. But that’s what happens. So we don’t want to do that. Yeah. And, and. Not necessarily unsafe for them to have a little bit of cow’s milk.

The fear in having a sort of gray recommendation rather than black and white, yes or no, is that if you give a baby a cup of milk when they’re supposed to be relying. on either formula or human milk that sort of replaces one of those feeds, right? And maybe the next day it’ll replace two of those feeds.

You know, just depending on your schedule and convenience and how much your baby likes cow’s milk. And so it can be a slippery slip for people. And cow’s milk might be cheaper than baby formula. Might be easier than breastfeeding. People might not make the smartest choices regarding that. And also babies that do not get delayed cord clamping.

Have more anemia at the age of two. So I think this could be wrong, but I’m gonna say it anyway. , I’m pretty sure. Wic, part of what WIC does is screen for anemia. Yeah. At that two year visit. And I think some research researcher put it together that these kiddos that did not get delayed cord clamping were the ones popping up as anemic at two years of age.

Yeah. So that’s why delayed cord clamping is recommended across the board, especially for preterm infants. Mm-hmm. . So you’re not excluded from it. If you have a 33 weeker C-section, they should still be minimum 30 seconds delaying that cord clamping because at any point in time, a third of the baby’s blood volume is in the placenta.

Yep. So if you cut it immediately, you’re cutting off a third of the baby’s blood volume, you need to let that kind of finish pulsing through. It does not go. Through the cord. Yeah. It doesn’t come back through the cord. The big fear for a long time was that you’re gonna make the baby jaundice, and there’s a difference between polycythemia and symptomatic polycythemia.

Right. So, just wanted you to know that. Yeah. The, the research has shown that babies with delayed cord clamping have a slightly increased like rate of jaundice, but not symptomatic. Jaundice not something we have to treat with Billy lights, what we would call breastfeeding jaundice, which is a dumb name.

But it’s like, you know, kind of that low level normal, not dangerous, but we should just keep an eye on that stuff. Normal physiologic jaundice. Yeah, like you’re getting, your liver is still getting kick started, so Uhhuh . But the risk benefit situation still points to delay the cord clamping anyway. We can treat the jaundice on the outside.

Exactly. We can’t transfuse the baby easily later. Blood. We’re not doing like iron runs on the baby after the baby’s born. That’s not a thing. So, no. Yeah. And you know, this is an interesting, it’s been an interesting difference between like midwifery and obstetrics and if you guys you know, made a birth plan when you were pregnant and having a baby, you probably looked at that and you were wondering perhaps why, you know, what’s the benefit of leaving the cord?

Unclamped? Here it is right here. . This is. Yep, this is it. And like just slow down and just let nature finish doing its thing. It figured it out a long time ago. You don’t need to try to like outsmart nature. It’s pretty well figured it out. Yeah, it’s a really tough balance between respecting a normal physiological process and intervening when necessary.

Yeah, absolutely. I mean, there are gonna be some times that you cannot delay the cord clamping. The mom’s just bleeding too much. Yeah, and you gotta get the placenta out. Okay. So maybe we could remove the placenta and leave the court. I don’t know. There’s a lot of different options, but we gotta think about it in the sense of like, this is still a priority.

How can I do the other things I need to do while leaving this as a priority? And if not, oh, well we tried everything. Right? You’re alive. Yay. But yeah, this has been a really interesting finding, especially as we are trying to undo like three generations, maybe longer of like bad birth practices, right? Of harmful obstetrics rather than supportive.

Measures, right? Yeah. It’s, it’s an interesting place to be in history, . But I know probably at this point you’re sitting at home being like, okay, but what am I supposed to do? I promise We’re getting there. I promise we’re gonna get there. But I do wanna maybe take a quick break and then we’ll get back to it.

Yep. We’re gonna thank a couple sponsors that keep this show going and thriving. And then we are gonna come back and talk about how your baby’s body can use the iron and how to know if your baby is de.

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All right. Welcome back everybody. So why not use iron supplements as a protective measure for every baby then? I’m so glad you asked because I have answers. Oh, answers. Yay. Let me preface this by saying I am going to go for the risks of using iron supplementation when it’s not necessary. That does not mean you are harming your infant by using it.

Okay? These are sort of. Complications that can happen. But we need to consider them, especially when we’re considering protocols for the greater population. Many, many. So the iron in human milk is bound with proteins that make it available to the baby rather than to the bacteria that might be in their gut, especially harmful bacteria like e coli, salmonella, Clostridium, et cetera.

Ooh, can I have a quick story? Mm, please. So iron travels around throughout your body on your hemoglobin. Mm-hmm. . Okay. And so. Fun fact had an ameba for 10 years. Did you know this? 10 years? No. You never told me about your little parasitic friend. Yes, so I had diarrhea every day of my life from 10 years old to 20, Heather, and I was about to be 21, and my dad said, you’re gonna get kicked off the insurance soon.

So go. You know, figured out anything you needed to get figured out. And I was like, well, maybe I’ll go get this little diarrhea situation checked out. But my whole life, everyone had always told me it was ibs. Right? I’m telling you, if I went to a restaurant and I ate, I was shitting it out before I left the restaurant, which made dating basically impossible.

And I was bloated all the time. Also, I was on Accutane for my acne, and they will test your iron every single month to make sure that you don’t have too much iron in your blood. And they put the iron in a. Test tube and mine sank straight to the bottom. Every single. and they said, you need to work out more and because the only way you can get rid of iron is by sweating it out or bleeding it out.

And they said, you need to work out more. And I said, it’s lacrosse season. I’m running four miles a day. You’re like, I’m working out a lot. I am actually working out a lot. So, and I was exhausted because I had iron poisoning. You wanna know why? Oh my God. When the Ameba rides around on the iron, it’s too big to sweat out. Heather, so you, I could not sweat it out and I wasn’t bleeding it out, so I had actual iron poisoning, which is why I slept in class every single day.

Heather, I, no, I. Dia. Really? This is such a surprise, also very pertinent to today’s episode. Yes. Which kind of delights me, but I’m also sorry, you had iron poisoning? Yeah, so I go to the GI specialist, they draw my blood and they find the ameba in my blood. Yeah. Which is concerning cuz usually you find it in a stool sample.

Someone has diarrhea, they’ve just been somewhere tropical. They find it in the stool. No, I had it for so long. What? What was it? What was its name? An enba. Oh, it was the regular. The regular and nasty one. So anywho, they said, the attending himself called me and said Heather, I’m calling you personally cuz I need to know where you got an amba.

And I said, sorry, what? And he was like, yeah, you have an amba in your blood, which means you’ve had it for so long that it ate its way through your intestines. Oh my God. And. Riding around on your iron molecules, visiting your other organs and feasting off of your other organs. I am now picturing a scene from Osmosis Jones, though, you know?

Mm-hmm. like in Yeah. Or like Magic School bus. Yes. So Mrs. Frizzle was in my body. So anyway, so you can imagine. A miba is riding around on iron now throughout your body, and it makes a lot of sense. Absolutely. Well, thank you for that very on point story, . Yeah, I forgot about that. . Oh, and I took FLA for two weeks and it was all better.

I wasn’t bloated anymore. And I can go on dates, without shitty myself. Yay. God, I’m so pleased. Thank you. Well, yeah, and you know, this is why vitamins that contain iron have a warning label, like not to take too much because iron can be toxic in large amounts. But like I said, In human milk, the lact, farrin, and the transference, those proteins help bind that iron into baby’s digestive tract, stopping harmful bacteria from using it and doing their bad things with it.

Now oral iron supplementation like from vitamins. Can acutely elevate bacterial growth? An iron overload is considered an independent risk factor for bacterial infection, which is why I was sick all the time. . Yeah. Supplemental iron, particularly administered by itself rather than with a meal can interfere with zinc absorption.

Iron supplements and iron fortified food can sometimes just cause. Digestive upset in babies there. I see this in the nicu, by the way. Yeah. When I have to do the iron supplementation for the NICU babies. Oh my goodness. It makes their bellies kind of hurt a little bit. Mm-hmm. , and then they vomit it up.

Especially if you give it at the same time as the pre the vitamin, the multivitamin. Ugh, my god. It’s so disgusting. Right. But necessary. Yeah. And then there was one study, I don’t know if you’ve ever seen this replicated, so you know, just consider that from 2002, that found that routine iron supplementation of babies who were exclusively breastfed with normal hemoglobin levels were presenting risk to the infant, including slower growth increased risk of diarrhea and.

There was another article which was interesting from around the same time saying that if your baby was generally healthy, iron deficiency in the absence of like symptoms would not have developmental consequences. That makes sense to me. Right. Again, those are studies that I haven’t seen like other studies replicate, so who knows?

But interesting to note that that was produced in those cases. And it also makes sense to me that if you basically over supplement with Iron, that you would have. More diarrhea because of the bacteria. So you can have more acute bacterial infections with too much iron. And you know, this is just something to consider.

Okay. If we are really recommending essentially universal iron supplementation of infants even. Formula fed infants are often recommended it, depending on their age. These are the risks that we should be telling parents and maybe considering in a risk benefit scenario, if that’s worth it, to recommend that universally, I was under the impression that iron supplementation was recommended, even if you are strictly formula feeding.

Yeah. Yeahing. Yeah. From what I was reading, it’s recommended. For infants who are exclusively formula feeding, the AAP recommends an iron fortified formula. Although only 4% of iron contained in formula is absorbed by babies’, intestinal tract and supplementation is not necessarily recommended. Well, how does that make any sense if 70% of the iron and breast milk gets absorb?

But only how much in formula? About four, four to 10% depending. Four to 10% gets absorbed. Why would we need to supplement iron with breastfed babies, but not formula Fed babies,

Yeah. And, and the AAP even recommends supplementing with babies who are mixed feeding. So I, it’s, it seems that these recommendations might do with some revisit. But I wanna talk to you guys as parents now about what, what should you do, ? Well, yeah, and actually, let me, let me let you talk to us, because I did a poll on this.

Oh. In the Facebook group. So we got a hundred responses. The question was, did you supplement your baby with iron? and out of a hundred responses, which is pretty good. Mm-hmm. , I would say 12 people supplemented with iron prior to six months of age. Okay. Seven. Supplemented with iron after six months of age, 59 people did not supplement with iron at all.

So that’s like almost 60%. Yeah. Of the people, 21 people did not know what I was talking. Cool. Had never heard of it. And we had one write in response that said they discovered the anemia and their kid after a lab draw for a fever. Mm-hmm. and began iron supplementation at that time. Yeah. So really that is 20% of people supplemented after six months of age and 20% had no idea what was going on.

Well, 80, I’d say 81% did not. Yeah. And 20 didn’t know what I was talking about. So, You know, yeah, maybe it’s a recommendation, but it’s clearly not one that is like very well enforced or educated on, well, I wanna tell my story with my son and then kind of lead into what you guys can do, because I went through this whole decision tree

Oh yes. So sometime around a year, maybe a little before, maybe a little after his doctor did a finger prick to check his hemoglobin levels, and they were low. And so, you know, she recommended iron supplementation. She was like, oh yeah, you can just, you know, get any of these brands as long as there’s this much iron in them and do that daily.

And so my first kid, and I did not expect to have them make that decision that day, so I was just like, okay, thank you. And I went home and I bought the poly vial whatever, iron supplementation, and it was disgusting and he hated it, . And I was like, okay. Mm-hmm. don’t know what to do now. So, I spoke with her again and I was like, what if we just like change his diet and then recheck in a couple months?

And she was like, okay, which I should have done at the appointment. But you know how those go. You’re like, even if your doctor is trying to take time and be like, just like answer all your questions. You forget. You walk in the door and they’re like, do you have questions? You’re like, Nope, nope. Never had a question in my.

I will do whatever you tell me too, cuz it is the easiest way to go. Absolutely. And I’ve gotten better about that in recent years. But anyway, so my son, the thing that I realized, you know, and she had asked like, does he drink a lot of cow’s milk? No, none. But then I realized when I got home, he doesn’t drink cow’s milk, but he eats yogurt all day long.

All day long. This kid loved yogurt and cheese. Cheese was his second. , , maybe his third word. And he was like, cheese, cheese, cheese, cheese. Oh, that’s so cute. So this kid loved his dairy. And so of course cheese and yogurt can be just as much of a problem for iron absorption as milk can because the amount of calcium in them, if you’re ingesting it at the same time as the iron, it stops your body from absorbing it properly.

Mm. And that is a big problem in toddlers who are just chugging cow’s milk all the time. It’d be better to give it a shot of juice meal. Exactly. And vitamin C increases absorption. So we were already cooking all on cast iron pans, but I adjusted his diet. I made sure we did dairy once a day and then the other meals were heavier in iron.

And in a couple months he was fine. And this is how old he was a little. I, so I think we tested around a. And then we, we tested like three to five months later or something. Eight year is when they’re telling you to switch to cow’s milk. Mm-hmm. . And they should be having however many ounces of cow’s milk a day.

And what, yeah, . I know there is a lot of contradiction, but also, of course, if we’re recommending everybody gives their kid cow’s milk, of course we’re gonna have to recommend the iron supple. Well, right. It’s like, okay. Or we do almond milk with vitamin D drops, right? And then we separately do iron rich foods and vitamin C at a different time of day.

So let’s get into that. Okay. If you or your baby’s healthcare practitioner are concerned about baby’s iron levels, it is very easy to test. For hemoglobin. You can do it with a finger prick. You need one drop of. If they wanna do a complete blood count, it is gonna be a blood draw. But the hemoglobin screening is a really simple test and it’s a good way to kind of, you know, with low intervention, kinda gauge where you’re at if you’re concerned about that.

From there, you have the decision tree. going down the standard path of iron supplementation, which if you do that, that’s fine, but I highly recommend that you choose your vitamin carefully. You administer it with some vitamin C, so like orange juice or broccoli, you know, whatever, broccoli. Sure.

Vegetables. But stay away from dairy at the same time. Yeah. The other pathway that you can choose is to offer a diet high in iron rich foods. And you know that’s gonna be important in ensuring that baby continues to have adequate iron as they grow, is also getting them to like those foods when they’re little

Can I pause to ask a stupid question? Yeah, go for it. So if cow’s milk is obviously dairy and dairy blocks, iron absorption is breast milk from a human not considered dairy. So it’s the calcium. that’s in it. Oh yeah. With calcium. So I don’t actually know how much calcium is in human milk, but apparently it’s different cuz we absorb a lot of the iron in human milk.

Uhhuh, . But it’s like the same thing where if you have to take a calcium supplement and an iron supplement, your doctor tells you to take them one morning and one at night. Yeah. Okay. Thank you. And a lot of our cow milk is like even calcium enriched, you know, there’s like so much calcium in it. Right.

right. And I think even some orange juices, right? Yes. Now with calcium. Yeah. So maybe don’t get that one for this purpose. You just eat an orange . Yeah. But let’s talk about what those foods look like, because sometimes feeding a baby is difficult. Sometimes you have picky babies, babies with texture issues, baby, who don’t like certain foods, but lucky for you, tons of foods have lots of iron, and also lucky for you.

If you introduce the same food to your child seven times, they’re much more likely to accept it in their normal food group. So if you give your baby mushrooms and your baby goes no, try six more times before you decide that they don’t like it. They do have a little bit of a protective mechanism in their brain to keep them from poisoning themselves as they were when they were little cave babies, right?

And they would go, like, crawl around and find random stuff to put in their mouth and their cave mom would be like, don’t do that. That’s gonna kill you . But if the cave mom gives. Seven times they can be pretty certain. This is in the okay list, so I’m just envisioning now like a laminated poster with different foods.

You’re like putting hash marks next to Uhhuh. Yeah. Well, you know, if you do that, please email us at Milk Minute podcast@gmail.com and let us know how many times it took your little gremlin to accept mushrooms into their diet or whatever you’re. Okay, so foods that are higher in iron include winter squashes, so the hard skinned ones like butternut squash sweet potatoes, prunes meat, and poultry, which I think most people know, but it’s bears mentioning again mushrooms, sea vegetables like seaweed and algae’s and kelp.

Dark leafy greens like spinach and charred and dandelion leaves. Grains, whole grains like mullet and brown rice and quinoa. Black strap molasses. Oh, this is a great source of iron. Also, story time, . Wait, wait. Should I finish my list first? No. Okay, fine. No, tell your story. We’re staying on molasses for just a moment.

So we live in Appalachia. Mm-hmm. and the people that settled Appalachia. Lots of Scottish people. We got lots of red heads. You know how redhead like to bleed during their births, . So we have all of these red heads settled in Appalachia, having tons and tons of babies. Everyone’s poor. They really don’t have much livestock, and they could basically have to eat an entire field of greens in order to get the amount of iron they would need in pregnancy to like not bleed to death, and also be able to pass it on to their baby.

So the midwives in Appalachia came up with a solution and would make giant vats of molasses and bring it to prenatal visits and give them all kinds of molasses to keep their iron up and make sure that they were good and not. I bet they also added yellow doc root, which is a really common like herbalist quote, like iron vitamin, you know, is a tincture of yellow doc and black strap molasses.

Interesting. Why don’t we do that anymore? Why don’t you do that more? You do can happen . Well, I don’t make molasses, but I’ve recommended that to people and it works pretty well. I need to learn how to make it. But anyway, that’s your story. Time for the day about Appalachia. Yeah. And anyway, molasses is sweet.

You know, you can put in cookies, cereal, rice, whatever. Brewers, yeast has some iron beans, like black beans, lima beans, kidney beans tofu eggs tomatoes, dried fruit, shellfish, fish, et cetera. I mean, it’s really in a lot of foods, but sometimes with toddlers, we get stuck with feeding them like bread, cheese.

Cereal puffs, . Mm-hmm. , you know, yogurt process, corn items, right? Because we’re busy or they’re at daycare or whatever, and we don’t really have the time to incorporate these foods. So if you need to have a list and just like check it off every day, like, oh yeah, they got a pouch of dark, leafy, green mush.

And, you know, I, I made sure to give them meat for dinner. If do that, if you need to. You can also consider cooking in a cast iron, which I know is not for everybody, but I love it. Oh, I didn’t even think about that. And the iron comes through. Mm-hmm. . Or you can consider something like in one of the iron fish.

Do you know what this is? No. So it’s something I recommend when I have patients with iron issues in pregnancy. this little metal fish that you put in all of your food while you’re cooking and like your food absorbs iron from it. What, I don’t know why it’s fish shaped. It’s like, it’s like a little iron weight and you just like plop it in soups or sauces or whatever that you’re cooking with.

That is the craziest thing. I’ve never heard. . How do you not know about the iron fish? I don’t know. We do use cast iron, but yeah, never have I heard of this. it. Where does this hail from? You can order it on Amazon, man. No, but I mean like what culture started that? I don’t know. And why? I don’t know. Hold on,

I will find it. Oh my goodness. Okay. Well this is so good. Well, Heather’s looking up the origins of the iron fish that she’s flabbergasted by. I can talk some more. So, yeah, you know, the conclusion of that is there are a lot of ways to get iron into your baby’s body if you need to. You’re not going to harm them by giving them a high iron diet regardless of their like anemia level.

So, you know, I think all children should probably be eating these foods, right? Like sweet potatoes and squash and dark leafy greens there, you know, meat, there’s so many other amazing nutrients in those. Anyway, so this is. , you know, this is a good preventative measure, good maintenance measure for baby’s health, and really, I’m sure you could do with eating more of these foods.

I got it. . The iron fish were developed in 2008 by Canadian health workers in Cambodia, and in 2012, a company, the Lucky Iron Fish project was formed to develop the iron fish on a larger scale, , pun intended, promote them among rural areas and distribute them to non-governmental organization partner. . So they actually do have some research on this now.

Mm-hmm. That was published in 2017 that found that the iron Ingo had no effect on anemia caused by factors other than iron deficiency. It therefore is not recommended for use in Cambodia and other countries where the majority of anemia is not due to iron deficiency and the prevalence of genetic hemoglobin disorders is high.

Ah, so it. Yeah, if your oral intake of iron is low, and that’s like 80% of iron deficiency or something. Yeah. Or 80% of anemia or something like that is from iron deficiency. So get yourself an iron fish. Why not? Yeah. I have to warn you, it does slightly change the taste of some dishes, and so it takes a little bit of getting used to.

It’s not, it’s not like a strong flavor. It’s like a subtle. Tang. I don’t know how to describe it. You know what? Here’s what’s weird though. Most stuff like this is not from 2008 . It’s like, Something that we stole from cultures from a, a million years ago. I’m sure that, so if anyone knows, said you invented this, got the idea from somewhere else, , right.

If anyone knows the true origin, please let me know. Yeah. And, and I think also like it’s more accessible than a cast iron pan. For a lot of people, right? Like buying the little iron fish for 10 bucks or whatever. Rather than getting a whole new set of cookware, my mother-in-law found a cast iron that was discarded on the side of the road in Southern West Virginia, in Wyoming County and brought it to us and I was like, someone could have cooked meth in that.

Like I’m not using that. It absorbs all the properties that you’ve used, you know, so there are people who like fix up old cast irons like that through electrolysis tank. Okay, thanks for making me feel better, because I was like, I’m not using this. And my husband was like, you’re being so dramatic. Yeah, no, it’s, and I was like he just cleaned it and used it anyway.

But I mean also there’s just like if, if they’ve been used for cooking for like 50 years, there’s so many layers of stuff on there that. You know, it doesn’t need to be there. Yeah. There’s someone in St. George that I know near me that does it, and you can like, drop off all your cast iron to her, she’ll put them into electrolysis tanks, get all the gunk off, and then re season them and give them back to you.

Whoa. Mm-hmm. . That’s amazing. Yeah. Yeah. It’s, it’s really cool, especially when you find junked ones and you’re like, I don’t know what this gunk is on here. I know the metal’s cool and sound and I could cook in it, but what is that? I don’t know why I’m so full of stories today, , but my first cast iron pan was actually a re-gift I’m pretty sure from my boyfriend’s boyfriend, no, from my boyfriend at the time.

I went to his parents’ house. He was Polish and his parents did not speak any English, and it was around Christmas time and I don’t think he told his mom that I was coming. And then she was like really mad because she didn’t have a gift for me. And then he’s an idiot and realized he didn’t have a gift for me either

And so I’m trying to put this together, but like he randomly hands me a bag that just. A cast iron pan in it and a scarf. And I was like, oh, thank you boyfriend of three months for this cast iron. Very odd. He’s like, I was gonna have it engraved for you, but I didn’t have time. And I was like, I don’t think that’s a thing.

Oh my God. But thank you much A, he was also the one that pretended to be a Polish prince. Stop. Did, have you not heard this story? Heather? Why are you only thinking of telling me these stories now, I’ve known you for like 10 years. He even showed me a picture of a castle on Google from Ch Nisa, Poland.

Stop it and told me that that stop. That was his family’s castle. He did not. Yes, he did. It gets worse. He told me that and it’s like a dilapidated council, and he was like, after World War ii, the Nazis destroyed it. So my family just donated it to, oh God, the, the Chsa Poland Association or whatever. And I was like, who would lie about that?

Of course. So I’m like, oh my God. That’s crazy. Yeah, that’s an elaborate lie. He, oh, you can fact check the lie. Went on and on and on. He told me his mom’s name was like 15 names long. She was royalty and that’s standard over there. And I was like, whoa. So when he invited me to his parents’ house, I thought I was about to meet like the fricking king and queen.

And I walk up, he tells me, oh yeah, we live in Philly, blah blah, blah. And I put it in the gps and it takes me to a two story walk up in Jersey. And I’m like, what? And they don’t speak English, so. Like his cover is still intact because they can’t tell me one way or another. And he’s like, oh yeah, they lost all their money in the move.

They wanted a better life for us, blah, blah, blah. I was like, what is happening? And so I got back from that trip and I went to a local watering hole and I ran into his roommate and his roommate was kind of drunk, and he came out to me and he was like, Heather, you’re a really good person, so I’m just gonna go ahead and tell you.

He’s not a Polish prince and he has a girlfriend who’s studying abroad in France. Oh, . I got that cast iron though. Hell yeah. . Oh my God. Girl. I even made for Christmas; I made him a collage of Chso with a castle in the middle. That’s what, what a good girlfriend I was. I was like, here you go. Here’s your collage of your homeland.

He was, Thank you so much. And in his mind, he’s probably like this idiot. . . Oh my god, what the fuck? I know, guys. It wasn’t pretty out there in the dating scene for me. Oh, it really, dating was rough. Thank God we’re not doing that now. You know, we. I did run into him playing music on my first date with my husband now though , which is really funny in retrospect.

Yeah. Our first date we like went out to a little bar club and there’s Mache playing music and so I told my now husband the story. So he like of course made it a point to like really? Yes. Ham it up that night for me, which I really appreciated. So yeah. Thank you. Cash, I won in the end. Yeah. . Yeah. My. The only thing I have to say about cast irons is humble brag that I do have a Griswold, which is like very umbrella.

Oh, is it engraved? No, but it is an antique. Nice. . I’d like to see that sometime. It’s really not. It just looks like every other one. just says Griswold on the bottom. It’s just heavier and harder to clean. It’s actually thinner. Oh, is it? It’s thinner bottom. I like it. It’s my favorite one. Oh. Well, you can get them on eBay, but they’re expansive.

If you’re not cooking with cast iron, you’re missing out friends, . Okay, so in conclusion, we’ve brought it full circle here. Is iron supplementation necessary? We’d say definitely not before six months for infants in a low risk category for anemia. So if you have a full term medically, well infant and you yourself are not anemic, you probably don’t need to be supplementing before six months of.

Supplementation might be necessary after six months. However, it’s likely acceptable to offer a diet high in iron-rich foods. As a substitute, you can request that your provider test your baby’s hemoglobin levels as a general screening tool for iron deficiency if you are worried about it. Mm-hmm. . And that’s, that’s kind of it folks.

Don’t, don’t overthink it. Yeah. If you’re normal, keep being normal. really try to focus on Whole Foods and getting your kid to like a lot of different kinds of foods and yeah. If your kid keeps barfing up the iron supplement, maybe like give it a rest and switch to Yellow Fish. Get. Get a little fish.

Get a little iron. Fish. . Oh man. This has been way more fun than I thought it gonna be. I know. Well, you just whipped out these stories. Oh my goodness. You don’t even know me. . I don’t know you at all. I had a whole past before I was this. Domestic Nevas and Princess. and ire. No, boy. Oh my gosh. Well, let’s take a minute to thank one of our sponsors before we get to our favorite segment in the show, the award and the Alco.

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Welcome back to the award in the alcove of everyone. Who are we giving an award to today? Heather, I’m going to give an award to Kelly w from our Facebook group. She posted the picture that absolutely made me giggle out loud three days ago. And she says, I thought babe and I were awesome at this breastfeeding thing.

And now this breastfeeding with a roll of toilet paper as a lovey isn’t as easy as one would think . So she posted the cutest picture ever of her baby who’s just gingerly holding a toilet paper roll while nursing, and apparently this is the new lovey that this baby has to use all the time. I’m, let me guess, her baby’s like nine months old or something.

Yeah. Looks, looks to be. That old. Yeah. So yes, . Oh, I’m so sorry to say. It is only beginning the world of nursing dump trucks and crayons and chaps. Did anything that your toddler wants to pick up? Let’s see. What award should we give you this week we’re gonna give you the honor roll award, . Cause you’re on a roll.

Absolutely. You’re doing great. And I have every confidence that you’ll meet all the challenges. Yes, and you’ll do it with a lovey in your hand, , or you know, just some emergency teepee. Yeah. At least if you have a glistening tear while nursing, you’ll have something to wipe it with , or if your baby does that weird thing where they sneeze with your nipple in their mouth and then it sort of like comes out their nose.

Myra did that yesterday. It’s so weird and gross when they do that. She’s been snotty with like no other symptoms. Just like pouring faucet. Pouring snot. Yeah. And so when we’ve been nursing, I’m stuck with that, like slimy residue all over my areola. After. Yeah. Well maybe it’s not a bad idea to hold a toilet paper roll while you nurse.

Okay. Do we wanna read an Apple Review before we go? We do. Okay. Today’s Apple Review is from our friend Jamie. Thanks Jamie. She says, informative and fun. Love this podcast. They keep it so real about breastfeeding and are fun to listen to. It’s great having a community on their Facebook page as well.

Looking forward to the next episode. Oh, that’s sweet. Thank you. Thanks, Jamie. That’s so sweet. We do read all of the reviews and would love it if you’d write us one. So thank you so much for tuning in to another episode of the Milk Minute podcast. The way that we change this big, crazy system we’re all stuck in that’s not really supporting us, is by educating ourselves and our friends and family.

If you found value in the epi in the episode that we produced for you today, you can join us on Patreon. You can give us money there, and we will give you things like merch or bonus material or early ad-free episodes or a friendly response in a message about breastfeeding if you have a question. Yes.

So please join us there. We are devoted to our patrons. We are, and we love you and we hope you have an excellent day. Okay, bye friends.