Some women’s breasts can’t make enough milk, and the effects can be devastating
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Many new mothers worry about their milk supply. For some, support from a breastfeeding counsellor or lactation consultant helps.
Others cannot make enough milk no matter how hard they try. These are women whose breasts are not physically capable of producing enough milk.
Our recently published research gives us clues about breast features that might make it difficult for some women to produce enough milk. Another of our studies shows the devastating consequences for women who dream of breastfeeding but find they cannot.
Some breasts just don’t develop
Unlike other organs, breasts are not fully developed at birth. There are key developmental stages as an embryo, then again during puberty and pregnancy.
At birth, the breast consists of a simple network of ducts. Usually during puberty, the glandular (milk-making) tissue part of the breast begins to develop and the ductal network expands. Then typically, further growth of the ductal network and glandular tissue during pregnancy prepares the breast for lactation.
But our online survey of women who report low milk supply gives us clues to anomalies in how some women’s breasts develop.
We’re not talking about women with small breasts, but women whose glandular tissue (shown in this diagram as “lobules”) is underdeveloped and have a condition called breast hypoplasia.
Tsuyna/Shutterstock
We don’t know how common this is. But it has been linked with lower rates of exclusive breastfeeding.
We also don’t know what causes it, with much of the research conducted in animals and not humans.
However, certain health conditions have been associated with it, including polycystic ovary syndrome and other endocrine (hormonal) conditions. A high body-mass index around the time of puberty may be another indicator.
Could I have breast hypoplasia?
Our survey and other research give clues about who may have breast hypoplasia.
But it’s important to note these characteristics are indicators and do not mean women exhibiting them will definitely be unable to exclusively breastfeed.
Indicators include:
- a wider than usual gap between the breasts
- tubular-shaped (rather than round) breasts
- asymmetric breasts (where the breasts are different sizes or shapes)
- lack of breast growth in pregnancy
- a delay in or absence of breast fullness in the days after giving birth
In our survey, 72% of women with low milk supply had breasts that did not change appearance during pregnancy, and about 70% reported at least one irregular-shaped breast.
The effects
Mothers with low milk supply – whether or not they have breast hyoplasia or some other condition that limits their ability to produce enough milk – report a range of emotions.
Research, including our own, shows this ranges from frustration, confusion and surprise to intense or profound feelings of failure, guilt, grief and despair.
Some mothers describe “breastfeeding grief” – a prolonged sense of loss or failure, due to being unable to connect with and nourish their baby through breastfeeding in the way they had hoped.
These feelings of failure, guilt, grief and despair can trigger symptoms of anxiety and depression for some women.
Bricolage/Shutterstock
One woman told us:
[I became] so angry and upset with my body for not being able to produce enough milk.
Many women’s emotions intensified when they discovered that despite all their hard work, they were still unable to breastfeed their babies as planned. A few women described reaching their “breaking point”, and their experience felt “like death”, “the worst day of [my] life” or “hell”.
One participant told us:
I finally learned that ‘all women make enough milk’ was a lie. No amount of education or determination would make my breasts work. I felt deceived and let down by all my medical providers. How dare they have no answers for me when I desperately just wanted to feed my child naturally.
Others told us how they learned to accept their situation. Some women said they were relieved their infant was “finally satisfied” when they began supplementing with formula. One resolved to:
prioritise time with [my] baby over pumping for such little amounts.
Where to go for help
If you are struggling with low milk supply, it can help to see a lactation consultant for support and to determine the possible cause.
This will involve helping you try different strategies, such as optimising positioning and attachment during breastfeeding, or breastfeeding/expressing more frequently. You may need to consider taking a medication, such as domperidone, to see if your supply increases.
If these strategies do not help, there may be an underlying reason why you can’t make enough milk, such as insufficient glandular tissue (a confirmed inability to make a full supply due to breast hypoplasia).
Even if you have breast hypoplasia, you can still breastfeed by giving your baby extra milk (donor milk or formula) via a bottle or using a supplementer (which involves delivering milk at the breast via a tube linked to a bottle).
More resources
The following websites offer further information and support:
- Australian Breastfeeding Association
- Lactation Consultants of Australia and New Zealand
- Royal Women’s Hospital, Melbourne
- Supply Line Breastfeeders Support Group of Australia Facebook support group
- IGT And Low Milk Supply Support Group Facebook support group
- Breastfeeding Medicine Network Australia/New Zealand
- Supporting breastfeeding grief (a collection of resources).
Shannon Bennetts, a research fellow at La Trobe University, contributed to this article.
Renee Kam, PhD candidate and research officer, La Trobe University and Lisa Amir, Professor in Breastfeeding Research, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Psychology Sunday Rewind: Healing Family Rifts
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Estrangement, And How To Heal It
The following article was first published a little under six months ago, and it proved to be our most popular “Psychology Sunday” article of the year.
We republish it today, in case it might also be of value to readers who have joined us since
Having written before about how deleterious to the health loneliness and isolation can be, and what things can be done about it, we had a request to write about…
❝Reconciliation of relationships in particular estrangement mother adult daughter❞
And, this is not only an interesting topic, but a very specific one that affects more people than is commonly realized!
In fact, a recent 800-person study found that more than 43% of people experienced family estrangement of one sort or another, and a more specific study of more than 2,000 mother-child pairs found that more than 11% of mothers were estranged from at least one adult child.
So, if you think of the ten or so houses nearest to you, probably at least one of them contains a parent estranged from at least one adult child. Maybe it’s yours. Either way, we hope this article will give you some pause for thought.
Which way around?
It makes a difference to the usefulness of this article whether any given reader experiencing estrangement is the parent or the adult child. We’re going to assume the reader is the parent. It also makes a difference who did the estranging. That’s usually the adult child.
So, we’re broadly going to write with that expectation.
Why does it happen?
When our kids are small, we as parents hold all the cards. It may not always feel that way, but we do. We control our kids’ environment, we influence their learning, we buy the food they eat and the clothes they wear. If they want to go somewhere, we probably have to take them. We can even set and enforce rules on a whim.
As they grow, so too does their independence, and it can be difficult for us as parents to relinquish control, but we’re going to have to at some point. Assuming we are good parents, we just hope we’ve prepared them well enough for the world.
Once they’ve flown the nest and are living their own adult lives, there’s an element of inversion. They used to be dependent on us; now, not only do they not need us (this is a feature not a bug! If we have been good parents, they will be strong without us, and in all likelihood one day, they’re going to have to be), but also…
We’re more likely to need them, now. Not just in the “oh if we have kids they can look after us when we’re old” sense, but in that their social lives are growing as ours are often shrinking, their family growing, while ours, well, it’s the same family but they’re the gatekeepers to that now.
If we have a good relationship, this goes fine. However, it might only take one big argument, one big transgression, or one “final straw”, when the adult child decides the parent is more trouble than they’re worth.
And, obviously, that’s going to hurt. But it’s pretty much how it pans out, according to studies:
Here be science: Tensions in the Parent and Adult Child Relationship: Links to Solidarity and Ambivalence
How to fix it, step one
First, figure out what went wrong.
Resist any urge to protect your own feelings with a defensive knee-jerk “I don’t know; I was a good, loving parent”. That’s a very natural and reasonable urge and you’re quite possibly correct, but it won’t help you here.
Something pushed them away. And, it will almost certainly have been a push factor from you, not a pull factor from whoever is in their life now. It’s easy to put the blame externally, but that won’t fix anything.
And, be honest with yourself; this isn’t a job interview where we have to present a strength dressed up as a “greatest weakness” for show.
You can start there, though! If you think “I was too loving”, then ok, how did you show that love? Could it have felt stifling to them? Controlling? Were you critical of their decisions?
It doesn’t matter who was right or wrong, or even whether or not their response was reasonable. It matters that you know what pushed them away.
How to fix it, step two
Take responsibility, and apologize. We’re going to assume that your estrangement is such that you can, at least, still get a letter to them, for example. Resist the urge to argue your case.
Here’s a very good format for an apology; please consider using this template:
The 10-step (!) apology that’s so good, you’ll want to make a note of it
You may have to do some soul-searching to find how you will avoid making the same mistake in the future, that you did in the past.
If you feel it’s something you “can’t change”, then you must decide what is more important to you. Only you can make that choice, but you cannot expect them to meet you halfway. They already made their choice. In the category of negotiation, they hold all the cards now.
How to fix it, step three
Now, just wait.
Maybe they will reply, forgiving you. If they do, celebrate!
Just be aware that once you reconnect is not the time to now get around to arguing your case from before. It will never be the time to get around to arguing your case from before. Let it go.
Nor should you try to exact any sort of apology from them for estranging you, or they will at best feel resentful, wonder if they made a mistake in reconnecting, and withdraw.
Instead, just enjoy what you have. Many people don’t get that.
If they reply with anger, maybe it will be a chance to reopen a dialogue. If so, family therapy could be an approach useful for all concerned, if they are willing. Chances are, you all have things that you’d all benefit from talking about in a calm, professional, moderated, neutral environment.
You might also benefit from a book we reviewed previously, “Parent Effectiveness Training”. This may seem like “shutting the stable door after the horse has bolted”, but in fact it’s a very good guide to relationship dynamics in general, and extensively covers relations between parents and adult children.
If they don’t reply, then, you did your part. Take solace in knowing that much.
Some final thoughts:
At the end of the day, as parents, our kids living well is (hopefully) testament to that we prepared them well for life, and sometimes, being a parent is a thankless task.
But, we (hopefully) didn’t become parents for the plaudits, after all.
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Hardwiring Happiness – by Dr. Rick Hanson
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Publishers are very excitable about “the new science of…”, and it’s almost never actually a new science of. But what about in this case?
No, it isn’t. It’s the very well established science of! And that’s a good thing, because it means this book is able to draw on quite a lot of research and established understanding of how neuroplasticity works, to leverage that and provide useful guidance.
A particular strength of this book is that while it polarizes the idea that some people have “happy amygdalae” and some people have “sad amygdalae”, it acknowledges that it’s not just a fated disposition and is rather the result of the lives people have led… And then provides advice on upgrading from sad to happy, based on the assumption that the reader is quite possibly coming from a non-ideal starting point.
The bookdoes an excellent job of straddling neuroscience and psychology, which sounds like not much of a straddle (the two are surely very connected, after all, right?) but this does mean that we’re hearing about the chemical structure of DNA inside the nuclei of the neurons of the insula, not long after reading an extended gardening metaphor about growth, choices, and vulnerabilities.
Bottom line: if you’d like a guide to changing your brain for the better (happier) that’s not just “ask yourself: what if it goes well?” and similar CBTisms, then this is a fine book for you.
Click here to check out Hardwiring Happiness, and indeed hardwire happiness!
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What’s Your Plant Diversity Score?
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We speak often about the importance of dietary diversity, and of that, especially diversity of plants in one’s diet, but we’ve never really focused on it as a main feature, so that’s what we’re going to do today.
Specifically, you may have heard the advice to “eat 30 different kinds of plants per week”. But where does that come from, and is it just a number out of a hat?
The magic number?
It is not, in fact, a number out of a hat. It’s from a big (n=11,336) study into what things affect the gut microbiome for better or for worse. It was an observational population study, championing “citizen science” in which volunteers tracked various things and collected and sent in various samples for analysis.
The most significant finding of this study was that those who consumed more than 30 different kinds of plants per week, had a much better gut microbiome than those who consumed fewer than 10 different kinds of plants per week (there is a bell curve at play, and it gets steep around 10 and 30):
American Gut: an Open Platform for Citizen Science Microbiome Research
Why do I care about having a good gut microbiome?
Gut health affects almost every other kind of health; it’s been called “the second brain” for the various neurotransmitters and other hormones it directly makes or indirectly regulates (which in turn affect every part of your body), and of course there is the vagus nerve connecting it directly to the brain, impacting everything from food cravings to mood swings to sleep habits.
See also:
Any other benefits?
Yes there are! Let’s not forget: as we see often in our “This or That” section, different foods can be strong or weak in different areas of nutrition, so unless we want to whip out a calculator and database every time we make food choices, a good way to cover everything is to simply eat a diverse diet.
And that goes not just for vitamins and minerals (which would be true of animal products also), but in the case of plants, a wide range of health-giving phytochemicals too:
Measuring Dietary Botanical Diversity as a Proxy for Phytochemical Exposure
Ok, I’m sold, but 30 is a lot!
It is, but you don’t have to do all 30 in your first week of focusing on this, if you’re not already accustomed to such diversity. You can add in one or two new ones each time you go shopping, and build it up.
As for “what counts”: we’re counting unprocessed or minimally-processed plants. So for example, an apple is an apple, as are dried apple slices, as is apple sauce. Any or all of those would count as 1 plant type.
Note also that we’re counting types, not totals. If you’re having apple slices with apple sauce, for some reason? That still only counts as 1.
However, while apple sauce still counts as apples (minimally processed), you cannot eat a cake and say “that’s 2 because there was wheat and sugar cane somewhere in its dim and distant history”.
Nor is your morning espresso a fruit (by virtue of coffee beans being the fruit of the plant, botanically speaking). However, it would count as 1 plant type if you eat actual coffee beans—this writer has been known to snack on such; they’re only healthy in very small portions though, because their saturated fat content is a little high.
You, however, count grains in general, as well as nuts and seeds, not just fruits and vegetables. As for herbs and spices, they count for ¼ each, except for salt, which might get lumped in with spices but is of course not a plant.
How to do it
There’s a reason we’re doing this in our Saturday Life Hacks edition. Here are some tips for getting in far more plants than you might think, a lot more easily than you might think:
- Buy things ready-mixed. This means buying the frozen mixed veg, the frozen mixed chopped fruit, the mixed nuts, the mixed salad greens etc. This way, when you’re reaching for one pack of something, you’re getting 3–5 different plants instead of one.
- Buy things individually, and mix them for storage. This is a more customized version of the above, but in the case of things that keep for at least a while, it can make lazy options a lot more plentiful. Suddenly, instead of rice with your salad you’re having sorghum, millet, buckwheat, and quinoa. This trick also works great for dried berries that can just be tipped into one’s morning oatmeal. Or, you know, millet, oats, rye, and barley. Suddenly, instead of 1 or 2 plants for breakfast you have maybe 7 or 8.
- Keep a well-stocked pantry of shelf-stable items. This is good practice anyway, in case of another supply-lines shutdown like at the start of the COVID-19 pandemic. But for plant diversity, it means that if you’re making enchiladas, then instead using kidney beans because that’s what’s in the cupboard, you can raid your pantry for kidney beans, black beans, pinto beans, fava beans, etc etc. Yes, all of them; that’s a list, not a menu.
- Shop in the discount section of the supermarket. You don’t have shop exclusively there, but swing by that area, see what plants are available for next to nothing, and buy at least one of each. Figure out what to do with it later, but the point here is that it’s a good way to get suggestions of plants that you weren’t actively looking for—and novelty is invariably a step into diversity.
- Shop in a different store. You won’t be able to beeline the products you want on autopilot, so you’ll see other things on the way. Also, they may have things your usual store doesn’t.
- Shop in person, not online—at least as often as is practical. This is because when shopping for groceries online, the store will tend to prioritize showing you items you’ve bought before, or similar items to those (i.e. actually the same item, just a different brand). Not good for trying new things!
- Consider a meal kit delivery service. Because unlike online grocery shopping, this kind of delivery service will (usually) provide you with things you wouldn’t normally buy. Our sometimes-sponsor Purple Carrot is a fine option for this, but there are plenty of others too.
- Try new recipes, especially if they have plants you don’t normally use. Make a note of the recipe, and go out of your way to get the ingredients; if it seems like a chore, reframe it as a little adventure instead. Honestly, it’s things like this that keep us young in more ways than just what polyphenols can do!
- Hide the plants. Whether or not you like them; hide them just because it works in culinary terms. By this we mean; blend beans into that meaty sauce; thicken the soup with red lentils, blend cauliflower into the gravy. And so on.
One more “magic 30”, while we’re at it…
30g fiber per day makes a big (positive) difference to many aspects of health. Obviously, plants are where that comes from, so there’s a big degree of overlap here, but most of the tips we gave are different, so for double the effectiveness, check out:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Enjoy!
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How Much Alcohol Does It Take To Increase Cancer Risk?
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Alcohol is, of course, unhealthy. Not even the famous “small glass of red” is recommended:
Alcohol also increases all-cause mortality at any dose (even “low-risk drinking”):
Alcohol Consumption Patterns and Mortality Among Older Adults
…and the World Health Organization has declared that the only safe amount of alcohol is zero:
WHO: No level of alcohol consumption is safe for our health
But what of alcohol and cancer? According to the American Association of Cancer Research’s latest report, more than half of Americans do not know that alcohol increases the risk of cancer:
Source: AACR Cancer Progress Report
Why/how does alcohol increase the risk of cancer?
There’s an obvious aspect and a less obvious but very important aspect:
- The obvious: alcohol damages almost every system in the body, and so it’s little surprise if that includes systems whose job it is to keep us safe from cancer.
- The less obvious: alcohol is largely metabolized by certain enzymes that have an impact on DNA repair, such as alcohol dehydrogenases and aldehyde dehydrogenases, amongst others, and noteworthily, acetaldehyde (the main metabolite of alcohol) is itself genotoxic.
Read more: Alcohol & Cancer
This is important, because it means alcohol also increases the risk of cancers other than the obvious head/neck, laryngeal, esophageal, liver, and colorectal cancers.
However, those cancers are of course the most well-represented of alcohol-related cancers, along with breast cancer (this has to do with alcohol’s effect on estrogen metabolism).
If you’re curious about the numbers, and the changes in risk if one reduces/quits/reprises drinking:
❝The increased alcohol-related cancer incidence was associated with dose; those who changed from nondrinking to mild (adjusted hazard ratio [aHR], 1.03; 95% CI, 1.00-1.06), moderate (aHR, 1.10; 95% CI, 1.02-1.18), or heavy (aHR, 1.34; 95% CI, 1.23-1.45) drinking levels had an associated higher risk than those who did not drink.
Those with mild drinking levels who quit drinking had a lower risk of alcohol-related cancer (aHR, 0.96; 95% CI, 0.92-0.99) than those who sustained their drinking levels.
Those with moderate (aHR, 1.07; 95% CI, 1.03-1.12) or heavy (aHR, 1.07; 95% CI, 1.02-1.12) drinking levels who quit drinking had a higher all cancer incidence than those who sustained their levels, but when quitting was sustained, this increase in risk disappeared.
Results of this study showed that increased alcohol consumption was associated with higher risks for alcohol-related and all cancers, whereas sustained quitting and reduced drinking were associated with lower risks of alcohol-related and all cancers.
Alcohol cessation and reduction should be reinforced for the prevention of cancer.❞
Source: Association Between Changes in Alcohol Consumption and Cancer Risk
Worried it’s too late?
If you’re reading this (and thus, evidently, still alive), it isn’t. It’s never too late (nor too early) to reduce, or ideally stop, drinking. Even if you already have cancer, drinking more alcohol will only exacerbate things, and abstaining from alcohol will improve your chances of recovery.
For a reassuring timeline of recovery from alcohol-related damage, see:
What Happens To Your Body When You Stop Drinking Alcohol
Want to stop, but have tried before and find it daunting?
There are a few ways to make it a lot easier:
Rethinking Drinking: How To Reduce Or Quit Alcohol
Take care!
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Cardiac Failure Explained – by Dr. Warrick Bishop
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The cover of this book makes it look like it’ll be a flashy semi-celebrity doctor keen to sell his personalized protocol, along with eleventy-three other books, but actually, what’s inside this one is very different:
We (hopefully) all know the basics of heart health, but this book takes it a lot further. Starting with the basics, then the things that it’s easy to feel like you should know but actually most people don’t, then into much more depth.
The format is much more like a university textbook than most pop-science books, and everything about the way it’s written is geared for maximum learning. The one thing it does keep in common with pop-science books as a genre is heavy use of anecdotes to illustrate points—but he’s just as likely to use tables, diagrams, callout boxes, emboldening of key points, recap sections, and so forth. And for the most part, this book is very information-dense.
Dr. Bishop also doesn’t just stick to what’s average, and talks a lot about aberrations from the norm, what they mean and what they do and yes, what to do about them.
On the one hand, it’s more information dense than the average reader can reasonably expect to need… On the other hand, isn’t it great to finish reading a book feeling like you just did a semester at medical school? No longer will you be baffled by what is going on in your (or perhaps a loved one’s) cardiac health.
Bottom line: if you’d like to know cardiac health inside out, this book is an excellent place to start.
Click here to check out Cardiac Failure Explained, and get to the heart of things!
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Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
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Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
First things first… How much fiber should we be eating?
- The World Health Organization recommends we each get at least 25g of fiber per day:
- A more recent meta-review of studies, involving thousands of people and decades of time, suggests 25–29g is ideal:
- The British Nutritional Foundation gives 30g as the figure:
- The US National Academy of Sciences’ Institute of Medicine recommends 21g–38g per day, depending on age and sex:
- A large study last year gave 30–40g as the figure:
*This one is also a great read to understand more about the “why” of fiber
Meanwhile, the average American gets 16g of fiber per day.
So, how to get more fiber, without piling on too many carbs?
Foods that contain fiber generally contain carbs (there’s a limit to how much celery most people want to eat), so there are two key ideas here:
- Getting a good carb:fiber ratio
- Making substitutions that boost fiber without overdoing (or in some case, even changing) carbs
Meat → Lentils
Well-seasoned lentils can be used to replaced ground beef or similar. A cup of boiled lentils contains 18g of fiber, so you’re already outdoing the average American’s daily total.
Meat → Beans
Black beans are a top-tier option here (15g per cup, cooked weight), but many kinds of beans are great.
Chicken/Fish → Chickpeas
Yes, chicken/fish is already meat, but we’re making a case for chickpeas here. Cooked and seasoned appropriately, they do the job, and pack in 12g of fiber per cup. Also… Hummus!
Bonus: Hummus, eaten with celery sticks.
White pasta/bread → Wholewheat pasta/bread
This is one where “moderation is key”, but if you’re going to eat pasta/bread, then wholewheat is the way to go. Fiber amounts vary, so read labels, but it will always have far more than white.
Processed salty snacks → Almonds and other nuts
Nuts in general are great, but almonds are top-tier for fiber, amongst other things. A 40g handful of almonds contains about 10g of fiber.
Starchy vegetables → Non-starchy vegetables
Potatoes, parsnips, and their friends have their place. But they cannot compete with broccoli, peas, cabbage, and other non-starchy vegetables for fiber content.
Bonus: if you’re going to have starchy vegetables though, leave the skins on!
Fruit juice → Fruit
Fruit juice has had most, if not all, of its fiber removed. Eat an actual juicy fruit, instead. Apples and bananas are great options; berries such as blackberries and raspberries are even better (at around 8g per cup, compared to the 5g or so depending on the size of an apple/banana)
Processed cereals → Oats
5g fiber per cup. Enough said.
Summary
Far from being a Herculean task, getting >30g of fiber per day can be easily accomplished by a lentil ragù with wholewheat pasta.
If your breakfast is overnight oats with fruit and some chopped almonds, you can make it to >20g already by the time you’ve finished your first meal of the day.
Enjoy!
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