Ask Dr. Hale
Dear Dr. Hale,
I have a family member who is very interested in breastfeeding, but she is hesitant due to the Calcitriol she is taking. She is currently taking 0.5 mcg of Calcitriol - down from 0.75 mcg when she became pregnant. I'm afraid information out there will scare her out of wanting to nurse. She's also read that it's an L3 - which I have explained, but she insists "research has not proven it safe." Can you offer any help?
I have a family member who is very interested in breastfeeding, but she is hesitant due to the Calcitriol she is taking. She is currently taking 0.5 mcg of Calcitriol - down from 0.75 mcg when she became pregnant. I'm afraid information out there will scare her out of wanting to nurse. She's also read that it's an L3 - which I have explained, but she insists "research has not proven it safe." Can you offer any help?
Calcitriol is the active form of Vitamin D. It is virtually all bound to plasma protein and is unlikely to ever reach the milk compartment (99.9% bound). Milk levels of Calcitriol reported by the manufacturer are only 2.2 picograms/ml. In essence, virtually none of the calcitriol gets to the milk. I do not think it would ever reach levels in milk to produce clinical effects on the infant.
Dear Dr. Hale,
I was wondering if you can give me an answer to the following question. The mother of a 4-month-old exclusively breastfed infant was just diagnosed with severe vitamin D deficiency and will start a regimen of oral vitamin D, 50,000 IU a week for 12 weeks, followed by 2,000 IU PO daily. Is it safe for the baby to stay on the breast milk while his mother is being treated? If so, should the baby be monitored for hypercalcemia (clinically or labs) and how frequently?
I was wondering if you can give me an answer to the following question. The mother of a 4-month-old exclusively breastfed infant was just diagnosed with severe vitamin D deficiency and will start a regimen of oral vitamin D, 50,000 IU a week for 12 weeks, followed by 2,000 IU PO daily. Is it safe for the baby to stay on the breast milk while his mother is being treated? If so, should the baby be monitored for hypercalcemia (clinically or labs) and how frequently?
I checked with a colleague who is an expert on Vitamin D. She says not to worry. We are probably soon going to recommend doses as high as 6400 IU per day for breastfeeding mothers, which is 44,800 IU per week in order to drive up levels in milk to a therapeutic range for infants. Monitoring the infant’s plasma calcium levels and even vitamin D levels is advisable, however.
Dear Dr. Hale,
Can you provide some evidence-based documentation for the fact that we should not be using vitamin E as a topical treatment for sore nipples.
I do not at all suggest you should not use Vitamin E topically on the nipple, just that you should not use "pure" highly concentrated vitamin E. A 400 IU dose/day is probably just fine.
In the 1980's, over 40 infants were killed with high-dose IV vitamin E. They died from hepatosplenomegally. So high dose vitamin E could and is, in my opinion, hazardous. Two of these infants died in our own NICU.
In the 1980's, over 40 infants were killed with high-dose IV vitamin E. They died from hepatosplenomegally. So high dose vitamin E could and is, in my opinion, hazardous. Two of these infants died in our own NICU.
Dear Dr. Hale,
I am a lactation consultant in private practice. A mom of a 6-month-old baby wants to take a multivitamin with green tea extract. Is this safe while breastfeeding. The baby feeds 5 times a day.
I am a lactation consultant in private practice. A mom of a 6-month-old baby wants to take a multivitamin with green tea extract. Is this safe while breastfeeding. The baby feeds 5 times a day.
I don't know of any problem with either the multivitamin or Green Tea extract...just don't take too much of the tea.
Dear Dr. Hale,
I am a 30-year-old mom breastfeeding a 2-month-old. I was wondering if it is okay to take probiotic supplements. The package says it also contains soy. Also, is it ok to take nexium? My GI doctor wanted to prescribe it to me because my endoscopy showed that I have GERD. If not nexium, what would be a better alternative?
I am a 30-year-old mom breastfeeding a 2-month-old. I was wondering if it is okay to take probiotic supplements. The package says it also contains soy. Also, is it ok to take nexium? My GI doctor wanted to prescribe it to me because my endoscopy showed that I have GERD. If not nexium, what would be a better alternative?
Prilosec (omeprazole) is similar to Nexium (esomeprazole)) and has been studied. Milk levels were very low. It should be no problem whatsoever (other than being horribly expensive). The probiotic supplements shouldn't be a problem, either. Don't go overboard with the vitamins, however.
