The Postpartum Dance of Estrogen, Insulin, and Cortisol, for Milk Production

by Hilary Jacobson | Oct 24, 2022 | Course_Work, Low Milk Supply

The Postpartum Dance of Estrogen, Insulin, and Cortisol, for Milk Production

Introduction

To understand common lactation difficulties, we need to investigate the sensitive dance of estrogen, insulin, and cortisol after childbirth and during lactation.

How we use Energy – It Matters

All living beings are able to absorb energy from outside sources and to use that energy to fuel their life. Plants get their energy from sunlight on leaves. The sunlight is metabolized into starch in the cells of leaves and is then used by the plant to fuel its further growth. This process is called photosynthesis.

Animals and insects eat the leaves and then use the plant’s starch for their own energy needs. These starches are changed into a form of sugar called glucose, which is transported around the body in the blood (blood glucose) and used to fuel the muscles and organs. Excess glucose is put into storage in the liver and muscles. When a burst of energy is needed, the stored glucose is mobilized for rapid use.

Animals and insects eat plants, but they also eat other animals and insects. This allows the eater to absorb types of tissues, vitamins, proteins, minerals and fats that the predator does not easily produce itself. For instance, humans do not produce vitamin C or vitamin B12 in our bodies. We depend on food sources. We also have a hard time producing important fatty-acids that are needed for the brain and the nerves. We get these fatty acids from certain leaves, seeds, nuts, and fish. Humans are less able to produce vitamin D in our body as we age and need to absorb it from food sources.

Human women store excess glucose in our fat pads for the specific use of having extra energy for pregnancy and lactation. In fact, fertility typically only turns on when there is enough stored fat to support a pregnancy.

The Dance of Postpartum Hormones

Insulin and cortisol are hormones that orchestrate the uses of energy (calories) that we derive from food. Insulin tells the blood glucose where to go. Cortisol dictates how our stored fat will be used.

After childbirth, insulin levels sink to an all-time low and they remain that way throughout the first long phase of exclusive lactation. With these lower levels of insulin, the body does not use blood-glucose to fuel the needs of muscles or organs. Instead, the breastfeeding hormone, prolactin, makes the breast tissue highly sensitive to even these lower amounts of insulin, so that blood-glucose can be directed into the breasts and the milk.

In this dance, the priority is on milk production. At the same time that insulin levels are kept low, the hormone cortisol is kept high. Cortisol tells the mother’s body to take its energy from stored fat. The fat is now metabolized and used for a mother’s daily energy needs. This is why, after childbirth, a mother gradually loses her excess weight: higher levels of cortisol tell her body to access its calories from her stored fat pads.

Estrogen, a hormone of fertility, is the dance partner of insulin. When insulin goes low, estrogen also goes low. This is why women no longer have menstrual cycles while breastfeeding.

When, after months of exclusive breastfeeding, a baby begins eat solids and to gradually wean, the mother’s body increases her levels of insulin. Now she begins to use her own blood-glucose for energy during daily life, and no longer her fat reserves. She begins to gain weight and to build fat reserves in preparation for the next pregnancy. When her insulin levels are high enough, and she has gained enough weight to support another pregnancy, her estrogen levels also increase. This turns on her menstrual cycle. She is ready to conceive.

Scroll down past the summary and the science extract to read how our present-day blood-sugar and insulin imbalances interfere with the hormonal dance of lactation, leading to the many lactation difficulties that are widely experienced.

Summary of the Hormone Dance

This, then, is the unique dance of hormones that is supposed to occur after childbirth.

Insulin low, estrogen low, cortisol high.

But the mammary cells are particularly sensitive to even low levels of insulin. This allows the breasts to be fully active.

We see this postpartum pattern in studies on animals and primates (gorillas, chimpanzees and orangutans). This pattern also emerges in a set of studies from the 2000s, in which postpartum insulin levels were measured in Toba women who lived a Paleolithic lifestyle in the forests of Argentina.[1]

The Problem of Insulin Resistance

Most people today have some degree of a condition called “Insulin Resistance.” It typically develops throughout our formative years in response to a diet with foods that are high on the glycemic index, such as French fries, potato chips, bread, packaged breakfast cereal, candy, cookies, ice-cream, soda, pizza and so on. On this diet, the hormone insulin is constantly in demand. It becomes so active and “loud,” so “nagging,” that the cells of the body stop listening to it. They “resist” responding to insulin’s signals. They are now “insulin resistant.”

Lifestyle factors also play a role: certain medications, chemicals around the house and garden, lack of good sleep, and chemicals in the soaps and cosmetics that we use on our body: anything that causes further inflammation in the body contributes to the furthering of insulin resistance.

Insulin resistance leads to a vicious circle. When the cells of the body resist accepting energy from blood-glucose, we are actually in danger of death. Too much sugar in the blood is that dangerous.

Accordingly, the levels of insulin in the blood increase dramatically, more and more. This is called hyperinsulinemia. Higher levels of insulin produce a stronger signal so that eventually the cells do accept the signal and open up to absorb the excess glucose. But the underlying condition remains. As the body produces more and more insulin, the stage is being set for diabetes, a serious illness.

Gestational Diabetes, often dismissed as being just temporary, is a clear risk factor for diabetes and it is also a red flag for a potentially difficult start to breastfeeding.

Symptoms of Insulin Resistance

Feeling hungry throughout the day, easily gaining weight, experiencing sudden drops in energy, loss of concentration and fatigue, are signs of progressing insulin resistance.

Insulin Resistance and Lactation

Now that you understand the Dance of the Hormones, imagine the body attempting to create this dance pattern in the presence of Insulin Resistance and with perpetually higher levels of insulin in the body. It is not possible.

The result can be a lack of full maturation of the mammary tissue during pregnancy, delayed onset of lactation after childbirth, an unreliable supply, and early return of menstruation.

There are other results, such as mothers being unable to lose weight while breastfeeding, even needing to eat more calories to maintain their supply: they are in a struggle with their body’s insulin resistance. Drinking a sugar-laden “sports drink” is one way to force insulin to peak so its signal can get through all the resistance, and this is surely one reason that sports drinks are so popular for supply-challenged mothers.

As well, insulin resistance during our teen years, especially in combination with health problems such as eating disorders (not allowing the body to develop its normal fat pads at the onset of puberty, or being too thin to have menstrual cycles), or a hormonal condition called PCOS (polycystic ovarian syndrome – present in approximately 10% of women), can lead to a condition where the mammary glands do not fully develop at this time. This condition is known as insufficient glandular tissue, IGT.

Yet, even in the face of all this, most mothers are able to produce their personal, optimal supply. Her supply may not cover all of her baby’s needs, and she may have to top it off with donor milk or formula, but she and her baby will have that special and unique time together.

To navigate these breastfeeding hurdles, families require patience, understanding, and the guidance of a knowledgeable lactation consultant.

We pass Insulin Resistance to our Babies in the Womb

Sadly, insulin resistance is passed from mother to baby in the womb. Our children gain weight more easily and are at risk to develop health problems linked to insulin resistance earlier in life.

This cross-generational increase in insulin resistance is manifestly seen across the world in quickly rising levels of obesity, diabetes, kidney disease, heart disease and dementia. Because insulin resistance also increases what is called “systemic inflammation,” it promotes the development of inflammatory or autoimmune conditions, which can include depression and anxiety.

The cross-generational passing of insulin resistance is a world-health tragedy. Yet it is never described in mainstream sources and very little research—on humans—has focused on ways that we might correct it.

Solving Cross-Generational Insulin Resistance

On animals, however, a plethora of research exists. From these studies, we know that one way to turn it around is to eat foods and take supplements that are high in antioxidants.

In animal studies, antioxidants reduce and even eliminate the impact of a mother’s insulin resistance on her unborn children. These same antioxidants protect the delicate mammary and placental tissue, and thus support the maturation of the mammary glands during lactation.

Insulin Resistance, Dehydration, and Lactation

One of the mechanisms that the body uses to get rid of excess blood-glucose is to pee it out. It does this by extracting water from the deeper tissues of the body and directing this moisture into the blood, diluting the sugar in the blood so it is less damaging as it passes out in the urine.

To do this, the body takes water first from the areas between the cells (the extracellular matrix), and then from within the cells.

Only a fully hydrated extracellular matrix allows for fully functional cells and a fully developed mammary gland complex. By not addressing deep hydration, the problem remains.

It is no coincidence that traditional postpartum soups and gruels, without exception, have deep-hydrating ingredients that maintain the extracellular matrix and keep the cells fully functional. We’ll talk about this in class.

Additionally, extracts from lactogenic foods and herbs are frequently used in high-end cosmetic products because of their hydrating and moisturizing properties.

To summarize, the lactogenic diet is:

Deeply hydrating
Uses herbs and foods and are anti-inflammatory
Contains herbs and foods that are used in traditional medicine to treat insulin imbalances.
Contains herbs and foods that are anti-anxiety and anti-depressant.
Contains herbs and foods that support immune health.
On top of this, uses kitchen spices and herbal galactagogues to positively influence the hormones of lactation: prolactin and oxytocin.

1) Valeggia, C. and Ellison, P.T. (2009), Interactions between metabolic and reproductive functions in the resumption of postpartum fecundity. Am. J. Hum. Biol., 21: 559-566. https://doi.org/10.1002/ajhb.20907

2) Gesquiere, LR, Altmann, J, Archie, E, Alberts, SC. Interbirth intervals in wild baboons: Environmental predictors and hormonal correlates. Am J Phys Anthropol. 2018; 166: 107– 126. https://doi.org/10.1002/ajpa.23407

3) Melissa Emery Thompson, Martin N. Muller, Richard W. Wrangham, The energetics of lactation and the return to fecundity in wild chimpanzees, Behavioral Ecology, Volume 23, Issue 6, November-December 2012, Pages 1234–1241, https://doi.org/10.1093/beheco/ars107

Beating Candidiasis safely while breastfeeding

by Hilary Jacobson | Jul 3, 2022 | candidiasis

For information on our classes for mothers, IBCLCs, and postpartum caregivers, go HERE.

Beating Candidiasis safely while breastfeeding

An infection, whether from a virus, bacteria, fungus or parasite, presents a challenge to the immune system and leads to fatigue and general malaise, (also called “having the blahs”). Fungal infections in particular can be insidious, meaning, we can have them for a long time without realizing that we have them. We may not realize that they are affecting our health. Doctors might tell you, for instance, that it is normal for a mother to be tired, or that you are simply beginning to feel your age.

It gets complicated when we also have a secondary infection, whether a reactivated virus, a stealth-bacterial disease such as Lyme, a problematic digestive system with an off-kilter biome, a hormonal imbalance or mental health condition. Many “conditions” interact with and exacerbate one another. Knowing how to unravel the entangled interactions between infections, toxins, the microbiome and food allergies is the art of today’s medicine.

Candidia albicans is a common fungus that hunkers down in moist and warm parts of the body such as in the mouth, throat, gut, and vagina. Normally, candida albicans (and similar fungi and bacteria) is not a concern. However, if it dominates and over-grows, it can enter the bloodstream and colonize organs such as the kidney, heart, or brain. Candidiasis is the clinical name for this overgrowth. We can have a mild case and be unaware of the infection, or it can break out and be symptomatic, for instance as vaginal, nipple, or oral thrush.

Fungus has an affinity for moist tissue. You might have experienced vaginal thrush and used an insertable cream to beat back the infection. “Beat back” is key. We do not want to completely eradicate the fungus. It is just one member of a community of bacteria that make up the body’s microbiome.

The varieties of these micro-members, bacteria, viruses, and parasites, have a profound effect on our health. We aim to reduce the fungus and then keep those numbers low over a period of time, so that the microbiome can establish a better balance and the immune system can recover. Otherwise, we might have repeat infections and more complications.

Nipple Thrush

Breastfeeding mothers can experience a painful fungal infection of the nipple called thrush. Again: it occurs when the microbiome is out of balance and unable to prevent fungal overgrowth.

When I lived in Switzerland, I learned that nipple thrush is practically unknown in that country. Why? For starters, Swiss doctors do not over-prescribe antibiotics, many of which degrade the microbiome. The Swiss also typically eat a whole-foods diet including fresh fruit and vegetables. The Swiss also value cleanliness, regularly changing sheets, vacuuming and wiping down surfaces, cleaning the fridge, etc. Importantly, the weather in Switzerland is rarely humid, and humidity increases the growth of fungus. Those of us who live in high-humid parts of the world need to take extra care to maintain the balance of the microbiome and to keep the home clean.

Leaky Gut

Candidiasis (and similar fungi) is a major contributing factor in a condition called leaky gut or permeable intestine. Here, the cells of the intestinal lining are not tightly bound together. Spaces open between them, microscopic “holes” through which tiny food molecules and toxins pass through. See my article on priming the baby during pregnancy for colic and food allergies.

Candidiasis is opportunistic: it overgrows and invades the body if the immune system is unable to fight it off. People with a compromised immune system such as those with chronic fatigue, chronic inflammatory conditions, or brain fog, frequently also have a systemic candidiasis infection. (Systemic means that it is found in multiple parts, or systems, of the body.)

Resolving a fungal infection can be tricky – but absolutely worth the trouble as it is an essential step toward re-balancing and strengthening the immune system.

The short-term use of an anti-fungal medication called Nystatin is considered generally safe for a breastfeeding mother.

If you develop nipple thrush, first talk with your lactation expert to learn what you can do to resolve the infection. For a long term solution, take the steps listed below in the next section.

Re-balance the microbiome and strengthen the immune system against candidiasis

A successful, long-term approach has three parts:

1) eliminate mold from the home (also eliminate irritating and toxic chemicals);

2) eat a whole-foods diet including gut-healing vegetables and broths; remove all foods made with refined sugar (but some fruit and berries is okay);

3) rotate herbal supplements that have strong anti-fungal properties. We alternate these supplements to prevent the fungus from developing resistance to any one of them. In order to overwhelm the defenses of the fungal infection, hitting it from many sides repeatedly and frequently with different kinds of anti-fungal herbal supplements is what works.

This long-term approach does not quickly eradicate the fungus, but it does slowly reduce the fungus while allowing your immune system to become stronger and more effective against the fungus, while allowing your intestine and organs to heal.

Scroll down to the end of this article to read about “Die Off,” and learn about the ups and downs of an intense healing protocol.

Why a rotation schedule? And why use several products?

Fungal infections can develop resistance to any one product, even if it consists of several ingredients. To overwhelm the defenses of the fungal infection, hitting it from many sides repeatedly and frequently is needed. See the suggested products, listed below.

Do not use oregano oil

Not all antifungal supplements are suitable for breastfeeding mothers. Oregano oil is a case in point. Although oregano oil is one of our strongest anti-fungals, oregano oil sometimes reduces milk supply. Keep oregano oil in mind for later, when you have weaned. I like this particular NOW brand because it also contains oils of fennel and ginger, and both are good for intestinal healing.

Grapefruit Seed Extract is a strong antifungal that has a long history of use by breastfeeding mothers. With a liquid product such as this one by NutriBiotic, you can modulate your dosage from just 1 – 2 drops in a cup of water to 5 – 10 drops, taken 3 – 5 times a day.

The ability to experiment and find your best dosage gives you control. This may feel new and uncomfortable for many, as we are used to following dosage recommendations. In the case of clearing infection, and using natural products, it is useful to start with. alow dosage and build up, watching your body’s reaction. You can scale back if you notice increased fatigue or any unwellness, and then gradually increase your dosage again at a later time.

If the acidity of Grapefruit Seed extract irritates your digestive system, combine the GSE with a half-teaspoon of baking soda in a cup of water. This will neutralize the acidity.

Cautions: do not combine grapefruit seed extract with domperidone or fluconazole.

Caprylic Acid is the part of coconut oil that is most strongly antifungal, and it is experienced as being particularly potent and often causing “die-off.” Start slowly, just one capsule a day. If you do not experience a “die-off” (see below), continue increasing the dosage to tolerance.

Acacia Fiber (also called “gum arabic”). Take up to one tablespoon daily in yogurt, juice, or water, or blended into juices and smoothies. Acacia fiber has many benefits. It is antimicrobial both against bacteria and fungus. It “smooths” and “coats” the contents of the bowels, relieving constipation. In a study¹ from 2012, a daily snack of acacia fiber in yogurt with Bifidus lactobacilli improved both constipation and diarrhea in persons with IBS (Irritable Bowel Syndrome).

Olive leaf extract is a home-remedy must-have, and Herbpharm is one of my favorite brands. Although olive leaf has not been safety-tested for breastfeeding, it is widely used as an herbal antibiotic by breastfeeding mothers. It is also a powerful antifungal. I would use it at a low dosage along with the other antifungal products, several times a day.

Turmeric: To fully eradicate a fungal infection, we have to dissolve the biofilms where they hide throughout the body. Some enzymes achieve this, and another way is to use turmeric. It is antifungal, antibacterial, a biofilm-buster, plus it supports lactation.

Turmeric relieves muscle aches and joint pain by acting as an anti-inflammatory. It is protective against brain damage and memory loss. Overall, it is worthwhile to learn how to “stomach” a simple dose of turmeric every day, or as needed.

“Golden milk“ is a popular way to drink turmeric. This product is made with dates, cardamom, ashwaganda, and other herbs that are both immune supportive and lactogenic.

I personally make for myself the simple, fast, and inexpensive version: a half-teaspoon of turmeric powder, stirred into a cup of water and quickly swallowed down. If you don’t mind the taste, a very small shake of black pepper into the turmeric is believed by many to improves its bioavailability, though I find it highly medicinal without the pepper.

About Fungal Die-Off

Some people go through a phase of feeling tired, foggy-brained, and toxic when using antifungal supplements. This can be due to a large and sudden die-off of the fungi.

“Die-Off” is a period of time in which your body is dealing with a flood of dead cells from the fungi. They are now in your blood and as they pass through your body and organs, you may notice sudden fatigue, brain-fog, or even a flare-up of a rash or arthritic pain.

This is a sign that the supplements are working, but that your detox organs need time to catch up with the extra detox work. Eventually, your liver will neutralize the toxins. Depending on the degree of the infection, and the pace of your liver, the symptoms of Die-Off might last 1 – 3 hours or 1- 3 days.

If this happens to you, back off the supplements, drink a lot of water, and rest. Trust that you will soon feel better.

While “die-off” sounds like bad news, it is actually very good to know about the possibility and to be mentally prepared for it. As you go forward with the treatment, the periods of Die-Off should become less strong and less frequent.

If you have access to a healthcare practitioner or MD with a foundation in “functional medicine,” they are your best bet for clarity and continuity of treatment. Functional MDs are trained to connect the dots and get a handle on these somewhat mysterious health conditions and opportunistic organisms.

Min YW, Park SU, Jang YS, et al. Effect of composite yogurt enriched with acacia fiber and Bifidobacterium lactis. World J Gastroenterol. 2012;18(33):4563-4569. doi:10.3748/wjg.v18.i33.4563

For information on our classes for mothers, IBCLCs, and postpartum caregivers, go HERE.