Breastfeeding While Taking High Dose Vitamins

CQ #147 – June 4, 2019
by Anne Eglash MD, IBCLC, FABM
#LACTFACT
High doses of vitamin C, B-2, B-6, B-12, K, biotin and vitamin D are unlikely to be harmful during lactation.
High Dose Vitamins
Breastfeeding Medicine 14(5) 2019

What vitamins, in high doses, are safe during breastfeeding?

High doses of some vitamins has made it into mainstream medical therapy for various health conditions. For example, high dose riboflavin 400mg (vitamin B-2) is recommended by neurologists and primary care physicians alike for migraine headache prevention (usually in combination with coenzyme Q and magnesium). But is this safe during breastfeeding?

First, let’s review the principles of how vitamins get into breastmilk. Vitamins are by definition essential nutrients that our bodies need to function, which must come from the environment usually within food. This means that the human body does not manufacture them. Breastfeeding individuals are often advised to take a multivitamin supplement, given the demand for extra vitamins required by breastmilk.

Vitamins vary in their ability to transfer into breastmilk. Fat soluble vitamins, such as vitamin D and E, easily transfer into breastmilk and reliably increase their levels. Water soluble vitamins, such as B and C are more variable in their transmission into breastmilk. If maternal ingestion of high dose vitamins leads to high levels in breastmilk, it needs to be determined whether that higher dose is safe for the nursing infant.

The author of the article for this week’s CQW reviewed the effect of maternal high dose ingestion of vitamins C, B-2, B-6, B-12, K, biotin and vitamin D on breastmilk vitamin levels. As a reference for the question below, the doses of these vitamins in prenatal vitamins are:

Vitamin Dose in a Typical Prenatal Vitamin
Vitamin C 100mg
Vitamin D 400 units
Biotin 30 mcg
Vitamin B-2 2mg
Vitamin B-6 2mg
Vitamin B-12 4mcg
Which statements do you believe are accurate regarding the safety and use of high dose vitamin intake during breastfeeding? Choose 1 or more:
  1. Vitamin C 500mg a day is not only safe but when combined with 100 units of vitamin E, improves the milk’s biochemical antioxidant profile.
  2. Daily ingestion of 400mg of vitamin B-2 (riboflavin) should be avoided due to safety concerns for the infant.
  3. A high dose of vitamin B-6, such as 200mg-600mg daily for many months/years can increase the risk of neuropathy in the mother.
  4. A low maternal B-12 level can cause B-12 deficiency in the nursing infant, while maternal vitamin B-12 supplementation will prevent deficiency in the infant.
  5. High dose biotin, such as 2500mcg, is likely safe during breastfeeding because it has such a wide safety margin in humans.
  6. Maternal vitamin D supplement of 400-2000 units is associated with an average breastmilk level of 50-80 units per Liter. Since infants usually drink less than 1 liter of breastmilk a day, an infant would not ingest the recommended 400 units of vitamin D each day.

See the Answer

Correct Answers: A, C, D, E, F (not B)
High Dose Vitamins
Breastfeeding Medicine 14(5) 2019
Jason B Sauberan

Introduction

Concentrations of most vitamins in breast milk are dependent on maternal diet. Daily vitamin supplementation to achieve adequate dietary intake is thus a recommended intervention for lactating mothers who are undernourished, or for those with dietary restrictions. Even in mothers with no known dietary deficiency risks, the use of prenatal vitamins during lactation is commonplace and is considered safe for the breastfed infant. Some lactating mothers may elect to consume high-dose or ‘‘megadose’’ vitamin therapy, beyond that required for adequate daily intake. Commonly used vitamins taken in megadoses are listed in Table 2. Depending on the vitamin, dosage, and the mother’s underlying vitamin status, this practice could potentially lead to vitamin concentrations in milk that are harmful to the infant. This column briefly reviews the available published data and provides recommendations for nursing mothers considering vitamin megadosing.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

Daily dose of vitamin B-2 (riboflavin) as high as 400mg is considered safe because vitamin B-2 has a wide margin of safety. It turns the urine bright yellow, and may do the same for the infant.

High dose vitamin B-6 increases the level of B-6 in breastmilk, but its high protein binding in the maternal serum limits transmission into breastmilk. Although prolonged high doses can cause neuropathy in the mother, no negative effects have been reported in infants.

Vitamin C has been shown to be safe in high doses, such as 1000mg a day, and does not appear to significantly increase the breastmilk level, unless mom was deficient before taking the supplement.

I periodically receive phone calls from breastfeeding mothers who are taking various vitamin supplements in the form of gummies, shakes and other foods, asking if they are OK to take. Based on what we now know regarding vitamin transmission into breastmilk, if the levels of nutrients in the supplement are considered safe for the mother (according to a knowledgeable health professional) she can be advised that these are likely safe while nursing.

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