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Postpartum Weight Loss for Nursing Mothers Using TCM and Modern Techniques

by Juliette Aiyana


Over the past few years, there have been many published studies, articles and one book written on the effectiveness of acupuncture and Chinese herbs for weight loss and weight management. However, none have focused on post-partum weight loss. Now that Traditional Chinese Medicine (TCM) has become extremely popular for fertility, gestational diseases, and labor induction; practitioners have the opportunity to follow-up with these same patients for post-partum healthcare.

Many pregnant and post-partum mothers are concerned about losing the “baby weight” as soon as possible. During pregnancy it is contraindicated to lose weight, but we can assist with weight management techniques to control weight gain during pregnancy if needed. In addition, we can educate mothers about how to safely and effectively lose weight after the baby is born. Many new mothers focus on losing weight as quickly as possible after her baby is born.  However, as practitioner’s we ought to teach these mothers to lose weight healthfully and slowly for the sake of their personal health and the health of their nursling(s).

Weight Loss in the first six weeks Post-Partum

It is not advisable to begin any special weight loss dieting during the first eight weeks postpartum so that the mother can recover her energy and heal from the birth. Eating a healthy, balanced and varied diet is advisable. In fact, nursing mothers need to eat an extra 500 calories per day to support milk production. A nursing mother’s diet should be 1,800 calories per day and definitely not less then 1,500 calories per day. Most women can begin exercising at about six weeks post-partum.

Most women lose about ten pounds (4.5kg) during the birth: the baby, the placenta and the amniotic fluid. Nursing the baby helps the uterus to shrink which will also result in weight loss. Typically in the first few weeks after birth, the mother will spontaneously lose about 5 to 8 pounds of leftover fluid weight, without the need for special weight loss techniques. That water is commonly lost through urine and sweating. Post-partum sweating occurs frequently in the form of night sweats, day sweating, and sweating while nursing the infant. All of these types of sweating result in water weight loss and are such sweating is usually considered normal and is not classified in TCM as pathological fluid (Yin) loss.

Weight Loss after eight weeks

Weight loss after eight weeks postpartum should not exceed 2-4 pounds (1-2kg) per month. Loss of more then that may cause a drop in milk supply and therefore an inability to adequately provide nutrition to the nursling. It can also prove unhealthy for the mother because patients who lose weight quickly tend to regain the lost weight and then some, whereas patients who lose weight in a slow and steady manner tend to maintain their weight loss.

Research shows that consistent acupuncture treatments help reduce baseline body weight by 8-10% within six months. In addition to body acupuncture administered in the office, the acupuncturist can place ear seeds or magnets on auricular acupuncture points which can remain in for up to two weeks. However, new mothers are usually very busy with their newborn so it may be hard for them to schedule acupuncture treatments regularly. Therefore the practitioner must do their best to counsel the patient very specifically regarding the methods of healthy eating (which will be discussed in detail later) and physical activity. Activities a new mother can do that will burn calories include walking, walking while wearing baby in a sling, or pushing a stroller, rocking her baby in her arms, taking the stairs instead of the elevator, light cleaning, cooking, and playing with crawling and walking baby. She can ask her partner to aid her in prioritizing time to exercise by helping out with the new baby while she goes to a fitness class, or works out with a DVD at home. Also, many fitness centers offer free or low-cost childcare services to members and/or offer mom & baby classes such as mom & baby yoga, pilates or Stroller-fit classes.

Mel Wolk writes in her article Weight Loss while Breastfeeding (LEAVEN, Vol. 33 No. 5, October-November 1997, p. 115)

“Dr. Judith Roepke, a nutritionist at Ball State University in Indiana and a member of La Leche League International's Health Advisory Council, feels that the ideal time to lose weight is during lactation. Dr. Roepke suggests that breastfeeding mothers should not consciously try to lose weight during the first two months postpartum. This extra time in the early months allows a mother's body to recover from childbirth and establish a good milk supply. It's common for mothers to lose weight during this period by just following a normal diet and eating to hunger. One study showed that breastfeeding mothers tend to lose more weight when their babies are three to six months old than mothers who are bottle-feeding and consuming fewer calories.

The Subcommittee on Nutrition During Lactation reports:

"On average, lactating women who eat to appetite lose weight at the rate of 0.6 to 0.8 kg (1.3 to 1.6 pounds) per month in the first 4 to 6 months, but there is a wide variation in the weight loss experience of lactating women (some women gain weight during lactation). Those who continue breastfeeding beyond 4 to 6 months ordinarily continue to lose weight, but at a slower rate than during the first 4 to 6 months."

Breastfeeding for the sake of weight loss should never be advised by the practitioner since weight loss may slow down after several months, or weight loss may not occur at all for some nursing mothers. We would not want mothers to give up breastfeeding because it does not work for weight loss. Instead, we should support breastfeeding for the benefits that breastfeeding provides to nurslings as well for the benefits of the mother-child bond. The World Health Organization  recommends that babies are to be breastfed for at least two years.

Chinese Medicine Promotes Healthy Lactation and Healthy Weight Loss

Chinese medical professionals have used acupuncture, Chinese herbs and diet to help women lactate healthfully for thousands of years. The need for weight loss is a relatively new phenomena due to the obesity epidemic that has spread through out the industrialized world. And unfortunately, many modern mothers feel the constructed, societal pressure to lose the baby weight as soon as possible thanks to mass media bombardment of images of ultra-thin women and super-star models and actresses. Post-partum mothers are asked by the media to compare our weight loss with those of ultra-rich super-star mothers, without comparing that fact that those women can readily afford to hire a team of full-time personal chefs, personal trainers and nannies to help them achieve their weight loss so readily. Due to this pressure many women feel frustrated. Frustration can lead to liver qi stagnation depression. And liver qi stagnation depression is a common pattern treated for weight loss and may also contribute to lactation difficulties.

Practitioners of TCM always base the treatment of these syndromes on pattern differentiation. Healthy lactation and weight loss both require optimal yang qi’s transformation and transportation functions. Yang qi and blood are derived from the spleen’s transformative function. Yang qi is needed to transform acquired (food & drink) qi into qi, blood and body fluids. Healthy lactation is dependant upon the production of enough blood and the free flow of qi. If there is blood vacuity and/or qi stagnation then the breast milk will not flow.

In his book Fu Qing-Zhu’s Gynecology (Translated by Yang Shou-Zhong and Liu Da-wei, Blue Poppy Press, Boulder, CO, 1996: p129-131) the author states:

“Milk is a product of the transformation of qi and blood. Certainly milk cannot be produced without blood, but it also cannot be without qi. In comparison, blood transforms milk less speedily than qi does. In the newly birthed woman, blood is too depleted to look after itself. (Therefore), how can it transform milk? It is entirely due to the strength of the qi that blood is moved to transform milk.

Ignorant of the importance of greatly supplementing qi and blood, people nowadays know no better than to promote lactation. It should be understood that without qi, milk has nothing to transform it and, without blood, milk has nothing from which to be produced. The appropriate treatment method is to supplement qi to engender blood”.

Therefore eating a nutritious healthful diet, never skipping meals and taking in enough fluids are extremely important for nursing mothers. Source qi is derived from essential qi. Source and essential qi are mainly stored in the kidneys. Essential qi is made of both congenital qi and acquired qi. Acquired qi is derived from eating, drinking (nutritive qi) and breathing (air qi). Thus, in addition to acupuncture and moxibustion treatment, instruct the patient to eat a balanced, healthy diet to cultivate source and essential qi. Crash diets and deprivation diets may cause detriment to the source & essential qi. If the body does not have enough acquired qi, it will draw energy from congenital qi. Congenital qi and acquired qi comprise essential qi, which must be preserved. The loss of this extremely important energy source will cause detriment to every organ system in the body leading to chronic, long-term illness and insufficient lactation. We must advise our patients of these possibilities if they are using crash or deprivation diets, liquid diets, or purgatives or laxatives.

The patient would do well by eating warming and qi circulating foods as well as blood building foods. The practitioner can also give the patient a qi and blood supplementing herbal formula. Some blood building foods are; leafy green vegetables, black beans, yellow squash, stews and soups made with meat or poultry bones.

In my book Chinese Medicine & Healthy Weight Management An Evidence-based Integrated Approach, Blue Poppy 2007, I list a vast number of foods based on their thermal quality (cold, cool, neutral, warm, hot) as well as give the following advice (pg 41);

“Diet & lifestyle: Eat warming, cooked foods and avoid raw and chilled foods. Also avoid too much sugar and sweets as well as too many refined carbohydrates, especially in the form or bread and pasta. According to Chinese medicine, in excess, the sweet flavor damages the spleen and engenders too may fluids. [Excess]Breads and pastas are called “sodden wheat foods” in Chinese medicine and are also believed to damage the spleen and engender dampness. Use some warming spices, such as black and white pepper, cayenne, cardamom, ginger, and cinnamon. Eat more warm soups and stews.

Get enough exercise to be energized afterwards, not more fatigued. Too much sitting and lying down damage the spleen. Whereas moderate exercise fortifies the spleen and frees the flow of the qi mechanism. Many patients who live a sedentary lifestyle feel too fatigued to exercise. In that case, encourage these patients to take small steps in exercising to build up their qi. Soon they should be able to exercise regularly and will feel more energy overall.

Try not to think too much or worry. According to Chinese medicine, over-thinking and worry also damage the spleen. Many patients (overweight or not) worry and obsess about their weight or health and feel overwhelmed by societal and self-induced pressure to lose weight. Some constantly think about calorie-counting. When this kind of thinking and worrying themselves become pathological, they directly work against losing weight”.

Breast milk is brought upward through the Yang Ming channel into the breasts. The free movement of qi through the Yang Ming Stomach meridian and through the nipple, which is governed by the Liver meridian, thus promotes healthy lactation. Acupuncture administered to these channels is helpful. I have encountered women in my practice who think they are not producing enough milk, but when I ask them questions about their nursing practices, how the baby latches, and infant weight gain, I discover they are needlessly worried as it is evident that the milk production and infant latch and feeding are normal. In cases like these, women do not need acupuncture or herbal treatment but simply should be encouraged that their milk production is normal and to continue breastfeeding. Conversely, blocked lactation due to mastitis or nipple shape must be treated differently. The milk might not flow if the infant has latch problems such as ankyloglossia (tongue tie), cleft palate or other latch problems. However, a discussion about these problems is not within the scope of this article. Suffice to say that practitioner’s must carefully diagnose the problem before deciding on a treatment strategy. In such cases, refer the mother to an IBLCE certified lactation consultant or other qualified breastfeeding professional when there are problems not treatable by Chinese medicine.

The Lung and San Jiao also play a significant role in weight loss

The lung organ dominates the qi and plays a role in fluid metabolism. It circulates constructive (ying) qi derived from clear yang qi which is borne up from the spleen and from blood produced by the spleen. Strengthening spleen qi energy will give the lung the qi and blood needed for proper functioning. Therefore, the lung organ does not usually need focused herbal or diet treatment for weight loss.  If the patient has qi vacuity then the regulation of air qi (kong qi) through breathing is an essential part of treatment. They can regulate air qi with breathing exercises and physical exercise. If the patient has little energy to exercise, supplementing all acquired qi (air qi & food qi) sources will be very helpful.

The san jiao controls qi transformation and is responsible for fluid metabolism by transporting fluids throughout the body. These fluids are distributed through the muscles and flesh, and they firm the skin. Because the san jiao is a yang and a fu organ which receives and passes, a disorder of this organ would tend towards excess. Therefore the most effective treatments are to move, clear and descend the organ’s function. Warm the spleen yang qi so that untransformed pathogenic water dampness will not spill over into the san jiao channel. The source of the san jiao’s warm, transforming energy is source qi (yuan qi). Source qi is made of essential qi (jing qi) from the kidney, food qi and air qi. As Wiseman’s A Practical Dictionary of Chinese Medicine explains, (p. 549, 1998, Paradigm Publishing, Brookline, MA), “[s]ource qi springs from the kidney (or gate of life) and is stored in the cinnabar field (dian tian).” Therefore it is advisable to supplement, warm and move the source qi in order to boost fluid metabolism throughout the body. Cultivating qi and storing qi in the dian tian with qi gong or tai chi exercise or with meditation can also be very helpful. It is very important for the new mother to sleep as much as possible. Advise the mother to sleep when the baby sleeps. At night time, the mother will sleep best if the baby is in the same room as she so when she has to nurse the newborn at night, every two hours, she will not have to arise from bed or leave the room, thus disturbing sleep even more.

To support how important it is to preserve the essential kidney qi, Chinese medical scholar Steven Clavey provides this translation of an excerpt from Chen Shi-Duo’s work Secret Records of the Stone Chamber (Shi Shi Mi Lu, 1687)(Clavey 2003).

Only when the Heart has access to Mingmen fire can it rule consciousness, only when the Liver has access to Mingmen fire can it exercise decision. With Mingmen fire, the Stomach is able to accept food, the Spleen can transport and distribute jin-ye, and the Lungs may provide rhythmic regulation (over the qi of the whole body). If the Large Intestine obtains Mingmen fire it can provide passage (to the solid wastes), if the Small intestine obtains Mingmen fire it can distribute and transform (fluids). If the Kidneys obtain Mingmen fire they can act strongly, if the San Jiao obtains Mingmen fire it can rule fluid passage, if the Urinary Bladder obtains Mingmen fire it can receive and hold (fluids). None of these but borrows the nourishing warmth of Mingmen fire.

Effective treatments for the kidney and source qi are the application of acupuncture and moxibustion along the kidney and san jiao channels, herbs and diet. The potency and arousal of mingmen (the gate of vitality) fire warms and motivates qi function and thus unblocks stagnant phlegm and fluids within the san jiao channel. Congealed phlegm and fluids within the san jiao channel pour over into the flesh and muscles; therefore, an effective treatment strategy to clear the blocked channel is the application of direct or indirect moxibustion on mingmen, or the use of Fu Zi (Aconiti Carmichaeli) insulated moxibustion on this point or TDP over the area.

Safe Chinese Herbal Medicinal Administration for the Nursing Mother

Chinese herbs should only be administered based on pattern discrimination for the duration needed to correct the imbalance, whilst also using the least amount of herbs to achieve the therapeutic result. All herbs should be manufactured in a GMP certified factory.

Many herbs contain a natural level of lead which passes through into the breast milk. Here is a research article published in Science of The Total Environment, Volume 354, Issues 2-3, 1 February 2006, Pages 120-12, Effect of the mother's consumption of traditional Chinese herbs on estimated infant daily intake of lead from breast milk. Ling-Chu Chien, Ching-Ying Yeh, Hung-Chang Lee, Hsing Jasmine Chao, Ming-Jer Shieh and Bor-Cheng Han

Abstract: Infant exposure to lead through breast milk is of special concern because breast milk is considered the best food source for infants under 6 months. In this study, a total of the mothers provided colostrum samples once in the early postpartum period, but only 16 of them provided breast milk weekly at 1–60 days postpartum. The geometric mean of lead concentrations in all colostrum samples (n=72) was 7.68±8.24 ěg/L. The concentration of lead in the breast milk of the consumption group (the mothers who consumed traditional Chinese herbs) was 8.59±10.95 ěg/L, a level significantly higher than the level of 6.84±2.68 ěg/L found in the control group (mothers who did not consume traditional Chinese herbs). In the consumption group (n=9), the mean concentration of lead in the breast milk decreased with days postpartum, from 9.94 ěg/L in colostrum to 2.34 ěg/L in mature milk. We found the highest daily lead intake in infants at birth, and the level gradually decreased after the first month. We used an estimation of the hazard index (HI) to analyze the health risk of infants. In total, 5.7% (2 out of 35) of the HI estimates exceed 1.0 for the consumption group. In conclusion, the consumptions of traditional Chinese herbs by the mothers in this study significantly affected the body burden of lead in their infants.

Therefore it seems that it would be safest to avoid Chinese herbal medicinals in the first month. Use remedial dietary therapy, acupuncture and tui-na instead.

In his article, On Taking Herbs While Breastfeeding, Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine suggests:

“Based on the potential for some drugs to have an effect on nursing infants, certain herbs that might have a strong effect should be used minimally or avoided. In particular,  one should be cautious about using high doses of herbs that contain alkaloids, particularly those that affect the nervous system. Examples of Chinese herbs that would fit this category include coptis and phellodendron (berberine alkaloids), sophora root (contains oxymatrine), ma-huang (contains ephedrine), and evodia (contains rutecarpine). One should be cautious also about herbs that have a potent hormonal effect, such as fennel and anise, at least if they are used in large amounts over an extended period of time. Such herbs are most often used in small quantities as digestive aids or tonics, which is not of concern; they are sometimes used in large amounts to stimulate milk production over a period of several months (licorice has been listed as an herb to avoid for the same reasons). Herbs that contain pyrolizidine alkaloids, which can accumulate in the liver if taken daily, are also to be avoided (e.g., comfrey and coltsfoot), as are strong purgatives (e.g., aloe, senna, rhubarb root) that might cause colic or diarrhea in the infant Powerful immunosupressive herbs, such as tripterygium, are not used by Western practitioners. A list of herbs that have appeared in the literature as being of concern in relation to nursing appear in the original authors article, Appendix 2.

Mothers can watch for possible infant reactions to drugs, herbs, foods, and beverages. Although reactions are rare overall, the most common reactions are related to nervous system effects (e.g., irritability, insomnia, somnolence), digestive system reactions (e.g., colic, diarrhea), or allergic skin reactions (e.g., rash). Since all of these possible reactions are also consistent with normal infant experiences, it is not always possible to make a direct correlation between drug (or herb) ingestion and infant responses.

The level of drug or herb ingredients increase in the milk as the blood concentrations rise, but also leave the unexpressed breast milk as the mother's blood concentrations of the drug decline. It is common for drug concentrations in the serum to peak about 45-90 minutes after ingestion and to peak in the breast milk about 15 minutes later. Therefore, in order to minimize infant exposure to maternal drugs via breastfeeding, it is recommended that women take the drugs immediately after breastfeeding so that the drug concentration peak is passed by the time the next feeding session begins. During early infancy, some babies may feed every hour or so, in which case, this advice is not relevant. Once the feeding frequency declines to an interval greater than 2 hours, this suggestion makes sense”.


I highly recommend reading the full article found at www.itmonline.org/arts/breast.htm.

To conclude, nursing post-partum mothers can return to their pre-pregnancy weight in about seven to nine months with the use of acupuncture, diet, activity and/or exercise and moderate use if Chinese herbs. This author is a living example of how well these techniques work because I went back to my pre-pregnancy weight in just seven and a half months.

Biography

Juliette Aiyana is an acupuncturist, herbalist, author, teacher, activist and La Leche Leauge member who is practicing extended nursing with her toddler. She practices in New York, New York.

References

Aiyana, Juliette. Chinese Medicine & Healthy Weight Management An Evidence-based Integrated Approach, Blue Poppy 2007: p. 41

Clavey, S. (2003). Fluid Physiology & Pathology in Traditional Chinese Medicine  Churchill Livingstone, p.273.

Ling-Chu Chien, et al. Chinese herbs on estimated infant daily intake of lead from breast milk.  Science of The Total Environment, Volume 354, Issues 2-3, 1 February 2006, Pages 120-12

Subhuti Dharmananda, Ph.D., On Taking Herbs While Breastfeeding. http://www.itmonline.org/arts/breast.htm

Wiseman, Nigel. A Practical Dictionary of Chinese Medicine. Paradigm Publishing, Brookline, MA, 1998: p. 549

Wolk, Mel. Weight Loss while Breastfeeding. LEAVEN, Vol. 33 No. 5, October-November 1997, p. 115

World Health Organization. Exclusive Breastfeeding.
http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/index.html

Yang Shou-Zhong and Liu Da-wei. Fu Qing-Zhu’s Gynecology. Translated by Yang Shou-Zhong and Liu Da-wei, Blue Poppy Press, Boulder, CO, 1996: p129-131

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