Micronutrient Additional Requirements (Vital Substances) in the Breastfeeding Phase: Trace Elements

Trace elements whose requirements are increased during breastfeeding include iron, iodine, copper, selenium and zinc… In addition to these trace elements, breastfeeding mothers should also ensure an adequate dietary intake of chromium, fluorine, manganese, molybdenum, as well as tin. The daily requirement of these trace elements is not increased during breastfeeding. Nevertheless, they must not be missing in a balanced and adequate diet, since the vital substances (micronutrients) are also of important significance for the growth and development of the child and the health and vitality of the mother. The supply of these trace elements ultimately serves to secure the reserves. Intake values for the daily requirements of breastfeeding women (based on the DGE):

Micronutrients Concentration
Chromium 30-100 µg
Iron 20 mg
Fluorine 3.3 mg
Iodine* 260 µg
Copper 1.0-1.5 mg
Manganese 2.0-5.0 mg
Molybdenum 50-100 µg
Selenium 75 µg
Tin 3.6 mg
Zinc 13 mg

* Supplementation of 150 µg/day requiredDGE: German Society for Nutrition e. V.

Iron

Maternal as well as infant iron requirements are very high during lactation due to rapid tissue proliferation and the increase in hematopoiesis of the newborn. Since the mother’s iron stores are depleted especially during the last months of pregnancy, breastfeeding women must pay special attention to a high iron intake. In order to prevent a deficiency and to be able to supply the infant sufficiently with the trace element, breastfeeding women should give preference to foods containing heme-iron compounds. Only in animal foods – meat products, liver and fish – is part of the iron present as heme iron. Heme iron compounds have a higher bioavailability than non-heme iron compounds. As a result, iron requirements can be better met with animal foods. Nonetheless, plant foods that have non-heme iron compounds should not be avoided because the absorption rate of non-heme iron from the plant diet can be doubled by eating meat at the same time. This is due to the low molecular weight complexing agents contained in meat, including animal proteins, which are of higher quality than vegetable proteins due to the high number of valuable amino acids and thus favor the absorption of iron Furthermore, the absorption of iron from food increases gastroferrin – secretion of the gastric mucosa, vitamin C, fermented foods, polyoxicarboxylic acids in fruits and vegetables, and other organic acids – citric acid. These substances form a highly soluble complex with iron. Therefore, it is recommended to consume iron-rich plant foods, such as whole-grain cereal products or certain vegetables – broccoli, peas and others – combined with animal products. Breastfeeding women with little or no meat consumption due to vegetarian, vegan, or macrobiotic diets need to pay particular attention to their iron intake to meet their needs and not jeopardize the health of their child. Phytic acid (phytates) in cereals, corn, rice, whole grain and soy products, tannins in coffee and tea, and polyphenols in black tea have a strong inhibitory effect on iron absorption. These substances form a non-absorbable complex with iron and therefore block its absorption. They should be avoided during the breastfeeding period. The iron requirement during lactation is between 20 and 30 milligrams, as during pregnancy. In breast milk, the iron concentration is low, which means that relatively little of the trace element is passed on to the infant via the milk. Newborns therefore have an increased requirement of 8-10 milligrams a day. If infants are born with a birth weight below 3,500 grams, they should be supplemented with iron and vitamin C due to their increased growth. The simultaneous intake of vitamin C supports iron absorption. To be protected against deficiency symptoms and to maintain iron reserves, women in the breastfeeding phase should not fall below the requirement of about 20-30 milligrams of iron per day.If, as a result of an iron deficiency, the hemoglobin value falls below 11 g/dL and a ferritin deficiency is present at the same time, anemia occurs in the breastfeeding woman and substitution with iron is necessary. It should be supplemented with well-absorbable 2-valent iron compounds. Combined intake with vitamin C improves the absorption of iron. Fasting intake before bedtime also promotes iron absorption, since bioavailability is reduced by nonabsorbable complexing agents in the diet. Function of iron

  • Iron is bound to proteins – hemoglobin, myoglobin, cytochromes – to be bioavailable to the organism despite its poor solubility
  • Occurrence as heme iron and non-heme iron.

Hemiron compounds – 2-valent iron.

  • Iron is responsible for oxygen transport as a component of hemoglobin
  • Iron as a component of myoglobin contributes to the formation and storage of oxygen
  • Iron as a component of cytochromes is important for electron transport in the respiratory chain

Occurrence in predominantly animal foods – meat products, liver and fish.

Non-heme iron compounds – 3-valent iron.

  • Antioxidant effect
  • Oxygen transfer
  • Detoxification processes
  • Energy production, as non-heme iron proteins participate in energy production in the mitochondria
  • Production of hormones and neurotransmitters
  • Collagen synthesis, as iron is essential for the regeneration of bone, cartilage and connective tissue
  • Transferrin as a carrier protein of iron protects against damage by free radicals and lipid peroxidation, protection against atherosclerosis (arteriosclerosis, hardening of the arteries).

Sources: Occurrence in predominantly plant-based diet – fruits, vegetables and cereals, lentils, white beans, wheat flour, parsley, whole grain and soy products, brewer’s yeast Note! Iron is better absorbed by the body if you take a food containing vitamin C – such as orange juice – with it; tea and coffee, on the other hand, inhibit the absorption of iron.

Iodine

Breastfeeding places a significant additional functional burden on the mother’s thyroid gland. To meet the increased demand associated with an increased basal metabolic rate during lactation, the thyroid gland must produce more thyroid hormones. In addition, there is additional iodine excretion with breast milk, which worsens the iodine supply to the thyroid gland. Due to this, the iodine losses of the mother must be compensated by a specific additional iodine supply. Because the iodine content of breast milk depends on the iodine supply status of the mother, the breast milk-fed infant shares the risk of iodine deficiency with his mother. Breastfeeding women who follow a vegan or macrobiotic diet, or who do not use iodized table salt when preparing their food, put themselves and their infant at high risk of inadequate iodine supply. The thyroid function of the mother and especially the development as well as the motor and manual abilities of the newborn are considerably endangered under such circumstances [2.1]. Premature infants are particularly vulnerable to maternal iodine deficiencies due to their increased growth and developmental needs and should be substituted if deficient. Therefore, supplemental iodine intake is recommended for all breastfeeding women. This also applies to women with autoimmune thyroid diseases such as Hashimoto’s thyroiditis or Graves’ disease in remission (temporary or permanent remission of disease symptoms, but without achieving recovery). In addition, the iodine supply in Germany is insufficient, which makes iodine substitution of the mother during breastfeeding as also necessary. With the help of a prophylactic iodine supplementation a healthy development as well as an undisturbed growth of the child can be ensured. Function of iodine

  • The most important function is the synthesis of thyroid hormones, which regulate metabolic activity.
  • Antioxidant effect, scavenger of free radicals.
  • Activating effect on certain immune functions
  • Prevents inflammatory degenerative diseases

Sources: Good sources of iodine are seawater products, such as raw fish – sushi, sea fish and sea tank; iodine-rich mineral waters, milk, eggs if the supplying animals are fed appropriately, as well as foods enriched with iodized salt. Caution.The Federal Institute for Risk Assessment (BfR) recommends for food supplementation not to exceed the maximum value of 100 µg iodine per day. The Federal Institute for Risk Assessment recommends 100-150 µg of iodine per day in tablet form for pregnant and nursing women.

Copper

In most cases, premature infants are poorly supplied with this trace element because copper mobilization from the liver depends on the maturity of enzyme equipment and often insufficient stores have been created. In addition, the increased growth and immature transport-mediated absorption mechanisms of the intestine contribute to the increased requirement. Premature infants should therefore be substituted with 900 µg per liter. To prevent deficiency symptoms, it is recommended to also supplement normal newborns, whereby about 0.5-1.5 milligrams per day are appropriate. If copper deficiencies occur, they usually do not become noticeable until the third month of life. Neonates on long-term parenteral nutrition are particularly at risk of deficiency. Copper supplements should not be taken in conjunction with vitamin B6, C, iron, or zinc, because these vital substances (micronutrients) reduce the absorption of copper Function of Copper

  • Component of various enzymes
  • Antioxidant effect, detoxification free radicals, immunostimulant, anti-inflammatory.
  • Important component of the endogenous antioxidant cell protection of the cell membrane, promotes cell growth.
  • Promotes iron absorption
  • Component of the respiratory chain, cellular oxygen utilization, serves for energy production.
  • Protection of amino acids
  • Melanin and connective tissue synthesis

Sources: Copper is strongly present in the diet in cereal products, offal (liver and kidneys of ruminants can have particularly high copper levels), fish, shellfish, legumes, nuts, cocoa, chocolate, coffee, tea and some green vegetables. Important notice! The data available for the Federal Republic of Germany on the intake of copper indicate that an insufficient supply of the trace element copper is not to be expected in otherwise healthy individuals (supply category 3). The addition of copper to food supplements is therefore not recommended. In addition, a study from the USA showed that elevated serum copper levels are associated with an increased risk of cancer. The supply of these trace elements ultimately serves to secure the mother’s reserves. If the mother is adequately supplied, an optimal concentration of vital substances (micronutrients) for the infant can also be ensured in breast milk. Fluoride represents a caries prophylaxis in particular. Fluoride supplementation in infancy should be about 0.25 milligrams per liter daily at a fluoride content of drinking water up to 0.3 milligrams per liter. The daily requirements of chromium, fluorine, manganese, molybdenum and tin within the breastfeeding period are approximately the same as during pregnancy. They must not be absent from a balanced and adequate diet and must be supplied in sufficient amounts, since the vital substances (micronutrients) are also of important significance for the growth and development of the child and the health and vitality of the mother.

Selenium

If newborns are fed cow’s milk instead of breast milk, deficiencies in selenium and zinc can develop rapidly because their levels in cow’s milk are lower than in breast milk, depending on the location [3.2. ].If selenium is substituted along with physiologic doses of vitamin E and vitamin C, this increases the rate of absorption Function of selenium

  • Causes increase in activity of the main antioxidant enzyme – glutathione peroxidase.
  • Antioxidant action via glutathione peroxidases to maintain the balance of oxidants and antioxidants in organism.
  • Stimulates the production of antibodies
  • Glutathione peroxidases are responsible for the conversion of harmful hydrogen and lipid peroxides to water and prevent production of oxygen radicals
  • Selenium affects activation and deactivation of thyroid hormones via the selenium-dependent enzymes – deiodases.
  • Through the glutathione peroxidases, selenium protects macromolecules – carbohydrates, proteins, fats – as well as cell membranes and components, working closely with antioxidant vitamins A, C, E and some B vitamins
  • Some selenium proteins have immunomodulatory and membrane stabilizing effects.
  • Forms nontoxic selenite-protein complexes with heavy metals such as lead, cadmium, and mercury that are sparingly soluble and thus difficult to absorb

Sources: Good sources of selenium are sea fish, kidney, liver, red meat, fish, eggs, asparagus and lentils; the selenium content in cereals depends on the selenium content of the soil Breastfeeding women do not have an increased selenium requirement. However, if women eat a vegan diet during pregnancy, those in our regions do not reach sufficient selenium levels without substitution and are at high risk of deficiency. In particular, Germany, Switzerland and Austria are selenium deficient areas because agricultural soils contain too little of the trace element due to fertilizers and acid rain, and animal feed is insufficiently enriched with selenium. Selenium is not needed for plant growth, making cultivated grain virtually selenium-free. Bioavailability is further reduced by heavy metals in the soil, with which selenium forms an insoluble complex. If selenium is substituted together with physiological doses of vitamin E and vitamin C, this increases the absorption rate Notice. Selenium supplementation of 20-50 µg daily is particularly needed by children on parenteral nutrition and premature infants with a birth weight below 1,500 grams.

Zinc

Because the trace element is particularly involved in many anabolic and catabolic enzyme reactions, in cell formation, and in the metabolism of thyroid hormones, growth hormones, insulin, and prostaglandins, nursing mothers should consume at least 22 milligrams of zinc daily. In addition, the trace element influences the development and maturation of male sex organs as well as spermatogenesis. Zinc consumption is increased not only during pregnancy, but also during breastfeeding due to rapid tissue proliferation and the increase in blood formation of the newborn. During the breastfeeding period, the woman loses about 1.7 milligrams of zinc daily with breast milk. If the mother absorbs insufficient amounts of zinc, the content in breast milk is subsequently reduced – the same applies to selenium. Newborns have a daily zinc requirement of about 2-5 milligrams. In order not to put the infant in a deficient position, the mother should ensure her zinc reserves via adequate dietary intake or supplementation. A zinc supplement – of 15-50 milligrams daily – during breastfeeding significantly increases the concentration of the trace element in breast milk. However, zinc should be supplied in the form of chelate, orotate, gluconate, and protein hydrolysate, as these have better bioavailability than inorganic zinc sulfate. Frequent consumption of animal products-especially oysters, wheat germ, muscle meat, and offal-also significantly increases zinc concentrations in breast milk. Zinc bioavailability is significantly better from animal products compared to plant products. For example, zinc absorption from beef is 3 to 4 times higher than from cereals. The reason for this is animal protein, which is of higher quality than plant protein and, as with iron, increases bioavailability. Amino acids, such as histidine, methionine and cystidine in protein, are low-molecular complexing agents, which explains the good absorption rate of animal protein. Animal protein also has a corresponding resorption-promoting effect with regard to zinc absorption from plant foods. Therefore, it is advisable to eat meat products combined with plant foods in one meal during lactation and not to completely avoid animal protein. Furthermore, the organo-zinc compounds found in animal foods – chelate, orotate, gluconate and protein hydrolysate – are better absorbed by the human organism than the inorganic zinc salts found in plant foods. In contrast, excessive calcium, copper, iron and phosphate intake, phytic acid from cereals, corn and rice, dietary fiber and heavy metals reduce zinc absorption due to non-absorbable complex formation. If breastfeeding women eat a predominantly vegetarian diet, only about 10% of zinc is absorbed, since the high-quality animal protein is completely omitted. This increases the risk of zinc deficiency [3.2]. Also with regard to zinc, infants are better supplied with breast milk than with ready-mixed milk foods, since the amino acids, peptides and citrates contained in breast milk promote the child’s absorption.If newborns are fed on cow’s milk, zinc deficiencies can quickly develop, since the zinc content in cow’s milk is lower than in breast milk, depending on the location [3.2]. Zinc deficiencies in infancy occur when there is a lack of absorption of nutrients and vital substances – malabsorption.. Zinc deficiencies usually become symptomatic only in the third month of life. Function of zinc

Involved in many anabolic and catabolic enzyme reactions, either as a cofactor or as an essential protein component in enzymatic reactions, thus fulfilling functions such as.

  • Stabilization of the structures of DNA, RNA and ribosomes, protects them from oxidation.
  • Large-scale wound healing and regeneration of burns.
  • Carbohydrate, fat and protein metabolism.
  • Alcohol degradation
  • Affects the visual process, as responsible for the conversion of retinol to retinal.
  • Involved in the metabolism of thyroid hormones, growth hormones, insulin and prostaglandins; affects development and maturation of male sex organs and spermatogenesis.
  • Antioxidant effect – protects cells from attacks of free radicals.
  • Immunomodulation – activity of T-helper cells, T-killer cells and natural killer cells depends on adequate zinc supply.
  • Essential for the normal functioning of skin, hair and nails; involved in the structural strength of nails and hair.

Sources: Very rich in zinc are oysters, wheat germ, muscle meat – beef, veal, pork, poultry; offal – liver, kidneys, heart; lower zinc levels have eggs, milk, cheese, fish, carrots, whole grain bread, fruit, green vegetables, legumes and fats Table – Need for trace elements.

Vital substance (micronutrient) Deficiency symptoms – effects on the mother Deficiency symptoms – effects on the infant
Iron
  • Chronic fatigue syndrome (CFS)
  • Loss of appetite
  • Disorders of thermoregulation
  • High susceptibility to infection of the upper respiratory tract
  • Dry skin with itching
  • Decreased concentration and retentiveness
  • Increased lactic acid formation (lactic acid formation) during physical exertion associated with muscle cramps.
  • Increased absorption of environmental toxins
  • Body temperature regulation may be disturbed
  • Anemia (anemia)
  • Disorder of physical, mental and motor development
  • Behavioral disorders
  • Lack of concentration, learning disorders
  • Disturbances in the child’s intelligence development
  • Loss of appetite
  • High susceptibility to infection of the upper respiratory tract
  • Body temperature regulation may be disturbed
Zinc Instead of zinc, toxic cadmium is integrated into biological processes, resulting in

  • Inflammatory changes of the mucous membranes in the nose-.
  • And throat area
  • Cough, headache, fever
  • Vomiting, diarrhea (diarrhea), cramping pain in the abdominal regions.
  • Renal dysfunction and increased protein excretion.
  • Osteoporosis (bone loss),
  • Osteomalacia

Leads. Disturbances in the functioning of the immune system

  • Inhibition of cellular defenses leads to increased susceptibility to infections
  • Wound healing disorders and mucosal changes, as zinc is required for connective tissue synthesis.
  • Increased keratinization tendency
  • Acne-like symptoms

Metabolic disorders, such as.

  • Weight loss despite increased food intake
  • Failure of beta cells in the pancreas – high risk of developing diabetes mellitus.
  • Blood clotting disorders, chronic anemia (anemia).
  • Reduction in the sensation of smell and taste,
  • Reduction in vision
  • Night blindness
  • Sensorineural hearing loss
  • Depression, psychosis, schizophrenia
Low concentrations of zinc in plasma and leukocytes (white blood cells) cause.

  • Malformations and deformities, especially of the central nervous system.
  • Growth disorders and retardation with delayed sexual development.
  • Skin changes in the extremities – hands, feet, nose, chin and ear – and natural orifices.
  • Wound healing disorders
  • Alopecia (hair loss)
  • Acute and chronic infections
  • Hyperactivity and learning disability
Iodine
  • Thyroid gland, hypothalamus and pituitary gland try to compensate for iodine deficiency
  • Increased growth of the thyroid gland (goiter).
  • Formation of new thyroid follicles to increase hormone synthesis.
  • Constriction of the trachea and esophagus due to continuous growth of the thyroid gland.
  • Formation of thyroid nodules due to increased cell division and growth of the thyroid gland.
  • Development of tumors in endocrine glands due to mutations in increased cell division
Iodine deficiency causes

  • Goiter (increased growth of the thyroid gland).
  • Neurological cretinism in severe iodine deficiency – mental defects, deaf-muteness, inner ear disorders,
  • Strabismus
  • Minor development
  • Central developmental disorders – deafness, speech disorders, lack of motor coordination.
  • Maturation deficits – deficient lung maturation.
  • Reduction of intelligence
  • Learning and developmental disabilities
Copper
  • Neurological deficits
  • Elastin depletion in vessels, vasoconstriction or occlusion, thrombosis.
  • Anemia due to impaired blood formation
  • Increased susceptibility to infections
  • Increased total cholesterol and LDL cholesterol levels (hypercholesterolemia).
  • Glucose intolerance
  • Hair and pigment disorders
  • Osteoporosis due to impaired collagen synthesis
  • Proliferation of smooth muscle cells
  • Weakness, fatigue
  • Copper deficiency interferes with the utilization of body iron
  • Anemia (anemia) due to impaired blood formation leads to maturation disorders of leukocytes (white blood cells) and lack of immune cells in the blood
  • Failure to thrive
  • Skeletal changes with changes in bone age.
  • Frequent respiratory infections