Vitamin C and Breastfeeding

Vitamin C (ascorbic acid) is a water soluble vitamin found in fruit and vegetables. It is an important antioxidant (has a protective function in the body). Vitamin C protects cells and keeps them healthy, helps wound healing and aids the absorption of iron. It is popularly used for preventing and treating infections, fatigue and cancer 1. Our bodies can’t make vitamin C so we rely on food sources. Good sources of vitamin C include berries, peppers, kiwi, citrus fruits, leafy vegetables, tomatoes and more. Our kidneys carefully control the amount of vitamin C in the body keeping it at the right level and excreting any excess that isn’t needed. A deficiency in vitamin C causes scurvy.

Vitamin C in breast milk

A well nourished mother with a healthy diet will have just the right concentration of vitamin C in her breast milk for her baby.

How will vitamin C in my diet affect breast milk?

Authors Lawrence and Lawrence 2 state that within 30 minutes of a mother being given vitamin C, increased vitamin C is measured in breast milk (p.131) and that levels in milk can be increased through diet (p.535).

How will vitamin C supplements affect breast milk?

Hoppu et al 3 found that taking vitamin C supplements didn’t appear to influence the concentration of vitamin C in a well nourished mother’s breast milk very much compared to taking vitamin C from the diet.

Another study in 1985, also found that taking vitamin C supplements above a certain level (1000 mg/day) didn’t influence the concentration of vitamin C in a well nourished mother’s breast milk very much4.

However, if poorly nourished mothers with very low levels of vitamin C in their bodies take vitamin C supplements, levels of vitamin C can be doubled or tripled in breast milk 5.

These studies suggest vitamin C is regulated in breast milk.

Can I take vitamin C while breastfeeding?

Yes, the Office of Dietary Supplements say the recommended daily allowance (RDA) for vitamin C in a breastfeeding mother over age 19 is 120 mg/day. And the Infant Risk Center, USA says:

The Use of Herbal Supplements and Remedies During Pregnancy and Breastfeeding, Infant Risk Center [accessed Oct 2017]

The normal recommended amount of vitamin C in pregnant women is 85 mg/day and for breastfeeding women it increases to 120 mg/day. Side effects are generally not seen until consumption increases to massive amounts of 1800 mg. High doses of vitamin C stimulate the liver to metabolize it at a high rate.  Hence, too much vitamin C during pregnancy may in fact cause scurvy in the newborn soon after delivery. Therefore, vitamin C should be used with care in pregnant and breastfeeding mothers, and at lower levels. Conversely, low levels of vitamin C can also have detrimental health affects for the fetus. Usually the diet, or prenatal vitamins, is an adequate provider of sufficient vitamin C levels.

Thomas Hale MD and Hilary Rowe, authors of Medications and Mothers’ Milk 2017 (or online at Medsmilk) advocate only undernourished mothers need vitamin C supplementation and to avoid excessive amounts while pregnant or breastfeeding. They mention mothers of babies with poor kidney function and G6PD deficiency should avoid taking excess vitamin C. Discussing intravenous (through a vein) vitamin C therapy, they speculate that as this bypasses the kidney’s regulatory system, levels in breast milk could become very high possibly giving a higher risk of kidney stones, but intravenous vitamin C in breastfeeding women has not been studied. They recommend:

Avoid intravenous vitamin C during breastfeeding, or in those cases where it is used, mothers should avoid breastfeeding, pump and discard milk, for a minimum of 12-24 hours after therapy.

What about therapeutic doses?

Although side effects are only said to be seen with very high doses of vitamin C supplements e.g. 1800 mg per day (Infant Risk Centre, 2017) or higher6, and that the breast appears to regulate the levels in breast milk, therapeutic levels are not recommended during lactation according to my available resources (Medsmilk, 2017). If you do want to take higher than recommended doses of supplemental vitamin C, discuss this with your health professional who will be able to advise you based on the amount of vitamin C already in your diet, any medical conditions you have and any medications or supplements you already take.

Safety of vitamin C

According to the Institute of Medicine, vitamin C has low toxicity with adverse effects mostly reported with doses above 3 g/day:

There is no evidence suggesting that vitamin C is carcinogenic or teratogenic or that it causes adverse reproductive effects. Reviews of high vitamin C intakes have indicated low toxicity (Johnston, 1999); adverse effects have been reported primarily after very large doses (greater than 3 g/day).

The Mayo clinic lists various side effects but doesn’t clarify the dose that might be associated with these negative outcomes in Vitamin C (ascorbic acid), Mayo Clinic, 2015.

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Smoking and vitamin C

Smoking while breastfeeding reduces the amount of vitamin C in a mother’s breast milk. Smoking causes a baby extra oxidative stress (a type of cell breakdown) so anything that reduces antioxidants e.g. beta carotene, vitamins C and E can cause more peroxidation (an undesirable reaction stimulated in the body by some toxins and infections) 7. The fact sheet by the Office of Dietary Supplements 2016 explains that a smoker needs additional vitamin C:

individuals who smoke require 35 mg/day more vitamin C than non smokers.

Vitamin C and mastitis?

Wambach and Riordan, 2015 8discuss that in the dairy industry, giving antioxidants to cows is a way to prevent mastitis. They very briefly mention that mothers with mastitis have reported taking vitamin C supplements to fight infection however they do not give any discussion on suitable amounts or success rates. Sheila Humphrey in The Nursing Mother’s Herbal also says:

Immune-System-stimulating herbs such as echinacea, adaptogenic or tonic herbs such as ginseng, and vitamin C are often recommended for treating mastitis.

Laboratory studies suggest how vitamin C may work against mastitis as it has been shown to limit Staphylococcus aureus 9.

Vitamin C and milk supply

In Mother Food, p 123 author Hilary Jacobson lists vitamin C supplements as a possible anti-lactogenic food i.e. one that could decrease a milk supply. For some sensitive mothers, she says citrus fruits can be problematic and are also reputed to be anti-lactogenic.

Vitamin C and preventing allergy

Hoppu et al 10 noted a reduced tendency to atopy (tendency to develop allergies such as asthma or eczema) in the breastfed offspring of mothers with a diet rich in vitamin C. Interestingly the babies at risk of low vitamin C levels belonged to mothers with food hypersensitivity.

Summary

Vitamin C is an important vitamin for the body. A breastfeeding mother with a healthy diet will have just the right amount of vitamin C in her breast milk. Dietary vitamin C has a greater influence on the levels of vitamin C in breast milk than taking supplements. Therapuetic doses (very large amounts) of vitamin C are sometimes taken for certain health issues. Although sources suggest the breast regulates the amount of vitamin C in breast milk, and side effects are not seen over 1800 mg per day, taking therapeutic doses of vitamin C are not recommended in current breastfeeding resources during pregnancy or breastfeeding.

Important

This article should not be construed as medical advice. Information found online should always be discussed with your own IBCLC lactation consultant and doctor to ensure it is appropriate for you and your baby’s situation. Contact your doctor, paediatrician or health care provider with any concerns about your baby’s health and welfare. Read our full disclaimer.

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