Imagine a world filled with optimism, joy, and the soft patter of small footsteps—a realm where the aspiration of becoming parents materializes effortlessly. For numerous families touched by PCOS, this vision might appear distant, and the expedition towards achieving parenthood can be fraught with obstacles and uncertainties.

PCOS, impacting millions, triggers an array of sentiments. Its hormonal imbalances disrupt the intricate ballet of conception, leaving couples longing for the moment when they can finally hold their precious little one.

In this deeply moving exploration, we will delve into the influence of PCOS on fertility and unearth how a lifestyle focusing on low-carbohydrate and wholesome fats can serve as a guiding light, steering you towards the path of parenthood. Let's journey together into a world of boundless possibilities, where the aspiration of starting a family can ultimately transform into a stunning reality.

PCOS affects innumerable individuals, giving rise to a rollercoaster of hormonal imbalances and undesirable symptoms. The traditional approach often encompasses medications, yet what if we could assume control over our well-being by embracing a lifestyle that naturally nurtures our bodies?

Envision this: your body serves as a finely tuned mechanism, and the type of fuel you provide can yield a profound impact. A low-carbohydrate lifestyle resembles offering your body the highest quality fuel it rightfully deserves. By curbing refined carbs and sugars (and offering a superior substitute), we assist in stabilizing blood glucose levels, a critical aspect in managing PCOS symptoms.

Insulin, our hormone responsible for storing fat, fluctuates in response to erratic blood glucose levels. Opting for a low-carbohydrate and healthful fat-centered lifestyle equates to bidding farewell to those abrupt insulin surges that disrupt hormone fluctuations, and embracing a more balanced and invigorated self. Embracing nourishing, whole foods like vegetables, proteins, and healthful fats can empower you to triumph over PCOS and regain mastery over your life.

Contrary to common notions, fats are not adversaries. They perform a pivotal role in our hormonal equilibrium and overall well-being. Embrace healthful fats such as avocados, nuts, seeds, and olive oil, as they facilitate hormone generation, combat inflammation, and foster a sense of fullness. These nourishing fats may also contribute to enhancing overall nutritional intake, enabling your body to recuperate and decrease fat mass.

Navigating through fertility challenges can prove to be a formidable journey. Through adopting a lifestyle focused on low-carb, healthful fats, we might uncover the gateway to amplified fertility. Consistent blood glucose levels and harmonized hormones can pave the route to a more robust reproductive system.

Together, let's step into the realm of low-carb and healthful fats, and unleash the dormant potency within us to triumph over PCOS and elevate our fertility.

As dedicated healthcare professionals, we understand the crucial role digestion plays in maintaining overall health. However, there's an under-the-radar hormone called cortisol that can sometimes disrupt the seamless functioning of our gastrointestinal (GI) system. In this article, we'll delve into how heightened cortisol levels redirect resources away from non-essential functions, like digestion, resulting in a decelerated GI tract activity. This, in turn, can trigger unwelcome symptoms such as bloating, constipation, or indigestion.

Cortisol, often dubbed the "stress hormone," is a pivotal player in our body's stress response. Whenever stress hits or perceived threats arise, cortisol swoops in to help us cope. Yet, when chronic stress persists, cortisol levels can remain elevated, casting a shadow on our digestive processes.

Under the cortisol's watchful eye, our GI tract adopts a more leisurely pace, slowing down the secretion of digestive enzymes and hampering the smooth passage of food through our system. As a result, this sluggishness can lead to discomfort and hinder the effective breakdown of nutrients.

So, how can we navigate the effects of cortisol on our digestion with finesse? The first step lies in mastering stress management techniques. Introducing mindfulness practices, deep breathing exercises, or yoga into our routines can work wonders in reducing cortisol levels, cultivating a state of relaxation that promotes digestive well-being.

Mindful eating also takes center stage. Meticulously chewing our food and adhering to regular eating patterns facilitates the digestion process, optimizing nutrient absorption.

Additionally, we uncover a hidden gem in the low-carbohydrate, healthy-fat lifestyle. Embracing foods rich in healthy fats, such as avocados, nuts, and olive oil, grants our bodies sustained energy and supports various physiological functions, including digestion.

While caffeine and alcoholic beverages may add spice to our lives, moderation becomes our ally. Excessive consumption of these delights can exacerbate GI issues, making it crucial to strike a balance.

Lastly, the significance of quality sleep cannot be overstated. Adequate rest allows cortisol levels to stabilize and affords our bodies the chance to rejuvenate, paving the way for improved digestion and holistic well-being.

As dedicated healthcare advocates, we recognize the profound impact of stress on the body and the pivotal role of a well-balanced lifestyle. By incorporating stress management techniques, mindful eating habits, healthy fats, prudent caffeine, and alcohol consumption, and prioritizing restful sleep, we empower ourselves to navigate the challenges presented by cortisol and foster an optimal digestive experience.

Remember, our bodies are incredible ecosystems, and with thoughtful care and attention, we can foster a harmonious GI system and embrace a thriving life.

Have you ever noticed that when you're feeling stressed, your stomach seems to be in knots? Cortisol is a hormone that kicks in when we're under stress. And while it's important for our survival, having too much cortisol can wreak havoc on our gut health. Now, the gut is known as the "second brain" for good reason. It's got millions of nerve cells that communicate with our brain, so anything that affects our gut can have a big impact on our brain function and overall well-being.

Elevated cortisol levels can cause something called "leaky gut" syndrome, which is when the gut lining becomes more permeable, letting in toxins, bacteria, and undigested food particles. That's a recipe for inflammation and autoimmune disorders, folks.

But it's not just leaky gut that we need to worry about. Cortisol can also mess with the composition of the gut microbiome. Now, this is a fancy way of saying that there are a bunch of microorganisms living in our gut that contribute to our health. When things are out of balance, it can lead to all sorts of issues, like irritable bowel syndrome, inflammatory bowel disease, and even obesity.

So, what can we do about it? First and foremost, we need to manage our stress levels. Meditation, deep breathing, yoga, and exercise are all great ways to lower cortisol levels and promote gut health. And let's not forget about diet. Eating a diet rich in fiber, healthy fats, and probiotics can also do wonders for our gut health.

In short, we need to pay attention to the connection between cortisol and gut health, my friends. Chronic stress and elevated cortisol levels can do a number on our gut, but with the right mindset and lifestyle habits, we can take control and optimize our gut health. Let's do this!

Nowadays, stress is an everyday occurrence that can impact our health in several ways. Cortisol, a hormone produced in response to stress, can cause a range of health problems, such as weight gain, specifically around the waist, and insulin resistance, which may lead to type 2 diabetes.

When we're stressed, our bodies release cortisol, which causes the liver to release glucose into the bloodstream. This glucose is then used as fuel to give us the energy we need to deal with the stressor. However, if we're constantly stressed, our bodies will continue to produce cortisol, which leads to an increase in blood sugar levels.

A great way to counteract the negative effects of cortisol and stress on weight and health can be by following a low-carbohydrate diet that is high in healthy fats and low in refined carbohydrates. This type of diet can enhance insulin sensitivity, reduce cortisol levels, and improve overall health.

Cortisol and insulin are interrelated, and high cortisol levels can result in insulin resistance, leading to weight gain and increased difficulty controlling weight. Cortisol stimulates the release of glucose, which the body then uses as an immediate source of energy. Nevertheless, when glucose levels are high, insulin is also released, signaling the body to store the extra glucose as fat. Eventually, this can lead to weight gain and insulin resistance.

On the other hand, low-carbohydrate diets are known to enhance insulin sensitivity, which can help decrease cortisol levels. This is due to low-carb diets regulating blood sugar levels, which lowers the need for insulin. Consequently, cortisol levels decrease, and weight gain is less probable.

Aside from improving insulin sensitivity, low-carb diets should also be high in healthy fats, which can reduce cortisol levels. Healthy fats like those in avocado, nuts, and olive oil have been found to have a positive effect on cortisol levels and overall health. These healthy fats also provide a long-lasting source of energy, which can help reduce stress levels.

To sum up, cortisol, stress, and weight gain are linked, and the harmful effects of cortisol can be decreased by following a low-carbohydrate diet. Low-carb diets are high in healthy fats and low in refined carbohydrates, which can improve insulin sensitivity and decrease cortisol levels. By decreasing cortisol levels, weight gain is less likely to occur, and overall health is enhanced. If you're dealing with weight gain, stress, or other health issues, consider incorporating a low-carb diet into your lifestyle to benefit from its numerous advantages.

The Keto-Fad | Fact or Fiction?

From corsets to camisoles, diet fads have been used through the ages. In 1820, Lord Byron commercialized the vinegar and water diet, which involves drinking water mixed with apple cider vinegar. One of today’s latest diet trends is the ketogenic diet (KD). In actual fact, the KD was already developed in the 1920s and was used worldwide for the non-pharmacological management of drug-resistant epilepsy1. In modern times, however, the applications of the KD, as well as other low-carbohydrate and high-fat (LCHF) diets are evolving. These applications may vary from weight loss, Type 2 Diabetes Mellitus (T2DM), Polycystic Ovary Syndrome (PCOS), and Inflammatory Disorders (ID) to cancer (as combination therapy) and so much more. Many individuals who follow an LCHF or KD state that they experience long-term benefits and tempt to make this a lifestyle and not a ‘quick fix’. Many of the ‘diets’ or lifestyles that are applied in the modern world were developed centuries ago. Another example is Banting, this low-carbohydrate diet was already described by William Banting in the 1800s.

As a registered dietitian, who has seen the benefits of the KD in individuals with drug-resistant epilepsy and cancer, I do believe there are surely benefits for certain individuals when following some form of a LCHF lifestyle. When I talk about benefits, my very first epilepsy patient was a 2-year-old female who was suffering from GLUT-1 Deficiency Syndrome (GLUT-1 DS) and had 10 seizures on average per day and is now completely seizure free since 2017. But what is the difference between applying a classical KD (in which 90% of the total energy comes from fat) or just following an LCHF lifestyle? Thinking about it, a LCHF diet or lifestyle consists of a lot of foods that are readily available in nature, which therefore means that the diet does not (or is not supposed to) consist of unnatural foods. While on the other hand a classical KD, which is applied for medical purposes, is very strict, all foods should be weighed, and there is only just enough protein provided within the diet to ensure growth, while almost all of the remaining energy intake comes from fat. A strict KD then causes an individual’s body to use fat, in the form of ketones as the primary energy source (known as ketosis) and no longer carbohydrates in the form of glucose, hence the name, ketogenic. A LCHF lifestyle can cause ketosis as well, but usually not to such a severe extent. Keep in mind, that the human brain is 60% fat, and the brain’s capabilities may improve when fat is supplied as the energy source, for example in individuals suffering from Parkinson’s Disease, Alzheimer’s, and even Attention Deficit Disorder (ADD), etc. 

A narrative review written by Professor Tim Noakes and Johann Windt, which was published in 2016, aims to provide clinicians with a broad overview of the effects of LCHF diets on body weight, glycaemic control, and cardiovascular risk factors while addressing some common concerns and misconceptions. The conclusion made from this study states that although LCHF diets may not be suitable for everyone, available evidence shows this eating plan to be a safe and efficacious dietary option to be considered. The Dietary Guidelines for Americans (DGA) recommend a total carbohydrate intake of 45-65% of total energy per day. Any carbohydrate intake of less than 45% of the total energy, is considered to be a reduced carbohydrate diet/lifestyle. But why do individuals follow LCHF or Keto-diets? One of the main understandings is due to the leptin and ghrelin hormone balances. Leptin hormone contributes to the feeling of satiety while ghrelin contributes to the feeling of hunger. Leptin levels may be improved by an increased intake of omega-3 fatty acids, which is often something that naturally occurs in a LCHF lifestyle or KD. Therefore, some individuals suffer from less cravings, making it easier to control their calorie intake when wanting to shed some weight. With all the diet trends, I have experienced that individuals will often try something for a short period of time, but it is important to plan for the long-term future and find something that is appropriate for the entire family. 

There is concrete evidence that supports the application of ketogenic diets in individuals with drug-resistant epilepsy. However, in practice, the applications of LCHF and KD remain patient-specific. Beneficial responses to any diet are entirely reliant on the degree of patients’ adherence, thus an LCHF diet is only appropriate for those patients motivated to comply and completely grasp the aspects thereof. 

Bibliography

1. Kossof, EH, Zupec-Kania, BA, Amark, PE, Ballaban-Gil, KR, Bergqvist, AGC, et al. Optimal clinical management of children receiving the ketogenic diet: Recommendations of the International Ketogenic Diet Study Group. Epilepsia: 1-14, 2008.

2. Noakes, TD, Windt, J. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. British Journal of Sports Medicine: 51; 133-139, 2016.

Berberine health benefits as a supplement

Once we have decided to leave all fad diets and quick fixes behind, and follow a sustainable low-carbohydrate and healthy fat lifestyle, we often expect to see our bodies heal completely within months. Unfortunately, this is not how it works, I think that we are lucky that our bodies can heal quicker than the time it took for our bodies to become unhealthy. But also, fortunately, there are natural products available that may aid in such processes for example Berberine.

Berberine is a plant-derived traditional medicine used in China for more than 3000 years [1]. The search for natural products is continuously on the increase due to drugs that have some limitations because of adverse effects [2]. Berberine is considered one of the most promising natural products for the treatment of metabolic diseases [2]. Metabolic diseases include diabetes, obesity, non-alcoholic fatty liver disease (NAFLD), hyperlipidemia, and gout [2].

Berberine in diabetes:

Studies have illustrated that Berberine may aid in the following which may help to improve diabetes [2]:

• Promotes insulin secretion
• Increases cellular insulin sensitivity
• Inhibits the formation of glucose (gluconeogenesis)
• Prevent glucose uptake
• Inhibits inflammation

Berberine in weight-loss and insulin resistance:

As low-carbohydrate dietitians, we aim to lower circulating blood glucose levels, which in turn lowers circulating insulin hormone. Lowering insulin, a fat-storing hormone, may aid with weight loss. As described above Berberine aids in lower blood glucose and consequently also lowers insulin and thus may aid in weight loss. Yes, a lifestyle change is still required, but some individuals have such high insulin levels that it takes years to recover. A natural supplement like Berberine may aid to speed up the initial process to a stage where one only requires healthy food to become and stay healthy.

Berberine and inflammation:

Berberine has anti-inflammatory effects by downregulating inflammatory markers [2]. Studies illustrated reduced inflammation in the liver and visceral fat tissue [2]. 

Berberine and Non-alcoholic fatty liver disease (NAFLD):

Berberine improves fat accumulation in the liver as well as retention of fat within the liver [2]. Berberine is also associated with the inhibition of inflammation of the liver and aid in regulating gut bacteria which can be associated with improved gut health [2].

Berberine and cholesterol levels:

Berberine remarkably reduces serum Triglycerides (TG) which is known to be the very unhealthy cholesterol also associated with metabolic diseases. Berberine also lowers total cholesterol (TC), and low-density lipoprotein-cholesterol (LDL-C) concentrations and increases serum high-density lipoprotein-cholesterol (HDL-C; good cholesterol) concentrations [2].

Berberine and gout:

Multiple studies demonstrated that Berberine could substantially reduce fasting serum uric acid (UA) levels [2]. This reduction is beneficial for the treatment of hyperuricemia or gout. The uric acid lowering effect of Berberine may be ascribed to several mechanisms. Berberine could dilate blood vessels, regulate blood flow, and improve renal function, which leads to the increased excretion of UA [2].

An increasing number of studies illustrate that Berberine has a good therapeutic effect on five metabolic diseases, namely, T2DM, obesity, NAFLD, gout, and hyperlipidemia [2]. However, natural medicine should be used in combination with improved lifestyle changes to achieve optimal and sustainable results.

References

1. Gaba S, Saini A, Singh G, Monga V. An insight into the medicinal attributes of berberine derivatives: A review. Bioorganic & Medicinal Chemistry. 2021: 38; 116143.
2. Xu X, Yi H, Wu J, Kuang T, Zhang J, Li Q, Du H, Xu T, Jiang G, Fan G. Therapeutic effect of berberine on metabolic diseases: Both pharmacological data and clinical evidence. Biomedicine & Pharmacotherapy 133. 2021; 110984.

Cow’s milk protein allergy (CMPA) and the lactating mother by Elzette Struwig RD(SA)

An allergy is an immune-mediated response.

A food allergy occurs when the immune system identifies a food protein as hazardous, which causes the immune system to become activated. This is to protect the body from this protein. Symptoms that range from asthma, eczema, rashes, rhinitis, or even anaphylaxis can then occur. Regarding food allergies, IgE-mediated Cow’s milk protein allergy (CMPA) is the most common allergy in infants during the first year of life [1].

Cow’s milk protein allergy (CMPA) can often manifest in a breastfed or formula-fed infant through delayed reactions, such as vomiting, diarrhea, colic, and intestinal constipation [2]. The diagnosis of CMPA is based on the improvement of symptoms on the exclusion of cow’s milk protein (CMP) from the diet or IgE blood tests, which can be very traumatizing for the infant [2]. The treatment option is the exclusion of the allergen from the diet. In a breastfeeding mother, the milk protein is transferred from the mother’s bloodstream, due to intake from her diet, to the breastmilk. A breastfeeding mother may and ideally should continue breastfeeding her infant with CMPA. A mother who makes this decision, for the benefit of her child, should then exclude CMP from her diet. Cow’s milk elimination (in a child who is no longer being breastfed) without adequate replacement feed may impair the normal growth and development of the child [2]. Please keep in mind that this allergy is not related to lactose (the sugar found in dairy products), but whey and casein, the protein found in dairy products. In this case, lactose-free products would make no difference. Unfortunately, whey (the CMPA seen more often), is found in an even greater variety of food products than lactose. For example, whey is often used as a seasoning in food sources such as chips, sauces, and baked goods.

A lactating mother of an infant with CMPA should exclude all the allergens from her own diet. This can be done by proper label reading. Or better yet, to avoid products contained in packages and wrapping and rather stick to natural options such as fruit, vegetables, meat, fish, eggs, and foods high in fatty acids such as nuts, seeds, avocado, and oils. 

Once the infant’s symptoms start to improve, it is a confirmation that the CMPA was the cause for the little one’s discomfort. It is recommended to reintroduce an allergen with the supervision of a dietitian. The reintroduction of an allergen is called a food challenge and it is to determine whether the infant has outgrown the allergy. Ideally, a mother should first start using cow’s milk protein products again, before providing it directly to her infant.

The mother and infant need to maintain a well-balanced dietary intake while excluding cow’s milk protein from the diet. A dietitian can help to establish these requirements and assist with the reintroduction of the allergen.

References

1. Perezabad L, López-Abente J, Alonso-Lebrero E, Seoane E, Pion M, Correa-Rocha R. The establishment of cow’s milk protein allergy in infants is related with a deficit of regulatory T cells (Treg) and vitamin D. Pediatric Research. 2017: 5 (81); 722.
2. Faria D, Cortez A, Speridião P, Morais M. Knowledge and practice of pediatricians and nutritionists regarding the treatment of cow’s milk protein allergy in infants. Rev. Nutr. 2018;31(6):535-546.

Carbohydrate restriction and ketogenic diets in patients suffering from Type 2 Diabetes Mellitus (T2DM) by Elzette Struwig RD(SA)

According to the United States center for Disease Control and Prevention, 85% of the diabetic patients are overweight and 55% are obese [1]. Due to the number of overweight/obese individuals increasing, the World Health Organization estimates that approximately 366 million people will have diabetes by the year 2030 [1]. This is of great concern, and can also be an indication that current practices, including dietary practices to prevent Type 2 Diabetes Mellitus (T2DM) are not effective enough to lower these figures. It is my opinion that current practices are focused on the management of T2DM and not as much the prevention thereof. Practices to prevent lifestyle diseases such as T2DM may include healthy eating, exercise, proper stress management, etc. 

As mentioned previously overweight/obesity is associated with T2DM, thus the management of weight can help to prevent T2DM. Weight loss these days could be done quite easily due to the abundance of weight loss clinics and programs available. The challenges are to maintain a healthy weight, and when losing and maintaining weight, to do so in a healthy manner. Currently, a lot of individuals are following some sort of low-carbohydrate diet to shed some kilograms. 

Being a dietitian myself who focusses on low-carbohydrate and ketogenic diets and follow such a lifestyle myself. I have seen that, if done correctly, this type of lifestyle may provide health benefits and is quite sustainable for most of our patients. There is also a vast majority of social media groups (not always following the correct medical guidelines) in which individuals find this type of lifestyle sustainable. I believe that sustainability is one of the most important aspects when choosing a specific dietary lifestyle, as, without it, it is just another quick fix. 

But why can a low-carbohydrate or ketogenic diet be considered for the prevention of T2DM? Several studies have shown the benefits of ketogenic diets for patients with type two diabetes may include, weight loss, reducing HbA1c, reversing nephrology, cardiac benefits, improvement of lipid profile and even have a potential effect on reversing diabetic neuropathy and retinopathy [1]. Saslow et al. conducted a 12-month study in 2017 in which adults with elevated HbA1c and body weight assigned to a very low-carbohydrate ketogenic diet had greater reductions in HbA1c, lost more weight, and reduced more medications than those instructed to follow a moderate-carbohydrate, calorie-restricted, low-fat diet (2). The study also found that the ratio of triglycerides to HDL, which predicts coronary disease, decreased in the low-carbohydrate group compared to the moderate-carbohydrate group, suggesting that the very low-carbohydrate ketogenic diets may have certain benefits on lipid profiles (2). 

As I have experienced the increased energy levels, better sleep, reduction in visceral fat, stabilizing blood pressure levels, so have many of our patients also experienced the benefits of a low-carbohydrate lifestyle. It is important to consider all aspects when choosing a dietary lifestyle, as weight is not the only indication of health. Make sure that the calories you consume count to contribute to your health, possibly prevent diseases such as T2DM and not contribute to them. 

References

1. Azar ST, Beydoun HM, Albadri MR. Benefits of Ketogenic Diet for Management of Type Two Diabetes: A Review. Obesity & Eating Disorders. 2016: 2; 22. 
2. Saslow LR, Daubenmier JJ, Moskowitz JT, Kim S, Murphy EJ, Phinney SD, Ploutz-Snyder R, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutrition and Diabetes. 2017: 7; 304.

Breastfeeding, diet and your child's future

Personally, I found breastfeeding very hard, with many moments where I wanted to give up. Our little one suffered from colic and severe reflux, and despite all the benefits associated with breastfeeding, I felt that this may be the cause of all these symptoms. Of course, it was not, and breastfeeding was still the best possible option, I just needed to remind myself of that on a regular basis. 

Breastfeeding benefits

Breastfeeding provides protection against respiratory and gastrointestinal infections and is associated with a reduced risk of inflammatory diseases such as asthma, atopy, diabetes, obesity, and inflammatory bowel disease [1]. Prolonged and exclusively breastfed infants have improved cognitive development [1]. A mother’s breastmilk also provides immunity to her infant and develops the infant's intestinal mucosa, microbiota, and their own immunologic defenses [1]. Breastfeeding provides so many benefits, and when possible, it is important to try and breastfeed for as long as possible. 

A mother’s diet and lactation

Can a mother’s nutritional status and or diet, affect the quality of her breastmilk? Unfortunately, the nutritional stores of a lactating woman may be more or less depleted as a result of the pregnancy and the loss of blood during childbirth [2]. The nutrients present in breastmilk comes from the mother’s diet or her nutrient reserves [2]. The alteration of nutrients in food to nutrients in breastmilk is not complete [2]. Thus for a breastfeeding mother to have a good nutritional status she has to increase her nutrient intake [2]. Luckily, the nutritional content of breastmilk remains quite similar, there are only a few nutrients that become deficient in breastmilk if it is deficient in a mother’s diet. A mother whose diet is deficient in thiamine and vitamins A and D will also produce breastmilk deficient in these nutrients [2]. Studies have also shown that the levels of polyunsaturated fatty acids especially Docosahexaenoic acid (DHA) in a mother’s diet influences the levels in her breastmilk [3]. Keep in mind that this fatty acid is essential for neurological development, and if not consumed within the diet, supplementation is recommended. 

In conclusion, we are all aware that breastfeeding is the gold standard for infant feeding and nutrition. However, we as mothers can get very concerned about our own diets and how it will affect the breastmilk provided to our infants. It is always best to speak to your medical professional but to maintain and sustain a well-balanced and nutrient-dense diet can provide benefits to the mother as well as her baby. Don't give up mommies at the end it is really worth it!

References

1. Le Doare K, Holder B, Bassett A, Pannaraj PS. Mother’s Milk: A Purposeful Contribution to the Development of the Infant Microbiota and Immunity. Frontiers in Immunology. 2018: 8; 361.
2. Segura SA, Ansótegui JA, Díaz-Gómez NM. The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements? Anales de Pediatría (English Edition). 2016: 84 (6); 347.
3. Bzikowska A, Czerwonogrodzka-Senczyna A, Wesołowska A, Weker H. Nutrition during breastfeeding - impact on human milk composition. Europe PMC. 2017.