Dear Laurel,
Thank you for the knowledge you shared with us during the 15th Annual Breastfeeding Conference of Galaxias in Rhodes, Greece, on April 13-14, 2024.
The structure of your lectures and the information you shared were fascinating.
Some of the things you said were completely new to us, while others helped us refresh our overall knowledge.
We would love to learn more from you, so let's dive into our questions.

During your lecture entitled "Hold the Phone! Diet Does Matter During Lactation: Implication of Diet on Fatty Acid Composition and Other Nutrients", you mentioned that research does not support the theory that the evening milk has more fat. What does the research support regarding the variation of fat content of the human milk?
Fat can vary on an individualized basis depending on how often a parent is feeding/pumping and whether or not they are spacing feeding or feeding on demand.

When a baby is exclusively breastfed/chested, what is the actual number of feedings per day?
When it comes to breastfeeding, the number of feeds per day that is recommended in the United States is a minimum of 8-10. However, it's important to note that the actual number of feedings per day can vary around the world. In the study I referenced in the lectures, which focused on breastfeeding practices, the average was 15 times per day for their research cohort.

At what time after the beginning of a feeding, is the fat content of the human milk higher?
There is no specific standard point at which fat gets higher in breastfeeding. It is highly individual. During milk ejection, the alveoli are compressed, and fat is forced off the sides of the alveoli, moving fat into the ductules. However, when and how often this occurs varies from lactating parent to lactating parent. For parents who are feeding on cue throughout the day, their levels of fat seems to be more steady than parents who time feeds or schedule feeds.

What may happen if someone restricts the duration of the feeding or sets a limit on how often a baby feeds from the breast/chest?
The lactating body reduces the amount of milk it makes over a 24-hour period. Also, when feedings are restricted or times are restricted, we tend to see more fat fluctuation from beginning to end of feedings.

Which are the essential fatty acids that pregnant parents need to consume during pregnancy and lactation?
All humans need to consume essential fatty acids in their diet because the human body cannot manufacture them. Omega 3 and Omega 6’s are vital. However, the modern diet tends to be overly saturated with omega 6’s, and many people do not get enough Omega 3’s. The last trimester seems to be the most important time to consume Omega 3’s in terms of essential fatty acid composition in breastmilk

Why are these fatty acids called essential? What are their roles? What happens if a pregnant or lactating parent is deficient in essential fatty acids?
Fatty acids are termed "essential" because the human body cannot synthesize them, and they must be obtained through the diet. The two primary essential fatty acids are:
Alpha-linolenic acid (ALA) - An omega-3 fatty acid.
Linoleic acid (LA) - An omega-6 fatty acid.
Essential fatty acids play several crucial roles in the body, including:
1) Cell Membrane Structure: They are key components of cell membranes, maintaining their fluidity and flexibility.
2) Inflammatory Response: They are precursors to eicosanoids, which are signaling molecules that play a role in inflammation and immunity.
3) Brain Development: Particularly important for the development and function of the brain and nervous system.
4) Cardiovascular Health: They help regulate cholesterol levels and blood pressure, reducing the risk of heart disease.
Effects of Deficiency in Pregnant or Lactating Parents:
If a pregnant or lactating parent is deficient in essential fatty acids, it can lead to several adverse outcomes:
For the Parent:
A) Impaired Immune Function: Increased susceptibility to infections.
B) Skin Issues: Dry, scaly skin and dermatitis.
C) Poor Wound Healing: Delayed recovery from injuries.
E) Mental Health: Increased risk of depression and cognitive decline.

For the Baby:
A) Neural Development: Essential fatty acids are critical for brain and retinal development. Deficiency can lead to poor cognitive and visual development.
B) Growth Retardation: Essential for overall growth and development; deficiency can lead to growth delays.
C) Immune System: Compromised immune function, making the baby potentially more susceptible to infections.

When is the most critical period in parenthood that needs an increase in the intake of essential fatty acids?
For a breastfed baby, it would be the last trimester of pregnancy.

What are the best sources of essential fatty acids? Is there a recommended daily/weekly intake?
Alpha-linolenic acid (ALA) - Omega-3:
Flaxseeds and flaxseed oil
Chia seeds
Hemp seeds
Walnuts
Soybeans and soybean oil
Canola oil
Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) - Omega-3:
Fatty fish (e.g., salmon, mackerel, sardines, trout)
Fish oil supplements
Algal oil supplements (plant-based source)
Linoleic acid (LA) - Omega-6:
Vegetable oils (e.g., sunflower, safflower, corn, soybean oil)
Nuts and seeds (e.g., walnuts, sunflower seeds)
Meat and poultry (from animals fed on grains high in omega-6)
Eggs
Recommended Daily/Weekly Intake
a) Omega-3 Fatty Acids:
ALA:
Men: 1.6 grams per day
Women: 1.1 grams per day
EPA and DHA:
Combined recommendation of about 250-500 mg per day for adults.
b) Omega-6 Fatty Acids:
LA:
Men: 17 grams per day
Women: 12 grams per day
Pregnant and Lactating People: Increased need for DHA. It's recommended to aim for at least 200-300 mg of DHA per day.
Balance: It's important to maintain a healthy balance between omega-3 and omega-6 fatty acids, typically aiming for a ratio of 1:1 to 1:4 (omega-3 to omega-6). Modern diets often have a higher ratio of omega-6 to omega-3, which can contribute to inflammation and other health issues.

Regarding your second topic, "Hormonal Harmony: Understanding the hormonal changes that support or hinder lactation", what are neohormones and how is lactation affected by them?
Neohormones are hormones that are involved in mammals' fertility and reproduction. They include ALL of the hormones associated with lactation, including oxytocin, prolactin, progesterone, and relaxin. In regards to lactation, neohormones help facilitate the development and preparation of the mammary gland and the production of human milk.

What kind of remodeling happens in the brain during lactation? What happens to the brain if there's a birth but no lactation?
Lactation induces significant neurobiological changes in the brain, crucial for supporting maternal/parenting behaviors and the physiological processes involved in human milk production. Some key changes include:
Hormonal Modulation: Increased levels of prolactin and oxytocin, hormones critical for milk production and ejection, also play roles in maternal bonding and stress reduction.
Neuroplasticity: Structural changes in certain brain regions, particularly the hypothalamus, amygdala, and prefrontal cortex, occur. These changes enhance maternal/parental behaviors, such as nurturing and protecting the offspring.
Increased Neuronal Activity: Enhanced activity in areas responsible for caregiving and social behaviors and emotional regulation.
Gray Matter Volume Changes: Increases in gray matter volume in regions associated with maternal motivation and caregiving behaviors and pruning of neurons that hinder maternal focus.
Brain Changes in the Absence of Lactation
When there is a birth but no lactation, the brain undergoes different changes due to the lack of the hormonal and neuroplastic stimuli provided by lactation. Some of these changes include:
Hormonal Shifts: Lower levels of prolactin and oxytocin compared to lactating mothers. These hormones not only facilitate lactation but also play roles in mood regulation and stress.
Reduced Neuroplasticity: Without the stimuli provided by lactation, the brain may not undergo the same extent of neuroplastic changes, particularly in regions related to maternal behavior and caregiving. This includes activation of over 500 genes, epigenetics action specific to mothering behavior.
Increased Risk of Postpartum Depression: Studies suggest that lactation can have a protective effect against postpartum depression due to the release of oxytocin. Mothers who do not lactate may have a higher risk of experiencing mood disorders.
Different Adaptation Strategies: Parents who do not lactate might develop different neural adaptations and coping mechanisms for maternal/parental care and bonding, which can vary significantly based on individual and environmental factors.

Can you share with us ways to increase the love hormone oxytocin in our every day lives?
Oxytocin, the "love hormone" or "bonding hormone," plays a significant role in social bonding, sexual reproduction, childbirth, and the period after childbirth. Here are several natural ways to increase oxytocin production:
1) Physical Touch:
Hugging and Cuddling: Physical contact with loved ones
2) Massage:
Receiving or giving a massage
3) Holding Hands:
Simple acts of touch, like holding hands
4) Social Interactions:
Spending Time with People You Love: Positive social interactions, such as spending time with family and friends
5) Acts of Kindness:
Performing acts of kindness, generosity
6) Physical Activities:
Exercise: Regular physical activity, particularly exercises done in groups
7) Yoga and Meditation:
Practices that promote relaxation and stress reduction, such as yoga and meditation
8) Positive Interactions with Animals:
Petting Animals: Spending time with pets can stimulate oxytocin release, especially with dogs, as they have large, dark pupils that facilitate a feeling of connection and facilitate oxytocin release.
9) Mindfulness and Stress Reduction:
Meditation and Mindfulness Practices: These can help reduce stress and promote relaxation
10) Deep Breathing Exercises: Practicing deep, slow breathing can also promote relaxation.
11) Diet and Supplements:
Healthy Diet: Consuming a balanced diet rich in fruits, vegetables, and lean proteins can support overall hormonal balance
12) Magnesium-Rich Foods:
Foods high in magnesium, such as dark leafy greens, nuts, and seeds
13) Vitamin D:
Ensuring adequate vitamin D levels, either through sunlight exposure or supplements
14) Positive Emotional States:
Laughter and Joy: Engaging in activities that make you laugh and bring joy
15) Listening to Music:
Enjoying music, especially in social settings

Some people call menopause the second adolescence. What do you think about this?
Menopause is often referred to as the "second adolescence" due to the profound hormonal changes and their wide-ranging impacts on the body and mind, similar to the transformations experienced during adolescence. Here are the key reasons why menopause is likened to a second adolescence:
Hormonal Changes
Decline in Estrogen and Progesterone: During menopause, there is a significant decline in the production of estrogen and progesterone, similar to the hormonal surge and subsequent regulation seen in adolescence.
Hormonal Fluctuations: Just as adolescents experience fluctuating hormone levels that can cause mood swings and physical changes, menopausal women often face irregular hormone levels leading to symptoms like hot flashes, night sweats, and mood swings.
Physical Changes
Changes in Body Composition: Adolescents experience rapid growth and changes in body shape, while menopausal women may notice changes in weight distribution, loss of muscle mass, and an increase in abdominal fat.
Skin and Hair: Both stages can bring changes to the skin and hair. Adolescents may deal with acne and oily skin, while menopausal women may experience dryness, thinning hair, and wrinkles.
Emotional and Psychological Impact
Mood Swings and Emotional Sensitivity: Hormonal changes can lead to increased emotional sensitivity and mood swings during both adolescence and menopause.
Identity and Self-Perception: Adolescents are forming their identities and self-perceptions, while menopausal women may reassess their identities and roles as they transition out of their reproductive years.
Social and Lifestyle Changes
Changing Roles and Responsibilities: Adolescents are preparing for adult roles and responsibilities, while menopausal women often experience changes in family dynamics, such as children leaving home (empty nest syndrome) and caring for aging parents.
New Phases of Life: Both stages mark the transition into new phases of life, with adolescents moving towards independence and adulthood, and menopausal women often moving towards retirement and later life stages.

At what age can pre-menopausal symptoms start and what are these symptoms?
They can start in mid 30’s, though most commonly around age 42 and can last upwards of 10 years. Symptoms include:
Irregular Periods: Changes in menstrual cycle length, flow, or frequency.
Hot Flashes: Sudden feelings of heat, often accompanied by sweating.
Night Sweats: Hot flashes that occur during sleep, causing sweating and discomfort.
Sleep Problems: Difficulty falling or staying asleep, often related to night sweats.
Mood Changes: Increased risk of mood swings, irritability, anxiety, or depression.
Vaginal Dryness: Decreased estrogen can lead to dryness, discomfort, or pain during intercourse.
Decreased Libido: Reduced sexual desire or arousal.
Urinary Issues: Increased frequency, urgency, or incontinence.
Weight Gain: Changes in metabolism may lead to weight gain, particularly around the abdomen.
Breast Tenderness: Soreness or swelling of the breasts.
Memory Problems: Difficulty with concentration and memory.
Hair Changes: Thinning hair or increased facial hair.
Joint and Muscle Pain: Generalized aches, pains, and stiffness.
Fatigue: Persistent tiredness not alleviated by rest.

Can (pre) menopausal symptoms cause trouble during lactation?
Yes, women develop estrogen dominance during perimenopause and/or develop an imbalance in the estrobolome, which can lead to heightened levels of estrogen. This can impact milk supply during lactation.

Can (pre) menopausal symptoms cause difficulties when parents are trying to conceive?
Here are just some of the issues related to perimenopuase and fertility:
Irregular Ovulation: One of the hallmark features of perimenopause is irregular menstrual cycles, which are a result of inconsistent ovulation. This makes it more challenging to predict ovulation and, consequently, to time intercourse for conception.
Decreased Number of Viable Eggs: As women approach menopause, the number and quality of their remaining eggs decrease. This decline in ovarian reserve reduces the likelihood of successful conception.
Hormonal Imbalances: The levels of estrogen and progesterone fluctuate during perimenopause, affecting the endometrial lining's ability to support a pregnancy and making it harder for an embryo to implant and develop.
Shorter Luteal Phase: The luteal phase (the time between ovulation and the start of the next menstrual period) may become shorter, which can affect the ability of the uterine lining to support implantation and early pregnancy.
Changes in Cervical Mucus: Hormonal changes can affect the production and consistency of cervical mucus, which plays a crucial role in facilitating sperm's travel through the cervix to meet the egg.
Uterine Changes: Changes in the uterus, such as fibroids, endometriosis, or a less receptive endometrial lining, can also hinder implantation and the ability to sustain a pregnancy.

How can women relief menopausal symptoms?
This all depends on the symptoms and the hormonal issues that they are experiencing. Women should seek care from a certified menopause practitioner and have their hormone levels checked. They may be a candidate for Menopause Hormone Therapy. If possible, work with a certified menopause health coach to support lifestyle changes.

Are there reliable resources for information regarding menopause? Can you share with us some of them?
International Menopause Society https://www.imsociety.org/
North American Menopause Society (NAMS) - Focused on Providing Physicians, Practitioners & Women Menopause Information, Help & Treatment Insights http://menopause.org/

Regarding your third topic, "Promotion of lactation in a digital world", what is the main source of information for this generation of parents?
It depends on whether you are referring to millennials or Generation Z. Generation Z tends to consume social media on Instagram, Tik Tok, Snapchat, and YouTube. Millenials tend to consume primarily Instagram, Pinterest, Facebook and to a lesser extent You Tube and Tik Tok.

What is the relationship of new parents with social media?
Almost all new parents are avid social media consumers, consuming nearly 3 hours of social media content per day and up to 5 hours of video content daily.

How can social media affect parents' decision on how to feed their babies?
Parents now get the majority of their information online, including social media. This means that many are consuming information about how to feed their babies from companies that can afford to pay influencers and pay for social media marketing. It has a great deal of influence on today’s parents.

How can parents tell if a social media source is reliable or not?
That is diffcult to ascertain. I would start with recognized health professionals and respected organizational social media pages.

What about information sources regarding breast/chestfeeding or influencers, sponsored by companies producing or selling formula? How can parents and health care professionals understand if they are being manipulated?
If the posts are being sponsored by a company, any company, the influencer has been “influenced” through payment or free product. All infant formula social media site are breaking the Code and cannot be trusted.

Can you share with us a story or a final message about the importance of the promotion of lactation in our digital world?
It is vital that we as lactation professional communicate with new parents in the places that they are seeking information, which currently is on social media. If they can’t find us there, we are invisible to them as a profession.

Thank you for your time and knowledge Laurel!
We are grateful for everything you shared with us.

Laurel Wilson Bio