Weight loss While Breastfeeding with Dr. Sarah Stombaugh

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week I am joined by Dr. Sarah Stombaugh to discuss postpartum, breastfeeding, and weight loss.

Dr. Sarah Stombaugh is a family medicine and obesity medicine physician in Charlottesville, Virginia. Dr. Stombaugh grew up in central Illinois. She attended undergraduate and medical school at Creighton University in Omaha, Nebraska. She and her husband couples matched at the University of Chicago for their residencies in family medicine and anesthesiology, respectively. During residency training, Dr. Stombaugh pursued an Obesity Medicine Track and completed the requirements to sit for the American Board of Obesity Medicine. 

After residency, Dr. Stombaugh practiced outpatient family medicine with NorthShore University Health System for three years. In 2021, Dr. Stombaugh moved with her family to Charlottesville, Virginia for her husband’s job at the University of Virginia, where he practices in cardiothoracic and critical care anesthesiology. Dr. Sarah Stombaugh took the opportunity to open a private practice weight loss clinic. She has a clinic in downtown Charlottesville, Virginia, but primarily sees patients by telemedicine, which allows her to see patients both in Illinois and Virginia. Outside of clinic, you will find her enjoying time with her three young children Jack (5), Max (3), and Eddy (11 months).

0:00 Welcome back! Guest Intro
16:40 Dietary Emphasis for Postpartum
20:49 Insulin Resistance During Pregnancy
22:58 Weight Loss Timing and Challenges
23:47 Impact of Breastfeeding on Weight Loss
25:02 Breastfeeding and Milk Supply
30:09 Personal Experiences
30:55 Key Points and Advice
31:30 Closing Remarks and Contact Information

Connect with Dr. Stombaugh 
Podcast: https://www.sarahstombaughmd.com/conquer-your-weight-podcast
Website: https://www.sarahstombaughmd.com/
TikTok: @ConquerYourWeight

Connect with Dr. Kerry Reller
My linktree: linktr.ee/kerryrellermd
Podcast website: https://gethealthytbpodcast.buzzsprout.com/
Facebook: https://www.facebook.com/ClearwaterFamily
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Clearwater Family Medicine and Allergy Website: https://sites.google.com/view/clearwaterallergy/home

Subscribe to the Get Healthy Tampa Bay Podcast on Apple podcasts, Spotify, Amazon music, iheartradio, Stitcher, Google Podcasts, Pandora.

#postpartum #postpartumhealth #motherhood #breastfeeding #weightloss #weightlossafterpregnancy

Transcript

Kerry: 0:28

Hey, everybody. Welcome back to the get healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller and today we have a special guest, Dr. Sarah Stombaugh. Why don't you tell us a little bit about who you are and what you do?

Sarah: 0:41

Yes. Thank you so much for having me today. Dr. Reller. I am a family medicine physician by training, and I also do obesity medicine. For the last couple of years, I had been practicing completely in the obesity medicine world. I have a private practice weight loss clinic in Charlottesville, Virginia and I help patients who are struggling with their weight and looking forward to some evidence based medicine in order to lose weight and ideally keep it off long term. And one of the areas that has become most interesting to me is how to lose weight while breastfeeding, because I've met many patients and even friends and family who've reached out to me because they hear the story of I should be just having the weight fall off, after you have a baby, the best thing to do is breastfeed the way it'll just fall right off. And that can certainly be the experience for some people, but for other people, they find that that's not the experience or they actually even gain weight during that breastfeeding period of time. And so I love to support patients around how to lose weight during that breastfeeding time in order to help reachieve their weight and their health.

Kerry: 1:50

Yeah. Awesome. I was thinking maybe we should say what is the normal weight gain in pregnancy? So what is expected to be lost? Like you're supposed to go back to your prenatal weight. What does that mean?

Sarah: 2:01

Yeah. Pre pregnancy.

Kerry: 2:03

pre pregnancy weight. Thank you. So can you talk a little bit about that?

Sarah: 2:07

Yeah. Absolutely. So I think supporting women during their pregnancies in order to make sure that they are achieving healthy weight gain, that's going to be dependent on your body weight going into pregnancy. So I always recommend to my patients that they talk to their OB GYN specifically about how much weight that they should gain. And that's going to be, you know, for most women we're talking about 20 to 35 pounds, depending on their weight. And if someone's struggling with obesity prior to pregnancy, they may even have a lower weight gain threshold, but there's other things that impact it. We know that if you're having twins, you should be gaining more weight. And so I do always say to my patients, Hey, go to your OB GYN and ask them how much weight should you gain during pregnancy. And then in losing that weight, a good rule of thumb is that the amount of time it took you to gain the weight is the amount of time that it may take you to lose the weight. And so we gain the weight over nine months. And it's really, you know, we should not be thinking about any sort of crash diet, any sort of, let's get this weight off in a month or two months. This is likely going to take the better part of a year for some people, more for some people, slightly less, but making sure that you have realistic expectations that it's going to take at least nine months to get that weight off.

Kerry: 3:18

Yeah, I think that is definitely important, setting those expectations. I think some people think that they're just, you know, the baby's out, the weight is going to go back to normal, but usually the baby's what, like six pounds to eight pounds and there's placenta and then some fluid and you might lose like 10 pounds, but the rest of the weight is still there.

Sarah: 3:38

Yes.

Kerry: 3:39

So a patient comes to you and they're wanting to breastfeed and are able to, and then they are also wanting to lose weight at the same time. How do you start approaching that?

Sarah: 3:50

So it will depend where they are at on their breastfeeding journey and how far they are into their postpartum period. So it's really important that in the first few months that you're really not thinking about weight loss at all. You want to be making sure that you are building your breast milk supply and that you're doing anything to protect your breast milk supply. But one thing you can be really intentional about really that first 12 weeks. So that first, you know, the fourth trimester, as we sometimes hear it called, that is the period of time your body is learning how to make breast milk, learning the amount that it needs to make your body doesn't necessarily know, did you have one baby? Did you have two babies? And so based on how much you're feeding your child every day, breastfeeding is a supply and demand. You are getting the signal of how much milk to be producing. So at that very beginning, you don't want to be doing anything to mess that up. So what we do need to be thinking about even during that time is though, let's not go crazy gaining weight because that could be a time where some weight can increase. And so that can be something to be cognizant of, making sure that we are maintaining our weight through that period of time. And then after that 12 week mark that we can start to implement some measures specifically towards weight loss. I think one of the biggest things in the postpartum period is that we really need support. We are a lot of times eating just kind of quickly. You can be really ravenous during breastfeeding, regardless of what your weight looks like. We know that prolactin, that's the hormone that drives breast milk supply makes us really hungry, and it wants to encourage us to eat so that we can make plenty of breast milk. And when you are feeling ravenously hungry at all hours of the day, it's really easy to just grab convenience foods. So grabbing, even if it's a granola bar, breastfeeding, you know, all those lactation cookies that are out there. Those seem like really easy things to grab, and they certainly are, but sometimes we end up really having a huge amount of processed food in our diet, even when we're talking about just sugars and flours. And so making sure that we are having good support to have easy things that are also nourishing, really delicious, and that are not going to be overly processed in order to help support our weight. So a lot of times if you have someone who is helping you, whether that's your partner, your mother or mother in law or sister or friend or someone who is coming over that they can help to make sure that you're getting lots of nourishing energy with real foods, that is going to be really, really important.

Kerry: 6:19

I like that with the support. One of the best things that my mother ever did was come and make us Food like a lot of it so we could freeze it for later. And then we would have, you know, real homemade meals. So I thought that was really important as well. So you're eating nutritious food. And sometimes I feel like People take that pregnancy and breastfeeding are a permission to quote eat whatever you want and I think that is sometimes not a good idea, obviously, but end up creating you know more weight gain. Gain and depending on what you're eating then it could be making a risk for the baby to like, if you're eating more sugar and processed foods, like you mentioned, and breastfeeding sometimes is the same thing. You feel like sometimes people get that perception where they can have permission to eat whatever they want cause, oh, you know, you're going to burn all those calories, but sometimes that's not so true. So what do you have to say about that? I think you mentioned like the actual calorie comment.

Sarah: 7:16

So I think the most important thing is thinking about your mindset around that. And so having some support to say, okay, like how many calories does it actually take to support a baby? How many calories does it actually take to support a breastfeeding relationship? And the interesting thing is It can be really variable, and it's usually not as much as we think. So during pregnancy, sometimes we're talking about like an extra 200, 300, 400 calories per day. It's not really a huge amount. The equivalent of one or two more apples per day is going to get you typically all of the extra calories and energy that you need for pregnancy. And in breastfeeding, that actually can be slightly more. So a rule of thumb I like to use is When we look at the calorie content of breast milk, so there's about 20 calories in a ounce of breast milk. And so if you are breastfeeding your baby 30 ounces, so the average breastfed baby is taking 24 to 30 ounces per day. If they're just getting breast milk, if you multiply that out, we're talking about like up to 600 calories. So 20 calories per ounce, 30 ounces per day that you're producing, that's going to take about 600 calories. That's the amount that's in the milk, but it takes about a similar amount of energy for your body to make it. And so you can look at that in the short term but as that changes, whether you're doing some formula supplementation, or as your baby starts to take food, they may need less breast milk and therefore you're going to need less calories to support that. And I tend to think about foods, not as good foods or bad foods, but what are the things that helped you nourish my body and help me to meet my health goals? And so wherever you're at in life, whether that's pregnancy, whether that's breastfeeding or whether that's somewhere else, your goals may be different and that may mean different foods that you're trying to incorporate and different liquids and making sure, I think that's the biggest thing in breastfeeding, but maybe not the biggest, I don't know, we could debate about it. Making sure you're getting nourishing foods and making sure you're getting plenty, plenty, plenty of liquid. A lot of breastfeeding mothers should be drinking up to a gallon of water per day if they are producing a full supply so that 30 ounces of breast milk, and that's a lot of like a lot of fluid to take in.

Kerry: 9:33

It is a lot of fluid, but I mean, when you're breastfeeding, it increases that thirst too. So I feel like it isn't as hard to get the fluid in because you're actually wanting to drink too and we usually, I remember like would always recommend, carrying water or at the bedside when nursing or pumping or whatever you're doing of having water with you. I like all the time. Cause it, I think as soon as you start lactating or, you know, with the stimulation the increase in thirst happens. Is that right?

Sarah: 10:03

Yeah, no, that's exactly right. And the important thing there is because our thirst and our hunger signals can get a little misinterpreted within our body, making sure that we are addressing our thirst as a priority can be really important for helping to mitigate hunger. You are still going to be hungry, but if you were thirsty first, make sure that you're really addressing that. And like you said, having that water or whatever other liquid that you're having, having it available. Sometimes we're tired and it's like, Oh, I just don't want to get out of bed. And so if you don't have that water sitting on your nightstand, you might not be drinking it and so have that water following you around the house is really important to make sure that you are getting that water in.

Kerry: 10:44

While we're on the topic of hydration, I know we obviously want to get you nutrition, but I wanted to bring in exercise because one thing that I suffered, cause I still continue to run and everything, but I would still be breastfeeding and I would get the worst cramps when I ran like at the end of my run or whatever it was like way more than I used to so I actually started having to bring hydration like with me on my runs and definitely electrolytes and stuff too. And I mean at that point you know I was safe to run and everything like that but all that breast milk production makes you more hydrated so you've really got to stay on top of it when exercising. So since we're talking about exercise, how would you incorporate exercise into a postpartum?

Sarah: 11:27

I would say, from an electrolyte standpoint, though, I do want to touch on that because making sure that we're getting plenty of electrolytes, whether you're talking about, I mean especially if you're talking about exercise, but even just in general, so that might mean mixing in a little bit of Gatorade powder, adding a little bit of extra salt, adding a little bit of extra potassium. A trick that I often use is Morton's mixes salt substitute for patients who are trying to decrease salt in their diet for hypertension, high blood pressure, and that is actually. Yeah, Morton. Yeah. Sorry, Morton. And that salt substitute is actually potassium. And so you can mix a little bit of that in mix a little bit of salt in and that can be a really excellent way to support your hydration to make sure that you are both getting plenty and repleting because when you're making breast milk, you are putting in salt, you're putting in potassium, you're putting in all of these different electrolytes in order to support your breast milk and to support your baby. So you need to make sure you're taking those as well. You can certainly get those from food, but make sure that you're getting those from your fluid. And then in terms of exercise with in the postpartum period, it needs to be something that you're starting slow and gradually building. So a lot of times people talk about getting exercise clearance at six weeks postpartum. There's no reason you have to wait to six weeks postpartum to start some really gentle movements. And when I mean that, I mean in the first couple of weeks, you're walking around the house, helping to move and you're still a lot of times swollen after having a baby. And so helping to get those fluids moving, get them out of your legs, if you're feeling swollen. I am someone who gets really swollen during pregnancy. So I literally will have like 10 pounds of fluid weight and so it's fun to watch that weight disappear. And you can help to encourage that by walking around, even just your house. And so by six weeks postpartum that you are feeling comfortable carrying your baby, that you are walking around the block, that you're really intentional about positioning. So a lot of people put themselves in a position where, they're breastfeeding, they're like hunched over and they will do absolutely anything to breastfeed their baby, and they end up causing all sorts of knots and they create problems that are still a problem for them months down the road. So that first couple of weeks, those first six weeks, really good time to start really gentle movement and then make sure you don't make anything worse. And then at your postpartum visit, it's really important to have a conversation with your OB GYN about any issues in terms of your pelvic floor. So are you having issues with your bladder? Are you having issues with your rectum? Are you with your uterus? We know that the organs of the pelvic floor, The muscles there can become lax during pregnancy. The childbirth itself can really stretch those out and there may need to be some strengthening that happens. So I honestly encourage all of my patients to participate in pelvic floor physical therapy and that can be such a good way then to learn. What is the strength of my pelvic floor? Can I start engaging in more intensive cardio, like running, which when you're pounding, if you don't have a good, strong pelvic floor can be really challenging to do that. Is it safe for you to be doing resistance type exercises like weightlifting? It can be hard to know until you've had a good assessment. And so I feel strongly that honestly, every single woman should have a pelvic floor physical therapy appointment just to assess. And then maybe depending on how significant their pelvic floor issues are, that may be an ongoing relationship over the next few months to help heal their pelvic floor so that they can participate in exercise.

Kerry: 15:06

I absolutely agree. I also encourage everybody to do pelvic floor PT after child bearing or anything like that. I did it myself and I was, you know, a great experience. I will say I was a terrible patient because I think

Sarah: 15:19

Yeah.

Kerry: 15:19

you're not quite ready to run. And I still went running. I'm like, are you sure? I know I shouldn't run, but yeah, I'm running. Sorry.

Sarah: 15:26

Yeah,

Kerry: 15:27

no, I really do encourage it for my patients as well. So I completely agree with that. Before we go away from exercises is there anything else you wanted to say on that.

Sarah: 15:37

I think paying attention to your sweat during exercise, if you are breaking up a sweat, that's going to mean more hydration, more electrolyte repletion. So just make sure that you're really cognizant of that. Exercise is going to increase your appetite as well, which is fine. We know that's part of the normal physiology. When you burn more calories, you are going to be hungry to take in more calories. And so having a good plan that the foods that are readily available to you are going to be nourishing. Things that are going to support your health goals so that you're not coming home and finding yourself unwinding into food that you didn't really mean to eat, you know, any sort of processed foods, cookies, chips, that type of thing that can be really readily available.

Kerry: 16:19

I mean, I know that the easiness of those foods, make them really attractive, right? So it's hard to not to want to do that. But I think one of the things you obviously were focusing on was avoiding the processed foods and things like that. So where do you counsel on nutrition, I guess, in the breastfeeding period?

Sarah: 16:40

From a dietary perspective, I like to emphasize a diet that is high in healthy fats as well as high in fiber and then emphasizing protein as much as we can and trying to make sure that you're choosing basically real foods that are going to help you feel nourished that are going to help you feel satiated. We know that fiber is really important for satiety. We also know that fats and proteins are really important for satiety. You want to have a good balance of those throughout the day in order to make sure that you're feeling full from your food, that you're feeling energized from your food. So I often encourage my patients to make sure that they are emphasizing plenty of fat. I think all of those who grew up in the nineties, the early two thousands, low fat era, we are still sometimes afraid of eating fat in the diet. And that doesn't mean that you need to be eating fat left and right, that you should be eating fried foods. We know that there's lots of different types of fat. Then we talk about healthy fats. We talk about fish fat that comes from fish, from olives, olive oil, avocados, any type of nuts and seeds. Those tend to be fats that are really good in or high in unsaturated fats, which are really excellent for promoting our health. And those fats play a really, really important role in helping us to feel full and stay full long. Protein provides the same satiety for us. And so making sure that you're getting that fat, making sure that you're getting the protein. And when you're choosing carbohydrates to choose ones that are in their whole form. So I mean, any whole fruits and vegetables, any completely whole grain foods or things like oatmeal, grains, like whole brown rice or quinoa or farro, bulgur, any of those types of things that are providing us some really good fiber. It also supports good bowel movements, which especially in that postpartum period, I mean, everyone needs to have good bowel movements, but especially in that postpartum period, if you're healing and recovering from a vaginal delivery, or even from a C section, you don't want to be dealing with any sort of constipation issues so emphasizing that fiber in the diet can be really valuable. It is important to know, I don't usually prescribe a specific diet for my patients. I pay attention to what they're already doing and then we start making tweaks under the guidance of that. So lots of healthy fats, emphasizing protein, emphasizing fiber. And with those emphases in our diet, we can a lot of times help someone to support what they're already doing rather than trying to give them a cookbook of, Oh, you should eat salmon and Brussels sprouts for every meal. If they hate salmon and Brussels sprouts, you just gave them totally useless advice. And so helping them to fit in a regimen within what their preferences are with what they're already doing is really, really valuable. In terms of a specific diet, sometimes people are really like, okay, I want a name for my diet. I want to do the keto diet or the Mediterranean diet or anything. We know that plenty of those diets can help support weight loss. One thing we do know though, is that ketosis is not recommended neither during pregnancy nor breastfeeding. So ketosis can be dangerous in breastfeeding that can put women in a situation where they actually go into acidosis, which can be a serious or life threatening condition. And so it's okay to have a high fat diet. It's okay to have a low carbohydrate diet, but not like a no carbohydrate diet. So carbs are good. Lots of fiber, lots of veggies, lots of fruits, lots of whole grains, but there's no reason to go full blown ketogenic diet. And you should not do that if you're breastfeeding. So I do counsel against that.

Kerry: 20:13

Yeah, I definitely would not recommend that either. So I have been reading some things and part of it has been the description of pregnancy kind of being that survival state, like foraging and creating insulin resistance in the body on purpose. So technically pregnancy is a state of insulin resistance, and I think that also may explain why it's supposed to take time or longer time to lose the weight by more like a year, like you said have you heard or read or anything about that? Or

Sarah: 20:49

So a lot of it is very driven by progesterone. So progesterone, which is highest during pregnancy really supports this insulin resistant state, which is important because that means that we have higher levels of blood sugar that can promote the growth of our babies. So it's really important to have that, but being a little bit insulin resistant is different than being hugely insulin resistant. And I think that's where we sometimes get a little bit caught up in terms of what is. Just because you are doesn't mean you just need to, like, throw yourself fully into that state. And so I think that's just an important thing to point out, making sure that you're not going overboard with some of the flour and sugar and processed foods in that way. In terms of the weight loss during breastfeeding, the hormonal state is quite a bit different, but it is It's really a very low hormone state. The progesterone can still be high. The estrogen is low, though. Low, low, low. And so with that, that actually promotes an insulin resistant state as well, which can contribute to some of that holding on to weight. And you have to remember... It's physiological to both gain weight during pregnancy as well as to hold on to weight because that's what we need to make sure that we do have enough energy and a fat stores on our body in order to make breast milk. The thing is in the society that we live in, we're surrounded by all these foods. It's easy for that physiology that's supposed to support us end up being a situation where it ends up sort of hindering us because we are more insulin resistant than we really need to be. And so as breastfeeding decreases, most people will find that that is a time where it's easier for them to lose weight. The hard thing though, is that the longer you've held on to weight, sometimes the harder it is for your body to start letting that go. And that's other hormonal adaptations in terms of our, GLP one and all this stuff that we're starting to talk about in terms of our body's recognition of hunger and satiety and metabolic set point. And so there's a close balance there of making sure that you're getting all of that energy and seeing that it is going to take time, but letting it sort of come off slowly, a lot of times that the rate at which it came on.

Kerry: 22:58

I really like that answer. I think that's the timing part is super important. It's not like you said, you don't want to be in ketosis. You don't want to do a crass diet. You probably don't want to be fasting and real natural whole foods are what is going to benefit you and your child. Cause some of the nutrients and everything that you're eating are being passed on to the baby while you're pregnant and when you're breastfeeding.

Sarah: 23:20

And there's actually really interesting studies that show the variety of food that a pregnant woman, you know exactly what I'm gonna say. The variety of food that a pregnant woman had or eats during breastfeeding, that some of those food flavors, I don't fully understand it, are passed down such that it can be predictive of a child's future palate, which I think is just wild. And a reason to make sure that you are getting a variety of different things, both during pregnancy and breastfeeding.

Kerry: 23:47

I like to think that's why my kids love salmon and broccoli, unfortunately, I think earlier on, like I had three children as well and breastfed them all up until like, gosh, I guess it was technically like less than two years ago, year and a half ago. And I don't even remember it goes by so quick, but I was, you know, guilty in I had trouble keeping supply with my first one. So I did dabble in the, what was it? You said the lactation cookies, right? I never bought any. I don't even know if they were available to purchase then, but I did make them and one of the magic ingredients is that brewer's yeast. But it still probably was not benefiting me to be consuming all of that. And I think I. kind of did have that mentality I was talking about before. It was like, Oh, it's permission. You know, I need to eat this to have milk supply. And it even got me introduced to a new flavor of Ben and Jerry's that I don't remember because it was delicious because it had oats in it, right? Oats were supposed to also increase the milk supply. So I don't know. I just had brought up some of those supplements in case, what is the risk of if you're losing weight, maybe not intentionally a little faster, what's the relationship with the milk supply are they going to lose supply if they're losing weight? Like, what would you say for all of that?

Sarah: 25:02

It depends on the person. So I think a lot of the very sort of traditional diets that people go on where it's like, okay, I'm going to decrease 400 calories per day and I'm going to be in this state where I'm depriving myself and therefore I'll start to lose weight. People very commonly, when they enter that type of diet, will see that their breast milk supply starts to decrease. Some people are going to experience at different levels so the best advice I can give you is just to pay attention in terms of what your breast milk supply is doing. Are you noticing that there's any decreases? Usually two or three days is not going to cause a long term issue. So if you've implemented something, you're saying, Oh wow, my breast milk supply is starting to decrease here. That's reversible. You can go back to what you were doing before, and you're not going to have caused the long term damage. So I see the exact opposite thing to be true that you were kind of alluding to with yourself. And I totally did this for my first was that I was starting to have issues with my supply and I was like, I will do anything, right. It's not even like lack of knowledge, it's just like mom guilt of it doesn't even matter. Like I would gain a hundred pounds if I could breastfeed my baby. Like if I could be able to provide this for them. I remember feeling so much guilt when my breast milk supply was not adequate for my baby. And I would have literally, and most women are in this situation, eaten anything, done anything to drive up that supply. And what I have learned is that the most important thing hands down for breast milk supply is supply and demand. So we know that when the baby empties breast milk from our breast or whether we're pumping the amount of milk that we remove from our breast sends a signal back to our brains, back to our body, that this is the amount of milk that you should be producing. And so what often happens is that babies will start to sleep through the night, for example, and, or we're sort of forcing them to sleep through the night if we're doing sleep training, not a big deal to be sleep training, but if that's a period of time where your body should have been emptying breast milk, and it's not you're going to start downregulating your breast milk production. So it's really common with things like sleep training, when women go back to work and you're pumping exclusively instead of feeding the baby, it can be harder to make sure that you're carving out the appropriate amount of time to be able to do that. Maybe you don't even have your employer support to do it. I remember having 20 minute breaks to pump, which really just wasn't quite enough when you're talking about maybe 20 minutes of actively pumping would have been enough for me. But when you're talking about sort of sitting down, get everything set up, getting things put away and cleaned up afterwards, 15 minutes of emptying your breast, it's not really quite enough. And so pay attention to that. One of my biggest advice for anyone is like, there is no amount of food. No amount of calories, no amount of lactation cookies, no amount of anything that is going to make up for not emptying your breast adequately. So that might mean that you are pumping before you go to bed. That might mean that you pump in the middle of the night. I remember being told that and being like, do I have to? no, you don't have to, but your breast milk supply may decrease as a result of that. And so really being cognizant of that, because all of those times where you start to see your supply decreasing for other reasons, we blame it on the fact that we're losing weight, but the reality is it may be related to just not simply emptying our breasts enough. And for most women, they need to be emptying their breasts every three to four, maybe five to six hours if you have a large storage capacity, but very few people can sleep even eight hours overnight without emptying their breasts and not seeing that impact their supply. And so just make sure, if you are feeling a little bit confused by this, it's not something easily we can talk about in two or three minutes or over the course of this podcast. But to sit and talk with a lactation consultant, I didn't even know that breastfeeding medicine was a field of medicine. A lot of pediatricians or OB GYNs or family medicine physicians like you and I will also train in breastfeeding medicine. So someone like that can be a really excellent support, but make sure that you are emptying your breast adequately, and that is going to be the best thing that you could do in order to protect your supply, and you might find that the weight loss actually isn't even impacting your supply as much as not emptying your breast enough.

Kerry: 29:30

Yeah, those are definitely very important tips. And I mean, I guess if I'm going to throw in a personal experience, when I was a resident, it was when I had my first child. And they obviously didn't give me enough time as what I needed, like in the clinic setting to pump properly. And I was extremely slow. And I think I was on a dealer pump, but then the next one's it was on a spectra. And I think if had the Spectra, maybe it would have been better, but I also think it was the stress, right? The stress did not help that effort of pumping either. So the stress and lack of time. It was harder to keep up the supply for that, but that's just my own personal journey.

Sarah: 30:09

Well, but we know that stress makes it harder to induce your let down. And so when women are breastfeeding, but when they're pumping, especially, and you're trying to like run around from clinic and then just like plop down and throw in your pumps quickly, it's hard to find yourself in that relaxing state where your body can actually do that. And so, yeah, family medicine residency is residency is challenging. So it's hard to, to go back. But for a lot of people is that, yeah, we made it right. And you go through and pull up pictures of your babies, videos, things that are going to help connect you to them can help to induce that letdown. But yeah, you need to have adequate time to be able to do it.

Kerry: 30:47

Yeah. Well, what else do you want to talk about? Or do you think we covered most everything you wanted to mention on breastfeeding and weight loss?

Sarah: 30:55

Yeah. No, I think we covered it, but I will leave you with these three points. One, everyone makes sure you're drinking enough, like a gallon of water per day if you are breastfeeding a full supply, two make sure that you were eating whole foods as much as you can. And three, make sure that you are emptying your breast adequately to keep up the supply and demand that is the breastfeeding relationship. And that will help protect your breastfeeding supply more than anything else from a calorie standpoint.

Kerry: 31:23

Perfect. Well, thank you so much for being on the podcast. And how can people find you if they want to know more about you or work with you?

Sarah: 31:30

I am licensed in Virginia, also in Illinois, where I see patients by telemedicine. So the best way to reach me is at sarahstombaughmd. com. It's S A R A H S T O M B A U G H M D. com. Should have also given you the domain conqueryourweight, which I also own. And I have a podcast also called conquer your weight podcast. So if people are interested in learning more specifically about weight loss, I would love to have them join me over there to hear about that.

Kerry: 31:58

I was in fear that you weren't going to mention your podcast because I listen to your podcast. I think you have the nicest,

Sarah: 32:06

gentle Well, thank you.

Kerry: 32:07

voice and it's so easy to listen to. But no, yeah, she has a great podcast. Everybody please check it out. Thank you for listening today and tune in next week for next week's topic.

Sarah: 32:18

Yeah. Thanks for having me, Dr. Reller. Take care.

Kerry: 32:20

Thank you for coming!