underweight

Question
I'm a 27 year old new mother. pre pregnancy I weighed 120lbs and was fit. (I am 5'6) I worked out through my entire pregnancy. I only gained 16lbs but gave birth to a healthy 6lb 6oz boy. I began nursing right away and have continued to do so for now 7 months. 2 weeks after my son was born I was down to 105lbs. I am now up to 110 but have recently started birth control again. I am always tired but eat all the time. Im a teacher so I snack at my desk throughout the day. I drink 2 ensure shakes in the morning, snack on granola bars, cheese sticks, veggies, nuts. I have veggie or chicken soups for lunch then snack on oatmeal. I usually eat a beef or fish dinner with pasta. All that and I still can not gain weight. I'm afraid that its affecting my ability to produce milk and causing me to feel run down and irritable. What can I do? I feel like I am eating pretty healthy and still no weight gain.

Answer
First of all, kudos on your decision to breastfeed and for sticking to it for so long!  Breastfeeding is not for everyone, but I am sure you know studies have shown breastfeeding has health benefits for both the mother and the baby.

I will give you two answers to your weight gain question because there are two popular schools of thought on the subject.  The first school of thought is to increase calories however possible, mostly by eating the opposite of what people trying to lose weight are advised to eat.  Suggestions would include: eat cheeseburgers, drink whole milk, add butter and mayonnaise to everything, have shakes for snacks, leave the skin on your chicken, only choose whole-fat foods, and always have a dessert.  

However, I do not believe that advise is necessarily healthy advice.  If your ultimate goal is to gain weight and you don't care how you do it, then enjoy all the butter and whole milk you would like!  I try to advise people to gain weight in a healthier manner, which is in-line with the second school of thought.  While still trying to increase calories, the goal is to do so with nutrient-dense, calorie-dense foods.  Nuts/seeds, avocados, olives, granola, cheese, yogurt (not fat-free!), fruit juices, smoothies, dried fruits, and trail mix are all nutrient-rich choices with condensed calories.  You can also dip carrots or pita chips in hummus, fruits or vegetables in peanut butter, vegetables or chips in guacamole, or whole grain breads in olive oil.  Another way to add calories in a healthy way without spending quite so much on Ensure Shakes (which is actually a good way to gain weight, especially if you drink them with snacks instead of as a meal) is to use Nesquick, Carnation Instant Breakfast, or Ovaltine (or their generic equivalents); you can also add powdered milk to many recipes without changing the flavor, especially cream soups, casseroles, and macaroni and cheese.  You can crush corn flakes to use as a breading for meats (a favorite of mine is to roll chicken legs in the crumbs and bake them), which will add a few calories.  Some people turn to protein powders, but I wouldn't recommend that since most Americans consume adequate amounts of protein and large amounts can be hard on your kidneys.

On a more personal level, you should continue to try to snack as much as you can, with a goal of no less than 3 snacks daily, although "grazing" on snacks all day is great.  If you really want to gain weight, soup may not be a good lunch idea; a sandwich on whole grain bread or a pita (turkey with avocado, bacon, Swiss cheese, and some veggies; tuna salad with provolone cheese; or peanut butter and jelly would all be good) with a vegetable and a dip and some fruit juice should pack in more calories...unless you've been choosing very high-calorie soups, which are out there!  Try to add some nuts (walnuts are pretty good) to your oatmeal.  Pasta is a good choice to add weight.  Salmon is a good, high-calorie fish choice.  Hydration and stress are usually more to blame for reduced milk production than caloric intake; make sure you are drinking plenty of water, juice, or milk...have a goal of 12-15 cups per day (more if you are exercising)...and try to get some alone time (easier said than done!)  You could be tired to due to lack of sleep or a vitamin or iron deficiency, so make sure to continue taking a multivitamin.  Lucky for you, some birth control increases your likelihood of putting on weight (but not usually birth control with low-doses of hormones) so that may or may not help you.

Good luck with your weight gain.  Try not to let it be one more stressful thing in your life!  If you have any further questions, please contact me again.

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