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Ep 165 – Am I making Skim Milk!? Human milk fat and infant weight gain

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Lipid Quality in Infant Nutrition: Current Knowledge and Fut… : Journal of Pediatric Gastroenterology and Nutrition (

Maternal BMI is positively associated with human milk fat: a systematic review and meta-regression analysis | The American Journal of Clinical Nutrition | Oxford Academic (

Lactose: The Key To Infant Weight Gain? — Mattos Lactation

Excessive weight gain in exclusively breast-fed infants (

Overview of the Lipids in Breast Milk (

Calorie and fat content of various milks •

Breastmilk Composition is Dynamic: Infant Feeds, Mother Responds – International Milk Genomics Consortium

Human Milk Composition: Nutrients and Bioactive Factors – PMC (

Hey, welcome to the Milk Podcast. Hey.

Are you ready? Yeah. Okay. I am ready. All right. Well, I hope you had your coffee already today. Otherwise we just blew you right outta your bed. We did, we definitely had our coffee. And we’re ready. We’re so ready to talk about fat, milk fat, fat. We could talk about all kinds of fat if you want all kinds of fat.

But today, today we have an episode where we’re going to talk about yeah, the lipids in your breast milk. Mostly because Do you know what I hear like. At least once a week. Yes, I do. Cuz I hear it too. My doctor told me I need to increase the fat in my breast milk. Yeah. I make skim milk. I. Yeah, my grandma told me I needed to eat more steak so my milk would be higher in fat for real.

And you know, I finally was like, fine, I will sit and read for like 10 hours and just figure out if the answer I have is actually the right one. Well, I mean, the, the problem I have with this, Whole thing at baseline is that if your child is struggling with weight gain mm-hmm. Everyone points at the mom and goes, it’s something wrong with you.

It’s something you are not doing. Yeah. And you know what it usually is, it’s something wrong with like baby’s mouth or their heart or their metabolism or, yeah. Or their thyroid. Or like, let’s not point at the mom. And just assume that that’s what’s going on without investigating all of these other issues.

Yeah. Now to be fair, like we’re trained kind of not to focus on milk composition and just to focus on like mechanics of transferring milk and making milk and all of that stuff. So that’s why I did wanna kind of look further into it because. Sometimes I know there’s a discrepancy between what we’re learning and what somebody of another healthcare discipline is learning.

And I was like, okay, let’s see. Like what, what studies do we have about this? And what do we know and what can we do from there? Mm-hmm. But before we dive into that, should we think some of our new amazing patrons, please, yes. Our patrons have been showing us so much love and we cannot thank you enough.

And by the way, we spent. Well, I don’t know how many hours today putting up the sound panels in half the studio. You guys pay for stuff like that, you know? Yeah, absolutely. No. We spent like two hours not knowing what we were doing, and then like 30 minutes doing it really well. Ask me about my fancy stud finder.

Ask me about how Heather’s walls have either all stud or no stud. And I don’t know what’s happening in this basement right now. Hashtag all stud. Anyway today we would like to thank Mary Zalo. We’re gonna guess that’s right, Mary z Chelsea Tevin. Deanna Larson and Sarah Choppa. Thank you guys so much.

We just love all of you guys joining us, and so many of our new patrons are coming because they want access to our new show called Beyond the Boob. If you don’t know about it, this is our little love child here in the podcast room. If you’re pregnant. You can have a baby with me. You can. So we’re following Heather’s third pregnancy week by week with Beyond the Boob.

I’m her midwife. We’re planning a home birth. It’s gonna be a party, and we’re just talking about it every week. So join us. And I just had my anatomy scan. So we are going to discuss all of that because mm-hmm. It might not have been a hundred percent normal, so we’re gonna get into that. So if you are, if you’re wanting to get into that with us, we’d love to see you over at Beyond the Boob.

Absolutely. Well, I think we got a really fascinating question to talk about today, and I, I really wanna get into it because this is something we talk about a lot. Okay. This is a question from one of our patrons, Darien, and. She said, I breastfed my son for 18 months and I’m now breastfeeding my daughter.

13 months and going strong. Your podcast has given me so much education and empowerment. My best friend recently had a baby and asked me for all of the breastfeeding advice. Mm. Sorry. I referred her to sorry. That triggers me. I referred her to the podcast. She’s really asking all the time, but not taking any of the advice I give her.

Oh, my question is, how do you handle people asking for breastfeeding advice and what do you do when they don’t take it? Then say, oh, you’re just successful because of genetics, because you’re just lucky. I’m sure you guys get asked for the blanket advice all the time and would love to hear how you handle it.

This is honestly like I could not think of a better question for us personally. Well, here’s what I did. I started a podcast that people could access for free, so I wouldn’t have to keep repeating myself and I could just send them the link and be like, if you wanna take a deep dive, here you go. If you would like to schedule an appointment with me, you can do that.

Cuz like this, literally, we started the podcast. I mean, not, you know, and. So, you know, obviously we get a lot of questions from listeners and that’s one thing. But of course we get a lot of questions from friends and family who are probably the biggest perpetrators of asking for advice and then not taking it.

Well, I mean, you know, that our buttholes pucker would like a cousin is like, I’m pregnant, and we’re like, oh, good. Like, I’m like, let me know if you need anything, but also don’t, but also, oh my God, I hope it’s fun. It’s a really hard dynamic though because you know, for us it’s our jobs and I. You know, I kind of have this, I have like kind of general rules for myself, like really good friends who I’ll do anything for.

Of course, I’m gonna catch your baby, Heather. I’m gonna give you every piece of advice you need. I’m gonna pay you also, but you’re also gonna take my advice. Like we have that level of trust, but then there’s this whole like the next circle of people. Yes. You know who I’m kind of like, okay, you can ask me a question.

If it’s an easy answer, I’ll just give it to you. But if it’s more than that, then I’m gonna be like, Hey, I, I really, you know, this is kind of complicated and I think we do need to schedule an appointment because we just, it, this is hard to like casually manage so, And the thing that defines a good friend for me is do they then make an appointment with me and respect my time and my energy and my expertise, or do they just keep asking little questions and not taking my advice and then get annoyed at me for it?

Well, and here’s the problem. If they are not paying clients, the chances decrease that they are going to take your advice seriously. Mm-hmm. And by you giving casual advice off the cuff, without knowing the entire history, you’re less likely to have a positive impact. Yeah. On their breastfeeding journey because you don’t know the whole story.

And so I stopped doing this really. I mean, not full stop, but like Yeah, I really. Put a hard boundary there with a lot of people. Mm-hmm. Because I wasn’t as effective for sure as a provider for them just giving it casually. And so what I usually say now is like, listen, it sounds like I really would like to know the whole story here, and if you’re comfortable with it, I’d love to have you come in for an appointment.

I’d be happy to bill your insurance. If you’d rather not see me, like if you want to talk to me but you don’t, you’re not comfortable showing me your breasts or whatever, I can hook you up with someone else, but like, you’re right, there’s an issue I. But I can’t just talk to you about this while I’m at my child’s baseball game.

Right. On a Sunday. And cuz I’m a mom and I want to be here for them. Yeah. You know, and I think if, if this is not your profession right. But someone just knows you’re knowledgeable, you’ve done this and you’re in this situation. One is I. Sometimes it’s hard to understand if somebody’s asking you because they want sympathy or they want solutions.

Mm-hmm. And the ask can look the same. Right. And you just kind of have to know personality base. Like if I’m asking for advice, I want solutions, I wanna sit down, I wanna make a plan. My husband, if he asks for advice, he’s asking for sympathy. Oh yeah. He doesn’t want you to solve the problem for him. And I, I’ve realized, Too that, you know, for a lot of people we just get to a point where they say, oh my gosh, I’m having this problem.

And I just say, wow, it sounds really hard. I’m really sorry you’re going through that. And that’s kind of the end of it, you know, because I know from past history that they’re not gonna take my advice. And if they really want like a solid solution plan, they can either ask me clearly for it or they can make an appointment with a professional.

Mm-hmm. And also, I come from a place where not everybody comes from this place, I realize, but I come from a place where yes, I want to use my friends for. Business purposes, right? So I can support their businesses and their lives. So I will pay my friends more, right, than what they ask. So, you know, I was fully prepared.

I’m like, whatever your base is, Maureen. Like I’m planned to pay you more. Or like at least ha, cater dinner. Sure. For the birth, or like do more. You know, not less. You do not take advantage of your friends. You boost your friends up and help them in their lives and their careers. Like my friends who are contractors, I’m like, don’t give me the friend discount.

Don’t do it. I will totally pay for it, and I want that for you. Right. And you know, I have some people who we have kind of like a mutually beneficial relationship. You know, like I have a friend who’s an np, she’s new, she works in a really rural clinic, you know? Mm-hmm. She sees a lot of problems about breastfeeding.

She’ll ask me for advice a lot of the time I text her too and I’m like, ah, I have this weird medication thing that i’s different. Don’t, that’s different. That’s value based exchange. Exactly. And so that’s a different situation. But really, like when you’ve got, and, and it’s, it’s, it’s disheartening, right?

When you’ve got friends in your life who just never take your advice. Mm-hmm. And you just have to get to the point where you don’t give it anymore. Well, if you’re also the person that when they don’t take your advice, they come to you to pick up the pieces. Yeah. No. No. Yeah, I’m sorry. And I just really then just go to straight sympathy and, and it’s, you know, I mean, it’s not fake.

I really do have sympathy for them. And I’m sorry that they’re going through something hard, but I’m not gonna solve it for them. Right. And I don’t mean to be such an ass about it, and I realize I’m being really intense about it. But let me just remind you all, and a lot of the listeners are in healthcare, there is not enough healthcare for the people in this country.

Yeah. So your healthcare providers, Are already struggling with burnout for the jobs they get paid for. So when you are asking them to take time out of their, you know, the very little amount of time they have in their personal lives mm-hmm. To work for free with something that does not fill their cup up.

You’re hurting them. Yeah. Like you’re hurting them. So like either pay them for their services or go to someone else if you don’t wanna bother them with it. That’s my public service announcement for the day. Are you feeling, are you feeling a little extra burnt out these days, Heather? Well, a little. Well, no.

I mean, yes, yes and no. Like we’re doing it to ourselves, but like, yeah. I also, let me say one more thing. I don’t discount my prices. Mm-hmm. And so people have asked me for discounts before. Yeah. And I don’t do it. And there’s a reason I don’t do it because I stand firm, like very firm. Right. That in our lactation profession, we cannot devalue ourselves.

Mm-hmm. Because it does not help the profession overall. Yeah. The only thing I discount for is pregnancy loss. Oh, yeah, that’s it. Oh, yeah. And, and that I have a pay, which you can policy different. Totally. So I will, I will do it either for free or full price. Mm-hmm. But I do not discount. Yeah. Yeah, I, I usually, I, and like, those are just like, it’s not every day that that happens, you know, it’s a total, like every situation is different, you know, we kind of have to do it on a case by case basis, and I’m like, you are grieving.

I don’t wanna cause like undo mm-hmm. You know, burden on your family right now. Mm-hmm. So, but yeah, I don’t do friend discounts either. You can’t do it. Can’t do it anyway. We love you guys. That has nothing to do with our love. Please know that. I just have a lot of friends. We have a lot friends. I wouldn’t make any money.

Exactly. We’re so damn friendly. Look at how friendly I am. Heather’s like this pregnancy’s making me so friendly. Well, and here’s the other thing too. When you are my patient, I give you, Everything. Yeah. Like I give you my full being, I’m like, yes, I’m here a hundred percent. I don’t halfass it. If I halfass it all.

Oh yeah. Heather all day just had a call and it’s a Sunday, guys. I mean, I’ve been texting with a postpartum client all day, like, right, right. Exactly. Yeah. So please don’t think that I’m like this heartless person. It’s because I give so much that I have to be careful. Yeah. So anyway, you should do the same with whatever your profession is or even like if you’re working from home.

Working within the home as a mom and, and sometimes you really have to step back and say, okay, like I don’t have power over someone else’s life. Yeah. And situation and I can’t fix their problems. And that hurts. Yeah, it does. It hurts. Especially when you think, like, I do have the knowledge to help them, you know?

But it’s, you can’t fix that. You can’t fix a breastfeeding situation for someone else. Right. We can just give you the tools to do it yourself. Right. I hope that answers your question. Yeah. It’s a frustrating thing. It is frustrating cuz it’s a system problem. Yeah. Like you don’t see Maureen and I rarely get upset like this.

Upset unless it’s like all based in a system problem. Yeah. And if we all had access to care and we didn’t live in healthcare deserts, we wouldn’t even be having this problem. Yeah. And if we had a supportive culture and if blah blah, blah, blah blah. It’s like, if, if, if like you’re making me say no, stop making me be the bad guy.

If this system would just support people, I wouldn’t have to give my whole life my whole weekend. And then it’s like Heather, no. No, pull it back together. Calm it down, but also don’t calm down. It’s okay. Yeah. Okay. I won’t, I think it’s okay to be mad about that. You know what I’m gonna do? I’m gonna start a podcast, then I’m gonna start another podcast, and then we’re gonna start a third podcast.


Alright, well let’s think after three. It’s not solving any problems. Okay. Let’s take a quick break and when we get back we’re gonna talk about the fat and your breast milk and whether or not you have any control over that. Mm-hmm.

Imagine a world where you seek lactation care and it’s easy and someone greets you at the door and they’re nice to you, and they give you a hot cup of tea and let you sit on the couch and talk about all the issues, not just the breastfeeding issues. What a cozy fantasy is there anywhere that’s real. Oh, it’s real girl.

It’s real, and I’ve been building it for quite a long time. My business is called Breastfeeding for Busy Moms, and me and every member of my team are trained in our three major tenants, which is accessibility, kindness, and personalization. If you wanna book a consult with Heather or anyone else on her team, you should head over to breastfeeding for busy

We do accept some limited insurance, and we’d be happy to walk you through it if you wanna give us a call. And that number’s on Google. So go sit on the cozy couch with Heather at breastfeeding for busy moms. Love you guys.

Welcome back. I’m better now. I got a drink. Heather needed to pee and have a drink of water. You feel more human? Hey, it’s me again. Yeah. You feel your baby kicking? Yep. Good. Well, now we’re gonna talk about the biological relevance of the human milk lipid. All right. I’m suddenly less ready, you know, just like we have a biome, apparently milk has a lipid.

Do like the lipid profile. I don’t know. This is interesting stuff to me. However, I don’t know. I, I, Heather, I feel like a broken record, but this is understudied, gosh, is what I found out. However, to date, we’ve identified 300 different lipids in breast milk. That’s wild actually. And frankly, we don’t know what most of them do.

So, yay. Oh my gosh. You know there’s a person out there like a super nerd who just studies lipids. There is, there are lipidologists. Absolutely. Oh, if you’re a lipidologist, we want a dog to you. Milk minute podcast Holler. So the human milk lipid do, which I love that word, is a complex mixture of these lipid species across.

Dozens of classes and subclasses and blah, blah, blah. And they all form these little human milk fat globules. They’re so cute. Cute. I love the word globules. I just feel like we’re using our favorite words in this episode. It’s so chubby. He’s so cute. By the way, my little brother back in the day, he loved to like squeeze my mom’s arm fat and.

But, and he’d look up at her and he’d say, mommy, you’re so chubby. And it was like a term of endearment. So now my whole family calls each other chubby when we’re being cute. They still cute. Cute. Oh you’re sure? Chubby Griffin used to like kind of like. Push around my belly. Like you’re like fluffing a pillow and then like put his head on it and he’d be like, I love your fluffy belly mom.

They make kitty bread on you. Yeah. Okay. Anyways, anyway so these globules, I’ll tell you what they are cuz they’re really interesting. They essentially have this little core of lipids. That’s surrounded by a double layered membrane containing cholesterol, phospholipids and others, as well as like little lipid metabolites and proteins and peptides.

It’s very cute. It’s like a little bundled. It’s like a It is, it is. It is. And of course, like, you know, we’ve got limited studies on this. Most of them are not like longitudinal, they’re just kind of random samplings without a lot of control. Right. So I’m gonna give you the best information we have now with the caveat that we need more.

Cool. Okay. So let’s chat about fat. We’ll chit chat about, we’ll chat about fat. Maybe we should title this episode, chat about fat. Oh, I, I don’t think so. Mostly because we need the search engine optimization to be, do I make skin milk? It would be so cute. You’re right. Okay. Although we could make a little cartoon of a lipid that’s like adorable.

Maybe I should make a little lipid drawing a little Glo. You, I should. Well, so lipids make up about half of the source energy for baby from breast milk, right? It’s about half that and about half lactose and a little bit of protein thrown in there. You know, and it is one of the most variable constituents in breast milk.

It varies in concentration during a feed between breasts during the day over time. And you know, we can see this fat content vary in concentration for people by as much as 50% wait. So does this mean that some people do make skim milk? The reality is that when I say that, it’s still in that like two to 5% range, right?

So it’s like, okay, somebody has 2% milk, somebody has 5% milk. That’s that variation. So that might be the two. The 2% babies need 30 ounces a day, and the 5% need 20. Let’s, let’s talk more about it, okay? Okay. All right. And because most of the research we have on. Breast milk lipids is focused on its association with cognitive development because that’s how we’re mostly using fats.

Folks. We’re not using fats to make fat. Like we’re using proteins to build muscles and new tissues. We’re using sugars to create energy to do that. And while we do use fat to create energy, we’re also using it to support our brain development, like our building blocks. Mm-hmm. Yeah. And the brain doubles in size in the baby’s first six months of life.

Yeah. So there’s a lot of structural stuff going on there too. Exactly. And you know, we have this two to 5% number from these studies that I think are a little flawed. Like I think we should look into it more because who knows, the 5% might be all people whose milk we collected at 10:00 PM and the 2% might be all people whose milk we collected at 9:00 AM And this is gonna be a question that we definitely ask a dairy farmer.

Yes. And we’re just gonna keep asking. Okay? And, and so we’ll, we’ll circle back, okay? But I want to just address the burning question that we’re talking about. Am I making skin milk, and is it causing babies poor weight gain and poor growth? All right. Most of the time, baby’s weight gain issues are due to low milk volume intake.

Not necessarily that you’re making not enough volume, but that they’re just not getting enough volume. Now we have so many reasons why baby might struggle to transfer milk, right, and breastfeeding challenges snowball. So as more time passes, one problem becomes two, becomes four, becomes eight. So not drinking enough milk becomes not making enough milk, becomes not getting enough milk, becomes not making, you know, just like exponentially grows.

And so when we’re looking into this issue in real life, it’s really complicated. And it’s not just my milk isn’t fatty enough or high calorie enough, it’s. So many different facets of that dyad, right? There’s so many confounding variables. There’s really only been one time that I can think of, so. Where we ran the gamut on everything with this kiddo.

Mm-hmm. And he was eating a ton, like a ton. Mm-hmm. He was eating 36 ounces a day and his thyroid was fine. Checked that and his pk, rest of his pku was fine and dude was just in the first percentile. He developmentally appropriate, but still, I was like, I don’t know. Right. Like you can’t do anything else.

Yeah. And you know, I, we focus so much on fat when really that’s half of the caloric equation. I. Sugar is the other half. Okay. And I’m gonna spend a bunch of this episode talking about that. What? Because it matters, Heather. I don’t know how we got it into our heads that more fat in our milk means more weight, like end of story.

Because obviously that’s not it. You have to have energy to do something with the fat and you get energy from sugar, so that makes sense. Exactly. Lactose is the predominant carbohydrate in human milk, and human milk has the highest concentration of lactose than any other species we’ve tested. Really?

Mm-hmm. That’s cuz of our big brains. It must be. It must be. Yeah. And lactose is actually made in your mammary gland. Which is kind of cool. Like some things we just absorb from the bloodstream. Mm-hmm. We make it. Oh my God, we’re so cool. I know. I got a little sugar factory in my titties. And it’s not very much impacted by your diet in the ways like how much DHA in your milk, you know, for example, so we have, let’s see, six or seven grams per deciliter of milk, of lactose, which, you know, random deciliter.

I don’t know. That’s what, that’s what every study I looked at had that. Measure, which just kind of frustrated that like a hundred ccs. Hmm. Oh God. Hold on. I gotta look it up. It’s a hundred ccs. Yeah, I was right. Yeah. Okay. So we have about six or seven grams of lactose per 100 milliliters of breast milk.

Super cool. Yeah. And breastfed infants consume like a high carbohydrate, you know, ratio, right? Yeah. They’re not keto. No, they’re, they do not have a keto diet. Chubby. They are. And you know, so lactose is providing a very significant amount of the calories that your baby needs. That makes total sense with how fast they grow and, Right.

Yeah. And lactose is broken down into glucose and galactose. Right. And it’s easier for baby to use for their essential aspects of growth and development. So, you know, central nervous system development intestinal microbio development, innate immune response essential mineral absorption, all of that relies on the energy we get from lactose.

It’s just so much easier to make energy from sugar. Yeah. It’s harder, it’s hard to break down fat and to turn it into other things, so. Right. And I’ve often wondered like, If we think there’s a problem with fat, why aren’t we looking into lipase? Because that’s what helps your baby break down fats. Yeah.

When you texted me that the other day, I did, I was like, Heather, what about lipase? Where was I? Oh, I was getting all caps. Where was I? Of course I was at Ikea. Like, when am I ever anywhere other than Ikea anymore? But I, I was getting out of the car and I got this. Text from Maureen. Hold on, let me just read it.

This is, this is what it’s like in case you’re wondering what our friendship looks like. This is like every day for us. It’s either what’s happening in my vagina or think about breast milk. I’m just skipping past the text where you said, am I pregnant? No, I’m not pregnant. I’m not everybody. I’m not. It was, it was a week though of thinking I was, okay, so this was 6:23 PM All caps, girl, what if people who think their milk is low fat just have poor lipase activity and their babies can’t access the lipids in their milk emoji with their brain exploding?

I said, whoa. Can we test that? And she says, I don’t know, but I absolutely want to. We need to ask LabCorp what tests they can do on breast milk for res. Anyway, and that’s what Maureen is like in real life. She’s exactly the same. It’s not justice, not just in the podcast. Her, her brain just never stops and I am all about it.

Oh goodness. Anyway, total sidebar there cuz we have no information on that. But I think I should just be in charge of designing studies on breast milk. I think we clearly need a breastfeeding institute. Yeah, or research institute. Then we can just email and be like, what about life privately funded? What if we did?

What if it was just like grant funded, private funded? It’d be amazing. Wouldn’t it be good? Yeah, but I’m not done talking about lactose yet. Oh my God. Okay. I know. Go ahead. I know. I’m sorry. There’s so much Because the role of lactose doesn’t just stop at like energy. Oh. Apparently it also helps to hold harmful bacteria at bay in the gut.

Yeah, because it’s food for other bacteria. Exactly. Because it helps the beneficial bacteria grow, which is so cool. And that helps your baby digest milk better, which means they’re using more of it. I actually love lactose. Okay. I love lactose on a t-shirt. I love lamp. I love LAC lactose. So, you know, for those who are concerned about their baby’s weight gain, I hope it’s reassuring to know that studies have found that glucose concentration was positively associated with infant fat mass, which means more glucose and more weight for baby.

So lactose does play an important role in their weight gain. And I’m saying relative weight, like lean mass, not just like Chubb a fat infant, you know? Mm-hmm. Or whatever. Yeah. Like we can make your baby as fat as we want with cereal. Right. But it doesn’t mean that it’s like good fat. Yeah. And really like, you know, all these studies we have indicate that there are just factors that we haven’t identified that affect growth patterns in infancy.

We just don’t know everything. And lactose gets a really bad reputation. Lactose intolerant. Right? Can we just talk about that for a minute? Yeah, we can. I have it on here, so let’s just talk about it. Let’s do it. Adults. Adults are lactose intolerant. Okay. Baby babies cannot be lactose and intolerant unless they have galactosemia, which is super rare or something like that.

Yeah. And that makes like everybody’s brain then. You know, jumps to like, oh, my baby’s lactose intolerant, cuz they’re spitting up a lot or they have green poops or whatever. But it, it’s literally like the most essential carbohydrate in your milk. If your baby can’t process it, they need to be on like special medication or special formula.

It’s not just like, has nothing to do with what you’re eating. You’re always going to make lactose in your milk. That’d be like a horse baby being like, I can’t eat horse milk. And you were like, what? Yeah. And, and lactose intolerance is the norm for adults. Yeah. Makes, makes sense. Because we grow out of the enzymes that help us digest lactose.

We don’t make them anymore when we’re adults. We don’t need them. We don’t need to drink milk. I don’t actually drink any milk. I’m not lactose intolerant, but I’m just like, I think it’s weird. It’s like a weird texture to me. It’s like not thick enough and not thin enough. It’s like in between. Agree. I don’t like it.

Agree. My husband loves it. I don’t know why. My husband does not. I think he is lactose intolerant. Ugh. Anyway, husband farts. Anyway, and you know, on top of this issue we also have the oddly popularized concern over four milk and Hein milk. Mm. Yep. Yep. Like w I need to find the person that first put that on the internet and just make them regret it.

Well, let’s just talk about that for a quick second. Yes. There is only one kind of milk. Yes, you do not make two different kinds of milk. You don’t have cells that make four milk and cells that make high milk. You make one kind of milk, and if you let it sit there long enough, just like in your fridge, it will separate.

Okay, so the, the milk that you do have, the one, the one cell that makes the one type of milk, that milk will separate and the cream will rise to the top. Right now it doesn’t exactly do that in your boobs. Right. But the fat is just like stickier. Those glo does do that. We were talking about Yeah, like get stuck.

Yeah. They get, they like each other. Yeah. They’re stuck to each other. And then so technically that does happen in your boobs, but it takes a long time. So if it’s like a Yeah. First three months, it doesn’t look like what it looks like in your fridge. It’s Sure, sure. People love to visualize it though.

And you know, so this, we get this question a lot in the first three months when babies are going through all those intestinal changes. Yeah. And every time the baby has a fart that smells different. The parents are like, or a green one, green poop. Right. They’re like, oh my gosh, is it, do I have too much four milk?

And it’s like, your baby nurse is every two hours bud. Like your milk doesn’t really have time to Yeah. To stick together in the back like that. Well, and you know, it’s often like, I get the question a lot when we have these frequent nurses who are like, are they ever getting the high milk? They latch for five minutes.

Mm-hmm. And they’re off. And I’m like, look, when your baby nurses like that, Their content of their milk changes. Mm-hmm. Which I’m really excited to talk to you about later. Yay. But let me just say the, the true issue of baby getting too much lactose. Or as some people like to call it, their four milk would be called lactose overload.

It’s pretty rare. It has pretty like specific symptoms and we can deal with it if it’s happening. But do not assume that that is happening. Mm-hmm. Do not. If you’re pumping 40 ounces extra on top of what your baby is eating eight times a day, you might have this issue. Right, exactly. And you might not.

I’ve seen it both ways. Mm-hmm. So holler if you, if you have questions, but I came across a really interesting. Study that I wanna talk about here about excessive weight gain in breastfed infants that might help us understand, please. Okay. So they were looking at infants who were way above the like weight chart.

And they were just like, what’s different about these babies? So they were, look, they were all breastfed. They were looking at breast milk composition compared to the general population. Just to see what was different. The hypothesis was that there was too much protein and that was to blame, but they found the protein levels were totally similar to everyone else and the fat levels were lower.

What? Yeah. And the samples suggested that in addition to the macronutrients, you know, there must be hormonal variations in human milk that are regulating a lot of this independently, and that the total fat and protein levels just didn’t matter. So it’s not what’s in the milk, it’s what their body can do with it.

Yes. Which is the, that’s like metabolism, right? And they didn’t have any hard conclusions from this study except that they were wrong. But I think their findings are supportive of the picture that weight gain related to breast milk lipid content is way more complicated than more fat equals bigger babies.

Because if these babies. Hmm. With their excessive weight gain, whatever that means, had lower fat content than the general population who fell into normal parameters. That’s obviously not the issue. Mm-hmm. Yeah. That’s really interesting. It is. I was so glad to find that study because I was like, yeah, like that is kind of where we need to be looking.

If we’re thinking this is the problem, and a lot of parents are now listening to this are probably like, well, shit, because wouldn’t it be the easier fix? Yeah. To just add in more calories or add in more volume and. You know, changing your baby’s entire, mm-hmm. Makeup is not easy. And also we wouldn’t even know where to point because it’s so complicated.

So that is frustrating. It is. But let’s take a quick break and then let’s talk about what we can do. Ooh, I love a good tactical plan.

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Welcome back everybody. I am excited to hear about what we can do to help our slow weight gain infants. If we can’t just add stuff to our breast milk, what can we do, Maureen? Okay. Is it diet Heather? Is it maternal health, feeding patterns, genetics? Do I not love them enough? Probably everything, right? Okay.

So. Out of all that stuff, what we see impacting like breast milk content the most is infant feeding patterns. Okay. Now I have just some tidbits from all kinds of different studies on this that I just wanted to share a little something, something from, so we had this one. Now these are all pretty small studies, right?

Like I said, like we have crap for data on this, like, There was this study of like 71 mothers who collected milk over a 24 hour period, and they found that their fat content was significantly lower in the like late nighttime and early morning feeds compared to the afternoon and evening feeds. That was the highest fat.

Which a lot of us, you know, are familiar with that the like kind of lower volume, higher fat afternoon evening stuff. There was another study that found a 25% variation in the lipid concentration between different mother’s milk, right? That they thought was explained by maternal protein intake. No idea why.

Other research has said you might be able to improve the quality of the lipids in your milk by your diet, but not the quantity. Hold on. So like better kinds of fats. Easier to use fats, but not the overall fat content, which makes sense because your, your, your mammary glands are just gonna take the fats that are available.

Yes. But isn’t this contradictory to our general thought that what you eat can’t change the macronutrients? So it’s not changing the quantity like how much, but it’s the building blocks that we’re giving it. So what you eat is gonna change what’s in your blood, right? The kinds of proteins that are in your blood, the kinds of fats, but it’s not gonna change how much.

Your body is taking to make the milk. Yeah. Okay. And that’s the tricky thing about diet and milk, right? Because on one hand we’re like it doesn’t matter what you eat, your milk’s kind of all gonna be the same on a big picture level. Mm-hmm. But the smaller you look, the more it varies based on diet.

So are you saying like, so if you’re eating like more dha, you’re gonna have a higher concentration of that in your overall lipid profile? Right? That’s what I’m saying. Yeah. So if there’s 300 different lipids that could be identified in your milk, there’s going to be a certain percentage of lipids, but we don’t know.

But they don’t come from nowhere. They don’t come from nowhere. Yeah. And it could be any number of the 300. Exactly. Am I getting that right? Yes. Okay. Yeah. And if you listen to our last episode where we were talking about milk composition over time, you’ll know that lipid concentrations vary a lot between like colostrum, mature milk, toddler milk, et cetera, right?

And that leads us into like, why, why is this changing? Why does it change? So let’s talk about one day. Okay, let’s talk about daily changes first. So the amount of fat and cells in your milk are gonna change the most through a day. So those are things like leukocytes, epithelial cells, et cetera, and the body gets cues by how often.

And how much baby eats. Okay. The mechanics of milk removal and the biology of milk synthesis, like cellular level making milk, those are coming together here. And we see this across all species of animals, right? Our milk contents are defined by how our babies are eating. Mm-hmm. That makes sense. And the fat content is actually peaking about 30 minutes after the last feed.

So babies who feed more frequently will get more fat. Really? Mm-hmm. And babies who feed less frequently are going to be getting usually a larger volume. Right. But less fat per ounce, and they’re gonna be getting more lactose, which makes sense. Mm-hmm. Totally makes sense. However, when we have those larger feeds that fully empty the breast, they’ll show a more significant rise in lipids after.

Okay. Yeah, because it’s like so, oh, hey, I just drank that whole boob. I’m going through a gross spurt. Yeah, I need to, I need more building blocks. And your body’s like, okay, have some fat, right? So it’s like the first thing your body’s replacing in that milk is like higher in lipids. And then the longer you wait, the more your body’s like, okay, here’s some water and some carbs, and let’s throw more of that in.

And then, you know, so if your baby then waits three hours to feed, that fat’s still there, but you also have this other stuff in this larger volume. Is this why like the colostrum and the toddler milk are lower in fat? Yeah, because we just have those really Well, the colostrum’s low in fat. Fat. The toddler milk is high in fat.

Different dynamics. Colostrum’s a special beast though. It’s like its own special thing. An interesting thing though is like literally the gene expression in our mammary glands is responding to feedings. That’s crazy. It’s super cool. And like we see that reflected in this milk content, in the cellular composition, right?

Like what cells are being made. It’s all stimulated by milk removal. Okay. And that’s facilitating the secretion of all this stuff into breast milk. You know? And there’s some theories as to like why exactly we see this happening the way it does. Right? The filtration theory. Proposes that these fat globules cluster and adhere to the walls of our little alveoli and our little baby ducks, and and then they’re filtered out as milk is gradually removed during an expression, right?

Mm-hmm. However, the absorption theory suggests that these globules remain absorbed by the membranes of the alveolar cells, and they only get displaced when the gland is empty is almost empty. Oh, that would be kind of like the hind milk theory. Right. Okay. Either way, there’s, we don’t really know which one’s right, but those are like the main theories.

Either way it’s complicated and we would love to get more studies about that. So if you have a baby with slow weight gain, who’s eating 30 something ounce a day, but maybe only. Six times a day. Right. Would you suggest like pumping after feeds to like more empty breasts to trigger the higher fat content within 30 minutes after that emptying?

Maybe. Or maybe you could consider pumping 30 minutes after to see if you can remove some of that, but also maybe fat’s not the problem. Right, right. Maybe we have a hormonal issue. Maybe we have an enzyme issue. Like, but what hormones? We don’t dunno. But, you know, this is good information to have though. I think just knowing what dynamic affects the fat content of milk.

And it also tells us then like why generally milk composition is the way it is. You know, when babies are smaller, so, And you know, they’re feeding a certain way versus when they’re like a 10 month old who’s feeding every four hours or something. You know, it’s kind of giving us a little bit more information and it can also reassure you.

Mm-hmm. When you pump your milk and you put it in the fridge and it like turns blue and the little fat rises to the top, it’s fine. Mm-hmm. It’s all fine. These are all good parts of your milk. So I’m gonna ask the hard question. Then when we fortify breast milk with formula, I. Does it help or does it make babies feed less often because they’re more full and had a question the other day about using, instead of formula, freeze dried breast milk to fortify breast milk.

I have thought about that before. I like, there’s a company, Milky. There is, yeah. That we are not promoting yet because we don’t know enough about it. Mm-hmm. But we would love to talk to them just about, I. This process, but I know that the founder did her doctorate in right this, so I’m very curious to talk to her about that.

But yeah, I mean, it’s, it’s a really good question, right? If we are giving baby a hefty meal, I. That’s taking them longer to digest and then they’re waiting longer to eat again. They’re burning more energy. Mm-hmm. Processing that food. Right. It’s really, that’s a metabolism thing. It is. And now I’ve certainly seen like fortification of milk help babies gain weight faster.

Mm-hmm. Like, I’ve seen that work and I’ve also seen it do absolutely nothing. Mm-hmm. You know, where we then are having a breastfeeding problem and we’ve made it more complicated, so, Or we have GI issues now because we’ve added formula, right? And the body’s like, what is this? Right? And I just really, I don’t really even know like what research is behind that.

Do we have research behind it or does was someone like, this is my expo opinion? I don’t know. I don’t know. But this is really one of those things that I’m like, How can it be this hard? Right. You know, I understand that with most breastfeeding research, it’s difficult because there’s so many confounding variables.

But you’re telling me we can’t get breast milk samples from 4,000 people in the United States. Oh, I know. And most of these are like 80 people. 50 people, a hundred people. I’m like, I wanna see bigger stuff. Yeah, more please. Yeah. Are, and, and with a survey, are you working? What do you normally eat? Are you on any medications?

And, you know, then we can kind of cross reference that way. But I. It can’t be that hard. Yeah. We just have to have someone that wants to do it. The problem is the money, right? Yeah. I mean, that’s always the problem is like who’s gonna fund it if the end result doesn’t mean somebody makes more money? Tony Robbins, you’re already investing in placenta and research.

Please invest in breast milk. Thank you. Yeah, and, and I think really like what I wanna kind of conclude from this. It’s just like we don’t know enough to say if how much fat in your milk is the problem. However, if for whatever reason you feel like baby really needs to get more fat, maybe adding in a snack 30 minutes after a normal feed could be a great way to give them some fattier milk, you know?

And. I don’t know. Maybe we should also then be talking to our pediatric providers about what other dynamics we’re looking at here. There’s also babies that I’ve seen that refuse the snacks cuz they’re not hungry. Mm-hmm. You know, the pediatricians will say, offer them an ounce and a bottle after a feeding, and then the baby doesn’t want it like curses its lips and we don’t wanna force feed.

No. I will say usually 30 minutes after a feed, most babies will be like, okay, fine. I’ll have a little snacky. You know, it’s like right after a feed. A lot of babies refuse 30 minutes, an hour after a feed. Like, but then aren’t you just pushing the next feed down the line? I don’t know. You might be, don’t either, but, but sometimes we can up the total number of feeds, you know?

But I think also, like, if that’s the advice you’re getting from someone where they’re like, Hey, add some more fat to your diet and your milk will be better. You might be able to, I don’t know, change the kind of fats in your milk. I always encourage people to eat healthy fats for yourself as well, but you should be looking at the other dynamics of milk removal, right?

And making sure that’s not a problem. Is your baby effectively transferring milk? Did you do just one weighted feed or did we do 24 hours of weighted feeds? What if you squeeze the alveola with some deep breast compressions? Can you knock some of it loose? Sure. You know do we need to look at oral restrictions?

Do we need to look at thyroid function at, you know, all kinds of stuff? So I am very sorry that this isn’t like, yes, eat five avocados a day and you’ll make super fatty milk. It’s gonna be great. No, do that if you like them, but, but you know, we are just beginning to learn about this stuff. Stay tuned. So hopefully in the future we’ll see.

Studies performed with much better controls. That are informed by more information that we have now. And that can give us just more targeted information. So right now, just to summarize mm-hmm. Because this is what I’m getting from this, we are going to not assume that it’s a fat problem in our milk if our baby is slow weight gain.

Mm-hmm. We. Do know for a fact it could be the way they are processing the food that they’re taking in. It could be their feeding patterns. So we could try offering a booby snack 30 minutes after or pumping 30 minutes after perhaps to maybe trick our bodies. Mm-hmm. We’re gonna check thyroid, we’re gonna call an I B C L C or another lactation consultant mm-hmm.

To try to help troubleshoot this. What else am I missing? Anything? You know what, if we’re also looking at slow weight gain, we’re gonna look at every other milestone. Mm-hmm. Right? Because sometimes babies really are exceptionally healthy at a low weight. Yeah. And how is that wrong for them? I, you know.

Right. And so usually when we can’t find something wrong, I’m like, okay, how are we with motor development? How are we with length? How are we with neural development? Right? Like, Let’s look at your general family genetics. Is that the only small person in your family? Mm-hmm. You know but typically if we have a baby who’s at, you know, this small percentile and we’re worried about them, but everything else is on track, they’re gonna be fine.

Like they’re rolling at appropriate times. They’re crawling, they’re making eye contact, they’re tracking movement. They’re verbalizing what you say. What do you say about starting solids at four months, which is two months early? So here’s my problem with it, is that when we start solids, your baby’s not digesting them well.

Right? Right. Like it takes a couple of months for them to be fully digesting. The new foods and then actually using the energy from that. Mm-hmm. So maybe it will kickstart that so that by the time they’re six months or seven months, they will actually be like getting more energy from the solids. But it’s not a short term solution.

Yeah. And I don’t think we have enough evidence. To say that that is good for their long-term digestive health? Well, I think anecdotally it’s tough because people are like, you know about the time they started solids, they were finally above the 10th percentile. Mm-hmm. And now they’re in the 50th or the 80th and you’re like, okay, but were they headed there anyway?

Right. And you know, I’ve definitely seen a number of infants that were small and you know, I usually end care around eight weeks. And then often I’ll see them again at like five months or six months. And I’m like, wow, that’s a really big baby now. You know? Did they just naturally turn around? Did they, you know, like my son was like, let’s see, he was in like the third percentile until about four months.

And then he skipped up to the 26th, you know, and then all of a sudden in another two months he was in like the 98th percentile, you know? And I didn’t, I didn’t start solids early. I don’t know if that would’ve made a difference. Interesting. Hard to say. Well, I wish we had more concrete answers for you.

Yeah, but the main takeaway is it’s not you, it’s your baby. And, and that like, I, I think we should not be accepting that as an answer, you know, if pediatric provider says that, I think you should say, okay, I’ll look into that. But I also wanna look into all these other things that we actually have evidence for those being weight gain problems.

Yeah. More brains are better, in my opinion. Right, right. Let’s recheck the heart. Let’s recheck the thyroid. I’m gonna, I’m gonna see an I B C L C and just double check some stuff. Mm-hmm. And you know, I’ll deal with the milk stuff with that person, but let’s deal with all of babies, like normal physiological processes here.

Yeah. But don’t stop at the fact that it’s, it’s a you problem that you need to solve. Mm-hmm. Because that’s a fruitless journey. And replacing with formula isn’t gonna solve that problem because it’s the same calorie, not, it’s not higher calorie, it’s. Not higher fad. It’s about the same. Yeah. Oy. Well, let’s take a quick break and when we get back, let’s give an award in the alcove to one of our listeners.

Sounds great.

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Welcome back everybody. Today we have a very exciting award. I’m going to give this award to Ellen H. Ellen kicked the nipple shield with her two week old and they got started on it early because, you know, baby needed that extra poke in the roof of the mouth to trigger the suck reflex.

And I knew this kid was gonna get on there, but when you’ve got that first couple weeks of exhaustion hitting, it’s like I can’t even handle trying to get rid of this thing. Yeah, let’s just feed and be done. And Ellen called me and she was like, so I did it. I spent 24 hours and we just like bit the bullet and we really focused on it with intention and now we haven’t nursed with the shield in, in a whole day.

And I was like, hell yes. And it takes bravery to do that. Yeah, it does. To change something that’s technically working, but you know, it could be better. So Ellen, congratulations on getting off the shield. You are one step closer to a much more peaceful journey. Not having to find that thing for every feeding.

Yeah. I was thinking we could give her the Warrior Award. Ooh, the Warrior Award. I like that. Yeah, she really, the shield. Exactly. And it did take some bravery and perseverance and, you know, You now, like, you now are on your way to hopefully like a really smooth road, you know? Yeah, I think so. Yeah.

Plus the baby’s so cute. They all are. I know. Yeah. But really good job. Everybody else out there who’s struggling still using a Nipple shield, not sure if you still need to give our episode about Nipple shield, Alyssa. We’re gonna link that in the show note. And you know, just know that it’s possible to get to the other side of that.

It’s absolutely possible and worth it, honestly. Well, before we get outta here, do we have any new Apple reviews? We just have one. It’s kind of short, but I’ll, I’ll read it. Tell me, tell me. This one is from Catherine 4 66. She gave us five stars. Oh, thank you. And she says, we’re so helpful. I can’t explain how helpful this podcast is.

I recommend it to everyone. Hey, thank you. Thank you so much, Catherine. We really appreciate it. Everybody else out there. If you listen on Apple, please leave us a review. They help other people find us and we think that is worthwhile. We know it is. Yeah. And thank you all for leaving your views and listening to another episode of The Milk Minute.

If you would like to join us for more behind the scenes and access to our new podcast Beyond the Boob, where we follow my third pregnancy, and Maureen is my midwife, you can hit us up on Patreon at minute podcast. And we love y’all. Thank you so much. We’ll see you next week. Bye-bye.


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