Lipase Question

iVillage Member
Registered: 06-07-2012
Lipase Question
9
Sat, 02-23-2013 - 3:46pm

I think I might have excess lipase in my breast milk.  My son is 1 month old, and I just recently started pumping.  I've followed all the guidlines regarding proper pumping and storage.  

I noticed that the breast milk started to smell a little funny after four days in the refrigerator, so I tasted some of my pumped milk from today and then tried the 4 day old milk.  It was terrible.  So terrible that it made me throw up.  

Doing a little research, it sounds like it might be a lipase issue and I also read that even though the milk might smell and taste bad, it's not really bad?  So how do you know when it actually goes bad?  I have no desire to EVER taste the milk again, as over an hour later, I can still taste it.  Ick.

I will be going back to work in about 3 weeks, so I definitely will be needing to pump and hopefully freeze some milk from time to time.  What are my best options here?

Complicating things is the fact that we're pretty sure my son has a dairy sensitivity/allergy and I've had to cut out dairy from my diet.  We don't want to have to switch him to formula because our formula options are alimentum or nutramigen...we definitely don't want to have to put him on either of those.

Thanks in advance!!

iVillage Member
Registered: 06-07-2012
In reply to: KD79
Fri, 03-22-2013 - 11:20am

Thank you for all the information.  I thought I would post an update.

After meeting with the hsopital's LC and pediatrician, it was determined that I DO have a very strong MER.  I expected this, so it wasn't a surprise.  We talked about strategies I could use to help my son not take in so much air during that time.

What WAS a surprise was that the doctor and LC both suspected my son of having acid reflux.  They thought that a lot of his stomach problems were due to the AR.  He was definitely overeating (taking in just under 3 oz each feeding, wanting to feed every hour), and he was doing so because the AR made him feel like he needed to eat.  The overeating was then upsetting his stomach even more, leading to gas and irritability, and then also making his AR worse, creating a horrible cycle.  We started my son on Zantac last week Wednesday and he's now feeding every 2 to 2.5 hours during the day, doing a sleep stretch of about 5 hours at night, and is generally a lot happier.

The doctor also ordered a hemacult and stool culture to try and figure out why he's still having mucousy diarrhea even after I cut dairy out of my diet.  I'm still waiting on those results.

I'm so happy the appintment went so well. The only bad news is that we're now dealing with thrush.  It's been a week and after a couple good days, the pain is back.  As a working mom who pumps, having to sterilize everything and do hot loads of laundry every night, I'm so over this!!

iVillage Member
Registered: 12-21-2009
Tue, 03-05-2013 - 7:51pm

Another strategy for oversupply is to pump one time until you are ‘dry’ or hardly any flow is coming. Some moms find they can do that one time and continue with one breast per feeding or block feeding while others need to do it another time a few days later and then they seem better.

It is possible to have oversupply in one side only. If you are worried about not keeping up with pump volumes it’s ok to pump now to build a bit of a stock pile. Don’t forget though you’ll have to scald the milk prior to freezing since you have the lipase issue. I would also try to scald then freeze milk and see if that works for your baby.

One thing though, ideally, it’s actually better to pump each day what is needed each day at daycare. If you build up a big stock pile and need to pull from it each day b/c you aren’t keeping up you will ultimately be signaling your breasts to make less milk each day. So in a way, the ideal of pumping each day what is needed each day will eliminate the lipase issue for you.

I did try to research a bit about the lipase and could not find anything else useful…………sigh!

One good aspect of oversupply is that it generally settles down over time anyway. If you feel the block feeding is not a good fit for you, it’s ok to go with your gut about what will work best for you and your baby.

Warmly,

iVillage lactation consultant

and Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas and Charlotte    

Kathy Kuhn IBCLC ivillage lactation consultant Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas, and Charlotte

iVillage Member
Registered: 06-07-2012
In reply to: KD79
Thu, 02-28-2013 - 10:13am

Thank you both.  

It does seem as though I'm dealing with oversupply, but maybe only in one breast? Would that even be possible?

I've been nursing him in the football hold, while reclined to help with my forceful letdown.  I've also started block feeding, but I'm not sure it's going so well.  My son seems to want to nurse even more frequently when I block feed.  I'm doing 2 hour blocks, and he's wanting to nurse every hour or sooner, when before, we were at about every 1.5 to 2 hours.  Also, when block feeding off my left breast, he seems frantic and like he's not getting enough...and my right side gets pretty full/engorged.  This is why I'm wondering if I have oversupply only on one side.

One additional question about block feeding...I'm going back to work in just under 3 weeks.  While oversupply is an issue for my son when he's directly nursing from me, I can only imagine that it will be helpful when I'm pumping.  I worry that block feeding will hurt my supply and that when it comes time for me to go back to work, I won't be producing enough to cover while I'm at work.  With my last son, I struggled to have enough.

I got the referrals I needed, so I have an appointment at my hospital's outpatient breastfeeding clinic next week.  Hopefully that will lead to some answers.  We'll be seeing an LC as well as a pediatrician that specializes in breastfeeding.

Thanks again!

iVillage Member
Registered: 12-21-2009
Wed, 02-27-2013 - 8:31pm

Here’s more on oversupply and reflux for you:

Oversupply

http://parenting.ivillage.com/baby/bbreastfeed/0,,94kctqn6,00.html

Reflux and bf baby

http://parenting.ivillage.com/baby/bbreastfeed/0,,9fjlkpq2,00.html

Often the oversupply creates irritation in the gut that makes babies more sensitive to the dairy. Sometimes when you clear the oversupply the baby’s gut heals and you can slowly reintroduce the dairy, but give it time to be sure the baby’s gut is totally healed.

As far as the lipase, it’s just a personal observation of mine, no research. I just feel like I see the lipase problem more frequently in moms with oversupply.

Keep us posted on what is working. That’s how we learn more!

Thanks Dana for your kind words as always! ((HUG))

Warmly,

iVillage lactation consultant

and Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas and Charlotte    

Kathy Kuhn IBCLC ivillage lactation consultant Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas, and Charlotte

iVillage Member
Registered: 06-10-2008
Tue, 02-26-2013 - 4:00pm

I would think if you're planning on using it the next day, you'll be a-ok. It sounds like you have a plan!!

Kathy, I knew that oversupply and dairy sensitivity often went together but I never knew lipase went hand in hand with those too. You learn something new every day!! (especially when you hang out with Kathy)

Can you take a look at this link and see if you feel like these symptoms ring a bell to you? Oversupply is quite common and fortunately quite treatable too. The two strategies that help many moms with regards to oversupply are uphill nursing and block feeding. Uphill nursing means using nursing positions where you're working against the flow of gravity. Block feeding means using one breast for a period of time to tame the milk monster. How milk production work is the more frequently a breast is emptied, the more milk is produced. By giving each breast a "rest" for a chunk of time, it will scale back production. Are you currently nursing one breast or both per session? For some moms, just nursing one breast per session for a little while is enough. For moms with more severe oversupply, they might need to use the same breast for a few nursing sessions to get things under control. Anyways, take a spin through this link and let us know what questions you might have.

http://kellymom.com/bf/got-milk/supply-worries/fast-letdown/

Dana

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iVillage Member
Registered: 06-07-2012
In reply to: KD79
Tue, 02-26-2013 - 2:57pm

Thank you, that information helps.  I am hoping to not have to scald all my milk, but only the excess that I plan to freeze.  For the most part, much of what I pump each day will be used the following day while my son is at daycare.  Does that sound like a feasible plan?

It's funny you should ask about oversupply.  I'm starting to think that I might have that issue.  I know for sure I have a strong milk ejection reflex (while I don't really ever spray, my son gags, chokes, gasps for air, and gulps during letdown).  I don't ever feel like I have an oversupply because my son eats every hour, so I never really get too full. 

I talked with the LC at the hospital where I delivered and she's starting to think that maybe all our issues (little one is gassy, has diarrhea, generally is not content, wants to eat every hour, etc.) is more due to an oversupply/MER issue versus a dairy sensitivity.  I'm trying to get a hemacult ordered by our pediatrician so we can look further into that.

Breastfeeding sure isn't easy...I knew this from nursing my now 5 year old...but this time around, it just seems like it's full of complications for us!

iVillage Member
Registered: 12-21-2009
Mon, 02-25-2013 - 9:11pm

If the lipase is an issue it seems best to scald as soon after you pump as possible and before freezing. Freezing does not stop the action of the lipase. If you scald you can refrigerate or freeze or freeze after a few days of refrigeration. However, since the lipase action seems to vary from mom to mom I’d try freezing right away vs freezing after refrigeration to see what happens to your milk.

It can be challenging to tell lipase action vs really bad except to say that when milk is spoiled it smells rotten or much worse than what the lipase action does.

I’m just curious, for my own information. Do you also have oversupply? The reason I ask is oversupply, dairy sensitivity and the lipase issue seem to go together often IMO. Or at least I think I see that connection. Just wondering? Thanks and let us know what works for you so we can pass along your tips.

 

Warmly,

iVillage lactation consultant

and Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas and Charlotte    

Kathy Kuhn IBCLC ivillage lactation consultant Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas, and Charlotte

iVillage Member
Registered: 06-07-2012
In reply to: KD79
Sun, 02-24-2013 - 6:22pm

Hi!  Thanks foryour reply.

Freshly pumped milk is okay and it seems to turn sometime around day 3 or 4 in the refrigerator.

I did see that article on KellyMom, however, I still have questions.

1. Would I need to scald the milk before freezing it, or does freezing it stop the breakdown of the fat?

2. How do I know if it's just a lipase issue or if the milk is really bad?  To me, if it smells and tastes bad, it IS bad, but I've read that babies can still drink it without a problem.  I guess I just want to know when I should throw the milk away versus trying to get my son to drink it.

3. If I scald the milk, can I put it in the refrigerator for a couple of days and then freeze it, or should I freeze it right after scalding it?  

I've been working with a couple of LC's because of the dairy issue and a couple other issues, so I will talk to them about this as well, but I appreciate your help.  I like to get as much information as I can.

Thanks so much for your help.  

iVillage Member
Registered: 06-10-2008
In reply to: KD79
Sun, 02-24-2013 - 8:11am

Welcome to the board and thanks for stopping by!!

From what you've described, excess lipase in your milk sounds like a pretty likely scenario. Is freshly pumped milk ok and is the issue only after a few days in the fridge? 

Have you already read this link? http://kellymom.com/bf/pumpingmoms/milkstorage/lipase-expressedmilk/  This is a pretty good resource about lipase in breastmilk, including instructions for heat-scalding your milk right after expressing. Can you give that a try and see if that makes a difference for your refrigerated breastmilk?

Please let us know if this helps or if you have any additional questions we can help with.

Dana

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