IN ADDITION TO EMPIRIC AND EXPERIMENTAL DATA SUGGESTING THE FATS IN HUMAN MILK ARE IDEALLY SUITED TO THE RAPIDLY DEVELOPING AND GROWING BRAIN OF THE NEWBORN AND INFANT, THE FATS IN HUMAN MILK ARE MUCH EASIER TO DIGEST. FIRSTLY, HUMAN MILK CONTAINS BILE SALT-DEPENDENT LIPOPROTEIN LIPASE. THIS ENZYME AUGMENTS THE INFANT'S CAPACITY TO DIGEST & ABSORB THE FATS IN BREASTMILK. BY THE WAY MARGIT HAMOSH HAS PUBLISHED DATA SHOWING THAT THIS ENZYME IS INCREDIBLY STABLE AT ROOM TEMPERATURE FOR UP TO 24 HOURS. IN OTHER WORDS, IF MOM PUMPS AT WORK AND PLANS TO GIVE IT TO HER BABY LATER ON, THE ENZYME IS STILL FUNCTIONING AT A HIGH LEVEL. SECONDLY, PRACTICALLY ALL FAT IN BREASTMILK IS PACKAGED AS MILK FAT GLOBULES. THE FAT GLOBULES ARE ALL COVERED BY A MEMBRANE, THE MILK FAT GLOBULE MEMBRANE. THIS LINING ASSISTS IN THE DIGESTION & ABSORPTION OF BREASTMILK FAT. IN OTHER WORDS, HUMAN MILK IS SO COMPLEX AND INTRICATE THAT WHEN COMPARING IT TO FORMULA, WE NEED TO CONSIDER MORE THAN CONTENT. ALSO, I THINK THAT WEIGHT GAIN IS NOT THE END ALL AND BE ALL. ONE NEEDS TO CONSIDER THE ENTIRE BABY. ASSUMING THAT BREASTFEEDING IS GOING WELL ... FOR INSTANCE, DOES THE BABY APPEAR WELL-NOURISHED (VS. HAVING DECREASED AMOUNT OF SUBCUTANEOUS FAT)? IS THE STOOLING AND URINATION PATTERN AND CHARACTER NORMAL? IS THE BABY ACHIEVING DEVELOPMENTAL MILESTONES ON TIME? DOES MOM REPORT THAT THE BABY IS SATISFIED AFTER NURSING? GIVEN THE NUMEROUS BENEFITS OF BREASTFEEDING, MANY OF WHICH WE PROBABLY HAVE YET TO DISCOVER, EXCLUSIVE BREASTFEEDING SHOULD NOT BE INTERFERED WITH OR POTENTIALLY SABOTAGED FOR THE SAKE OF ONE NUMBER OR MEASURE OF WELL-BEING. IN DECIDING WHETHER TO SUPPLEMENT, THE ENTIRE PATIENT NEEDS TO BE CONSIDERED. DANNY HIRSCH, MD, FAAP, CLC DIRECTOR, LACTATION INSTITUTE OF WESTCHESTER ASSISTANT PROFESSOR OF PEDIATRICS NEW YORK MEDICAL COLLEGE VALHALLA, NY, USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html