> Question:  Can lactose cause the sym of gas and fussiness insome bf infants
> without having galactosemia?  Could it be from too much lactose in
> foremilk?
>
I do not believe that there is too much lactose in the foremilk. However
it could easily be an issue of too much foremilk without adequate
hindmilk for balance. What results in such cases is not enough fat
intake (from the hindmilk cream). Actually, I believe it is *not* even
the lactose causing the problem in these *specific* cases (>>>> colicky,
frequent, short-duration feeders, gaining length faster than weight),
but rather a *calcium overload*. The foremilk carries alot of calcium,
and without a proper balance of fat (from the hindmilk), it breaks down
into gas in the gut resulting in the colicky breastfeeder.

The babies I've worked with fitting this clinical picture responded well
to 1)single-sided nursing or 2)mom pumping foremilk (*not* to be used as
a supplement by itself or you recreate the problem), and then nursing
just the hindmilk. These babies tend to be "fast nursers" and cannot be
convinced to nurse longer than 10 minutes as a rule.

If the calcium overload seems not to be the answer, before blaming
breastmilk for having Too Much Lactose, I'd rather look into baby having
Not Enough Lactase, especially if galactosemia, etc, etc has been ruled
out. (Can we supplement babies with lactase enzymes in such cases?)

Katharine West, BSN, MPH
Sherman Oaks, CA