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

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