A client is having problems with her EBM spoiling & she wants to know what
to do. Sometimes her milk is rancid & sometimes it is not. I told her about
the presence of lipase in her milk & also that she can prevent or stop the
lipase action by scalding her milk (see p.229 in new BAB). Scalding her milk
at work is not possible at this time though she does have access to a
microwave. That alone doesn't answer her question though. Her EBM isn't
always rancid and it doesn't seem to matter whether the EBM is freshly
pumped in the refrigerator or defrosted from the freezer. If the EBM is used
cold, the rancid smell is not evident though the baby will refuse the rancid
milk whether cold or warm.

Here's a little history: The client returned to work when her son was almost
4 mos. Her son is now almost six mo. (BW: 8lb.1oz.; current wgt: @17.5 lbs.)
and he is also getting three servings of solids per day. She is using a dbl
electric breast pump that she rinses between pumping sessions with hot water
(no soap at work). Does the lack of soap matter?

We have done a search of the archives on lipase as well as searching through
Ruth Lawrence's book, the new BAB, Riordan & Auerbach, etc. We have passed
along any information that was new or different from what we've already told
her. Does anyone know anything more about the variation of lipase levels in
one mother's milk? Is there a way for her to raise or lower it? Could it be
affected by the time of day she pumps, her diet, etc? We asked about
broccoli or cabbage use in mom's diet thinking a high sulfur or gas
producing food could elevate the lipase level but she hasn't been eating
either. The reason I ask is that this woman pumped two times the other day
and one feeding was rancid, the other not.

At what temperature would the lipase be destroyed or at least inactivated in
her milk? One of the archive posts mentioned that gentle heating was all
that was needed. How gentle? Would giving her EBM a quick zap in the
microwave before refrigerating or freezing help? How long should we suggest
for the "zap".

An additional question since her husband is the caregiver, is what can he
feed the baby if the milk in the freezer is rancid already. Her son has
never had ABM and she doubts that he would take it if offered. (Smart baby!)
Remembering something Jack Newman has written, I told her it wasn't
necessary to give him ABM and did suggest whole milk or alternate milks such
as soy or rice if allergies are a concern.

Is anyone doing research on lipase in breast milk? If so, would we be able
to contact them? I work for a resource and referral company supporting a
corporate lactation program and did mention to the client that I would be
posting to a lactation listserv to try to get more information for her. Both
the client and my fellow LCs at work are puzzled by what's been going on and
what seems to be the randomness of the spoiling of her EBM.

-Harriet F. Smiley, IBCLC (also LLLL)
LifeCare, Inc.

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