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Subject:
From:
"Kermaline J. Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 11 May 2001 19:35:21 -0400
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Elisheva asks:

<Now this prompts me to ask a question I have been sitting on for a long
time, because it seemed simple to me; but I can't figure it out yet.

My understanding of how "milk removal drives supply" is that we believe
there to be an inhibiting factor in the milk:  an emptier breast secretes
milk
faster, a fuller one secretes milk slower. That means that nursing more
at 3pm, say, ought to make you more milk by 5pm.>

I will start by making a small stab at one part of the answer. I am doing
this from memory from a lecture by Dr. Floyd Schambacher of Ohio State
Univ. Agricultural department. I will leave it to others to explain the
autocrine theory of inhibition.

One of the things he illustrated is that at the cellular level, milk
making cells of all mammals look alike under the microscope. Each
alveolus can be looked at as an individual milk factory.

The various microscopic parts of the cell (Golgi bodies, Rough
Endoplasmic Reticulum etc.) are laid out in a definite pattern as if part
of an assembly line.

Certain ingredients of the milk are made in a certain sequence and moved
along to the next station on the assembly line for further addition, or
"packaging" or whatever.

As the individual droplets of various milk component packages that have
been secreted across the membrane are collecting in the alveolar lumen
without an MER removing it into the ducts, the increasing pressure
changes the shape of the cell so that the "assembly line" parts are not
lined up as efficiently, and therefore, synthesis behind the membrane
slows because some portions are out of alignment with others.

I believe he said that some of the partially manufactured milk begins to
"self-destruct" because enzymes in the milk then begin to digest and
prepare for reabsorbtion into the circulation some of the milk components
that had not yet been secreted across the membrane.

How this actually works out in answer to your question is pure
speculation on my part. Experts tell us that not every milk making cell
is at the same stage of activity at any given moment, and that the % of
milk removed at any one feeding is never 100% of what's stored.

My imagination (I have a very fertile imagination) tells me that
inhibition and re-stimulation of milk synthesis is a fine-tuned process
whereby any slow-downs or speed-ups are relatively gradual.

That is why we tell moms who are trying to build the supply by frequent
nursing to expect not to perceive much difference for a few days, and
those who are weaning that it needs to be done gradually.

My assumption is that whatever the mechanism(s) at work, the suppy is
reduced slightly in total volume and spread out over the 24 hours. The
nursings earlier in the day may take a slightly greater percentage of the
(lesser total) stored supply each feeding.

Therefore any replacement storage of new secretion stimulated by the more
thorough removal is not enough to send a signal of "full" and elicit MER
at 3 p.m., but by 5 p.m., it may well grow to be.

That is not to say that if you chose to nurse anyway at 3 p.m. there
would be "nothing" there, but that you would be tapping your storage a
little more than usual.

That's the picture in my imagination. Not very evidence based, but it's a
beginning! I'm anxious to hear more from others. I realize there is much,
much more to it.

Jean
***************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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