Dear Michelle,

Just a few comments.  It could be that a severe lactose overload situation could irritate the bowel enough that it could cause some inflammation or could potentiate what would normally be only a minimal reaction to foreign proteins in the milk into a more serious allergic type response producing the bloody or mucousy stools.  Clearing up the lactose problem might thus also help to alleviate the apparent allergic response because the entire bowel function is more normal.

The work by Peter Hartman keeps coming up and I get the feeling that people are beginning to think that the upshot of it is that there may be no such thing as foremilk/hindmilk or lactose imbalance.  I have read a lot of his stuff (and hope to hear him speak next spring).  Some of it remains confusing to me, but the gist of it is that both the fat content and the rate of synthesis of new milk is related to the emptiness of the breast during milk production.  So if baby is sleeping for a longer period during the night, the breasts become much fuller before the next feed, fat content is lower.  After the first morning feed, there often is still a lot of residual milk in the breast (depending on storage capacity).  Rate of synthesis may still not be very high.  As the day wears on, baby is nursing more frequently, breast is "emptier" more frequently so that the relative fat content of the milk becomes more uniform from feed to feed, or even from beginning of feed to end of feed.  However, in moms with an oversupply, the breast is never very empty and the relative lactose to fat content remains high throughout the day.  I think that for the majority of moms there really is not much meaning to the foremilk/hindmilk thing because the babies are feeding frequently enough that the rate of synthesis and the fat content is fairly constant.  But for some moms, I think that there can be a problem.  Please feel free to correct me if I have gotten any of this wrong.  At the first ILCA conference I ever went to I still remember a session on the work by Michael Woolrich where  he sampled milk from the beginning of a feed through the end of the feed and showed a lovely increase in fat content as the feed progressed.  We now know that that was just part of the picture, a snapshot of a particular feed at a particular point in time.  I still find the whole subject of lactogenesis to be completely fascinating and intriguing and do hope that we somehow put the whole picture together sometime before I leave this earth.
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

             ***********************************************
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