In an ancient article written by Lawrence Gartner and Kathleen
Auerbach (Mothering, Fall 1986), they wrote that "the presence of
milk in the gut normally reduces the absorption of bilirubin from the
intestine." So all these years I have been thinking that one (among
many) of the reasons why early, frequent bf is so important is to
reduce intestinal reabsorption of bilirubin. Now after hearing Dr.
Gartner at LLLI Conv. last week, I have a new piece of information
that says that mother's milk in baby's intestine ENHANCES bilirubin
absorption. This does make sense in light of new thought about
bilirubin as an antioxidant. But I'm confused about the difference
btwn. early onset and so-called late onset jaundice. The new BAB
explains (on p. 226) that "prolonged jaundice may be due to a
substance in the milk of MOST mothers that increases their babies'
absorption of bilirubin from their intestines." So is this substance
almost always present but maybe in more detectable quantities in late
onset j.?  Could this be some kind of regulatory piece that normally
works to allow just the right amt. of bilirubin to be reabsorbed, and
in those babies who have late onset or prolonged j. maybe approp.
regulation has not yet occurred and mom's milk "compensates" by
increasing quantity of this substance (now detectable)? Can mom's
milk perform both functions, of preventing intestinal reabsorption of
bili while simultaneously regulating approp. amt. of bili to be
reabsorbed (kind of like a gatekeeper + a special carrier to take
across the bili)? I would believe anything to be possible concerning
mother's milk. There are mechanisms we have not yet even thought of.
Could the mechanism for increased intestinal reabsorption be the old
idea that we used to consider, of the substance in the milk
interfering with a liver enzyme involved in the processing of
bilirubin?  Can someone please clarify some of this stuff for me ???
It always bothered me to think of substances in mom's milk causing
problems for babies. With ABM as our cultural frame of reference,
it's hard to get away from perceiving things in a backward manner. I
think that whatever is present in mother's milk is there for a good
reason, even if we have not yet figured out how it works.  Linda C.