Ellen,
I think there are some other significant issues to consider. First, 
when babies are "gulping down" 4 oz in 4 minutes, there is not a lot of 
tongue peristalsis going on. Since gut peristalsis is in part dependent 
upon the peristalsis of the tongue, it seems to me that these babies 
would have digestive issues originating with the physiology of simply 
having to manage the rapid flow. Another concern that I continue to 
raise and have seen no reponse to is the issue of babies growing very 
rapidly on sugar (lactose) and how this may have long-term implications 
for development of type 2 diabetes. While I do see that tamping down 
the supply is beneficial, I also believe that fixing the latch is the 
real long-term solution to "oversupply' problems.
Jennifer Tow, IBCLC, CT, USA


Date:    Fri, 27 Jan 2006 14:24:12 -0800
From:    Ellen Steinberg <[log in to unmask]>
Subject: Relationship between excessive foremilk intake and digestive
disturbances

It is widely believed that babies who consume mostly foremilk may suffer
 from diarrhea or other gastrointestinal disturbances and discomforts.   
I
have not read any research that definitively has studied this 
phenomenon.
If you know of any studies that are conclusive in this area, please 
respond.

I have another theory to propose, and I wonder if any of you has also
considered this:

What if these gastrointestinal disturbances are not caused by the 
quality of
the milk ("foremilk has too little fat and too few calories") but by the
quantity of milk.  Permit me to explain further.  If a mother has an
overwhelming milk supply, we recommend to her that she breastfeed on one
side until that breast is empty before she switches to the other breast.
Often, these mothers end up using just one breast at each feeding.  This
helps to reduce her milk supply due to the negative feedback her 
breasts get
when they reach their storage capacity.  This technique also happens to
decrease the likelihood that the baby will get mostly foremilk.  It has 
been
assumed that since this one-sided nursing technique does result in a
decrease in digestive problems, it must be that the etiology of the
digestive disturbances is the baby consuming too much foremilk.

What happens when a baby simply consumes too much food?  He also 
experiences
gastrointestinal disturbances and changes in the bowel movements.  
Perhaps,
what we are seeing as too much foremilk is just a situation in which the
baby is consuming too much milk overall.  The mother who produces an
overabundant milk supply may believe that she needs to breastfeed for X
number of minutes per breast (i.e.15-20 minutes per breast), and that 
if her
baby doesn't stay on the breast for that long, he must not be eating 
enough
milk.

Case in point - I was contacted by a mother of a 3 week old baby who was
concerned that her baby would only breastfeed for 5 minutes per breast 
and
then would refuse to continue to nurse and would spit up half of what he
ate.  This 7 lb-8 oz baby was fussy, gassy, and had runny bowel 
movements.
During the consultation, the baby gulped constantly for 4 minutes and 
then
was not interested in continuing to breastfeed.  Test weights showed 
that he
consumed 4 ozs in 4 minutes.  No wonder he was always spitting up and
uncomfortable!  When the mother realized that the baby was overeating, 
she
learned to follow the baby's feeding cues and worked on decreasing her 
milk
supply.  Within 24 hours the baby's symptoms disappeared and he was 
calm and
comfortable.

This is just one dramatic example out of hundreds of cases I've had 
where
helping the mom understand her milk supply and her baby's response to 
it led
to a quick and easy resolution of the problem.

I recognize the benefit of understanding the difference between 
foremilk and
hindmilk.  However, I have also heard from many mothers how their milk 
must
be "bad" because they were told that they had too much foremilk which 
didn't
have enough fat content so either their baby is not gaining weight or 
the
excessive foremilk is causing the baby too much distress.  Mothers have 
no
easy way of knowing at what point in the feeding their foremilk has
transitioned into hindmilk.  But for those mothers who have been led to
believe that their milk quality is inappropriate, we might better help 
them
by evaluating whether their milk quantity is not appropriate (either too
much milk, as in the case above, or perhaps too little - but that is 
another
one of my favorite topics which will have to wait for a different 
posting.)

I welcome your comments on this issue.

============================================
Ellen A. Steinberg, RN, LCCE, IBCLC
E-mail: [log in to unmask]

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