Dear Brenda and all,
This is a largely personal perspective, based on my five and one-half
years (so far) of nursing experience with chronic, persistent and repeated
plugged ducts; I have also helped moms as an LLLL and take their
experiences into account.  The 1997 edition of The Breastfeeding Answer
Book had Ruth Lawrence's recommendation to use one tablespoon of lecithin
per day (in addition to limiting fat intake).  This was what I did,
intermittently, and I found that I seemed to have fewer bouts of plugs
when I was faithful about taking my lecithin.  My diet was already low in
fat and I didn't make changes in that area.  I see that the new 2003 BAB
(which, by the way, is a lovely revision!) has both the former
recommendation by Dr. Lawrence as well as a higher total daily dose of 1
TBSP 3-4x/day as suggested in Jack Newman's book.  I did find the single
daily dose quite helpful, for what that's worth, and have known of two
other mothers for whom 1 TBSP/day was also effective.  So, n of 3.  I
would probably feel comfortable sharing both recommendations with a mom
(along with reviewing the MANY other tips and techniques suggested for
resolving this persistent, painful, discouraging problem); if she did not
experience relief with the single dose, she could try it a few times a day
instead.
On a related note: In regards to the Australian news article that doubts
the existence of plugged ducts, I feel quite certain that the author has
neither personally nor professionally ever dealt with this phenomenon.
Anyone who has suffered with significant mastitis issues knows that plugs
(from stasis secondary to ineffective/inadequate milk removal, oversupply,
or both) are present in many cases.  Not only can they be palpated, but
sometimes they can actually be expressed.  I would agree that inflammation
of the ducts might feel like a "plug" when in fact one is not present.
However, as someone who has both expressed plugs and taken my fair share
of calls from panicked mothers who found "little white strands" in their
milk, I am confident that they are an actual physiologic entity.  Anyone
care to comment?
Karen Pogge, MD, LLLL (and local expert on persistent plugged ducts)

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