>>
>> But it is MY understanding that what IS important is that the higher fat
>> content of hindmilk will slow gut motility, and thus the rate at which the
>> lactose moves through the small intestine.
>
> This is a very interesting discussion. It has been my understanding that low
> fat
> milk or hindmilk causes a relative overload of lactose and that the lactase
> can't cope with that at one time and that therefor there is undigested lactose
> in the gut, free for use for gasing bacteria and co.
> Now are we talking the same in different wordings or is this really different?
>
Yes, I do believe we are probably saying the same thing, essentially, but
seem to be getting caught up in the belief that hindmilk means high fat. It
would probably be best discussed as the lactose/fat ratio rather than the
amount of lactose that the baby gets (which is always pretty much the same).
However as Denise observed the hindmilk is not always necessarily much
higher in fat when compared with the foremilk so we create a "myth", I
believe, by always referring to hindmilk as high fat. The definition of
hindmilk is the milk that can be expressed off when the baby has finished a
feed.  In the transient engorgement sometimes seen in the onset of
Lactogenesis 2 (along with the accompanying green stool that also often
accompanies this) babies cannot avail themselves of the fattier milk at the
back of the breast because the degree of fullness of the breast is very
high. This can also be seen in chronic oversupply problems. Or, if a baby
has a short feed in the morning (where the volume taken is very low and the
degree of breast fullness is very high - generally speaking) then the
hindmilk will then also not be very high in fat. A feed taken by a baby in
the evening will contain much higher fat in the foremilk and hindmilk than a
feed taken in the morning, again because the degree of breast fullness is
much lower and because the baby is probably feeding more frequently (the
shorter the duration between feeds the less opportunity the fat has to
ADSORB to the duct walls).  There are many variables that can contribute to
the amount of fat in the hindmilk and to the fat/lactose ratio which is why
I still maintain it is important not to consider single feeds when talking
about foremilk and hindmilk and the concentration of fat, and hence the
fat/lactose ratio.

Regards
Cathy Fetherston RM MSc IBCLC
Peerth Western Australia
cathy Fetherston

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