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Tuesday
Sep042012

Battling and Resolving Excess Lipase in Breastmilk

While it is unknown how common it is for a mother to have excess lipase in her breast milk, causing it to smell or taste soapy, I come across it often enough that I thought it would be helpful to share how to deal with it, from a mom's perspective.    Christina Williams was gracious enough to write this article, walking us through her journey battling and resolving her issue with excess lipase and her baby who refused to take a bottle, even when she went back to work.  Thank you so much, Christina, for sharing your knowledge and determination!

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In preparation to be a first-time mom, I’d been tearing through books and following countless blogs for months prior to my daughter’s arrival. I was sure I had everything in order and was ready for anything motherhood had to throw at me. I could distinguish common rashes from those that are more worrisome, had memorized the slide deck of normal infant poop, and had figured out the optimal wash routine for my growing collection of cloth diapers. Was I prepared to do the seemingly simple task of giving my new baby a bottle after we established our breastfeeding relationship? The thought hadn’t even crossed my mind.

We struggled for months to get my breastfed daughter to take a bottle. We tried every trick in the book – countless fancy bottles, different people, positions and places, and my husband even devised a few feeding contraptions. Nothing worked. She could see that bottle coming at her and would seal those cute little lips right up until it was out of sight. Everyone tried to be encouraging, “She won’t starve herself,” they would say. Maybe not, but she sure liked to scare me into thinking she would try. When I went back to work she reverse cycled, completely refusing milk during the day but eating almost constantly through the night. Staying up most of the night and working all day is not a recipe for success for a working mom. I was lucky to squeeze in two hours of broken sleep a night.

Then, when my daughter was nearly 5 months old, I tasted some breast milk that had been in the fridge for a few days. It tasted rancid, soapy, and a little metallic. No wonder she had been refusing it! I thawed some milk from my freezer stash – that was terrible, too. That confirmed it; there is excess lipase in my breast milk.

What is lipase, and what is it doing in my breast milk? Lipase is an enzyme that breaks down the fats in your milk to help baby digest it. When lipase occurs in excess, this process happens much more rapidly and can make the milk taste off or sour after a period of time. Milk with excess lipase is safe to drink, but some babies dislike the taste and refuse it. Sometimes this change happens in a matter of hours, but many women find that they have 24 hours or more before the milk fats break down enough to alter the taste. 

I think I have excess lipase. What can I do about it? Fortunately, lipase can be inactivated at high temperatures, and milk can be safely stored in the fridge or freezer. Milk must be scalded before freezing, as lipase is still active even at low temperatures. Unfortunately, many women find out that they have excess lipase after establishing a freezer stash and finding that their baby won’t take any of it. If you find yourself in this situation, consider donating. Many babies will accept this milk, and it is often used in tube fed babies who can’t taste it, anyway. My regional milk bank was thrilled to accept my milk, excess lipase and all.

The first step is to determine at what point your milk starts to taste funny. I tasted my room temperature pumped milk hourly until I noticed a difference. I found that I need to scald at work after each pump session, as I don’t have enough time before it turns to make it home at the end of the day and do it all at once. Once you’ve determined your personal timeline it will help you make a plan for scalding your milk.

What do you recommend as the easiest, most effective method to scalding pumped milk? There are two popular ways to scald – in a pan on the stovetop and using a bottle warmer. Both methods require that the milk reach a specific temperature and then cooled.  Some methods suggest heating to 180° and cooling immediately. Others*** recommend heating to 144.5° and keeping it at this temperature for 1 minute, or heating to 163° for 15 seconds and then cooling. Personally, I prefer the bottle warmer method and heating to 180°. I find it difficult to reliably heat to either of the lower temperatures and maintain those temps for the recommended length of time, so I tend to stick to the 180° method. Plus, having a new baby makes even basic tasks seem complicated, so I opt for the simplest option.

***Per Lawrence & Lawrence, bile salt-stimulated lipase can also be destroyed by heating the milk at 144.5 F (62.5 C) for one minute (p. 205), or at 163 F (72 C) for up to 15 seconds (p. 771).

How do you scald milk in a bottle warmer? What supplies are needed? How long does it take? I scald at work 2 or 3 times per day. It takes me exactly 7 minutes to scald and clean up.

Here are the supplies I use (total investment, around $70):

-Bottle Warmer – Select a bottle warmer that doesn’t have an automatic safety shut off. You need to heat the milk to a high temperature, so having the auto shut off kick in mid-scald isn’t going to get the job done. I prefer warmers that contain the entire bottle versus those that allow half of the bottle to stick out the top.

-Stainless Steel Bottle - I don't like to heat in plastic, especially to such a high temperature, and I found that heating in glass is sketchy. My glass bottles broke in the bottle warmer on too many occasions, plus the hot glass can’t be transferred directly into cold ice water or it will shatter. It must be poured it into another container first before cooling. Too many steps if you ask me! Stainless steel allows you do all the steps without transferring containers.

-Digital Thermometer - You'll need one of these regardless of what scalding method you use.

-Container for Ice – Select a container that is deep enough to submerge your bottle and around 3-4 cups of ice. I use a large, glass measuring cup.

-Ice - I like to bring a huge bag of ice in once a week. I can never remember to pack a bag of ice from my own freezer every day, and this seems to make the whole process a little easier.

Steps:


1. Fill up bottle warmer reservoir, fill the stainless steel bottle with milk, and set the timer for at least 5 minutes. I can usually heat 7-8 ounces in 3-4 minutes. It will take longer to heat if you are using a glass container.

2. Prep your ice bowl with a few cups of ice and cold water. I find it helpful to have this ready before I start heating the milk, as the last few degrees change very quickly and you don't want to over heat. Those last 20 degrees seem to happen in just a few seconds.

3. Start the bottle warmer and stick in your thermometer. As your milk is heating, stir it around a bit with the thermometer so it heats evenly.

4. As soon as you reach 180°, quickly remove from heat and submerge in the ice bath. I let it sit with the lid off for a few minutes while I pack everything else up.

 

5. After a lot of the steam has escaped and the milk is relatively cool, I put the cap on the bottle and put the container with the bottle inside in the fridge. Usually, I put a paper towel over it if I’m putting in the office fridge. It isn’t necessary to put the ice bath in the fridge, but if I leave it on the counter I will inevitably forget about it until it's too late. The fridge is a nice insurance policy for those Mommy Brain moments.

6. Once completely cooled, transfer the milk into a storage container.

Anything else I need to know? I find that my scalded milk doesn’t always last a full 7 days in the fridge. Your experience may be different, but it’s best to make sure it passes the sniff test after a few days before using. Scalding milk may reduce some of the anti-infective properties and nutritional value of the milk, but not enough for it to be of concern unless baby is getting only scalded milk all the time. Lastly, this all may seem overwhelming, but it is completely do-able, even at work. It took a bit to get in the swing of things, but now it’s just a part of my daily routine.

It took a while to get my daughter to start accepting a bottle, even after I started scalding. After all, we had been conditioning her to think bottles are full of gross milk. It took a few months of patience and persistence, but she now does most of her eating during the day and sleeps at night (well, maybe the sleep part hasn’t been worked out just yet). In true baby fashion, she hates the beautiful, enormous collection of glass bottles I picked out when I was too hormonal to know better. She loves the cheapest, least eco-friendly bottles out there. Typical.

Disclaimer: If you suspect you have an issue with excess lipase, please consult your physician or lactation consultant for advice on how to best manage your situation. I am not a medical professional, just a mom sharing my own experience.

 

Links to other articles about excess lipase:

Simply Rebekah: Excess Lipase (An Introduction through Becoming a Milk Donor)

Kellymom - My Expressed Milk Doesn't Taste Fresh.  What Can I Do?

La Leche League International - Can Diet Changes Help With Excess Lipase

 

Have you experienced excess lipase in your breast milk?  

Did it cause difficulties with your baby taking a bottle?

 

 

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Reader Comments (29)

Breast milk is the best source of nutrition for infants, but it is not always an available option. In cases where the mother is unable to nurse due to illness or if the baby is adopted, the parents have to look for other alternatives to replace breast milk.

September 6, 2012 | Unregistered CommenterBababoom

Holy moly - I had no idea that this even existed. I will taste my milk when I get home today. My daughter has been awful about the bottle and we couldn't figure it out. It has been seriously stressing me out!

Nothing I can do to change my diet?

September 6, 2012 | Unregistered CommenterAnn G-B

A personal thanks Christina! You made the process so much easier & took all of the guess work out for me! I'm scalding & it's working!
Sincerely
Susan & Amelia

September 6, 2012 | Unregistered CommenterSusan

I tasted the freshly pumped and the day old milk in the fridge. Tasted the same... On the flip side, my daughter took two bottles at the sitter today so things are looking up!

September 7, 2012 | Unregistered CommenterAnn G-B

Thank you for the information. I'm getting ready to go back to work and I suspect an excess lipase issue. I had it with DS (now 4yo) and I was hoping it wouldnt' happen with DD (6 weeks old). I will do the sniff test and likely get the supplies for heating/cooling at work.

Do you know if I can gather all the milk from different pumping sessions and heat it all at once. It seems like a lot of work to do at every pumping session!

September 7, 2012 | Unregistered CommenterJaneen

Just read your article. Great info. Extra lipase is such a pain in the butt, but once you get it figured out things are much easier. I thought I'd offer some encouragement, I had lots of extra lipase in my milk with our first, now with my 3rd baby there's none. I have better eating habits now, but nothing else has changed. So, maybe it will be this way for you as well.

September 7, 2012 | Unregistered CommenterSamantha R.

Great article! I'll definitely refer people here!

I think it is important to note that not all funny tasting milk is because of lipase - read to the bottom of the kellymom link above about how some items in your diet can also make milk taste rancid. I recommend that all Mom who are planning to store milk do a freezing trial. Pump a sample, taste it yourself, look at it, smell it, freeze for a week, defrost and then taste, look, smell again - just to give you an idea of how things change.

For babies receiving a bottle, this is one of my favorite articles ever: http://blog.nurturedchild.ca/index.php/2010/12/10/baby-led-bottle-feeding/

September 7, 2012 | Unregistered CommenterEllen IBCLC

We also had a lipase issue but mine cropped up ~10 months in. Very frustrating.

I didn't end up scalding my milk because I barely had enough time to pump. What we did do was immediately freeze he milk in a glass bottle after pumping. When I got home I would put in the fridge for the next day use. Thankfully since it was late onset my freezer stash was unaffected, so we used that for emergencies/when there wasn't enough for the day.

I bookmarked this post for baby #2 as maybe by then if it happens again I'll have time to scald.

September 8, 2012 | Unregistered Commenterkrystyn

Can you tell me what kind of stainless steel bottle you used please? And what kind of bottle warmer is that? I can't seem to find one without the safety shut off. This is very helpful. I used to scald in a stainless steel pan and it was a production. I'd much rather try your way. Thanks, Jessica

September 19, 2012 | Unregistered CommenterJessica Sawyers

Susan, I'm so glad to hear that scalding is working! I hope you guys have found your groove with it.

Janeen, you can collect the milk and scald at the end of the day, provided that your milk hasn't started to taste funny by that time. I find that the taste of my milk starts to change very quickly, so I have to scald after each pumping session.

Jessica, I have contacted Robin to find out the best way to get the product information to you.

September 25, 2012 | Unregistered CommenterChristina Williams

Jessica, thanks for your question. I've included links to the products Christina used above in the article. Hope that helps!

September 25, 2012 | Registered CommenterRobin

Is there anything I can do to save my milk in the freezer. This is my thrid child and the first time I have had this problem. It saddens me so much.

January 15, 2013 | Unregistered CommenterRachel

Thank you so much for this information. I just discovered I have this problem yesterday for the first time after sending my daughter to daycare and her refusing the bottle all day. I plan to use your method to scald my milk in the future, for now though a good old pot on the stovetop seems to be working, my daughter drank more milk today at daycare, still not what she should be, but we're getting there. She never cried from the bottle!

March 7, 2013 | Unregistered CommenterCandice

Thank you so much for sharing this! I had this problem with both of my girls but never new why until long after I had stopped breastfeeding! I talk about this in the breastfeeding class that I teach, purely bc it was not something anyone had brought up to me when I was breastfeeding. It would have saved a lot of dumped out breastmilk and a whole freezer stash if I had known back then!

March 27, 2013 | Unregistered CommenterAJ Cecil-Starlin

I am planning to donate my frozen milk from before I found out I needed to scald once I confirm my baby won't drink it. You can find your nearest milk bank at hmbana.org and give them a call to get the process started. A lot of times the babies are getting the milk through feeding tubes and don't taste it anyways...

April 26, 2013 | Unregistered CommenterSara

Thanks for this information. My milk seems OK if it's been in the fridge for a couple of days, but definitely not if I freeze it and then thaw it. Then it tastes and smells horribly soapy. I didn't know about this problem 3 yrs ago (when I had my son) until it was too late. I had loads of frozen milk that couldn't be salvaged and eventually threw it out. (*tear!*) Now I have a 4 month old daughter and I did a trial run. Unfortunately my milk goes funky after freezing and thawing. I have just tried to heat it after pumping (on the stovetop) and I will freeze it for a few days and then thaw it to check things out. I hope that works. Otherwise I guess I won't be storing any milk and will only pump what she will consume in the next day or 2, out of the fridge.

Sorry, that was long-winded. I just wanted to thank you for posting this info because it is pretty difficult to find out information about excess lipase in breastmilk. So thank you!

April 26, 2013 | Unregistered CommenterNicole

This is an excellent article. I am getting ready to go back to work and have been looking for advice on scalding at work. My milk starts to taste soapy after about 6-7 hours... In any event, I would appreciate hearing how the author transports the milk in stainless steel. If she has lids for the bottles, please say the brand. Thanks a bunch.

May 17, 2013 | Unregistered CommenterAmanda

My sister's baby refused to take a bottle and now we think this is an issue for her. Because it is likely genetic, I thought I should test my frozen stash too (we both have babies about the same age). Yup, tastes totally awful defrosted. However, I asked my husband to try and give her the defrosted milk and she sucked it down like nobody's business! So try the milk on your baby before you dump your frozen stash. Even if it tastes gross to you, some babies are epicureans and some just aren't. It isn't actually spoiled, it just tastes bad. Now I am considering scalding prior to freezing in case she changes her mind later.

May 25, 2013 | Unregistered CommenterLauren

I wish I had seen this with my first baby - it took me months to figure out what you did - but I did almost everything exactly the same way, except I never thought of using stainless steel bottles for heating. I used glass, and cracked a lot of bottles, I suspect I overheated many of them too... still better than formula! :) Good for us for going to these lengths to give our babies the best we can. I sure wish I could find out some info on what causes the excess lipase. I have an auto-immune disorder (Hashimotos) and I wonder if it's somehow related... I'm just now finding that Celiacs or wheat sensitivity is often associated with Hashimotos, and breast feeding also triggered Raynauds in my nipples, another auto-immune disorder. I'll keep looking, but wanted to comment on this post, since it's spot on, in my experience.

July 1, 2013 | Unregistered CommenterMarjorie

I kept being in denial about the problem with my breast milk until it was too late, and I had already frozen bags and bags of breast milk. Ended up discarding a lot of it (as well as making pancakes when the guilt of throwing it out overwhelmed me :P).

I have to travel for approx. 36 hrs for work, and really want to bring the breast milk back for the baby...am going to invest those 70 usd and cross my fingers that it'll work.

July 10, 2013 | Unregistered CommenterEva

After the milk is frozen can you scald it then cool it then give to baby??
Also what happens of you "overheat" the milk?

July 24, 2013 | Unregistered CommenterAlissa

Alissa,

To my knowledge, the lipase needs to be deactivated before you freeze it. Once it is in the freezer, you have lost your window of opportunity. Overheating the milk may cause it to curdle. It may also lower the amount of some nutrient levels in the milk.

July 24, 2013 | Registered CommenterRobin

Thank you so much for this website. After a month of wondering what was going on, I concluded I have the lipase issue. My milk tasted so metallic. The weird part was that we successfully gave our baby bottles from 1-3 months. The milk must not have turned yet. I talked to my doctor and she acknowledged the issue. I talked to a lactation consultant and she gave me very basic advice. But when I looked online, I found your inspirational story and steps to scald milk. I bought all the supplies you used and have been easily scalding my milk for a month now. My 4 month old baby has finally taken bottles again. I now feel confident to leave her with others. I go back to work pretty soon so I'm really glad I figured this out sooner than later. Thanks again!!!!!

August 9, 2013 | Unregistered CommenterHeather

Amanda, so sorry, just seeing your comment now. I never stored the milk in the stainless steel bottle, but rather transferred the milk to other bottles for storage and transport once it cooled completely.

September 6, 2013 | Unregistered CommenterChristina Williams

Thank you so much for your post, because of you, I won't have to give up feeding breast milk pumped at work! I had never thought of using a bottle warmer at work to scald the milk. Providing the links to the tools made it so easy. I did my first in bottle scald today, and it was so easy that I know I'll be able to do it at work just fine. After losing 400 oz of frozen milk, I was devastated. This post gave me hope that I can keep going on my goal to EBF for a full year! Thank you for sharing.

September 15, 2013 | Unregistered CommenterR

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