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Monday, August 1, 2011

A Breastfeeding Challenge: Excess Lipase in Breastmilk

Scald Breastmilk

In the 26 months that I’ve been breastfeeding, I haven’t had too many challenges. I dealt with the occasional nursing strike with Baby T and struggled with weaning, but it has been pretty smooth sailing. I did, however, have to deal with excess lipase in my breast milk.


Lipase in breastmilk? What is that?

Lipase is an enzyme that is present in breastmilk. Basically, it “eats” the fat in stored breastmilk. But fat is what makes the milk taste good. If you pump your milk and store it, the longer it sits, the more time the lipase has to “eat” the fat and the worse the milk is going to taste. This is not an issue for moms who don’t pump, because the lipase doesn’t have time to act when a baby is actively nursing on the breast. This only becomes an issue when breastmilk is stored, whether in the fridge or in the freezer, because the longer the milk sits after having been expressed, the longer the lipase has to “eat” the fat. It's not bad for the baby, but some babies don't like the taste.

There is not that much information available about issues with excess lipase in breast milk. Not many women experience it, and even if they do, even fewer have to pump--and pumping and storing milk  is the only way you would really find out if you had excess lipase in your breastmilk. I even called a lactation consultant, and she asked me to call her back and let her know what I found out after experimenting with it.

What were the symptoms?

It all began when Baby T would not take a bottle. We started trying to give him a bottle when he was maybe 3 or 4 weeks old. I knew I was going back to work, and I was paranoid that he wouldn’t take a bottle if we didn’t start early enough. He had a great latch and was growing well, so I wasn’t worried about nipple confusion.

He did not want the bottle. In fact, every time we tried to feed him my pumped milk, he would scream bloody murder, and then it would be difficult to soothe him for about an hour afterwards. We were convinced it was the type of bottle/nipple, so we tried just about every kind we could buy. Nothing worked. I was getting a little frantic, because I had to go back to work when he was six weeks old.

How did I figure out that my problem was, in fact, excess lipase?

I did a lot of reading online, and somehow, I came across some women who talked about having excess lipase in their milk. I had read about it in breastfeeding books, too, but ignored it because it was so rare. Surely that wasn’t my issue!

But after trying every bottle and dealing with a very cranky baby, I decided to do some experimentation. Let me preface by saying that you can inactivate the lipase in expressed breastmilk by scalding the milk after it is expressed and before it is stored.

How do you scald breastmilk?

Scalding breastmilk involves bringing it to a near boil. You can heat it over the stove just until tiny bubbles start forming around the edges. Then, you can remove it from the heat and pour it into heat-safe containers. It helps to set those containers in ice water to rapidly cool down the milk after scalding. You’re not boiling the milk enough to drastically affect its nutritional value. And you're not making espresso, either, unfortunately.

Excess Lipase: Scalding Breastmilk is a great post at Simply Rebekah that explains how to scald breastmilk.

The experiment

I decided I had to taste my milk. After getting over the weirdness factor of that, I was ready to begin my experiment. I pumped some milk and tasted it. Hmm… sweeter than I would have expected. I poured half of it into a container and stored it in the fridge. I scalded the other half and put it in the fridge. The next day, I tasted both.

The milk that had been scalded tasted pretty much the same. The milk that had not been scalded smelled strong and tasted even stronger. It made my nose curl, and I wanted to spit it out. A lot of what I read online said it would taste sour. It didn’t taste sour. It just didn’t taste good. It was strong and metallic and left a really potent aftertaste.

I did the experiment again, only I waited three days before trying the breastmilk again. Once again, the milk that had been stored for longer tasted much worse. It was unpalatable. I was pretty sure this was my problem.

The next step: Introducing the scalded milk to Baby T

After figuring out the problem, we tried to give some of the scalded milk to Baby T. He practically inhaled it. Although I was in denial that I would have to take yet another step every time I pumped my milk for the next year or so, I realized it was true. I had that rare issue that not too many people have, talk about, or even know about.

Pumping and scalding breastmilk at work

The longer breastmilk with excess lipase in it sits after being expressed, the worse it will taste. The sooner it is scalded, the more quickly the lipase will be inactivated, so the better it will taste in the long run. But I was dreading having to deal with the complexities of pumping at work. Now I had to add another step to the equation.

My office did have a kitchen. I could have brought in my own pot and scalded my breastmilk after pumping every time, but it was already going to take 25 minutes to pump the milk each time. I didn’t want to have to deal with scalding it too. And I also didn’t want to have to explain what I was doing in the company kitchen (although I was pretty open about pumping and talking about breastfeeding around the office—people got used to that).

I did some more experimenting. I pumped my milk, put it in the fridge, and waited about eight hours before scalding it. I scalded it, put it back in the fridge, and offered it to Baby T the next day. He took it. Fabulous. At least I wouldn’t have to scald it at work. I could pump all day and scald it all at once when we got home.

Scalding Breastmilk

Scalding my milk wasn’t that bad in the grand scheme of things, but it took a lot of time. I had to come home from work, scald the milk, put it back into different bottles (because the bottles that it had been stored in all day had some milk with lipase clinging to the inner walls—the lipase in that could act on the breastmilk), wash all the bottles the milk had been stored in, and wash the pot I had used to scald the breastmilk.

It was a constant revolving door of bottles. A lot of bottle washing. I hate washing bottles.

I tried using a bottle warmer. That scalded the milk quickly and I didn’t have to wash an extra pot, but the three Munchkin brand warmers I bought broke within a week or two. So it was back to the pot

Would I have to scald breastmilk forever?

Much of what I read said that at any point in time, your breastmilk could change and no longer contain excess lipase, or your baby’s taste could change. Throughout Baby T’s first year, I periodically tried not scalding the breastmilk to see if he would take it. He didn’t. I scalded it until I stopped giving him my own milk when he was about 16 months old.

It was a lot of time and effort, but there was no other option for me. I was going to give Baby T breastmilk. It was a challenge, but I tried not to take it personally. I knew that there was nothing I could do about it.

When I got pregnant with Little M, one of the first things I wondered was whether I would have to scald my milk again for him. I initially thought I would be going back to work, and I dreaded going through the entire process again, this time with a toddler to feed and entertain at the same time. Luckily, I didn’t have to go back to work, and so far, Little M has taken my milk from a bottle the few times I’ve given him one. I have only tried the milk once, and it did taste strong, but not overwhelmingly disgusting, so I might still have some excess lipase. But Little M is not as picky an eater as Baby T is either. He’s a little more easygoing. And maybe I am too.

I knew scalding my milk might be a possibility, and that also factored in my decision not to go back to work. It was taking me 45 minutes just to make lunch and snacks for Baby T to bring to daycare the next day; I couldn't imagine adding another 45 minutes to that mix after working all day. It would have left little time for my family. Luckily, I didn't have to go back to work, and I didn't have to scald my milk. But I know the challenges are never over. It's part of being a parent. And maybe the challenges we experience as breastfeeding mothers are just preparing us for the rest of motherhood.


Jet's Journey said... Best Blogger Tips

FANTASTIC POST! I have heard of excess lipase before but I did not what that meant/how to handle it. Thank you for this information! How useful!

And you are one dedicated momma. I'm glad you didn't have to go back to work with Baby M but I'm sure Baby T will thank you one day for all your blood, sweat, and breastmilk tasting. :)

Rebekah from Simply Rebekah said... Best Blogger Tips

Thank you for spreading the word about Excess Lipase. Every pumping mother should know about this! If I had known, it would have saved me many tears and 575 oz of frozen milk that I ended up donating. Thank you! said... Best Blogger Tips

Thanks for the comments, ladies! @Jet's Journey: Hopefully you'll never have to deal with excess lipase. @Rebekah: yes, it's nice to know. I know a lot of pumping moms whose babies don't take to the bottle easily and sometimes I suggest scalding. Maybe it's only so rare because so few mothers end up pumping (?)

For the record, I decided to taste some breastmilk I had pumped last Friday and Big T gave to Little M on Saturday (incidentally, Little M wasn't too big on the bottle that day). It tasted sour. It tasted different than with Baby T. More sour, less metallic.

But it tasted SOAPY. That is the best way to explain it. It left a soapy aftertaste on my tongue. I just thought that might help those people who are dealing with this and wondering: does my breastmilk taste ok?

Rochelle said... Best Blogger Tips

Good info. I am pretty sure I had this problem- my milk had a sour and metallic taste/smell. I had heard about excess lipase but didn't know much about it. We are out of the nursing/ bottle stage now, but I still have frozen breastmilk in my freezer that I couldn't give my son, and which I will probably end up throwing away. I will try scalding my milk for the next baby!

Kris Dursch said... Best Blogger Tips

Thanks for posting! I had the same issue with my milk. Does anyone know why our bodies produce higher levels of lipase in our milk than other mommies? Is this linked to any illnesses/disorders? I didn't find much medically supported information on the internet about the excess lipase, just a lot of people that have posted on blogs and forums. said... Best Blogger Tips

@Kris Dursch: I'm not really sure what causes it. Everything I've read just says some people may have it. I wonder if more people have it but don't realize it because not too many people pump and store milk compared with the number of moms who breastfeed (I assume). But you gave me something interesting to research!

Kris Dursch said... Best Blogger Tips

@Tmuffin.comlet me know if you find anything out! Thanks!

Anne said... Best Blogger Tips

Thanks for the post. I had this problem with my now 2.5 year old. My husband never got to give her a bottle and I have been with her for every single nursing (dropped down to 2/day only a month ago), so it has really impacted us! I've been wondering whether going back to work would be a possibility with Baby #2, just for this reason.
I read a lot about this when it first happened to me -- mostly posts on Mothering or LLL, nothing scientific. One poster said lipase breaks down omega-3s so she stopped eating the flax she took daily and that solved her problem. I take 2-3 fish oil capsules/day, so maybe she was on to something.

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