Biomarker discovered for low breastmilk supply

Unrecognizable young mother with her crying son in sling

The discovery of a biomarker for low breastmilk supply demonstrates that low supply is real, is common and that mothers who complain of low supply are not mistaken.

Perhaps that will stop lactivists from lying about the incidence low supply and gaslighting women who have concerns about supply and fear that their infants are starving.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Low breastmilk supply is NOT maternal misperception.[/pullquote]

Despite the fact that the scientific evidence shows that 15% of mothers or more can’t produce enough breastmilk to fully nourish and infant, lactation consultants, lactivist organizations and individual lactivists refuse to believe women who worry about low supply. They refuse to accept that babies are screaming from hunger. They refuse to acknowledge that infants are being injured and in some cases end up dying because of dehydration, seizures and malnutrition.

I wrote several days ago about the lactivist lie concerning infant stomach size. La Leche League UK has already modified its graphics. Did they say average newborn stomach size? Oops, they really meant average newborn intake per feeding; the newborn stomach is far larger and many infants need more than an average amount of milk per feeding.

Now comes word that low breastmilk supply may have a distinct chemical signature that should put to rest lactivists lies about supply.

Previous research found that low breastmilk production is accompanied by high breastmilk sodium, irrrespective of the mother’s diet.

High levels of sodium in breast milk are closely associated with lactation failure. One study showed that those who failed lactation had higher initial breast milk sodium concentrations, and the longer they stayed elevated, the lower the success rate. This association has subsequently been confirmed.Several possibilities have been suggested as to the cause of increased sodium levels in breast milk… It has been shown that sodium values are not affected by the mother’s diet by the method of milk expression…

A new prospective study confirms that relationship and refines it. The paper is The Relation between Breast Milk Sodium to Potassium Ratio and Maternal Report of a Milk Supply Concern by Murase et al. published this week in The Journal of Pediatrics.

The authors explain that the ratio of sodium to potassium changes as colostrum production gives way to milk production:

The ratio of breast milk sodium to potassium concentrations (breast milk Na:K) dramatically declines …  as lactation progresses through colostral, transitional, and mature milk production stages; thus, decreasing breast milk Na:K is an objective biomarker of mammary gland progress toward copious mature milk production over the first week postpartum.

The authors had two goals:

[O]ur primary objective was to determine if elevated breast milk Na:K at day 7, as an objective biomarker of lack of progress toward mature milk production, is significantly more prevalent in mothers reporting a milk supply concern, even in the context of current exclusive breastfeeding. Our secondary objective is to deter- mine whether elevated breast milk Na:K at day 7, in the context of exclusive breastfeeding, is predictive independently of stopping breastfeeding before day 60.

The authors found that high Na:K ratio in breastmilk at day 7 was associated with maternal perception of low supply and with decreased breastfeeding rates at day 60.


As demonstrated in the chart above, mothers who expressed concerned about low supply were more than twice as likely to have high Na:K ratios on day 7:

…[E]levated day 7 breast milk Na:K occurred in 42% of mothers with a day 7 milk supply concern, compared with 21% of mothers without a day 7 milk supply concern (unadjusted relative risk, 2.0; P = .008) (Table II). The unadjusted odds of elevated Na:K were 2.7 greater (95% CI, 1.3-5.9) with maternal report of milk supply concern (refer- ence = no concern, P = .01) and further increased after ad- justment for maternal ethnicity (3.4; 95% CI, 1.5-7.9; P = .003).

The risk of stopping breastfeeding by day 60 was also increased in women with high Na:K ratio on day 7:

The unadjusted odds of stopping breastfeeding by day 60 postpartum were 2.9 (95% CI, 1.1-7.8) with elevated day 7 breast milk Na:K (reference=normal breast milk Na:K; P=.04) and further increased after full adjustment for significant sociodemographic variables (3.3; 95% CI, 1.1-9.7; P = .03)

In other words, it was not a matter of flawed maternal perception; those who thought they had low supply had high Na:K ratios consistent with low supply.

The authors consider and disregard the typical lactivist denial about low supply and claims of maternal misperception:

If concerns about milk supply among exclusively breastfeeding women were primarily owing to a lack of knowledge about the signs of abundant milk production, then the expected outcome would be no difference in breast milk Na:K as compared with exclusively breastfeeding women without milk supply concerns… Instead, the observed prevalence of elevated Na:K was 2-fold greater in the mothers with milk supply concerns (42% vs 21%)… This result challenges the belief that milk supply concern in the context of exclusive breastfeeding is primarily maternal misperception. (my emphasis)

These findings have important implications:

1. Low breastmilk supply is an objective reality.

2. Low milk supply is relatively common.

3. Low milk supply is NOT maternal misperception.

4. Low milk supply is associated with a measurable biomarker that may be both diagnostic and predictive of low supply.

5. If we know early on that a mother has low supply, close watch should be kept on her infant and the threshold for formula supplementation should be low.

The bottom line is that low breastmilk supply is real, is common, and mothers who complain of low supply are not mistaken. Lactivists should be embarrassed that they ever claimed otherwise.

78 Responses to “Biomarker discovered for low breastmilk supply”

  1. Bernice Kelly
    March 5, 2017 at 8:59 am #

    If someone isn’t producing enough breast milk to satisfy your baby, don’t get disappointed. I was coping with the same problem and got it boosted through a home remedy healthy nursing tea. It’s a great and organic formula that works instantly and safely.

    • Azuran
      March 5, 2017 at 10:07 am #

      Sweet, have you done any scientific study to prove the efficacy of your herbs? We would be very interested in seeing it.

  2. evidencebasedbreastfeeding
    March 1, 2017 at 8:36 am #

    Nice to see this coming from Kathryn Dewey et al (an infant feeding researcher who I really respect, with decades of work from real-life epidemiological nutrition studies on mothers and babies). Just as an aside (totally off topic, veering into bedsharing and SIDS) – this article in Nature Ecol and Evol a couple of days ago:
    “Evolution-informed maternal–infant health”
    The author says, “Our research discovered that breastfeeding mothers who sleep with their
    babies protect them from such stressors by their characteristic sleep
    position (curled around their babies, making a constrained sleep-space
    with their bodies).”
    This finding comes from a study in “Human Nature” from 2006,
    “Parent-infant bed-sharing behavior”
    on ten formula feeding and ten breast feeding mothers/babies, observed sleeping in a sleep lab environment. Supposedly the mothers make a consistent “protective” sleep positioning when they bedshare (the BF ones, not the FF ones..)!
    This has been repeated in a lot of BF literature so as to suggest “safe” bedsharing when breastfeeding – however, the actual study cannot (in my view) draw any conclusions about actual sleep safety (despite the claims that it does), because no safety outcomes are actually studied. (You need a dataset of hundreds/thousands of actual SIDS/SUID deaths, matched up with controls, and examined in a proper epidemiological analysis, to draw those conclusions). Not 20 babies examined for a few nights in a sleep lab in which no actual harmful events occur (or could occur because of the small sample size and length of time).
    This idea has been repeated over and over as to imply breastfeeding mothers automatically bedshare safely:

    “During sleep you’ll automatically go into the same position as
    breastfeeding mothers all over the world and throughout time. It’s
    called a cuddle curl, and it’s nature’s way of protecting a baby during

    • evidencebasedbreastfeeding
      March 1, 2017 at 9:18 am #

      (again, sorry to derail and drivel on) – just read the full text, in that study (the human nature one), in the BF bedsharing babies 75% were laterally positioned – side lying! (This is actively recommended AGAINST as a sleep position and consistently associated with SIDS). So I find it even more flabbergasting that it’s claimed that breastfeeding mums will naturally adopt safe positioning and can bedshare safely, based on such very small studies, which actually show (if you dig into the data) unsafe sleep positioning being adopted. It bugs me that this is being repeated over and over, and in quite prominent and recent journal articles, and thence into national guidelines/recommendations.
      (I am not saying mums must NOT bedshare, I am saying it’s important they are given accurate info and from good quality epidemiological studies on actual outcomes relevant to the sleep safety issue, which is SIDS/SUID).

  3. Jules B
    February 28, 2017 at 6:11 pm #

    This makes me want to somehow test the last frozen bag of breast milk I have in my freezer (I have not yet been able to throw it away, for some reason…).

  4. SporkParade
    February 28, 2017 at 7:25 am #

    OT: Can someone explain to me why breastfed babies supposedly eat the same volume per feed as time goes on, while formula-fed babies eat more? Do FF babies drop feeds faster?

    • Gæst
      February 28, 2017 at 10:19 am #

      Is that connected to the idea that breastmilk changes as the baby ages? So the volume of breastmilk would stay the same, but the caloric and nutritive value could be higher or lower as needed? Although I don’t see why an older child wouldn’t need more water content to stay adequately hydrated…

      • SporkParade
        February 28, 2017 at 11:55 am #

        I was under the impression that it’s a myth that the composition of breastmilk changes over time.

        • Gæst
          February 28, 2017 at 6:24 pm #

          I meant that lactivists make that connection.

  5. Nick Sanders
    February 28, 2017 at 2:44 am #

    A fearmongering piece about C-sections being on the rise in India:

    The idea of publicly shaming hospitals for performing “too many” c-sections is kinda horrifying.

    • Sarah
      February 28, 2017 at 4:14 am #

      Yes, assuming by kinda you mean massively.

    • MaineJen
      February 28, 2017 at 9:17 am #

      I cannot think of a *less* important problem for rural Indian hospitals to be focusing upon.

    • fiftyfifty1
      February 28, 2017 at 11:06 am #

      I read the article, but my takeaway was different. It sounded as if they were criticizing private maternity hospitals that did non-medically indicated CS on nearly all their patients (over 80%). I am a strong supporter of maternal request CS, and yet I do worry that there is the potential for abuse. For a CS without medical indication to be right for a woman, there needs to be a lot of factors in place. The woman should be absolutely sure she wants only a very small family, and also must have access to reliable birth control. This should be 100% her decision and not pressed upon her by family. She should be fully aware that this CS makes her higher risk in future pregnancies, and needs to be sure that her family has enough money to provide her with OB care for any subsequent pregnancies. India has an extremely high rate of anemia, but less secure blood banking and surgical resources, and women should be aware that on average more blood is lost with CS. In resource poor settings, CS becomes relatively more dangerous.

      MRCS may be right for some women in India (like the wealthy ones), but could be a very risky choice for others. This is why Jeevan (The Learner blog), sometimes goes to great lengths to avoid CS in low-resource women.

  6. Platos_Redhaired_Stepchild
    February 28, 2017 at 12:49 am #

    “Perhaps that will stop lactivists from lying about the incidence low supply and gaslighting women who have concerns about supply and fear that their infants are starving.”

    Oh, you sweet summer child…

  7. myrewyn
    February 27, 2017 at 11:57 pm #

    Somewhat OT, have any of you with multiple children experienced vastly different production with different babies? Or does this tend to be consistent with each particular woman? (Barring a particular medical reason such as retained placenta)

    • February 28, 2017 at 6:23 am #

      I can tell you that, once you have more than one child, life becomes so much more complicated that various factors come into play. Just sitting and nursing can be problematic as soon as the older children realize that they can tear the house apart while she feeds the new baby. In my daughter’s case, who has to pump (inverted nipples) she’s finding it almost impossible to pump, feed, and burp before it’s time to start over, and she’s reporting a spontaneous decline in milk production due to simple exhaustion.

    • SporkParade
      February 28, 2017 at 7:15 am #

      I feel like my supply is better with #2, but that may be psychological. (I didn’t make enough colostrum for either kid, but since no one supports early supplementation, I ended up too emotionally traumatized to even think of trying to ebf #1.)

  8. GiddyUpGo123
    February 27, 2017 at 10:02 pm #

    Oh my god, I almost want to have another baby so I can participate in a study like that one. I have pretty normal looking breasts so I’ve never really understood why I could not manage to exclusively breastfeed any of my four children, despite increasing determination with each one. I think I’ve always just blamed myself for not being strong enough to stick it out, but it sure would have been nice to know if there was a biological reason for it.

  9. Deewhybaby
    February 27, 2017 at 3:49 pm #

    This study is really interesting and hopefully gives more weight to late or low milk being a real thing.
    I’m having my first baby in a week or so and late milk supply concerns me as I’m an older first time mum with PCOS, and junior looks like he’s going to be pretty big. I’ve looked up my state health department protocol for late lactotogensis and it’s basically pump and feed ALL THE DAMN TIME to encourage supply as hard as possible. No mention of feeding baby, no mention of mum’s physical or mental wellbeing.
    Serious question, is there evidence that a hardcore regime of pumping brings in milk faster?

    • Heidi_storage
      February 27, 2017 at 3:54 pm #

      Dunno, but anecdotally my milk came in quicker when I wasn’t utterly exhausted.

      • February 28, 2017 at 6:29 am #

        Maternal exhaustion is the biggest external factor in low or declining milk production, assuming there aren’t biologic or genetic influences.

        • Roadstergal
          February 28, 2017 at 1:33 pm #

          That’s 100% reasonable. It’s a general trend for non-essential bodily functions to shut down under stress, and lactation – sorry, LCs – is non-essential as far as mom’s body is concerned…

    • swbarnes2
      February 27, 2017 at 4:45 pm #

      I think pumping would increase prolactin, but lactogensis is started by the drop in progesterone caused by the placenta being expelled, so pumping might not affect that.

    • fiftyfifty1
      February 27, 2017 at 7:21 pm #

      “Serious question, is there evidence that a hardcore regime of pumping brings in milk faster?”

      There exists no evidence for this.

      • myrewyn
        February 27, 2017 at 11:55 pm #

        so then it blows my mind that hospitals hire “professionals” to teach new moms so many untruths.

        • Amazed
          February 28, 2017 at 5:45 am #

          Frankly, I think a part of it is simply the message that mothers are doing something. Usually when someone thinks they’re doing something to fix the problem, it keeps them from being THIS scared and ready to seek for other venues. They are less restless. IOW, a mother who is busy pumping is less likely to focus on, “Should I give the baby a bottle? Is she STARVING?” ‘cos they’re working on the problem, you see. Surely baby can wait a little? I think lactation “support” uses this natural leaning to have their way.

          I know, I know I’m a cynic.

          BTW, it blows MY mind that people expect LACTATION consultants to tell moms when they should stop breastfeeding. They aren’t FEEDING consultants. Their aim is there, in their very name. They’re here to help you breastfeed. Sure, it’ll be nice if they kind of take your kid’s life and health into account but it’s freaking dangerous to rely on basic humanity and unleash people devoted to breastfeeding on mothers who might end up needing to just feed their babies. Of course they’ll press for breastfeeding! After all, that’s why the hospital hired them, right? To help LACTATION. It’s unreal to expect of them to be objective, especially when it’s their salary on the stake.

    • yentavegan
      February 28, 2017 at 4:39 pm #

      Mothers who never intend to breastfeed ( like my mom) still experience the hormonal whoosh of their breasts filling up with milk. This occurs without an infant latching and this occurs without expressing/pumping to “bring in the milk”. If this early engorgement never takes place it is a red flag for insufficient milk production.

      • Megan
        March 1, 2017 at 10:05 pm #

        Some of us have the “hormonal trickle” instead. 😉

  10. mabelcruet
    February 27, 2017 at 3:24 pm #

    Off-topic, but once again British midwife ‘leaders’ are ignoring bereaved families and trashing the memory of dead babies. James Titcombe, father of Joshua, one of 11 babies who died needlessly at Morecombe Bay directly because of the failings of midwives, has tweeted that there is a conference being held in the hospital where those babies died aimed at midwives. Not, you might think, about how to improve services, but how to develop resilience in the face of adversity when midwives are blamed by families. And it’s chaired by none other than Sheena Byron, Sheena ‘stop talking about dead babies now James, it’s getting boring’ Byrom, Sheena ‘getting out of bed in the morning has risks, James’, fucking Byrom.

    • MaineJen
      February 27, 2017 at 3:28 pm #

      Oh jesus. What a slap in the face to James and other loss families. And really…11 babies??

      • mabelcruet
        February 27, 2017 at 3:35 pm #

        And one mother. And heaven only knows how many brain damaged oxygen deprived babies who should have been born healthy. The investigation report (the Kirkup report) is frightening to read.

        I also forgot Sheena’s other highlight-she retweeted a comment about James Titcombe’s book about his son, accusing him of lying ‘Exaggerated beyond all recognition of the truth’

        • mabelcruet
          February 27, 2017 at 3:45 pm #

          Actually, I misrembered the numbers. Kirkup identified 16 dead babies and 3 dead mothers.

          • MaineJen
            February 28, 2017 at 9:21 am #

            What the…what?? And these people are still practicing. Anyone know any UK journalists looking for a scoop?

          • mabelcruet
            February 28, 2017 at 12:54 pm #

            She’s in the inner sanctum of the Royal College of Midwives along with her enabler Cathy Warwick who is the President of the college.

            I’ve posted this before, but I heard a radio programme that Cathy Warwick appeared on called ‘You and Yours’ a while ago.

            It was a call in programme about maternity choices.

            She started out with a very gentle and really quite persuasive interview about personalised care, and how midwives really TRULY listened to women. And then the phone-ins started. Woman after woman called in saying that they had been upset by what a midwife had told them during their labour (things like ‘you must be so disappointed you didn’t have a real birth (when they delivered by section)), and how they felt personally insulted when it was implied that their baby’s birth wasn’t natural or that their baby was second-class or abnormal in some way because of the way he entered the world. Real women-real experiences that were still upsetting them.

            And to every caller Ms Warwick’s response was the same: that midwife wasn’t acting professionally, she must be a bad apple, she had the wrong attitude, we aren’t all like that, her views need to be challenged etc. Except it was every caller-how many bad apples out there? How many midwives with the wrong attitude? How many midwives not supporting the women and families?

            I know a lot of midwives-I know they struggle with workload, I know they are angry at what they see as cost cutting and I know they are upset that they physically cannot provide the time and care that each individual woman needs because they are expected to cover too many women during a shift and spend time constantly trying to catch up. These women are being let down by their own College, by their own establishment, which seems to be over run by a group of people who despise evidence-based care, ignore what women actually want, and insist that they know best because they are the professionals. They are far more paternalistic than any doctor I have ever met, but because this is cloaked by pseudo-caring, sanctimonious mother-earth-goddess, woo-infested, ‘feel the love and womyn-power’ and the ‘power of the all-important yoni’ belief system they seem to think they are somehow speaking for the mothers. Complete self-delusion. The college of midwives really doesn’t represent the majority of midwives as far as I can see, not the ones I know anyhow.

          • Amazed
            February 28, 2017 at 1:12 pm #

            Ah yes, midwives TRULY listen to women. Except when a baby dies and then midwives don’t want to listen. Instead, they howl to high heaven and back that they are “blamed”.

            Fuck Warwick. How is she different than Ina May? Except that she didn’t let her baby die and her credential is, alas, a true one. In everything else they’re like soul twins.

          • mabelcruet
            February 28, 2017 at 3:21 pm #

            I think my favourite Sheena quote is when she accused Mr Titcombe of retrospective negativity. FFS, his baby was killed by incompetent midwives. She has no compassion as well as having no understanding or insight into how incredibly cruel, egotistical and disrespectful she comes across.

        • Platos_Redhaired_Stepchild
          February 28, 2017 at 12:46 am #

          ‘Exaggerated beyond all recognition of the truth’

          I…? She said…? WTF!? The deaths of 11 children is an exaggeration? I feel like I wandered into a very surreal & grim version of that Monty Python skit about the ex parrot.

          • mabelcruet
            February 28, 2017 at 2:44 am #

            Excerpts from Joshua’s Story were being published in the Daily Mail. The health minister Jeremy Hunt tweeted about the book saying it was a very moving story, and some vicious bitch twittered that the story was no doubt sensationalized and exaggerated beyond all recognition of the truth. The Byrom creature liked the tweet and retweeted it. She is on the council of the royal college of midwives. She has a lot of midwife followers on Twitter, and they saw her basically spit in his face. When he pulled her up on it, she complained that he was victimising her and bullying her, and then she wrote a blog piece about how she wouldn’t allow this to break her and she would come through this stronger. Oh, and her area of expertise is social media-she hawks herself around the country giving lectures on effective use of social media.

          • Roadstergal
            February 28, 2017 at 1:37 pm #

            I keep pulling up this clip, because it keeps being relevant to midwives…


    • Empress of the Iguana People
      February 27, 2017 at 3:30 pm #


    • Sarah
      February 28, 2017 at 4:16 am #

      God that’s awful. They could surely hold their blame deflecting seminars somewhere that isn’t quite such a gross insult to the memory of the deceased.

      • Roadstergal
        February 28, 2017 at 1:35 pm #

        Or – here’s a great idea – have seminars on how to NOT kill babies, rather than deflect the blame post-hoc?

        • MaineJen
          February 28, 2017 at 3:24 pm #

          But then they would have to admit that their whole philosophy (and business model!) is seriously flawed. Can’t have that.

    • Amazed
      February 28, 2017 at 8:09 am #

      Oh god! Won’t a journalist be interested to attend this so called conference? I am speechless.

      So, let’s see. Studies show disappropriately high rate of outcomes for non-hospital birth in the UK. Big names in hospitals that kill and maim babies and mothers conspire to hide the truth. When confronted with questions they can’t just ignore, they resign with huge pensions. Midwife “leaders” shout for protecting normal births in the immediate aftermath of the release of the Kirkup report. They harass grieving parents and consider themselves the victims. They create midwife “dynasties” that keep being as bigoted and heartless as their owners (Anna, Byrom’s daughter, is a prime example.) They hold conferences in the hospital where midwives committed a veritable carnage.

      THAT’s the system NCBers adore so?

      Isn’t there a way to make it a legal issue? Court judged that at least a few of the midwives in the Morecombe Bay were guilty. They were not “blamed by families”. How can such a conference be allowed to take place?

  11. swbarnes2
    February 27, 2017 at 2:36 pm #

    From what I can tell, this study didn’t actually test for supply, it just correlated an altered ratio with mothers feeling that their supply was low, and mothers not breastfeeding as much on day 60.

    • The Bofa on the Sofa
      February 27, 2017 at 2:40 pm #

      The Na/K ratio as the biomarker was already known, wasn’t it? The quoted paragraph says,

      High levels of sodium in breast milk are closely associated with lactation failure. One study showed that those who failed lactation had higher initial breast milk sodium concentrations, and the longer they stayed elevated, the lower the success rate. This association has subsequently been confirmed.

  12. fiftyfifty1
    February 27, 2017 at 2:35 pm #

    So we know that on day 7, women who say they have supply concerns are twice as likely to have high Na:K ratios. And we know that women with high Na:K ratios are more likely to have weaned by age 60 days. But did they also tease this out based on perception? In other words, what was the weaning rate for women with high Na:K ratios AND low perceived supply on day 7 and what was the weaning rate for high Na:K ratios but WITHOUT supply concerns on day 7?

  13. Sophia Kogan
    February 27, 2017 at 12:53 pm #

    do we know whether trying harder to breastfeed is correlated with altered Na:K? Does paying an LC $$$ alter Na:K? Does burning incense while laboring post dates at home in a birthing pool alter Na:K?

    topics of studies not being undertaken by lactation “scientists”.

  14. TsuDhoNimh
    February 27, 2017 at 9:05 am #

    “low breastmilk production is accompanied by high breastmilk sodium”

    This is for cows, but …
    “when oxytocin is causing milk ejection, the tight junctions open or become ‘leaky’. This allows lactose and potassium to move from
    the lumen into the extracellular space, and for sodium and chlorine to
    move into the lumen from the extracellular space.”

    And if the junctions don’t open enough … less electrolyte swapping can happen and you don’t get the Na/K ratio shifting?

    • Spamamander, pro fun ruiner
      February 27, 2017 at 2:16 pm #

      Seems rational to me. The mechanisms for lactation should be similar among mammals.

  15. TsuDhoNimh
    February 27, 2017 at 8:44 am #

    Hmmmm … And testing for sodium and potassium is EASY in a lab. Like totally easy and cheap with existing equipment.

    Screening for this would not be hard, and recommending formula supplementing for the ones who test

  16. Empress of the Iguana People
    February 27, 2017 at 8:32 am #

    Lactivists are unlikely to change their minds but at least the more reasonable breast feeding advocates may well change theirs.

  17. Taysha
    February 27, 2017 at 8:02 am #

    Interestingly, this would put low supply at a 18% of the population with an additional 16% potentially having low supply, but “not concerns”.

    I wonder if they ran numbers on the kid themselves rather than “maternal concern” how well the correlation would show between high Na:K and slow weight gain/dehydration.

    • Azuran
      February 27, 2017 at 11:28 am #

      They would probably do so in another study eventually. Real studies usually start with one precise hypothesis and then test it out. And then you move on from then with another hypothesis.
      Since their original hypothesis was about maternal concern, they probably didn’t get any data on the baby, and they shouldn’t, since that’s not what they were trying to see. And taking those numbers afterwards wouldn’t be an acceptable way to do science.
      You know a study is going to be funky when they try to test 50 different things at the same time and just go with whatever works for them.

      • Taysha
        February 27, 2017 at 11:31 am #

        Well, mostly I wondered if the women who expressed no concerns and had high ratios also showed low production. It would speak to mentality.

        Musing, mostly. I do look forward to more studies in this vein.

    • February 27, 2017 at 2:01 pm #

      Getting permission to do research on lactating mothers is pretty tricky – but taking a milk sample which is non-invasive and has no real down-side for the mom or infant that I can think of will probably make it through a human research review committee pretty easily and possibly may be able to be expedited which means a single board member reviews the study to see if it meets the right criteria rather than needing a full-board review.

      Running on the infant means a blood draw on a minor – that’s got the red flag for being invasive plus the drawbacks of pain and potential draw site infection for no direct benefit to the infant. Added dimension – blood draws on minors automatically go to a full-board review which takes longer since the board has set meetings, there are other studies already on the agenda etc.

      That doesn’t mean it’s impossible to get that approved now – but before the first study on Na:K ratio was done, I don’t know that a HRRC would have ok the blood draw.

      So, that’s another reason why they probably stopped there instead of trying to add the infants to the study.

  18. Young CC Prof
    February 26, 2017 at 10:24 pm #

    The only thing that surprises me is that someone actually did this study. It does not appear that the Academy of Breastfeeding Medicine was involved.

    Newsflash to the lactation community: Telling women that their perceived low supply is just lack of support or self-doubt (or pernicious formula marketing) is just as sexist and patriarchal as telling them that their menstrual pain or morning sickness is all in their heads. Or the abdominal pain in middle aged women that’s shrugged off until the ovarian cancer is far too advanced to treat, or any of a hundred other examples of women’s complaints minimized and disbelieved.

    The fact that it’s now primarily women doing the telling makes no difference, it’s massively patronizing and sexist. The actual empowering thing is to investigate the medical problem that large numbers of women are reporting and see if a biological explanation and/or treatment can be found, like these researchers did.

    • Madtowngirl
      February 26, 2017 at 10:35 pm #

      I have unfortunately discovered, through being a mother, that many women have deeply internalized, sexist opinions. It seems especially true in “natural is best” communities.

      I am so glad that people are finally bringing these issues to light, and realizing, like so many other complaints women have, that this is a real and observable, measurable issue.

      • RMY
        February 27, 2017 at 12:40 pm #

        /scarasm But the natural crowd isn’t sexist, they’re empowering! You’re sexist for not agreeing with them.

    • Alana
      February 27, 2017 at 5:03 pm #

      Women are treated like shit by medical professionals. I was in and out of the ER for fainting spells and mysterious and excruciating pain in various parts of my body. I’d be hooked to some IVs for a few hours and sent home. After one check in, my husband saw them put “hypochondriac” on my intake and flipped his ever loving shit.

      So they finally did a CT Scan on me that night – brain tumor (non cancerous thank god) hitting an area that controls pain reception in the body. I don’t usually believe in suing, but we made those fuckers pay. No sympathy after finding out for three years they did nothing but give me fluids, something to knock me out and didn’t bother to actually check anything out on me. I also reported them to every medical overseeing board I could, with a complete list of all my ailments, time frames and their lack of treatment.

      • Chi
        February 27, 2017 at 6:06 pm #

        Dear god that’s horrifying. I’m glad you sued their asses. Maybe if enough women hit them where it hurts (the wallets) they’ll realize that they deserve to be taken as seriously as men.

        Not holding my breath though >_>

        • Alana
          February 27, 2017 at 9:18 pm #

          And I have heard so many other stories from other women. One told me there are two hospitals in her town – the good one and the one who thinks women are faking it even with bone sticking through the skin. And this is also FEMALE doctors and medical staff that treat women like this, this is not a male medical person issue.

          This is why I love my current doctor. He has no problem referring me for any tests or specialists ASAP and he even had his preferred peeps that he knows treats patients well.

          • Chi
            February 27, 2017 at 9:24 pm #

            Oh I get it. I was told I just ‘needed to be patient and let the codeine work’ when I was suffering from a KNOWN complication for the procedure I had just undergone.

            It took them nearly 5.5 hours from the onset of the pain to give me appropriate pain management (IV morphine). And this was by female nurses who all looked at me, curled up in the fetal position in my hospital bed, CRYING with pain, like I was a drug-seeking addict.

            For the record, I had pancreatitis. Oh and I also contracted pneumonia. So what was supposed to be only an overnight stay turned into 8 days.

            Unfortunately, because we have a public health system (I’m in New Zealand) it’s a lot harder to lay complaints and have them taken seriously. And even after I started recovering I was still too tired and weak to even want to think about legal stuff.

          • EmbraceYourInnerCrone
            February 28, 2017 at 11:43 am #

            Yup. I am grateful to have health insurance that covers most things. I am not grateful that it took almost 2 years of almost daily migraines to finally get medication that works. It was a constant round of 1) its just menopause just wait 2) must be because you are fat/high blood pressure (nope, normal except when I go to the doctor) 3) maybe its dental, allergies, stress, lack of exercise. It would not have made me so mad except I have had migraines since i was 6 years old! I know what a migraine feels like.
            It took ending up in the urgent care clinic after 18 hours of unbearable pain and my BP in the stratosphere due to pain, to get an actual prescription.
            I general don’t go to the doctor unless some one drags me because i have gotten sick of having my problems ignored. I have never liked going to the doctor but it’s even worse now that I am older and over weight.

  19. Emilie Bishop
    February 26, 2017 at 9:32 pm #

    This is fascinating. I’m curious if the Na:K biomarker occurred in women with other symptoms/risk factors like IGT, PCOS, etc., or if the mothers who participated were those without other obvious risk factors. It would also be interesting to see if they can determine what causes this ratio and if there is a way to prevent or compensate that doesn’t drive nursing mothers insane like the triple-feeding schedule.

    • Amy Tuteur, MD
      February 26, 2017 at 9:41 pm #

      I don’t think anyone has done that research yet but it would be very helpful to know.

    • TsuDhoNimh
      February 27, 2017 at 9:06 am #

      Compensating would be easy, but it’s the “F-word”. Formula.

      • Emilie Bishop
        February 27, 2017 at 2:34 pm #

        Totally. I’m not against formula in the least. My son had it from day 3 of life until he turned 1 and it saved his life. I’m just curious if there is a way to change that ratio for women who want to breastfeed and don’t have other issues, or if issues like IGT go along with this finding or are separate and can co-exist or not.

        • swbarnes2
          February 27, 2017 at 2:36 pm #

          The ratio is probably a symptom of poor lactation, not a cause.

          • The Bofa on the Sofa
            February 27, 2017 at 2:53 pm #

            It’s not just “probably”. See the part I quoted above

            High levels of sodium in breast milk are closely associated with lactation failure. One study showed that those who failed lactation had higher initial breast milk sodium concentrations, and the longer they stayed elevated, the lower the success rate. This association has subsequently been confirmed.

            It is known that they high sodium levels are associated with lactation failure.

          • fiftyfifty1
            February 27, 2017 at 7:50 pm #

            Sure, high levels of sodium are associated with lactation failure, but that doesn’t prove what causes what. I agree with swbarnes2, altered milk sodium is almost certainly a sign of poor lactation, not the cause, but we don’t yet have definitive proof. It is technically possible that there is some problem with electrolyte channels, for example, that leads to both altered milk sodium rations and poor production. (See TSuDHoNimh’s quote above for one idea. Another example is Cystic Fibrosis. Obviously it’s not at all the same system but in CF, abnormal chloride channels lead to increased levels of sodium in secretions AND altered volumes of secretions.)

        • TsuDhoNimh
          February 27, 2017 at 7:06 pm #

          “I’m just curious if there is a way to change that ratio for women who want to breastfeed and don’t have other issues”

          Mucking around with the extracellular transport mechanism has the potential to royally screw up a lot of things, like kidney function. It could cause issues you don’t want to have, or issues you would not survive.

        • EH
          February 28, 2017 at 7:54 pm #

          This study came out over 20 years ago, but it was interesting because it suggested that the few women with normal sodium levels in their milk who failed to breastfeed exclusively had a genuine physiological basis for their low supply (breast surgery, insufficient glandular tissue), while most of the women with elevated sodium levels had problems related with feeding technique (baby unable to latch, etc.). Mothers with a normal sodium level generally had effective breastfeeding technique, but in the case of, say, IGT, it wouldn’t guarantee them a full supply. This study (unfortunately, I can’t find the full version online) suggests that most causes of lactation failure are secondary but that primary causes do exist.

          • Emilie Bishop
            March 1, 2017 at 1:51 pm #

            Very interesting–thank you! I have many physical markers for IGT and my son had trouble latching so we were doomed a few ways. But being in a “baby-friendly” hospital, everyone threw up their hands and told me to try harder. Why are these simple measures not taken to ensure safety?

          • EH
            March 1, 2017 at 3:00 pm #

            No problem. I wish I could find the full-length study again, but Pediatrics has unfortunately stopped providing free full-length copies. I do remember it said that some of the women with high sodium levels were able to bring them down through excessive pumping (which isn’t practical or feasible for all women, such as a woman who’s working full-time at a variety store). I’m not necessarily against baby-friendly hospitals. In a way, I see them as a reaction against the ‘bad old days’ when women were pushed into formula feeding (like my mom was). Still, I think if a woman might be at risk of not producing sufficient milk (say she’s had a breast reduction or has signs of IGT), there’s a point where everyone – including hospital staff – should accept that there’s nothing more that can be done. ‘Combo’ feeding might be a satisfactory alternative.

            Out of curiosity, were you formally diagnosed with IGT?

          • Emilie Bishop
            March 1, 2017 at 4:51 pm #

            Not formally. I was never told it existed until I found Dr. Amy’s blog. I followed some links and found pictures of breasts with IGT and saw breasts like mine for the first time in my life–widely spaced, tubular, minimal growth during pregnancy, no sudden engorgement or feelings of let-down. I’ve diagnosed myself because it’s the only explanation that covers all the bases. My son had trouble latching on top of that, but we were destined for formula regardless.

            And I like the idea of having LCs and other breastfeeding support in hospitals for new moms. However, at my BFHI facility and others I’ve heard about, mothers are manipulated with false information on the benefits or breast feeding or the prevalence of physiological problems during pregnancy and as they struggle to feed their newborns. In any other healthcare arena, lying to achieve a desired outcome is frowned upon. Why should lactation be any different?

          • EH
            March 1, 2017 at 5:39 pm #

            You might want to look under ‘Sara Graefe’ and ‘The milk bar is empty’ (sorry, I can’t post the exact website) by a woman who actually experienced IGT. She had been a breastfeeding activist and even boycotted Nestle, but after she had her son, her milk failed to come in. Apparently none of her healthcare providers recognized IGT (it doesn’t seem to have been dishonesty but rather ignorance on their part) until she was diagnosed by a specialist. Her ending words were that if any one of her previous healthcare workers had recognized that she had this issue, she would have been spared the pain of the first month of her son’s life trying in vain to build a full milk supply.

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