EPISODE 58

What Rises to the Top? Human Milk Fat and more!

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Episode Transcript

May 21, 2021

What is ACTUALLY in the fat line that rises to the top of pumped milk?!

This is Maureen Farrell and Heather O’Neal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

So join us for another episode.

All right. Welcome to The Milk Minute. Yes. Welcome. Welcome. Welcome. We have some exciting things to talk about today. Today I’m going to talk to you guys about the cream line. You know, when you pump and you put your milk in the fridge and then you go back a couple of days later and it separates, and you’re looking at that line on the top and how thick it is, and you’re comparing it and yourself, you’re judging.

We’re going to talk about that today. You’re judging. You’re wondering if you can make more fat in your milk. You’re wondering if it’s something you’ve done. You’re wondering if it matters at all. So we’re going to address all of those questions today, but first, but first, we have a listener question. Of course. This one is from an anonymous listener who sent us an email and she’s having a hard time weaning her 18 month old.

She’s been dropping feeds and wants to replace it with cow’s milk, but baby won’t drink it. She doesn’t really have a lot of options for like having somebody else give baby milk, et cetera. And she’s feeling guilty. You know, I get it. This is the number one thing that people that are weaning feel is guilt, which I get it.

You know, your kids have a great way of pushing your buttons in order to get what they want, but it’s not necessarily something they need anymore. Yeah. And so let’s just say that about cow’s milk too. Baby doesn’t need that. And if baby doesn’t like to drink it, don’t bother. If you’re careful about crafting their diet so they get those nutrients in another way, you know, you can even give them other dairy, like cheese.

They don’t need cow’s milk and you can just see if she wants water. Even like, I would give my son watered down juice at that age. You know, I’m not a big fan of super sugary juice, but like for baby who has never had juice, like at a tablespoon of juice in a cup of water was a big deal.

Yeah. It’s special water. Yeah. And you know, when I work with my clients who are weening, I usually say to anticipate the times that they want it the most and then come up with an action plan for that time. So if you walk in the door from work and immediately get attacked and they go after your boobs and they’re screaming, Boobie, Boobie, or whatever they scream, anticipate that and come home with a snack in your pocket.

Be like, Oh, I’m sorry, Boobie, did you say cookie? Yeah. Take it and run. And then you’ll see their little faces and they’ll be so confused. They’ll be like, well, I do want a cookie. You’re distracting them. And then you can say, Oh, well maybe you can have boobie, but we’ll do it after bath.

So you’re just constantly pushing it back, pushing it back. And you know, I always just want to remind people, your kid loves you exponentially more than they love your milk. And they are not going to be in therapy someday because you weaned them at 18 months. No, it’s okay to ween right now. It’s okay to do it, even if you’re “only doing it because you feel touched out” or “you want your body back.”

Those are legitimate reasons to ween. That’s fine. Yeah. And when you do get your body back and you start to feel a little bit more stable with yourself, you’re going to be a better mom. All right let’s get into this cream line discussion.

Let’s take a quick break to thank our sponsor Aeroflow. Aeroflow is your one-stop shop to get the most popular breast pumps and accessories through your insurance. So don’t let your insurance go to waste. Why don’t you let Aeroflow do all the dirty work for you? You never have to call your insurance when you use Aeroflow and they remind you when you’re eligible for free replacement parts.

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Go ahead and check out the link to Aeroflow in our show notes and order your pump through them.

Today. Heather, I’m going to talk to you about cream, milk fat, self-value, all kinds of things. Oh my God. Are they related? No, they’re not. Oh, okay. Just, show over. I wish. Sorry. No, but we aren’t going to talk about it. Why are we doing this episode? Every day, every day, on social media, we see pictures of pumped milk.

And people either saying, Oh my gosh, it’s so amazing. Look at all this fat in my milk, or how do I get more fat in my milk? And they’re basing that judgment on how much fat is in their milk based on how much cream rises to the top. What do we have to say to that, Heather? Look at your baby. Are they fine? If the answer is yes, then it doesn’t matter.

That’s the short story. Unless your baby has been diagnosed with failure to thrive and your physician is ordering milk fortifiers, this isn’t a big deal. Now, if your physician is putting it on you to increase the fat in your diet, first of all, it’s not how it works. And second of all, they’re not that concerned.

Yeah. So if a, if a pediatrician is so concerned about an infant’s weight that they are mentioning it and like wanting an intervention to be done, but the only intervention they choose is your diet, it’s not that big of a deal. Nope. And if they say let’s check up on it in two months, they’re not that concerned.

Right? If you’re, yeah. If they’re really concerned about a baby, they’re seeing that baby every week. They’re doing weight checks, they’re doing follow-ups. They’re assessing how the interventions have gone. And they’re doing like an actual intervention, not like a pussyfoot intervention where they’re just like, Oh yeah, let’s just throw this at it and see if it works, you know, maybe it’ll work.

And then really what that does is it sends the parent home who starts flipping out about their diet and starts wondering if like, is it the, do you think it’s maybe this that I’m eating? Or should I be eating more steak? And it’s like, no, like if that’s what your pediatrician told you, if your pediatrician tells you to change your diet, and then doesn’t tell you how they don’t actually know how that works either.

Just let’s be clear, right. Phone a friend who’s specializing in this, but let’s explain the cream line and why you don’t have to freak out. I just want to explain why, yeah, like why we can’t visually assess milk content. Maybe we can start with that. Okay. All right.

So, first of all, when some people pump their milk for the first time and they leave it in the fridge for two days and they come back and they see that separation, they freak out. Do you know why? Because most of us have never seen unhomogenized milk before. So when you buy milk from the store, it’s been put in this crazy machine that like shakes it really hard and does all this stuff, and it really integrates the particles of different density so they don’t separate.

They also will put in a fat emulsifier to prevent that separation because Americans don’t like it when it looks different. Right. And you know, I’m sure many of you remember this little science lab from second grade where you put oil and water in a little beaker and wow, the oil floats because it’s less dense.

You understand density and you’re eight years old. Okay. This is the same thing, guys. Your milk is not just water. It’s not just fat. There’s a bunch of components. Some are more dense than others. And when you let them sit undisturbed for a certain amount of time, less dense things, float and more dense things sink.

Density is not, it’s, it’s not a measurement of worth or value. It’s literally just like how heavy something is. It’s also time dependent. Yeah. Sometimes the separation takes a while. So depending on where you are in time from the time you’ve pumped to, when you’re looking at your cream line. It depends on how much has separated.

It might not be done separating. So, you know, and like everybody’s different and your refrigerator is different and like so many things. Yeah. Yeah. And as we say over and over and over, your body is an organic biological thing. It’s not a machine and your breast milk is alive and active and responsive.

It’s not going to be the same every time. No. Yeah. Not only is it different between people, but it’s different between pumps. So you tend to have more fat in your milk as the day goes on. It’s fattiest at night, but the volume goes down. So again, that’s the other thing, people will pump at night and freak out and be like, Oh my God, I only pumped one ounce.

Right. Or they’ll take a supplement in the morning, like that has a bunch of fat in it and they’re like, Oh yes, this is going to make my milk more fatty. And then yes, by 5:00 PM you have a thicker cream line on your milk because that’s kind of the natural way that our body does that. And in the morning we’re going to have this really watery, sugary lactose-y milk.

Great. And your baby needs that. Yeah. And just to be clear, it doesn’t matter what time you feed it. So if you’re like exclusively pumping, you don’t need to worry about, you know, like only feeding your morning pumped milk in the morning and night pump milk at night. You know, if you can do that, that’s great.

But you don’t have to, it’s not going to make your baby less awesome. No, like the statistical data doesn’t support that, that makes that much of a difference. So the only thing that kind of does statistically makes sense is your, your melatonin hormone goes up at night, which we do see in the breastmilk. But it doesn’t seem to affect overall behavior that much.

So, yeah. Yeah, don’t worry about it guys. Because what they’re receiving hormonally from you is nothing compared to what their body produces once it finally kicks in. So most of this is always resolved by like 12 weeks.

Okay. So the cream line, as I said, a lot of people look at this and they’re like, look how fatty my milk is. Y’all. You cannot assess the fat content of milk visually because cream is not a hundred percent fat. When you buy heavy whipping cream at the store, that is not a hundred percent fat.

 That’s what’s on top of your milk there guys. It’s cream. It’s not even 50% fat. Really? Really, really. Let me just say overall, we have a lot of studies that assess milk composition for humans and for all kinds of dairy animals, it’s super fun to read through. Human milk tends to fluctuate between two and 6% milk fat.

Period. I’m sure some people go above six. Some people go below two, we kind of average around four or 5% is the norm. And so when you see somebody’s pumped milk, we’re half of it is cream, that is not 50% milk fat. Absolutely not. And actually you have no idea how much of that cream is milk fat. So what’s the rest of the cream?

Yeah, let’s talk about it. I couldn’t find exactly the studies I wanted, but I will say that it was very helpful that we are obsessed with cow’s milk in this culture, because it actually has a similar fat content to human milk. It averages around 4%. I mean, whole milk is 4% milk fat. Oh yeah. Some, some kinds of cows have like 8% and 10%.

But really like on average, it’s four to 5%. So it’s actually kind of useful because we just love to fuck around with cow’s milk and separated and do heavy cream and half and half and blah, blah, blah, whatever. And, and that’s FDA regulated. So we have all of these like specific ingredients and RDA values.

So let me just say, even in the fattiest cow’s milk cream that you can buy at the store, it has about 36% milk fat in that cream. Okay. So, you know, let’s compare that to human milk. If you’re seeing you know, some cream on there, at most, maybe we’re going to see a third of that being actual milk fat, maybe.

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Yeah. Right. And this cream in the store, they’re like skimming a bunch of milk and combining it and adding extra fat, all that kind of stuff. Right. They take it all out, pasteurize it and put it all back in at doses that they want. And so my big question was, well, what the heck is in cream? Just like you asked.

So cream is mostly fat, carbohydrates and mainly cholesterol.

Which by the way, babies need for brain development, we all need. And the interesting thing. So then I was like, Oh, ding, ding ding! Here’s my light bulb. Cholesterol, duh, let me look into cholesterol and human milk. This was really interesting. So I found a couple of studies that assessed cholesterol content, and it had a huge range, which makes so much sense to me since there’s such a little large range and how much cream rises to the top in human milk.

Oh my God. One study had a range of 5 milligrams per deciliter to 12 milligrams per deciliter. Another one had values ranging from 4 to 28 milligrams per deciliter. I mean, that’s a big range guys. Wow. Yeah, like that means it’s totally normal for some milk to have, you know, seven times as much cream as other milk.

And they’re not counting this cholesterol as fat? No. So they’re separating, because yes, like you said, cholesterol is a lipid, just like fat. So they’re cousins. Yes. They’re related, but they’re not the same. So the way we’re separating this, hold on. So, but I will say cholesterol, as far as I could tell was probably the widest ranging macronutrient in breast milk.

The one that changed the most from pump to pump, person, to person, baby, to baby. And so that explains our really big variation in visual cream separation. Now, cholesterol is a lipid. Fat is a lipid. What the heck? Why are they different? So fat and cholesterol are two distinct types of lipids that are organic compounds that are insoluble in water.

So that’s why they flipped. They don’t dissolve in water. They’re less dense than water. They have distinct mechanisms and roles in the body. They don’t act the same way. So that’s why we separate them out and don’t just call it all fat. So fat as we’re calling it in this is a single molecule of fatty acids attached to glycerol, a three carbon backbone.

Basically fat provides calorically significant energy. Cholesterol doesn’t. We’re not getting energy from cholesterol. We use it differently. Oh yeah. Interesting. Right. Cholesterol. So I’m told, from the internet, is an unsaturated alcohol in the steroid family of compounds. Oh, is that all? I know.

I’m like, Oh, cool. So. Different somehow, don’t really care. Are you drunk? Nah, I’ve just had some cholesterol. But it is essential for proper functioning of our cells. We absolutely need it to create cell membranes and there’s two types of cholesterol. We can actually create cholesterol in our liver and we send out this like lipoproteins thing, or we can get cholesterol from our food.

Cool. Right. And adults don’t really need a lot of cholesterol from our food. We kind of make enough of it in our liver. We’re not actually totally sure though how much babies need, although probably they need whatever’s in breast milk. Yeah, probably that much. I did try to find studies and they were kind of like, Oh, okay, well here’s how fetuses do it.

And here’s how babies do it and blah, blah, blah. But actually in conclusion, we don’t know anything except that formula has almost no cholesterol in it. Yeah. That’s the one thing that we have not been able to replicate from breast milk is the cholesterol. Which is why they add things like DHA and other stuff for brain health, because cholesterol is the number one thing that helps grow your brain.

Exactly. It is very important for brain and nervous system development. And let me just say, developmentally, humans, we are honestly born way too early because of this bipedal bullshit. Like we can’t fit out the pelvis because we stand up on two legs. So if we were like other mammals, we would gestate for like 24 months. You know, and the majority of what we do in that first year of life? What is it, Heather? It’s brain development.

 The first six months of life, your, your baby’s brain doubles in size. Right. I mean, imagine so the other day, I was driving home with my son and we literally saw a baby cow shoot out of a vagina, a cow’s vagina. Yes. A cow’s vagina. And we stopped and we watched, and it was great.

And we were there for five minutes and this baby cow gets up and starts walking. Right. But the, you know, the reality is like their brain development is much different from ours and they do you know, they have already done all of this skeletal muscular development in utero. Right. And they’re like, brain development’s kind of done.

Like, they’re not that much smarter as adult cows than they are as baby cows guys. But humans like, Oh my gosh, we’re so far behind when we’re born. You know, we have to spend at least six months doing this massive brain development. And then we like only then, did we really start this musculoskeletal development.

Well, yeah, even if you’re just looking at fetuses from 35 weeks to 40 weeks, the amount of brain development that’s happening in that last five weeks of gestation is huge. Huge, right? Huge. Yeah. So cholesterol is important and we need it. However, that doesn’t mean now that you get to look at your cream line and you’re like, I don’t have enough cholesterol.

My baby’s not going to be smart. Because? Because our bodies make what our babies need. It’s fine. Right? Because unless you’re like exclusive pumping and then analyzing all of your milk and the cholesterol amount in all of your milk all the time, you will not know what your baby is getting in a 24 hour period. Because you might have one pumped milk.

Like if you, for example, only pump while you’re at work. Right. And you’re only looking at those pumped milks from the middle of the day, they might have not as much cholesterol, but guess what? Your body packs it all in for the other exclusive breastfed feedings, you know, you don’t know what’s going on. And as long as your baby is developmentally on track, you’re good.

Honestly, even if you’re, you’re the kind of pumper who leaves your milk in the fridge for a day or two so you actually see that separation, right? Some people throw it right in the freezer. You’re not putting that milk through a centrifuge. Right. Like you’re not fully separating it. Right. And that water and lactose? That’s super important.

Very! Babies absolutely need that. And they need mostly water. Yeah. The foremilk is not shit milk. No, there’s good stuff in there too. I actually saw a great line in one of the articles I was reading about milk content that was basically like, stop saying foremilk and hindmilk cause it implies, there are two kinds of breast milk when there is not.

Yeah, if there’s only one milk making cell, it makes the same kind of milk. The only thing that’s separating is the particles within that one milk excretion. And we have to say this cause people ask this all the time. Are we allowed to shake the milk to reconstitute it? Sure. You are not strong enough to physically shake your milk so hard that you’re ripping apart proteins.

They always say gently swirl. And that’s really all you need is to gently swirl. But if you have a bunch of gobs of stuff, stuff in the side, warm it up, shake it if you want, you know, you just might want to let some of the bubbles settle out. Yeah. It’s not like you, you don’t have to shake it like formula.

Formula, you have to really get after it to make sure it’s all mixed all together. Breast milk isn’t really like that. You know, we just need to make sure that there’s not a glob that’s going to get in the way of the nipple hole. Right. And that’s it. That’s it guys. End of story. Maybe it’s more exciting for baby if there’s lumps? Who knows I’m not a baby, I don’t know. I never drank breast milk as a baby. Sometimes clumps will come out of the breast directly out of the breasts and babies will just chug it right down.

We have so much to say. Great green globs of grimy cholesterol. Cholesterol is good in this instance, guys. I know we’ve been trained to think fat and cholesterol and all of that stuff is bad, bad, bad, and heart disease and whatever. No. Not in this case. Your baby needs this. Your body’s making what your baby needs, and you’re doing a great job doing it.

Hey guys, it’s Maureen here and I wanted to let you know about my Etsy shop. I am an artist and a designer and I have a shop where I make educational breastfeeding posters, shirts for birth workers, like for your favorite nurse or midwife, shirts for people who are lactating, mugs, stickers, all kinds of stuff.

Some of my birth paintings are on there. It’s an eclectic collection and it’s really beautiful. So, if you want to find that you’re going to go to etsy.com/shop/thewanderingwom6, except instead of a B it’s a six. So that’s The Wandering Wom6 with a six instead of a B.

All right. Today’s award goes to Sharon who’s in our Breastfeeding for Busy Moms Facebook group. And she said that she just had a baby, another baby, her first one was 19 years ago. And she said with her first, breastfeeding came easy. But this time she had twins born at 36 weeks by C-section. We had tongue and cheek ties.

We had a meddling mother-in-law. We had formula supplementation and she says that. She says, and this is a quote, “I’m so filled with gratitude from what I learned in this group. No matter how you feed your baby, it’s all good, but it’s also okay to grieve when it doesn’t go the way you wanted.” But let’s celebrate the win because she just worked really, really hard.

And now she’s no longer supplementing with formula. Sharon, you get the double trouble award for those twins. Oh my gosh. Yes. And she has the cutest picture of herself with her pumped milk and you deserve all the praise and applause in the world. So good job.

All right, guys. Well, thanks for joining us. I hope you can stop assessing your self worth based on your cream line and know that you’re doing great and you’re making just what your baby needs.

And next time somebody tells you your milk needs to be , . You can tell him to shove it where the sun don’t shine. Let’s stick it right there. All right, we’ll see you next week, guys. All right. Bye-bye.

Thanks for listening to The Milk Minute. If you haven’t already please like, subscribe and review our podcast wherever you listen. If you’d like to support our podcast, you can find us on Patreon at Patreon.com/MilkMinutePodcast. To send us feedback, personal stories, or just to chat, you can send us an email at [email protected]

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