# foremilk/hindmilk questions



## 1gravidaOK (Aug 10, 2005)

I have been reading through some olds threads in this forum and found several responses about poop colors with regards to foremilk/hindmilk. One reply said that green poop + gassy baby = fore/hind milk balancing problems. So, could someone explain what you all mean by balancing the two and which causes the gassy baby with green poops?

My baby was born April 6th and we have been nursing (with a ROUGH start) since. The last couple of days I have noticed a lot more green poops where it had been very yellow. Also, we battle gas frequently. So, can you help a Momma out??


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## Quirky (Jun 18, 2002)

Foremilk is the thinner, watery milk at the beginning of a feed - it turns to fattier, richer milk as the feed goes on. Foremilk is high in lactose and too much lactose can cause the gassiness and green poops. Try nursing longer on one side - don't switch too soon. When the swallowing stops on one side, do some breast compressions (gently cup your breast and squeeze/massage) to try to trigger another letdown and keep baby going on the same side.

Many moms with green poopy/gassy babies have a problem with oversupply/overactive letdown. Do you have a TON of milk to the point that baby chokes and comes off the breast gasping? If so, one thing you can do is trigger the initial letdown either by latching baby on or by pumping a little and then let the excess milk spray out into a cloth diaper or towel. Then latch baby on. That will get rid of some of the problem, as will nursing exclusively on one side for several hours before switching to the other side.

HTH a little - please ask more questions and provide more info so we can do more troubleshooting!


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## MaryJaneLouise (Jul 26, 2005)

Here's more good info:

http://www.kellymom.com/bf/supply/fo...-hindmilk.html


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## mamazig (Nov 14, 2004)

nak...this might be too much info for you but it really helped me to understand and begin to fix our problem : http://www.health-e-learning.com/articles/Lactose.pdf


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## kindergirl77 (Jun 30, 2005)

i really don't understand why green poops are necessarily a problem as long as the baby is gaining weight? I have the same issue with green poops and have also tried block nursing so the baby gets one side for a block of 4-5 hours and I haven't seen any difference.


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## Quirky (Jun 18, 2002)

Quote:


Originally Posted by *kindergirl77*
i really don't understand why green poops are necessarily a problem as long as the baby is gaining weight? I have the same issue with green poops and have also tried block nursing so the baby gets one side for a block of 4-5 hours and I haven't seen any difference.

I don't think it's necessarily a problem as much as a symptom. If that's the only thing you see and baby is happy and gaining weight, then no worries. If baby is fussy, or miserable, with gas and isn't gaining well, then it's a problem.


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## mamazig (Nov 14, 2004)

and babe _might be gaining well too -- but if green poops and miserable, then imbalance is still a great possibility. Block feeding took us weeks and weeks to get worked out plus I had to get dairy out of our diet (we were having blood in poop too)_


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## CathMac (Jan 10, 2006)

Mamazig,
What a great article!!! It's not an easy read but I did skim it and hope to find the time to read it carefully some day.

It seems to vindicate my pet theory that Low Fat, "Junky Carb" (sugar and highly refined carbs) **may** (I emphasize the word may here) exacerbate or contribute to Hindmilk-Foremilk imbalance / oversupply / secondary lactose intolerance. Some breastfeeding advocates seem afraid to suggest this since it might make breastfeeding seem that much more difficult. My feeling is that any Mom with a colicky baby should know that modifying their diet may help.

I only hope I don't have these issues with DD2 (EDD 6/14/06)

1gravidaOK,
Try "finishing" the first breast first, to get as much of the hind milk as possible. You may be surprised at how long you may need to keep the baby on one side. In my case it was as long as 4 - 6 hours.

I have been repeatedly told that it is rare to need to keep a baby on one side for that long but if nothing else works I would experiment with the length of time it takes for your baby to "finish" one side.
~Cath


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## ndunn (Mar 22, 2006)

Ditto on that being such a great article. My daughter has been having 48 hour gassy periods about once ever 1.5 weeks since birth. I cut dairy out of my diet which made me miserable because I usually live on it. When I read this post, I tried eating way more protien and fat (I'm a carb junkie...not junk but fruit, whole wheat bread, juice , etc. ) and cutting down on the carbs a bit and WOW - it fixed the problem! I also nursed longer on each breast. So, its nice to know I can eat dairy. I've been eating a bit every day now and its been fine.

Thank you so much


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## kellykins (Oct 13, 2004)

Im way too sleepy to read that article right now but I have it open to read tomorrow...
My dd just recently started having green poop. It started as one green poop the other day, intermingled with several normal cheeto-orange poops (why does my kids poo look and smell like chewed cheetos? LOL) to today where there was one close to normal, orange with some green tinge and the rest have been like pea soup. Her eating habits have not really changed (although yesterday afternoon and tonight she seemed insatiable- eat for 40 min or more, break for an hour or less, eat again for a long time, but normal again through the day.) and neither has my diet. Things I have read also imply that there is usually a change in the poo around 5-6 weeks old. She will be 6 weeks Thursday.
Also, we did have a problem with gassyness (she farts like an old man!) but it seems to actually have improved some since the green poo.
Is there anything here that implies a fore/hind imbalance aside from the green poo?


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## vegetalien (May 28, 2005)

I recently attended a breastfeeding workshop as part of the baby friendly hospital initiative...anyway, from what I understand this foremilk/hindmilk at the beginning and end of a feeding is actually outdated information.
It is true that some milk is watery than others. But it doesn't change during a feeeding, rather it changes as a function of how full your breasts are and what time of the day (usually the milk is richest/fattier in the evening when we're tired). Basically if you are producing "too much" milk and your breasts are very full, it is likely to be more watery - but will still contain an adequate amount of fat, it's just the ratio is different. The baby is still getting what s/he needs, but it may produce the gassy green poop you described. When the breast is emptier, as when the baby feeds, and then again on the same breast half an hour later, that time that breast will contain fattier milk.

So, what you can do is block-feed which is to offer only one breast per feeding, and you can even offer the same breast again the next, then switch and do the same with the other side. Do this only if you have too much supply.


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## kellykins (Oct 13, 2004)

Good to know!
How do you know if you have too much supply?








Seems like a dumb question now that I type it out.
I tried "block feeding" this a.m. - now my other side is QUITE full and kinda hard.


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## mamazig (Nov 14, 2004)

Knowing or realizing I had oversupply and its associated problems came as a result of several symptoms: in the very beginning severe leaking and a letdown that would knock out a cow (kind of painful and sprayed everywhere), breasts would get rock hard in between feedings -- I had to pump off to relieve pressue -- but more importantly, my baby just couldn't handle any of this and even sometimes still can't: she'd choke and gurgle at letdown and then come off the breast entirely to the point that for evening feeds I had to express and feed her from a bottle for a couple of weeks. Before and after this period of bottle feeding, she would eat for a bit and then start popping off, screaming with her mouth around the nipple, bopping her head around, then an explosively loud painful green poop and wah wah wah -- poor babe. There were just so many things going on with us in addition to these things (thrush, dairy allergy, reflux) but when we finally worked out the oversupply, these other things didn't seem so bad. Oversupply and associated foremilk/hindmilk imbalance just exacerbated everything to make life ABSOLUTELY unbearable for all involved for a couple of months.
Jeez, what a bunch of unloading I just did -- sorry, but hope it might help someone figure something out. I just know that breastfeeding SHOULDN"T be miserable, but it certainly was for us for a while -- but there is hope. Things are going pretty well now -- she still has pea green poops for the most part but in this case I don't think it's due to imbalance -- probably an allergy I can't pinpoint or maybe it's just her thing . . . who knows? I just know we don't have those other symptoms and so I don't worry about the imbalance and oversupply anymore.


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## tash11 (Mar 12, 2006)

unfortunatly I dont know much about oversupply. but what about massaging the breasts? I have heard that foremilk is just milk that doesnt have the fatty parts mixed in that well and that hindmilk is when you finally get down to the fatty parts. maybe massaging would help mix things up more?

aslo my baby is very gasy. she doenst seem to mind usueally (sometimes she will frown right before a big one). but gas can be caused by fenugreek. although I doubt that most people with oversupply take it..........


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## CathMac (Jan 10, 2006)

Vegetalien,
I have never ever ever before heard that milk is richest / fattier when Mom is tired. I'd be very interested in reading more about that. As far as the conventional wisdom regarding hindmilk/foremilk being outdated, maybe but I don't think for the reason you describe.

If I understand correctly, you say that the fat ratio "doesn't change during a feeding" but you immediately go in to say that "rather it changes (partly) as a function of "how full your breasts are". I would agree that with extremely slow nurslings the change may be subtle but given enough time their nursing has to affect how full (empty) the breast is. However, because it may take the nursling awhile to reach or "release" (depending upon how you look at it) the higher fat milk, Moms & Nurslings with Hindmilk-Foremilk imbalance &/or Oversupply &/or Secondary Lactose Intolerance issues may benefit from "finishing the first side first" and possibly even having two or more nursing sessions on one side before switching. In my case I was nursing my "nip and napper" on one side --on and off-- for up to six hours.

For more information on milk production and milk composition there are some links to a few Kellymom articles and one University of Pennsylvania lecture / article found on a lactation biology website. The last Kellymom article below emphasizes the conventional wisdom that while you can improve fat quality you cannot increase fat quantity. This is the "conventional wisdom" I question. The University of Penns lecture / article may contradict the Kellymom article. Which is why I was so interested in the article cited earlier in this thread.

Kellymom Article:
I'm confused about foremilk and hindmilk - how does this work?
http://www.kellymom.com/bf/supply/fo...-hindmilk.html

Kellymom Article:
Frequently Asked Questions about Milk Production
http://www.kellymom.com/bf/supply/mi...ction-faq.html

Kellymom Article How does milk production work?
http://www.kellymom.com/bf/supply/milkproduction.html
Kellymom Article and Quote
What affects the amount of fat or calories in mom's milk? http://www.kellymom.com/nutrition/mi...e-milkfat.html
"What affects the amount of fat and calories in a mother's milk?
Mom's diet? The research tells us that mom's diet does not affect the average amount of fat or calories in her milk. However, mom can change the types of fat in her milk by altering the types of fats that she eats (Lawrence 1999, p. 106-113, 300-305; Hamosh 1996, Hamosh 1991, p. 123-124). An increase of one fatty acid could generally be expected to occur concurrently with a decrease in another. For example, one study has shown that black mothers in South Africa who eat a traditional maize diet have less monunsaturated fatty acid in their milk than urban mothers who consumed more animal proteins and fats (van der Westhuyzen 1988)."

Article adapted from a lecture by Mary Francis Picciano. Dr. Picciano is Professor of Nutrition, at the Pennsylvania State University -- Including Quote Comparative Lactation - Humans http://classes.aces.uiuc.edu/AnSci30...on/humans.html
"Synthesis of milk lipid. The mechanisms of milk fat synthesis and secretion are similar to other monogastric species. The major lipid of milk, triglyceride, is synthesized in the mammary alveolar cell from free fatty acids and glycerol. Both of these constituents can be derived from the blood stream or manufactured in the mammary alveolar cell itself. ****The proportion of fatty acids synthesized in the mammary gland is strongly influenced by diet****: on a normal western diet (~40% fat) only about 20% of fatty acids are synthesized in the mammary gland, the remainder are obtained from the chylomicra of the blood stream using the enzyme lipoprotein lipase. Their composition represents the composition of dietary or adipose depot fatty acids. The lipids synthesized in the mammary gland are medium chain (12:0, 14:0, and 16:0) fatty acids rather than the long chain (16:0, 18:1) fatty acids synthesized in the adipose tissues. On high carbohydrate, low fat diets as much as 40% of the fatty acids may be synthesized in the mammary gland. Although the enzyme, thioesterase II, responsible for the early termination of fatty acid synthesis in the mammary gland, has been purified and characterized, the advantage to mother or infant of these medium chain fatty acids is not yet clear."

So, my suggestion for nursing Moms with "sugar" related issues is that they at least consider increasing their fat intake (preferably "healthy" fats) and possibly decrease their "junky carb" intake, especially if they tend towards a low fat, highly refined carb diet.
JMO, ~Cath


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## kellykins (Oct 13, 2004)

Sadly, I am guilty of a low-fat high carb diet. (Im not big on the junk carbs, but I do eat lots of cereal -mini wheats.) Im not sure I fully digest (ha- punny) the whole idea as to how this affects the milk?


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## mamazig (Nov 14, 2004)

Kellykins,
According to the article I linked to way up there, such a diet could, stress *could* lead to "lactose overload" and it says that:
"Hence the presenting symptoms of lactose overload in breastfed babies are:
· excessive flatus (a "windy" baby)
· frequent explosive watery stools which may be yellow or green, depending on
severity
· "colic" (defined in this case as crying due to overproduction of intestinal gases)
· unsettled baby
· perianal acid burns may occur
· stools may be mucousy (8)"

So the researchers suggest:
For example, when the maternal diet has too little fat and too many simple sugars:
Instead of:
100% fruit juice, softdrinks, cordial
Substitute







ater, very dilute fruit juice, tea and coffee in moderation
Instead of: lots of fresh or dried fruit
Substitute:1-2 pieces fresh fruit daily, vegetables
Instead of:honey, jam, golden syrup, Vegemite
Substitute:fish/meat/cheese/egg spreads, peanut butter, sardines,canned fish, sliced meats/poultry
Instead of







lies, chocolate, biscuits, cake, desserts
Substitute







s and seed mixes, corn chips, potato chips,
chicken/meat sandwiches, sausage rolls, meat pies,
savoury crackers with canned fish/smoked mussels or
oysters/hard boiled egg, soup
Instead of:salad sandwich for lunch
Substitute:large serving of chicken/meat/fish with buttered bread roll,
substantial side salad with oil based dressing

HTH, Beth

edited to add: hee hee -- I didn't put those emoticons in on purpose -- never had that happen before! funny

edited again to add: I just realized that I didn't answer your question . . . slow start this morning -- a couple of things can happen when there is "lactose overload":
1. the excess lactose is fermented by microbial flora in babe's GI , which can cause gas and acid . . .
2. unsplit lactose and fermentation product in babe's colon can prevent water reabsorption from stools which can cause watery stools and more acid production and all the rest that goes with that . . .


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## kellykins (Oct 13, 2004)

I guess I didnt read down far enough on that article, because that makes more sense now haha!
I talked to her ped. yesterday about the green poo, for his perspective- and he said not to worry about it, as long as it isn't diarrea or bloody and she seems happy/not ill, and he said that it is probably bile in the poo from everything moving through her system too quickly. I really dont know how to tell what baby diarrea would look like and she does seem otherwise happy.
She has two good poos that are greenish/tannish/orangish tinged a day, and otherwise very similar to her normal orange poo then also several ahem, as my dh calls em- sharts- a little streak of poo- along with a very wet back part of the diaper.

I had no idea that bfing was going to be complicated like this.








If it was related to the food I eat, wouldnt she have had this green poo the whole time? Also, even with this green poo this week, is she still getting nutrients and good stuff? Id hate to think that she might be healthier-ly (eh?) fed by formula.


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## mamazig (Nov 14, 2004)

I'll have to totally agree with your ped on this one -- if she's not unhappy and there's no blood, I'd not worry. I might have mentioned before that my dd's poo is consistently green now but all those other symptoms have gone away for the most part, so I'm not too worried and nor is our nurse practitioner. I read on Dr. Jay Gordan's site that green poo can be attributed to the f/h imbalance, a stomach bug, cow's milk protein allergy, and/or other allergies or intolerances --- or it can be just a normal thing for a bf kiddo. I think it's important to look at the whole big picture rather than take the green poop on its own. And no way would she be healthier with formula. Just no way -- you're doing the right thing in my book, if my book counts for anything -- hee hee! I know I've thought the same thing a million times though with this dd -- after all we've been through, it's been hard NOT to think sometimes that she'd be better off with formula because then at least I'd know exact ingredients that she'd be reacting to. But, no, the benefits of bm FAR outweigh that. Coming here for encouragement -- just reading posts -- really helps me keep at it -- and we've made it past 4 months and I'm WOH full time -- yay for me!
Ok -- I'm done patting myself on the back.
Hope bf gets less complicated for you!!


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