All about high lipase
For many reading this, I’m going to take a guess and imagine you’ve found your way here because you noticed that your milk has a rather unique smell to it or that your baby has refused your expressed milk. This can be such a stressful situation to find yourself in. Read on to learn about what lipase is, if it’s an issue and what you can do about it.
So what is high lipase?
Lipase is a naturally occurring enzyme in your breastmilk. It works to breakdown the fatty component of your milk which helps your baby to adequately digest and utilise the nutrients in your breastmilk. Milk that is high in lipase is still safe to give your baby and doesn’t degrade it’s goodness in any way.
Why is it an issue?
Breastmilk high in lipase isn’t issue when directly feeding as the enzyme doesn’t activate until the milk is being digested and well past your babies taste buds. However it can be an issue when needing to give your child expressed breastmilk because it tastes distinctly different to fresh breastmilk. It is often described as smelling and tasting rancid/off, metallic or soapy. Personally, having tried my own milk that was high in lipase, it was the most horrendous taste I’ve ever experienced.
How do I know if my milk is high in lipase?
Testing options for milk are expensive and difficult to access, with the benefits not often outweighing the financial cost and effort. Breastmilk will naturally have it’s own unique smell, as any other milk does. Smell will differ between individuals, and even the same person depending on factors such as the time expressed, health of mother or baby at the time, medications or diet etc. Milk that is high in lipase, where the lipase has activated, will smell different to freshly expressed. Unfortunately bottle refusal isn’t a reliable method of determining whether milk is high in lipase, so it might be worth comparing milk that you think may be high in lipase to freshly expressed milk, in regards to smell and taste.
When does it become a problem?
For those with higher lipase levels in breastmilk, it may become active soon after expressing. This means expressed breastmilk either needs to be given soon after expressing or treating as soon as possible. For others, this may happen after hours or days in the fridge,. For some it’s not until frozen breastmilk is defrosted. Unfortunately there’s no way to know until you express, check and test your milk at regular intervals.
Can I stop the lipase?
We are unable to change the composition of your breastmilk and prevent high lipase levels occurring in your breastmilk, but there are treatment methods to manage the lipase in your expressed breastmilk. These involve what we call scalding, or heat treating your milk. This works to inactivate the lipase. By doing this, it can devalue some of the nutrients and antibodies in breastmilk, so where possible, scalded milk should not make up the majority of a babies diet. Where possible, babies should ideally be directly fed from the breast, but where this is not possible, the next best option would be for babies to receive freshly expressed breastmilk. There are multiple methods for scalding milk and I would encourage you to explore what works best for you. However, I will share the method I have used often after trial and error.
I have milk in the freezer that I think is high in lipase, what can I do?
Unfortunately there is no way to treat the lipase one milk has been frozen. There isn’t much concrete research around lipase and how it works, however we think that it continues to be active while milk is frozen, or that inactivates upon thawing. For some babies they will accept high lipase milk. However, if you are in the heartbreaking situation where you have a freezer stash and your baby isn’t accepting of your milk then your options are limited. You can try and mask the taste, however this can be quite difficult for some. Please be mindful of the age of your baby. Infants under 6 months of age should have no additives to milk unless directed by a health care professional. After the age of 6 months you could consider additives. Some suggestions are adding in a few drops of pure vanilla extract, a few drops of pure maple syrup or mixing high lipase milk with some freshly expressed breastmilk. Some are also able to use milk in smoothies. If there is no success with any of these options, breastmilk can be donated. There are infants who will accept breastmilk high in lipase, especially babies with a nasogastric tube which means milk bypasses their taste buds. If you are in this situation, I extend so much love and grace to you having been there myself.
How to scald breastmilk
What you need:
Bottle to hold milk, saucepan, instant read thermometer, water, jug of iced water, storage bottle/bag
It’s important to use fresh milk. Milk cannot be chilled, scalded, re-cooled and re-heated for feeding. Breastmilk can remain at room temperature for up to 6-8 hours after expressing, so scalding isn’t required urgently., however I’d recommend evaluating your milk as to when the lipase activates for you. High lipase milk will breakdown faster at room temperature than it does in the fridge, but much slower if scalded.
I personally use a metal bottle from Ceres Chill. This move was life changing and has made scalding so much simpler in terms of cleaning and safety. You can scald milk in a saucepan, or plastic or glass bottle if you’d prefer. I would caution against glass bottles as rapid cooling can cause the glass to crack. Similarly, our family minimises heating anything ingested in plastic for health reasons. If using a saucepan, I’d suggest a small one dedicated for scalding to prevent food contamination.
Place the milk in the bottle and put the bottle in a water bath in a saucepan. I ensure the water bath is at a similar height to the milk in the bottle. With the stove on, heat the milk and regularly stir (you can just use the thermometer). There are alternate methods that use a lower temperature point for a set amount of time, however it is quite challenging to maintain the temperature of milk. Personally, I find heating milk to 82 degrees and immediately removing to be the easiest method. Using an instant read thermometer makes this really simple as the temperature rises rapidly towards the end. Once your milk has reached 82 degrees, place the bottle into a jug of iced water and cool rapidly. After 5 minutes, or when milk has chilled, place into milk into the bag or bottle you want to store it in, and place in the fridge or freezer.
I hope that this article helps to guide you in regards to expressing and managing the lipase in your milk. Despite being an IBCLC, I didn’t know my milk was high in lipase until my 3rd baby was 12 months old! I unfortunately had spent 9 months expressing milk to give my son after we were required to wean so I could undertake cancer treatment. I hope I can help you to avoid the tears and frustration that often occur with expressed breastmilk feeling wasted or your child refusing your milk.