Behind the Latch

Informal Milk Sharing in the U.S. with Molly Waymouth

Margaret interviews, Molly Waymouth, a senior policy analyst at RAND, and they discuss her research on informal milk sharing, its prevalence, risks, and policy implications. They explores how systemic barriers and economic factors influence families' choices and what can be done to improve access to safe, affordable donor milk and lactation support. Chapters 00:00 Introduction to the Conversation 05:37 Molly's Background and Research Focus 07:10 Exploring Milk Sharing Practices 09:35 The Economics of Donor Milk 11:23 Understanding the Support Gaps 13:48 Equity and Access in Milk Sharing 16:27 Risks of Informal Milk Sharing 16:50 The Need for Comprehensive Support 18:34 Innovative Approaches to Milk Sharing 18:50 Designing an Ideal Support System 20:27 Conclusion and Future Directions 21:22 outro.mp3 Resources JAMA Open Network Publication - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841048 [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841048] RAND Corporation - https://www.rand.org/ [https://www.rand.org/] LinkedIn Profile of Molly Waymouth - https://www.linkedin.com/in/mollywaymouth/ [https://www.linkedin.com/in/mollywaymouth/] Connect with Margaret mail: hello@margaretsalty.com Instagram: @margaretsalty [https://www.instagram.com/margaretsalty/] Facebook: Margaret Salty [https://www.facebook.com/profile.php?id=61550829710885] Music by: The Magnifiers – [https://open.spotify.com/track/5Q7WMVIaE9Kos3eMHUvvow?si=f1121c31a020410d]My Time Traveling Machine [https://open.spotify.com/track/5Q7WMVIaE9Kos3eMHUvvow?si=f1121c31a020410d]

Rethinking Elimination Diets in Breastfeeding: What the Research Actually Shows with Dr. Trillitye Paullin

In this episode of Behind the Latch, Margaret Salty interviews Trillitye Paullin, CEO and co-founder of Free to Feed, who shares her groundbreaking work translating emerging research on food reactivity in breastfeeding into practical clinical guidance. Together, they unpack one of the most misunderstood topics in lactation: how dietary proteins transfer into breast milk and what that actually means for managing elimination diets. Trillitye explains why the long-standing belief that proteins remain in breast milk for weeks is not supported by current evidence—and how confusing “transfer timing” with “healing timing” has led to unnecessary dietary restriction and early weaning. They also explore the realities of non-IgE-mediated food allergies, why traditional allergy testing often fails these families, and how IBCLCs can more effectively assess, manage, and refer these cases. This conversation offers a practical, evidence-based framework that has the potential to change how clinicians support breastfeeding dyads navigating food reactivity. KEY TAKEAWAYS FOR CLINICIANS * Food proteins transfer into breast milk quickly—often within minutes—and typically clear within hours, not weeks * The timeline we see clinically is often driven by infant healing, not ongoing exposure * Elimination diets should be reassessed early (around 5 days) to determine effectiveness * Not all symptoms warrant elimination—rule out more common causes first * Most infants with food reactivity will have symptoms emerge between 2–4 months * Cow’s milk and soy are the most common triggers, but other foods may be involved * Reintroduction is critical to avoid unnecessary long-term restriction * Severe symptoms or lack of improvement beyond dairy/soy elimination should prompt referral * Non-IgE-mediated allergies cannot be diagnosed with standard allergy testing * Supporting parental mental health is essential—elimination diets are a significant burden GUEST Trillitye Paullin, PhD, CEO & Co-Founder, Free to Feed [linkedin.com/in/trillitye-paullin/?lipi=urn%3Ali%3Apage%3Ad_flagship3_feed%3BncLOgl1rRcirMUyitN0BzQ%3D%3D] Free to Feed [https://www.freetofeed.com/] Supporting Families as They Navigate Infant Food Allergies [https://pubmed.ncbi.nlm.nih.gov/41711302/] CONNECT WITH MARGARET 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty [https://www.instagram.com/margaretsalty/] 📘 Facebook: Margaret Salty [https://www.facebook.com/profile.php?id=61550829710885] Music by: The Magnifiers – My Time Traveling Machine [https://open.spotify.com/track/5Q7WMVIaE9Kos3eMHUvvow?si=f1121c31a020410d]

Lactation During Bereavement with Victoria Fonville: A Research Review

In this episode of Behind the Latch, Margaret Salty interviews Victoria Fonville, MS, PhD candidate in Nutrition at UNC Greensboro, about her recent scoping review on lactation during perinatal bereavement. Together, they explore what the research actually tells us about lactation after infant loss—from the lived experiences of bereaved families to the gaps in care from healthcare providers. Victoria shares the key findings from her paper, including the four major areas studied—producing milk, support, stopping lactation, and donating milk—and the six themes that emerged: hurting, lacking, valuing, succeeding, connecting, and redeeming. They discuss how lactation can serve as a powerful source of connection and identity for grieving mothers, why suppression is often presented as the default (and why that’s problematic), and how milk donation can be experienced as a deeply meaningful and even healing process for families navigating loss. This episode challenges the way we approach bereavement care and emphasizes the importance of presenting all options—so families can make informed decisions that align with their goals and their grief. KEY TAKEAWAYS FOR CLINICIANS * Lactation after perinatal loss is common due to normal physiology, but remains poorly addressed in clinical care. * Bereaved mothers often experience both physical pain and emotional distress related to lactation, requiring compassionate and informed support. * “Lacking” was a dominant theme across studies, highlighting significant gaps in provider knowledge, training, and communication. * Lactation suppression is frequently presented as the only option, but this does not reflect the full range of choices available. * Producing milk can help maintain maternal identity and connection to the infant after loss. * Milk donation is often experienced as “redeeming,” helping families create meaning and process grief. * Healthcare providers should present all options—suppression, expression, donation, and keepsakes—without bias. * There is an urgent need for quantitative research to better understand care practices, outcomes, and donation patterns. * Compassion, presence, and individualized care are critical when supporting bereaved families. GUEST Victoria Fonville, MS, [https://ntr.uncg.edu/fonville-victoria/]PhD Candidate in Nutrition, University of North Carolina at Greensboro [https://ntr.uncg.edu/fonville-victoria/] Lactation During Perinatal Bereavement From the Perspective of Families and Support Providers: A Scoping Review [https://pubmed.ncbi.nlm.nih.gov/41277241/] CONNECT WITH MARGARET 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty [https://www.instagram.com/margaretsalty/] 📘 Facebook: Margaret Salty [https://www.facebook.com/profile.php?id=61550829710885] Music by: The Magnifiers – My Time Traveling Machine [https://open.spotify.com/track/5Q7WMVIaE9Kos3eMHUvvow?si=f1121c31a020410d]

More Than Milk: The Science, Systems, and Future of Human Lactation with Dr. Lars Bode

Dr. Bode shares his journey into human milk research and the founding of the Human Milk Institute—the only institute in the world dedicated entirely to studying human milk in all its complexity. Together, they explore how human milk research is evolving from isolated disciplines into a collaborative, systems-based science that integrates molecular biology, clinical care, and public health. The conversation dives deep into human milk oligosaccharides (HMOs), the limitations of reductionist thinking in lactation science, and the urgent need to translate research into real-world clinical impact. Dr. Bode also shares his vision for the future, including the development of “lactology” as a formal field of study and what it would take to truly normalize breastfeeding on a global scale. Key Takeaways for Clinicians * Human milk is far more than nutrition—it is a dynamic system of signaling, protection, and communication. * HMOs play multiple roles beyond the microbiome, including direct immune and systemic effects. * Donor milk retains key bioactive components like HMOs even after pasteurization. * Variation in milk composition across individuals and time is expected and biologically meaningful. * Clinical care must align with real-world problems—research must start with the needs of families. * Multidisciplinary collaboration is essential to advancing both science and clinical outcomes. * Maternal health directly influences milk production and composition. * Breastfeeding provides significant long-term health benefits for both infants and mothers. * Formula can improve—but it cannot replicate the adaptive, responsive nature of human milk. * Early identification of barriers and inequities is critical to improving breastfeeding outcomes. * The future of lactation care depends on bridging research, clinical care, and public health systems. Guest Dr. Lars Bode, PhD [https://www.linkedin.com/in/lars-bode-bb70565/] Director, Human Milk Institute [https://www.linkedin.com/company/human-milk-institute/posts/?feedView=all] Human Milk Institute [https://hmi.ucsd.edu/] TRITON GIVING DAY 04.29.2026 [https://tritongivingday.ucsd.edu/campaigns/human-milk-institute-fund] Connect with Margaret 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty [https://www.instagram.com/margaretsalty/] 📘 Facebook: Margaret Salty [https://www.facebook.com/profile.php?id=61550829710885] Music by: The Magnifiers – My Time Traveling Machine [https://open.spotify.com/track/5Q7WMVIaE9Kos3eMHUvvow?si=f1121c31a020410d]

The High Lipase Myth: What’s Really Happening to Stored Breastmilk With Dr. Jimi Francis

WHAT WE TALK ABOUT The origin of the “high lipase” breastmilk myth and how it spread through the lactation community Why biologically it does not make sense that some mothers produce excess lipase in milk What lipase actually does in human milk and why it is critical for infant fat digestion What parents are actually noticing when milk smells “soapy,” “metallic,” or “rancid” How riboflavin oxidation and free radical reactions may contribute to off flavors in stored milk Why exposure to light, oxygen, and heat accelerates nutrient degradation Simple strategies for protecting expressed milk during storage The role of vitamin C and antioxidants in preventing oxidation Why scalding milk may damage valuable nutrients and enzymes How maternal diet influences the fatty acid profile of breastmilk The relationship between omega-3 and omega-6 fats in human milk Why formula cannot truly replicate human milk oligosaccharides or fatty acid complexity How breastfeeding exposes infants to diverse food flavors that shape lifelong eating patterns Why maternal nutrition matters—but breastfeeding remains resilient even with imperfect diets Future research questions about the human milk metabolome and maternal diet KEY TAKEAWAYS FOR CLINICIANS The “high lipase milk” explanation for off-smelling stored milk may not be supported biologically or experimentally. Off flavors may instead result from nutrient oxidation, particularly involving riboflavin and free radical reactions. Protecting milk from light, oxygen, and heat exposure may help reduce degradation. Scalding milk may stop some reactions but can also damage enzymes, vitamins, and bioactive components. Maternal intake of vitamin C and antioxidants may influence milk stability during storage. Maternal diet does influence certain components of milk, especially fatty acid composition and water-soluble vitamins. The fatty acid profile of milk largely reflects the mother’s dietary fat intake. Human milk oligosaccharides vary between mothers and environments, making them difficult to replicate in formula. Even when milk has an unusual smell, it is often still safe for infants, and strategies like dilution with fresh milk can help babies accept it. Human milk remains one of the most biologically protected food systems in nature, even when maternal diets are imperfect. GUEST Dr. Jimi Francis, PhD, RD, IBCLC [https://www.linkedin.com/in/dr-jimi-francis/] https://drjimi.net/ [https://drjimi.net/] References referred to in the discussion about Lipase in Human Milk: Allen, L. H. (2012). B vitamins in breast milk: Relative importance of maternal status and intake, and effects on infant status and function. Advances in Nutrition, 3(3), 362–369. https://doi.org/10.3945/an.111.001172 Bauman, D. E., & Bruce Currie, W. (1980). Partitioning of Nutrients During Pregnancy and Lactation: A Review of Mechanisms Involving Homeostasis and Homeorhesis. Journal of Dairy Science, 63(9), 1514–1529. https://doi.org/10.3168/jds.S0022-0302(80)83111-0 Chappell, J. E., Francis, T., & Clandinin, M. T. (1985). Vitamin A and E content of human milk at early stages of lactation. Early Human Development, 11(2), 157–167. https://doi.org/10.1016/0378-3782(85)90103-3 Daniel, A. I., Shama, S., Ismail, S., Bourdon, C., Kiss, A., Mwangome, M., Bandsma, R. H. J., & O’Connor, D. L. (2021). Maternal bmi is positively associated with human milk fat: A systematic review and meta-regression analysis. American Journal of Clinical Nutrition, 113(4), 1009–1022. https://doi.org/10.1093/ajcn/nqaa410 Demmelmair, H., & Koletzko, B. (2018). Lipids in human milk. Best Practice and Research: Clinical Endocrinology and Metabolism, 32(1), 57–68. https://doi.org/10.1016/j.beem.2017.11.002 Dickton, D., & Francis, J. (2018). Case review: food pattern effects on milk lipid profiles. J Nutr Health Food Eng, 8(6), 467–470. https://doi.org/10.15406/jnhfe.2018.08.00311 Donovan, S. M., Aghaeepour, N., Andres, A., Azad, M. B., Becker, M., Carlson, S. E., Järvinen, K. M., Lin, W., Lönnerdal, B., Slupsky, C. M., Steiber, A. L., & Raiten, D. J. (2023). Evidence for human milk as a biological system and recommendations for study design—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 4. American Journal of Clinical Nutrition, 117, S61–S86. https://doi.org/10.1016/j.ajcnut.2022.12.021 Dror, D. K., & Allen, L. H. (2018). Overview of nutrients in humanmilk. Advances in Nutrition, 9, 278S-294S. https://doi.org/10.1093/advances/nmy022 Evans, T. J., Ryley, H. C., Neale, L. M., Dodge, J. A., & Lewarne, V. M. (1978). Effect of storage and heat on antimicrobial proteins in human milk. Archives of Disease in Childhood, 53(3), 239–241. https://doi.org/10.1136/adc.53.3.239 Francis, J. (2015). Effects of Light on Riboflavin and Ascorbic Acid in Freshly Expressed Human Milk. Journal of Nutritional Health & Food Engineering, 2(6), 2–4. https://doi.org/10.15406/jnhfe.2015.02.00083 Francis, J., & Dickton, D. (2020). Feeding and refusal of expressed and stored human (FRESH) milk study - a short communication. J Nutr Health Food Eng, 8(6), 391–393. https://doi.org/10.15406/jnhfe.2018.08.00301 Francis, J., & Egdorf, R. (2020). Maternal Nutrient Metabolism and Requirements in Lactation. In B. Marriott, D. F. Birt, V. Stalling, & A. Yates (Eds.), Present Knowledge in Nutrition (11th ed., pp. 67–81). Elsevier. https://doi.org/10.1016/c2018-0-02422-6 Francis, J., Rogers, K., Brewer, P., Dickton, D., & Pardini, R. (2008). Comparative analysis of ascorbic acid in human milk and infant formula using varied milk delivery systems. International Breastfeeding Journal, 3(1), 19. https://doi.org/10.1186/1746-4358-3-19 Francis, J., Rogers, K., Dickton, D., Twedt, R., & Pardini, R. (2012). Decreasing retinol and αtocopherol concentrations in human milk and infant formula using varied bottle systems. Maternal and Child Nutrition, 8(2), 215–224. https://doi.org/10.1111/j.1740- 8709.2010.00279.x Hamosh, M., Clary, T. R., Chernick, S. S., & Scow, R. O. (1970). Lipoprotein lipase activity of adipose and mammary tissue and plasma triglyceride in pregnant and lactating rats. Biochimica et Biophysica Acta (BBA)/Lipids and Lipid Metabolism, 210(3), 473–482. https://doi.org/10.1016/0005-2760(70)90044-5 Hampel, D., Shahab-Ferdows, S., Islam, M. M., Peerson, J. M., & Allen, L. H. (2017). Vitamin concentrations in human milk vary with time within feed, circadian rhythm, and singledose supplementation. Journal of Nutrition, 147(4), 603–611. https://doi.org/10.3945/jn.116.242941 Jensen, D. R., Gavigan, S., Sawicki, V., Witsell, D. L., Eckel, R. H., & Neville, M. C. (1994). Regulation of lipoprotein lipase activity and mRNA in the mammary gland of the lactating mouse. Biochemical Journal, 298(2), 321–327. https://doi.org/10.1042/bj2980321 Krebs, N. F., Belfort, M. B., Meier, P. P., Mennella, J. A., O’Connor, D. L., Taylor, S. N., & Raiten, D. J. (2023). Infant factors that impact the ecology of human milk secretion and composition—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 3. American Journal of Clinical Nutrition, 117, S43–S60. https://doi.org/10.1016/j.ajcnut.2023.01.021 Lackey, K. A., Williams, J. E., Meehan, C. L., Zachek, J. A., Benda, E. D., Price, W. J., Foster, J. A., Sellen, D. W., Kamau-Mbuthia, E. W., Kamundia, E. W., Mbugua, S., Moore, S. E., Prentice, A. M., K, D. G., Kvist, L. J., Otoo, G. E., García-Carral, C., Jiménez, E., Ruiz, L., … McGuire, M. K. (2019). What’s normal? Microbiomes in human milk and infant feces are related to each other but vary geographically: The inspire study. Frontiers in Nutrition, 6. https://doi.org/10.3389/fnut.2019.00045 Lee, H., Padhi, E., Hasegawa, Y., Larke, J., Parenti, M., Wang, A., Hernell, O., Lönnerdal, B., & Slupsky, C. (2018). Compositional dynamics of the milk fat globule and its role in infant development. Frontiers in Pediatrics, 6. https://doi.org/10.3389/fped.2018.00313 Lemons, J. A., Moye, L., Hall, D., & Simmons, M. (1982). Differences in the composition of preterm and term human milk during early lactation. Pediatric Research, 16(2), 113–117. https://doi.org/10.1203/00006450-198202000-00007 Mitoulas L.R.*, Kent, J. C., Cox, D. B., Owens, R. A., Sherriff, J. L., & Hartmann, P. E. (2002). Variation in fat, lactose and protein in human milk over 24 h and throughout the first year of lactation. British Journal of Nutrition, 88(1), 29–37. https://doi.org/10.1079/bjnbjn2002579 Nommsen, L. A., Lovelady, C. A., Heinig, M. J., Lönnerdal, B., & Dewey, K. G. (1991). Determinants of energy, protein, lipid, and lactose concentrations in human milk during the first 12 mo of lactation: The DARLING Study. American Journal of Clinical Nutrition, 53(2), 457–465. https://doi.org/10.1093/ajcn/53.2.457 Nommsen-Rivers, L., Black, M. M., Christian, P., Groh-Wargo, S., Heinig, M. J., Israel-Ballard, K., Obbagy, J., Palmquist, A. E. L., Stuebe, A., Barr, S. M., Proaño, G. V., Moloney, L., Steiber, A., & Raiten, D. J. (2023). An equitable, community-engaged translational framework for science in human lactation and infant feeding—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 5. American Journal of Clinical Nutrition, 117, S87–S105. https://doi.org/10.1016/j.ajcnut.2023.01.020 Raiten, D. J., Steiber, A. L., Papoutsakis, C., Rozga, M., Handu, D., Proaño, G. V., Moloney, L., & Bremer, A. A. (2023). The “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Project – executive summary. American Journal of Clinical Nutrition, 117, S1–S10. https://doi.org/10.1016/j.ajcnut.2022.12.020 Rudolph, M. C., McManaman, J. L., Phang, T. L., Russell, T., Kominsky, D. J., Serkova, N. J., Stein, T., Anderson, S. M., & Neville, M. C. (2007). Metabolic regulation in the lactating mammary gland: A lipid synthesizing machine. Physiological Genomics, 28(3), 323–336. https://doi.org/10.1152/physiolgenomics.00020.2006 Schaefer W., Swindall R, Boyle J, &, & Francis J. (n.d.). Analysis of Macronutrient Content of Human Expressed Milk in East Texas Women. Smilowitz, J. T., Allen, L. H., Dallas, D. C., McManaman, J., Raiten, D. J., Rozga, M., Sela, D. A., Seppo, A., Williams, J. E., Young, B. E., & McGuire, M. K. (2023). Ecologies, synergies, and biological systems shaping human milk composition—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 2. The American Journal of Clinical Nutrition, 117(Suppl 1), S28. https://doi.org/10.1016/j.ajcnut.2022.11.027 Spencer, B., & Francis, J. (2021). The Composition and Specificity of Breastmilk. In K. A. Wambach & B. Spencer (Eds.), Breastfeeding and Human Lactation (Sixth, Four). Jones & Bartlett. https://www.jblearning.com/catalog/productdetails/9781284151565#productInfo Wang, C. S., Hartsuck, J., & McConathy, W. J. (1992). Structure and functional properties of lipoprotein lipase. Biochimica et Biophysica Acta (BBA)/Lipids and Lipid Metabolism, 1123(1), 1–17. https://doi.org/10.1016/0005-2760(92)90165-R Wang, Y., Tong, J., Li, S., Zhang, R., Chen, L., Wang, Y., Zheng, M., Wang, M., Liu, G., Dai, Y., Zhao, Y., & Li, N. (2011). Over-Expression of Human Lipoprotein Lipase in Mouse Mammary Glands Leads to Reduction of Milk Triglyceride and Delayed Growth of Suckling Pups. PLoS ONE, 6(6), e20895. https://doi.org/10.1371/journal.pone.0020895 Williams, J. E., McGuire, M. K., Meehan, C. L., McGuire, M. A., Brooker, S. L., Kamau-Mbuthia, E. W., Kamundia, E. W., Mbugua, S., Moore, S. E., Prentice, A. M., Otoo, G. E., Rodríguez, J. M., Pareja, R. G., Foster, J. A., Sellen, D. W., Kita, D. G., Neibergs, H. L., & Murdoch, B. M. (2021). Key genetic variants associated with variation of milk oligosaccharides from diverse human populations. Genomics, 113(4), 1867–1875. https://doi.org/10.1016/j.ygeno.2021.04.004 📝 CONNECT WITH MARGARET 📬 Email: hello@margaretsalty.com 📸 Instagram: @margaretsalty [https://www.instagram.com/margaretsalty/] 📘 Facebook: Margaret Salty [https://www.facebook.com/profile.php?id=61550829710885] Hosted by: Margaret Salty Music by: The Magnifiers – [https://open.spotify.com/track/5Q7WMVIaE9Kos3eMHUvvow?si=f1121c31a020410d]My Time Traveling Machine [https://open.spotify.com/track/5Q7WMVIaE9Kos3eMHUvvow?si=f1121c31a020410d]