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Welcome to “Ask a LC” by Melissa Yetter RN CLC

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“@birthserene How about tips for how to increase milk with galactogogues and OTC herbs?”

 

Thank you for this great question!

Low milk supply is one of the most common reasons why mother’s say they have decided to stop breastfeeding. Occasionally, mothers will look for an answer to their supply problem with Galactogogues  (sometimes called lactogogues). These are types of medication, food or herbal substances believed to help initiate, maintain or enhance a mother’s milk supply.

 The experts agree that any time a mother feels she needs help with milk supply, it is so very important that before she considers taking any of these substances; she should get help to figure out why the supply could be low.  It is most common that a mother’s supply may be low due to management or technique which can possibly be turned around quickly.

FIRST- Please get qualified help to fully evaluate your situation as I discussed in this post. Milk supply can decrease if the breasts are not regularly and frequently emptied. Milk supply generally will increase if there is an increase in the frequency and complete draining of the breasts. No medication can take the place of full evaluation and each individual should be fully counseled on what options may best be suited for her situation.

SECOND- As with all medications, any over the counter herbal preparations should be discussed with both your doctor and your baby’s doctor BEFORE taking to rule out any health concerns. Close follow-up and support for both mother and baby is very important.

In my current practice, I usually discuss many options with them and send them to LC’s working outside the hospital for the full evaluation and plans, and point them to some of the excellent references you’ll see throughout this post. While I’ve worked with mother’s taking Reglan and Fenugreek, I have had limited experience working with mothers taking these other preparations.

The following highlights I’ve compiled on many of the common galactogogues are important to know from an LC’s perspective, or point of view.

I will briefly define two of the common medications and then outline some of what I’ve found on the most common herbal preparations. I am very happy to provide this information and hope it’s clear I’m not making any specific recommendations.

Prescription Medications:

Metoclopramide (Reglan)

·      Most commonly used medication as galactogogue in the United States, well studied

·      Prescription only and should be followed up by LMP (Licensed Medical Provider)

·      Action is that it suppresses or antagonizes dopamine (a prolactin inhibitor) in the central nervous system (CNS) which then helps increase prolactin levels

·      Gastrointestinal stimulant, used as an anti-nausea medication and as treatment for reflux in infants

·      Usual dose is 30 to 45 mg per day divided into 3 or 4 doses

·      Response of increased milk is dose related and individualized

·      Regimen is usually taking a full dose for 1 to 2 weeks then taper off over about a week

·      Side effects (SE) usually mild: diarrhea, sleepiness, fatigue, restlessness.

·      Possible rarer SE where stopping the drug should be considered include: anxiety, agitation, sleeplessness, dizziness, confusion, headache, depression.

·      Found to be present in milk but hasn’t shown side effects in infants.

·      Listed as L2  “Safer” in Hale 2008

Domperidone (Motilium)

·      Similar to Reglan in action, also used to control nausea and reflux

·      Not commercially available in the USA, surrounded by controversy here despite reported safe track record and still not fully FDA approved

·      Prescription only and should be followed up by LMP (Licensed Medical Provider)

·      Regimen usually 10 to 20 mg three to four times per day taken for 3 to 8 weeks. Dr. Newman has sometimes suggested higher doses.  Link

·      Response individualized, some show improvement with in 24 hrs, others need a couple weeks

·      SE mild and uncommon, include: dry mouth, thirst, rash, itchy, headache

·      Unlike Reglan, this doesn’t enter the brain compartment and has less risk of CNS Side Effects

·      According to Hale 2008, “considered the ideal galactogogue” listed as L1 “Safest”.

Natural or Herbal Galactogogues

Historically, women have used natural foods and herbs to help their milk supply. Many times these substances have not been scientifically evaluated however through the “test of time” these have been passed through generations as “safe” according to tradition. How these herbs actually work is not always known. The common commercial herbal teas are considered relatively safe for most mothers however for other uncommon substances, safe quality may be questionable.  Some over the counter preparations haven’t been fully studied.

It is important to mention that the FDA does not inspect these dietary supplements and some may really vary in composition. There may also be a concern over fraudulent or toxic substances. Please be careful of who supplies and manufactures the product. It is always a good idea to find the most information possible before deciding to start taking one.

Some of the herbs most commonly used as galactogogues are fenugreek, goat’s rue, and milk thistle. Others reported include: fennel seed, blessed thistle, alfalfa, anise, nettles, caraway seed, dill, basil and red clover.  One of the favorite sources I have for searching on botanicals and herbs in Lactation is Dr. Tieraona Low Dog. I had the great pleasure of hearing her speak at the ILCA conference in 2006.  Here is a link to her website and link to a great article on alternative therapies by Dr. Low Dog.

Fenugreek (Trigonella foenum-graecum)

·     Most commonly recommended herbal galactogogue, widespread good reputation but not clearly documented

·     One of oldest medicinal herbs. Sold as a spice, dried seed or extract and is a member of the pea family

·     Historically used in India and Middle East

·     Extract also used as flavor for artificial maple syrup

·      Listed as GRAS (Generally Regarded As Safe) by the U.S. Food and Drug Administration

·     Usual dose is one to four capsules (580–610 mg) three to four times per day, although there is no standard dosing. Huggins [LINK] recommends 2 or 3 capsules 3 times/ day.

·     The higher of these doses may be required in relactating or adoptive mothers.

·     Alternative dosing- can be taken as one cup of strained tea three times per day (¼ tsp seeds steeped in 8 oz water for 10 minutes).

·     Huggins (above) reported the anecdotal use of fenugreek in at least 1200 women with increased milk supply within 24 to 72 hours.

·     Reported side effects are rare: maple syrup like odor to sweat, milk, and urine; diarrhea; and increased or exaggerated asthma symptoms.

·     Not recommended for use during pregnancy because of possible stimulant effect on uterus.

·     Higher doses of Fenugreek also known to cause hypoglycemia (low blood glucose), so caution is advised.

·     Hale 2008 Lists as “L3” Moderately Safe. {No controlled studies in breastfeeding women, however risk of untoward effects to breastfed infant is possible or controlled studies show only minimal …adverse effects}

Goat’s Rue (Galega officinalis)

·     Traditional galactogogue, recommended widely in Europe, based on studies in 19th century early 20th century which support increased milk supply when fed to animals

·     Used in veterinary medicine. No controlled human clinical studies trials have ever been done

·      Despite a large following, not a lot of data to document use, effectiveness, or to report side effects

·      There have been no adverse events reported in Europe or South America, where the herb is also used as a hypoglycemic (to lower blood sugar) agent.

·     One source (Rosti) reports adverse effects of drowsiness, hypotonia (low tone), lethargy, vomiting, and poor suckling in two breastfed neonates after maternal ingestion of a combination product. A lactation tea containing extracts of licorice (Glycyrrhiza glabra), fennel, anise, and goat’s rue. The symptoms resolved when stopping the tea combined with a 2-day temporary break from breastfeeding. (Tea never tested for contaminants.)

·      It is usually used as a tea (1 tsp dried leaves steeped in 8 oz water for 10 minutes) with 1 cup taken three times a day.

·      Not listed in Hale 2008

Milk thistle (Silybum marianum)

·      Historically , many thistles used as lactogogues.

·      No restrictions on the use of seed for tea by any authority

·      Often used throughout Europe, but there had not been randomized controlled trials to validate effectiveness

·      2008 study by Di Pierro et al studied 50 healthy women, dosages of 420 mg Silymarin/ day (a Silybum marianum standardized extract) with reports of increased milk volume  when treated for 60 + days

·      Di Pierro et al conclude Silymarin may be considered as a safe and effective herbal product that can be orally administered in order to improve the daily milk production in healthy women after delivery, without affecting milk quality.

·      St. Mary’s thistle is still a common name for the plant in honor of the Virgin Mary.

·      Early Christian belief that the white colored veins in the leaves were symbolic of her breast milk.

·       The American Herbal Products Association gives it a rating of 1, meaning that the herb may be safely consumed when used appropriately and does not contraindicate its use during lactation

·      It is often used as a strained tea (simmer 1 tsp crushed seeds in 8 oz water for 10 minutes) taking two to three cups per day

·      Listed as “L3” Hale 2008

Additional Substances

·      Fennel SeedUsed as flavoring spice, medicinal herb. Has no modern evidence of lactogogue effect. Common use in infant colic. (Low Dog)

·      AlfalfaHistorically used as a lactogogue. Nourishing with calcium, potassium, and vitamin K. No known or reported safety concerns with normal use of alfalfa leaf . (Low Dog)

·      NettlesHistorically used as a lactogogue. Very nutritious food- herb. Freeze dried nettle is said to be anti-allergenic. No known safety concerns or issues with nettle leaf. (Low Dog)

·      Red CloverFlowers have been traditionally used as lactogogue. Has been used as an expectorant. The leaves are rich in phytoestrogens and are popular for menopause. There are no known safety issues with flowerheads. (Low Dog)

CONCLUSION

There are various options for mothers who find themselves in a situation with low milk supply. From a professional standpoint, it is highly recommended to have a proper evaluation before considering any galactogogue. As always, get the best information possible, weigh your options and make the best choice for you.

If you have a question for Melissa please use the contact form at the top of this homepage. You can also send it via Twitter to @bfmom. 

Please remember that since each actual mother-baby breastfeeding relationship is unique, some specific questions or situations are not easily answered unless the mother/baby are physically observed, examined, or seen in person. In this format, it’s best to answer questions which are more general in nature. As always, check with your health care provider for specific concerns about your baby’s or your own health. 

Melissa Yetter RN CLC is an experienced OB/L&D/Newborn nurse since the 70’s. She started her specialized lactation career in 1988, became a CLC in 1991, and an IBCLC in 1993. In 2003, due to unforseen circimstances, opted not to sit for the required 10 year IBCLC recertication exam but maintained LC status. She recently recertified for CLC (Certified Lactation Counselor) in 2008. She blogs at “Stork Stories… Birth & Breastfeeding” about her experiences as a maternity nurse and lactation professional from the 1970’s to present.

 References:

Various links throughout post

Additional references:

  • Hale, Thomas: Medications and Mothers’ Milk 2008, 13th edition; Hale Publishing, Amarillo, TX 2008 
  • Center for Breastfeeding Education, Healthy Children’s Project: Course Syllabus; Lactation Counselor Certificate Training Program; Ft. Collins, Colorado; October 2008
  • Low Dog T: Botanicals and the Breastfeeding Woman: A Review of the Evidence. Presentation at International Lactation Consultants Association (ILCA) Annual Conference, August 2006.
  • The Academy Of Breastfeeding Medicine: “Protocol #9: Use of galactogogues in initiating or augmenting maternal milk supply” accessed 8/2009 at http://www.bfmed.org/
  • Rosti L, Nardini A, Bettinelli ME, Rosti D: Toxic effects of an herbal tea mixture in two newborns. Acta Pediatr 83:683, 1994. 
  • Di Pierro et al: Clinical efficacy, safety and tolerability of BIO-C®(micronized Silymarin) as a galactogogue. Acta Biomed. 2008 Dec;79(3):205-10. Abstract accessed via Pubmed.gov August 2009

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15 Responses to “Ask a LC: How to increase milk supply with galactogogues and over-the-counter herbs”

  1. #2 Pure Mothers Says:

    August 19, 2009 at 3:26 pm
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