As a companion to the post on the milk microbiome, this post explores the latest scientific evidence to support breastfeeding mothers. Perhaps the most worrisome aspect of breastfeeding is milk supply. Many moms wonder if baby getting enough milk, especially after the infant has normalized her feeding schedule and become more efficient at removing milk. Of course, not all babies are the same and many factors play into this give-and-take dance: growth spurts, distractability, efficiency, etc. In fact, anecdotal evidence suggests many moms quit breastfeeding at 3-5 months because they believe they have a low milk supply problem. And of course, this triggers stress in mom, which may in fact negatively impact milk supply.
This seems to be a problem of the ages. Lactation failure is mentioned in the earliest medical encyclopedia from ancient Egypt, The Papyrus Ebers, dating back to 1550 BC and contains a small pediatric section that includes a prescription for lactation failure:
To get a supply of milk in a woman's breast for suckling a child: Warm the bones of a sword fish in oil and rub her back with it. Or: Let the woman sit cross-legged and eat fragrant bread of soused durra, while rubbing the parts with the poppy plant. (Wickes, 1953a, p. 154)
Clearly, ancient practices are not exactly to be followed these days, but it just goes to show how milk supply has worried women for generations.
Enter the galactagogues.
They are substances that promote mammalian lactation, whether synthetic, plant-derived, or endogenous. Basically, they are the things women eat, drink or supplement with to boost their milk supply. And these practices have also been done for ages. While there are foods that can be considered galactagogues, I'm focusing on herbal sources here.
A word of caution
Herbal medications have been used for ages treat a variety of ailments. Unfortunately, people often self-medicate without consulting an appropriate healthcare professional. This can have serious consequences, especially in sensitive individuals or those already taking medications. Breastfeeding mothers who want to use herbals should consult with a physician or pharmacist who has information concerning the safety of herbal medications.
Foeniculum vulgare Mill commonly called fennel has been used in traditional medicine for a wide range of ailments related to digestive, endocrine, reproductive, and respiratory systems. Its main component, anethole, is structurally similar to dopamine, which may be responsible for galactogenic activity. Dopamine acts to inhibit the secretion of the milk-producing hormone, prolactin. Anethole might influence milk secretion by competing with dopamine at the appropriate receptor sites, thereby inhibiting the antisecretory action of dopamine on prolactin - in other words, the fennel compound might block natural dopamine from preventing lactation.
Fenugreek (Trigonella foenum graecum) is used for a variety of purposes and is one of the more widely-available ingredients in milk-enhancing products. If it makes you smell like maple syrup, it's because Fenugreek seed extract is the principal flavoring ingredient of simulated maple syrup. The seeds contain 6–10% lipids, 44–59% carbohydrates, and 20–30% protein. Fenugreek seeds have been known for a long time for their antidiabetic action, while the plant has also been used topically as a dressing for wounds or eczema. Besides, several medicinal pharmaceutical and nutraceutical properties, fenugreek can have toxic effects as well. Side effects of fenugreek are skin reactions following repeated exposure to the external products. However, there aren't really contraindications that limit the use of fenugreek for milk production. That said, fenugreek contains bitter compounds, so if used externally around the nipple area prior to nursing, residual drug may alter nursing performance. It's not very clear whether coumarin derivatives, found in fenugreek, are compatible with breastfeeding, but nowadays there are fenugreek-free lactation supplements to keep your mind at ease. what's more, it's not the end-all when it comes to lactation boosters - a recent study found that fenugreek was substantially inferior to Coleus amboinicus Lour and palm date in enhancing milk supply.
Goat’s rue, Galega officinalis, has also been reported to stimulate milk production, after its discovery on boosting cow's milk production. It consists of the dried, above-ground parts of the herbal family, Fabacae. If you're familiar with the anti-diabetes drug, Metformin, you'll be surprised to know that it originated from goat's rue. Goat’s rue contains galegin, which has a hypoglycemic action. Although it has a long history of use as a galactogogue, very limited scientific data exist on the safety and efficacy of goat's rue in nursing mothers or infants. In general, goat's rue is well tolerated, but it might cause hypoglycemia, so caution should be used in women taking antidiabetic drugs.
Milk thistle is another popular galactagogue used to increase milk supply.
The plant contains silibinin, silydianin, and silychristin, which supposedly have liver-protecting properties. Common side effects include laxative effects and reported allergic reactions. There are no known contraindications to its use, but of course studies are rather lacking.
Hailing from Indonesia, Torbangun, or Coleus amboinicus Lour, is another promising galactagogue. A recent study found that women taking this had a 65% increase in milk volume in two weeks of supplementation, compared with only a 20% increase in those taking Fenugreek. Perhaps this plant could increase the growth of mammary secretory cells (something also attributed to Goat's Rue).
This is far from exhaustive look into the herbal galactogogues. Fenugreek, goat's rue, alfalfa, and blessed thistle are safe in modest doses in lactation. Sage, peppermint oil, and parsley can be used to reduce milk supply in modest doses. Finally, milk production is a reflection of stimulation - inadequate stimulation from a baby suckling leads to involution of the mammary glands, which is characterized by reduction in lactose synthesis and elevated electrolyte concentration in milk.
As already stated, herbals are in effect, medicines and should be taken under supervision. From a science perspective, using herbs as extracts, tinctures or teas is relatively safe. A double-blind, randomized controlled trial of a herbal galactagogue versus placebo among healthy, exclusively/fully breastfeeding mothers and infants found no adverse events associated with the test tea across the 30-day study or the first year of their infant's life. In fact, some herbal teas with several ingredients have been shown to improve milk production.
Whew this is a lot of science. But for those moms worried about their supply, it's nice to know that often these fears are unfounded. Herbal teas are for the most part safe when used in moderation. And there are plenty of other things to do to boost supply - pump more often, lower stress levels, have a healthy diet rich in healthy fats and complex carbohydrates, and most of all give yourself a break. Formula ain't never hurt nobody. If it's easier for you, then the baby's health and wellbeing is most important. As they say, a fed baby is a happy baby.