Lack of milk is one of the main concerns of breastfeeding mothers. The fact of not being able to know how much the baby has suckled and not even calculating how much milk we produce, often generates anxiety and doubts about whether the milk the baby takes is enough.
The vast majority of mothers are able to produce all the milk that their baby (or their babies, in the case of twins or tandem breastfeeding) needs. And yet, sometimes we find babies who gain little weight or mothers who need to supplement breastfeeding with artificial formula. Can we take something in these cases to increase milk production?
What are galactogogues
Galactogogues are substances that stimulate milk production . We usually speak of two types: pharmacological and non-pharmacological (or natural) galactogogues.
Within the first group there are certain medications that, without having been specifically designed for this purpose, can increase milk production. These pharmacological galactogogues could only be administered under medical supervision and for a short period of time ; Like all drugs, they are not without adverse effects, so the risk and benefit of their use would have to be balanced.
Natural galactogogues
For thousands of years, plants, infusions and other natural products have been used to increase the production of breast milk. Especially in non-Western cultures it is common for the woman in labor to be offered certain plants and foods in order to increase the production and quality of milk.
Is there evidence that natural galactogogues work?
No. As of today, there is no scientific evidence that natural galactogogues work . There are several articles published about herbal galactogogues; some of them do describe an increase in milk volume and / or prolactin levels. However, all of them have a poor methodology that makes them of very low quality and unreliable (few patients, very few data collected, poor follow-up, not very objective assessment…).
It is common to hear that it worked for someone (mother, aunt, grandmother …) but these personal experiences need to be scientifically proven . On some occasions the improvement may be due to the placebo effect: knowing that we are taking something that will increase the milk we gain confidence and it gives us the impression that we are producing more.
The ABM protocol (from the Academy of Breastfeeding Medicine, Breastfeeding Medicine) verbatim states that:
“Because the current state of research on galactogogues is relatively inconclusive and all agents have potential adverse effects , he cannot recommend any specific pharmacological or herbal galactogogues at this time.”
We therefore need more studies, with an adequate methodology, to be able to determine whether or not these substances increase the production of breast milk.
In the Clinical Practice Guide for breastfeeding and in recent publications, the different articles published about natural galactogogues are analyzed with similar conclusions.
Are Natural Galactogogues Safe?
The web par excellence to consult the compatibility of medicines and other substances with breastfeeding is www.e-lactancia.org, a project of APILAM (Association for the Promotion and Scientific and Cultural Research of Breastfeeding).
Some substances are safe (eg milk thistle), but others, such as anise or fennel, could have adverse effects on the infant. In fact, we can find cases of poisoning in infants described in the literature after consuming certain infusions by their mothers.
For example, Rosti published in 1994 the poisoning of two infants aged 15 and 20 days (who came to the emergency room with weight loss, hypotonia, lethargy and vomiting) after their mothers consumed large quantities of an infusion containing fennel, anise and Galician and that they drank for the purpose of increasing their milk production. It is important to note that infusions and other herbal preparations do not have a standardized dosage of preparation and there is the possibility of interaction with other medications as well as an allergic reaction.
What are the most frequently used natural galactogogues?
- Milk thistle : its fruits are used from this plant. It has been attributed a hepatic protective effect. There are studies evaluating its efficacy as a galactogogue in cows and humans, but they are inconclusive. It has a very low risk for breastfeeding as it is hardly excreted in milk.
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Beer , widely used in different cultures for the belief that it increases milk production, can have the opposite effect. Alcohol increases prolactin levels (the hormone “responsible” for breastfeeding) but decreases the secretion of oxytocin (the hormone responsible for the ejection of milk), being able to reduce milk production by between 10 and 25%. In addition, alcohol diffuses into breast milk, affecting the infant. 0.0% beer can be consumed while breastfeeding.
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Brewer’s yeast is a fungus that is used to make beer, bread, and wine through fermentation. Although it has been used for this purpose, there is no conclusive evidence of its efficacy as a galactogogue.
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Fenugreek : this seed has been and is widely used to increase milk production and is included in various preparations for this purpose. Its effect has been studied in various studies, some of them do find an increase in milk production and in others no effect is seen. More studies are needed to determine its effect as a galactogogue. In moderate amounts, its consumption is safe during lactation, however, in high doses it can cause hypoglycemia (low blood sugar). Also, it gives a maple syrup urine and milk smell, which would force you to rule out maple syrup disease.
- Fennel : the fruits of this plant have been used to treat infant colic and as a galactogogue, but there is no evidence that it increases milk production; in fact, due to its estrogenic effect, it could even decrease it. In addition, it is not without adverse effects. Two cases of lethargy, vomiting and hypotonia have been described in two infants and in their mothers after taking it in excess. The e-lactancia.org website qualifies its consumption as unsafe during breastfeeding.
- Basil : we use it frequently as a condiment in the kitchen (I take this opportunity to remember the importance of washing it well). Traditionally it has been used in infusions and as an essential oil, giving it various properties. As with the previous ones, there is no evidence of its efficacy as a galactogogue and in addition, its consumption is not recommended during pregnancy or lactation as well as in young children.
- Anise : widely used culinary and in infusion to alleviate various discomforts. Widely used for years to relieve colic in infants (and NOT currently recommended). There is no evidence that it increases milk production and, at high doses, it could even decrease it, as well as being toxic. The European Medicines Agency (EMA) does not recommend its use in children under 18 years of age.
- Chamomile : it is widely used as an antispasmodic, digestive and anti-inflammatory; there is no evidence that it is effective as a galactogogue, there is only some anecdotal publication. Some of its components seem to pass into breast milk but there is no toxicity data, so its moderate consumption is considered safe during lactation.
If we take herbal teas, what precautions should we take?
- Check your compatibility with breastfeeding . As I said previously, a reliable source is www.e-lactancia.org
- Do not take in excess . Many infusions are safe in low doses but can be toxic if we ingest large amounts. The “natural” is not always safe
- If we are taking any medication, make sure that the plant does not interfere with it. Several herbal products increase the levels of blood thinners such as warfarin or heparin.
- Use a reliable source ; sometimes one plant is confused with another with toxic properties.
What is the best way to increase milk supply?
A frequent and demanding lactation with correct technique is the best galactogogue. Maternal self-confidence also plays an important role.
When faced with a mother with low milk production, it is recommended to evaluate breastfeeding technique and increase the frequency of feedings, favor skin-to-skin contact and self-confidence; remember that the vast majority of mothers are capable of breastfeeding their babies . Primary hypogalactia (inability of the mother to produce milk) appears in a very small percentage of women.
