What is a Galactagogue?

What is a galactagogue?

A galactagogue (from the Greek “galacta” which means milk) is a food, herb or drug that increases the production of breast milk. Most mothers won’t need galactagogues because there are many ways to increase or maintain a breast milk supply without using herbs or medicines. If you are worried about your milk supply and whether your baby is getting enough milk, see an IBCLC lactation consultant for a full assessment and have a look at How to Make More Breast Milk for self help ideas.

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This article looks at some of the popular herbs, food and medications that are often suggested as galactagogues, and where to find information on their use and safety in lactation.

Do I need a galcatagogue?

Milk production is usually naturally regulated by supply and demand—your baby demands it and your breasts supply it. Not only will most mothers not need a galactagogue, some mothers have induced lactation for adopted babies or relactated for their own baby after a break simply by pumping and supplementing their baby at the breast.

If your milk supply is still not increasing despite good positioning and attachment, plenty of skin-to-skin contact, breast compressions, frequent breastfeeds and pumping—then you may want to consider trying a galactagogue. Bear in mind that galactagogues won’t normally increase your milk supply on their own, you will still need efficient milk removal by your baby or a pump. The Womanly Art of Breastfeeding explains:

One option to speed things along is to use a galactagogue, an herb or medication that increases milk production. It is important to take these ONLY after you’re nursing or pumping regularly to remove the milk that they will help create. When it comes to building a supply, galactagogues are the frosting on the milk removal cake. They never substitute for milk removal itself. Many mothers have been successful in increasing their milk by nursing and expressing alone, so it is worth trying this before you go to galactagogues.

Herbal galactagogues

Herbs have been used to help milk supply for thousands of years. Although there isn’t much scientific research on their effects, many mothers who have taken them felt they helped increase their milk supply.

Many of the herbs and foods used to help milk supply today were recorded in a book some 2000 years ago by a Greek physician Dioscorides. They included herbs for increasing milk supply, helping the let-down (milk ejection reflex), keeping the milk “fresh”, and herbs to help with mastitis, engorgement, weaning and even relactation. Therefore the idea of using herbs is not new, but how effective they are and their safety in large amounts has had little research.

Discuss with your doctor

The quality of herbal products can vary a great deal, so it is important to buy them from a good reputable source. Many herbs can have side effects, particularly if taken in medicinal doses, so it’s important to know how they work, what dose to take and which ones might be more suitable for you. Seek the advice of someone qualified and knowledgable and check with your doctor in case any herb or combination of herbs are not compatible with your medical history. The Womanly Art of Breastfeeding explains:

If you choose to use a galactagogue, it’s important to tell your doctor, even if she or he disagrees with your use of it, because there is always the possibility that it can interfere with other medications or cause reactions. Avoid herbs that can decrease your supply, such as parsley, sage, and peppermint (in large quantities), and mediations such as pseudoephedrine, hormonal birth control (especially when introduced before four months postpartum), bromocriptine, ergotamine, and Methergine.

Avoid herbs during pregnancy

Sheila Humphrey author of The Nursing Mother’s Herbal recommends avoiding most herbs during pregnancy as they could cause miscarriage. Pregnant mothers considering taking a galactagogue should always discuss this with a knowledgable medical professional.

I recommend caution when using herbs during pregnancy, particularly the first and early second trimester. Many of the herbs used to increase milk supply (fenugreek and blessed thistle, for example) are also uterine stimulants; they may have strong enough actions to cause a miscarriage.

Which herbs increase breast milk?

There are many herbs that are thought to increase breast milk supply. Some breastfeeding experts advocate choosing a herb that has a dual role of stimulating mammary growth, or giving hormonal support in some way. Resources that cover herbs and their role in more detail include:

Note: these books are 9 and 14 years old respectively and may not include more recent information on individual herb safety. For more recent resources on herb safety during lactation see the next section.

Herb safety during lactation

Resources with up to date information on individual herb safety while breastfeeding include:

  • Lactmed, a database from the US National Library of Medicine, includes a “Summary of use during lactation” for each entry.
  • e-lactancia, a website run by Spanish paediatricians has information on herb compatibility with breastfeeding (available in Spanish and English).

Popular herbal galactagogues

Popular herbs in the breastfeeding literature include:

Fenugreek is one of the best known and most popular galactagogues. It is a common middle-eastern spice and one of the oldest medicinal herbs known. It can be used in conjunction with blessed thistle. See Will Fenugreek Increase Breast Milk? for more information including possible side effects for the mother and baby.

Blessed Thistle is recommended by Canadian paediatrician and breastfeeding specialist Jack Newman as a galcatagogue to be tried in conjunction with fenugreek. It is traditionally used for indigestion and loss of appetite. There is sometimes confusion between blessed thistle and milk thistle. They are not the same herb but they are both members of the Asteraceae family and both are said to be galactagogues. Milk thistle has traditionally been used as a food (peeled, tender shoots). E-lactancia classifies the safety during lactation of blessed thistle and milk thistle as “very low risk” 1 2 however Medication’s and Mothers’ Milk Online [paywall] is more cautious as both may cause allergic reactions in the mother and blessed thistle is not recommended in pregnancy.

Nettle or Stinging Nettle has a long history as a powerful galactagogue along with various other medicinal uses. It contains all the essential nutrients and this may be how it supports lactation. See Lactmed for further information on the use of stinging nettle when breastfeeding.

Goat’s rue belongs to the legume family with alfalfa and fenugreek and is often suggested for insufficient glandular tissue and breast surgery situations. Authors West and Marasco say that goat’s rue can be helpful for low milk production related to Polycystic Ovary Syndrome (PCOS) because it contains galegin—a herb that metformin was originally developed from 3. Goat’s rue is widely used as a galactagogue across the world however both Lactmed and e-lactancia have cautions for its use as a galactagogue. E-lactancia cites goat’s rue as “high risk” 4.

Wild asparagus or shatavari, is often used for hormonal support and stomach problems and is widely used for increasing milk in India. It is a different plant species from the asparagus commonly used as a food. Further information and a discussion of studies on shatavari use during lactation can be found at Lactmed.

Fennel is often used for milk release problems (let-down). Fennel seed is said to increase milk supply and improve mother’s digestion, although scientific trials are lacking 5. In Mother Food a book by Hilary Jacobson, the author suggests a baby’s digestion may also be improved through her mother’s milk if the mother takes Fennel. However e-lactancia cites fennel’s compatibility with breastfeeding as “high risk” 6.

Alfalfa leaf is a very nutritious herb full of minerals, numerous vitamins and essential and non-essential amino acids. Alfalfa is said to have many medicinal uses such as reducing inflammation. However, alfalfa is linked with worsening or triggering autoimmune disease symptoms and should be avoided if you suffer from lupus or another autoimmune disorder 7. E-lactancia classifies alfalfa’s use during breastfeeding as “high risk” 8.

alfalfa seeds and sprouts, including tablets, contain L-canavanine, which has been found to cause or exacerbate lupus symptoms

Food as a galactagogue

Can diet affect milk supply?

Special milk promoting foods have been eaten by breastfeeding mothers for more than 2000 years across all cultures. Such cultures strongly believed that diet affected the quality and abundance of breast milk. In Mother Food, Hilary Jacobson looked at traditional milk-making (lactogenic) foods and believes there is a connection between diet and breast milk supply and composition. Many other current authors covering the topic of nutrition for breastfeeding mothers favour that even a very poor diet will yield perfectly good breast milk as only the type of fats in breast milk tend to change with your diet. For a further discussion about how fat content in breast milk can change see Best Breastfeeding Diet and Foods to Avoid.

While some experts think that dietary galactagogues might work by a placebo effect (mind over matter) Jacobson argues that the connection with diet is very real and in addition, eating the right essential fatty acids (EFAs) could potentially change mothers’ milk from skimmed to fuller fat and increase milk volume.

Essential fatty acids

In the following excerpt Jacobson names essential fatty acids that may increase milk production:

many mothers find that supplementing with EFAs, such as borage seed oil, evening primrose seed oil, black currant seed oil, or flax seed oil, increases their milk production.  These oils contain hormonal precursors which may influence the chemistry of lactation.

Milk-making food

In The Breastfeeding Mother’s Guide to Making More Milk p 172, many foods are mentioned that support good milk production; e.g. almonds, coconut, sesame seeds, millet, rice, anise, fennel, dill, barley, oats, chickpeas and many more.

For information about Myo-inositol and Malunggay see Polycystic Ovary Syndrome and Breastfeeding.

Medications as galactagogues

There are no drugs specifically licensed as galactagogues or for “making more milk”. However there are a few drugs which are known for causing extra or spontaneous milk flow (known as galactorrhea) as a side effect of their intended medical use. For example domperidone and metoclopramide are usually prescribed for stomach problems such as sickness or reflux but can influence milk supply. Most of the medications that can help milk supply are thought to work by indirectly increasing prolactin levels (a hormone important in producing breast milk) in the body.

Which medications can increase breast milk?

Prescription drugs such as domperidone, metoclopramide, metformin and sulpiride are said to have an effect on milk supply. Discuss with your health professional whether they might be suitable for your specific situation and medical history and see a short summary about each below. For the latest information on each drug’s compatibility with breastfeeding or potential side effects refer to the resources in the next section.

Domperidone (Motilium). This drug has historically been used for controlling sickness, indigestion and reflux but recent changes recommend it only to be prescribed for nausea in future. It is not available in America. Canadian paediatrician, Jack Newman, has comprehensive information about using domperidone as a galactagogue, see Domperidone—Getting Started. A number of physicians support its use in lactation see A Consensus Statement on the Use of Domperidone To Support Lactation on Dr Newman’s website and see The National Infant Feeding Network statement The use of Domperidone in inadequate lactation (2014). Maternal side effects may include dry mouth, itching, headache and abdominal cramps.

Metoclopramide (Maxolon, Maxeran, Reglan). This drug has several uses but mainly it is used for patients with reflux. Side effects for the mother may include gastric cramping, diarrhoea, tremors, slurred speech, anxiety and severe depression.

Metformin (Glucophage). This drug stabilises blood sugar in non insulin dependent diabetics and is used to treat polycystic ovary syndrome (PCOS). Metformin can help improve milk supply for some PCOS mothers. Maternal side effects may include headache, dizziness, nausea, abdominal pain, hypoglycaemia and vitamin B12 deficiency.

Sulpiride (Eglonyl, Equemote, Dolmatil, Sulpor). This drug is primarily an anti-depressant and antipsychotic but may increase breast milk production during breastfeeding as a side-effect. Sulpiride is used to help lactation in Zimbabwe, South Africa and Chile, but is almost never used in the U.S.A., Europe or Australia. Maternal side effects may include physical symptoms such as tremors, slurred speech, feeling restless or anxious and sedation.

How can I found out more about the effects of medicines on me or my breast milk?

The following resources offer current information about medications in lactation and include the latest research:

Note: no online resource should be a substitute for advice from your own medical professionals.

Which galactagogue?

The Academy of Breastfeeding Medicine has a clinical protocol discussing the use of galactagogues. It recommends a cautious approach and concludes:

Because current research of all galactogogues is relatively inconclusive and all of the agents have potential adverse effects, ABM cannot recommend any specific pharmacologic or herbal galactogogues at this time.

Summary

There are many herbs, foods and medications reputed to help a milk supply. However, all herbs and medications can have side effects, particularly in medicinal doses, and to be effective, galcatagogues also require efficient breast drainage. Galactagogues should not therefore be used as a substitute for careful breastfeeding evaluation by a breastfeeding specialist. There are several ways to increase or maintain a milk supply without using herbs or medicines. If you have a low milk supply, work with your IBCLC lactation consultant to identify the most likely reasons and to find the best management plan to increase your breast milk. If a mother wishes to try a galactagogue, she should discuss this with her health professional first.

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