What is a Galactagogue?

Reprinted with permission from Breastfeeding Today Jan 2015

A galactagogue is something that increases the production of breastmilk such as certain herbs, foods and a few prescription medicines. Most mothers won’t need galactagogues (from the Greek “galacta” which means milk) as there are several ways to increase or maintain a 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 or LLL Leader for a full assessment and have a look at How to Make More Breast Milk for self help ideas.

Do I need a galcatagogue?

If your milk supply is still not responding with skin to skin contact, breast compression, good positioning, frequent feeds and pumping—then it might be a good time to try a galactagogue alongside. But using a galactagogue on its own won’t normally increase your milk supply without 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.

Milk production is usually a robust process. Not only will most mothers not need a galcatagogue, many mothers have induced lactation for adopted babies or relactated for their own baby by pumping and supplementing their baby at the breast—their hormones respond to demand by producing milk.

Herbal galactagogues

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

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 medicinals for increasing milk, “bringing down” the milk, keeping the milk “fresh”, helping mastitis, engorgement, weaning and even relactation. So while using herbs is not a new idea, how effective they are is not certain.

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, 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 knowledgable.

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.

Galactagogues during pregnancy

Telling your medical professional is particularly important for pregnant mothers considering a galactagogue. Sheila Humphrey author of The Nursing Mother’s Herbal suggests avoiding most herbs during pregnancy or discussing their use with a herbalist midwife or knowledgable obstetrician:

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 breastmilk?

There are over 30 herbs that are thought to increase breastmilk. Great resources that cover them in more detail include The Nursing Mother’s Herbal and The Breastfeeding Mother’s Guide to Making More Milk. Experienced breastfeeding experts suggest choosing a herb that has a dual role of stimulating mammary growth, or giving hormonal support in some way.

Popular herbs in the breastfeeding literature include:

Goat’s rue belongs to the legume family with alfalfa and fenugreek and is often suggested for insufficient glandular tissue and breast surgery situations. It is widely used as a galactagogue across the world. See Polycystic Ovary Syndrome and Breastfeeding for more information.

Wild asparagus is often used for hormonal support and stomach problems and is widely used for increasing milk in India (called shatavari). It is a different plant species from the asparagus commonly used as a food.

Fennel is often used for milk release problems (let-down). Fennel seed is said to increase milk supply and improve mother’s digestion. In Mother Food the author suggests a baby’s digestion may also be improved through her mother’s milk.

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 triggering auto-immune disease so take in moderation and avoid it if you suffer from lupus or another auto immune disorder.

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.

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).

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.

Which foods can help my milk supply?

Many authors covering the topic of nutrition for breastfeeding mothers give the impression that you can have quite a poor diet and still make perfectly good breastmilk. They may mention a passing caution that the type of fats in breastmilk will differ depending on your diet but it’s never made into a big deal. And up until the 1990s many experts thought dietary galactagogues worked by a placebo effect (mind over matter). Yet special milk promoting foods have been eaten by newly breastfeeding mothers for more than 2000 years across history and all cultures. These women held a strong belief in the connection of diet and quality and abundance of breastmilk.

In Mother Food, Hilary Jacobson looks at different cultures’ traditional milk-making (lactogenic) foods through history. She believes there is a connection between a very poor diet and breastmilk supply and composition. And if you are one of the mothers who has a low supply it is important to know about this and what you can do to help it. As the composition of fats in breastmilk can alter depending on mother’s diet, it might well be that eating the right essential fatty acids (EFAs) could potentially change mothers’ milk from skimmed to fuller fat.

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.

In The Breastfeeding Mother’s Guide to Making More Milk by Diana West and Lisa Marasco, 2009 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

Which medicines can increase breastmilk?

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.

How do they work?

Most of the medications that can help milk supply work by indirectly increasing prolactin levels in the body (a hormone important in producing breastmilk) for example domperidone, metoclopramide and sulpiride. These drugs are available on prescription only. Discuss with your health professional whether they might be suitable for your specific situation and medical history.

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 U.S.

Canadian paediatrician Jack Newman has comprehensive information about the safety of domperidone and how it may help milk supply on his website. Maternal side effects may include dry mouth, itching, headache and abdominal cramps. Rated L1 ‘Safest’ limited data—compatible (paywall) with breastfeeding by Hale’s Medications and Mother’s Milk 2014.

Metoclopramide (Maxolon, Maxeran, Reglan). This drug has several uses but mainly it is used for patients with reflux. Maternal side effects may include gastric cramping, diarrhoea, tremors, slurred speech, anxiety and severe depression. Rated L2 ‘Safer’ significant data—compatible (paywall) with breastfeeding by Hale’s Medications and Mother’s Milk 2014.

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. Rated L1 ‘Safest’ limited data—compatible (paywall) with breastfeeding by Hale’s Medications and Mother’s Milk 2014.

Sulpiride (Eglonyl, Equemote, Dolmatil, Sulpor).  This drug is primarily an anti-depressant and antipsychotic but may increase breastmilk 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. Rated L2 ‘Safer’ limited data—probably compatible (paywall) with breastfeeding by Hale’s Medications and Mother’s Milk 2014.

How can I found out more about the effects of herbs and medicines on me and my breastmilk?

There is more information about each of these herbs and medications online at Diana West and Lisa Marasco’s website: www.lowmilksupply.org, e-lactancia and on Lactmed.

Which one shall I choose?

The choice of herbs, foods and medications that can help a milk supply, not to mention ideas about pumping and breast compressions can be quite confusing. Bear in mind that herbs and medications are not a substitute for careful evaluation by a breastfeeding specialist as their safety and efficiency have not been proven in reliable randomised control trials. Working with your LLL Leader or IBCLC is recommended to find the best combination of ideas to increase your breastmilk while the safety of galactagogues can be discussed with your health professional.

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