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Herbs and Foods as Galactogogues

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1 Herbs and Foods as Galactogogues
Lisa Marasco, MA IBCLC © Copyright Lisa Marasco 2007

2 Herbs: the original “medicine”

3 Current day knowledge There is little in the American literature regarding the use of herbs in general, and almost no research on herbal galactogogues at all Our basic knowledge comes from Commission E (Germany), oral & written tradition, and anecdotes

4 Many resources flawed; not all animal studies can or should be extrapolated to humans, as plant actions can vary on different animals Many report isolated in vitro study results without consideration of actual in vivo experience: thus, some herbs experienced as galactogogues may be “contra-indicated” due to theoretical concerns not proven in vivo Judging an herb by individual constituents does not take into account the possibly ameliorating effects of its other constituents

5 Example: Herb X ACTIONS Antidepressant, antihypercholesterolemic, cardiotonic, demulcent, laxative, nervine, nutritive, thymoleptic, tonic CHEMICALS & NUTRIENTS Calcium, Carbohydrates, Chlorine, Choline, Fats, Fiber, Iron, Magnesium, Manganese, Phosphorus, Potassium, Protein, Sodium, Starch, Sulfur PREPARATION & DOSAGES (3x/day) Liquid extract: 1:1 in 25% alcohol, dose ml Tincture: 1:5 in 45% alcohol, dose 1-5 ml CONTRAINDICATIONS: Celiac disease.

6 herb X DRUG INTERACTIONS Due to the cardioactive chemicals in this herb the following drug interactions are possible: interference and/or antagonism with antiarrhythmics; antagonism of beta-adrenoceptor blocking drugs; potentiation of cardiac glycosides and increased risk of hypokalemia; when combined with depolarizing muscle relaxants there is a risk of arrhythmia; interference with nitrates and calcium-channel blockers; may increase the potential terfenadine has to cause arrhythmias. SIDE EFFECTS (Possible adverse effects and/or overdose effects) Allergic reactions. WARNING Large doses can cause headaches and diarrhea. REFERENCES 1. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum, 1988, OATS!

7 Understanding the issues
While there is some regulation of herbs, quality/potency can still vary, especially with non-standardized products. Standardized vs Non-standardized Part of plant used or % of parts in mix used (Different parts can have different effects) Freshness of herb Time on shelf (limited life) light exposure Some brands more reliable than others.

8 Potential toxicities are not well understood
Potential for allergic reactions often overlooked; ie, chamomile is related to ragweed, therefore not recommended to those with ragweed allergies Opinions vary between experts

9 Targeting: the unconsidered problem
We don’t know a lot about how many of the galactogogues act Little research has been done on reputed herbal galactogogues to analyze how they may work (exception: Farnsworth) Are they boosting prolactin, or another part of the equation? Inherent difficulties of researching galactogogues

10 Underlying problems may vary; does the herb even affect the problem system…
Or are we simply guessing our target and hoping to hit the right one?

11 Dosing: No such thing as “the right amount”
Potency varies by manufacturer Potency can vary by batch Experts vary on recommendations Most pkg instructions based on generic use, not lactation Little info on therapeutic dosages for lactation Titrate to need

12 Teas Tinctures Capsules Cover to steep Crush seeds Can use sweeteners
Strengths vary Some dosed by weight, others by standards Capsules Check capsule size (mg/grams); many suggested dosages do not specify mgs.

13 Best reference aid Herb ratings:
A- no safety issues identified; generally considered safe when used appropriately B- May not be appropriate for self-use by some individuals, or may cause side-effects if misused. Seek reliable safety and dose info. C- Moderate potential for toxicity, mainly dose related D- Use only with supervision of knowledgeable physician E- Avoid. Toxic plant with no justifiable medical use. By Sheila Humphrey RN IBCLC

14 Better known herbs reputed to be galactogogues

15 Anise seed (B) Pimpinella anisum
NOT star anise Actions: anti-spasmodic, mildly estrogenic, expectorant, carminative, aromatic (Handout: Indexing Herbs by Action) May also be helpful for MER Parts used: seed “Culinary use”

16 Not for use in pregnancy
Safety: USA: GRAS UK: General sales list Canada: approved as an OTC drug France: Traditional Medicine Germany: Comm E approved as an OTC Not for use in pregnancy Tea: 1-2 tsp crushed seeds in 1 c water, cover & steep 10-20min, x/day. Tincture: 3ml 2-3x/day

17 Caraway seed (A) culinary use… Carum carvi
Actions: appetite stimulant, anti-spasmodic, expectorant, carminative, emmenagogue, astringent Parts used: seed Has been used for infant colic Safety: considered safe by FDA Often combined with other herbs Tea: 1-2 tsp/5oz water, steep min, 5-6x/day Tincture: 3ml TID Carum carvi

18 Coriander- Coriandrum sativum
Seed of cilantro plant Popular galactogogue among Chinese and Indian mothers Diuretic, nutritive, anti-flatulent, anti-diabetic (mild) 1 heaping T seeds to 1 mug of hot water, steep min, take 3-5x per day. Can sweeten as desired.

19 Dill (A)- Anethum graveolens
Actions: anti-spasmodic, diuretic, carminative, emmenagogue, anti-inflammatory, aromatic Parts used: seed Used in “gripe water” May help with MER Contraindicated for low sodium diets Often combined with other herbs culinary use…

20 Tea: 2 tsp/8oz water, steep 10-15 min, 2-3x/day
Dill culinary use Tea: 2 tsp/8oz water, steep min, 2-3x/day Decoction: Steep ½ c dill seeds in water overnight; boil until very dark in color, strain. Drink one cup of this a day. 2 tsp seeds on meal

21 Actions: Liver, anti-spasmodic, diuretic, aromatic, estrogenic (weak)
Fennel Seed (A) Hale L4 Foeniculum vulgare Actions: Liver, anti-spasmodic, diuretic, aromatic, estrogenic (weak) Parts used: seed Note: has toxic look-alike relatives! For gastrointestinal disorders One source suggests may promote milk ejection; another suggest may have bust-enhancing properties Also studied for anti-hirsutism properties culinary use…

22 Not recommended during pregnancy
culinary use… Possible side effects: allergic reactions, dermatitis Fennel oil can be toxic. Avoid. Hale: L4 due to concerns regarding estrogenic property effects on lactation Safety: One European case report of 2 infants who reportedly became weak and lethargic when mom ingested 2 qts of tea daily made from fennel, licorice, galega. However, plants never ID’d. Not recommended during pregnancy

23 culinary use Tea: 1-3 tsp freshly crushed seeds per 8oz water, steep min, 2-6x/day Tincture: 3ml X 3

24 Fenugreek (B) Hale L3 Trigonella foenum-graecum Actions: Stimulate breast growth, digestive aid, hypoglycemic, expectorant, emmenagogue, anti-inflammatory, hypotensive, demulcent, diaphoretic Parts used: seed culinary use…

25 Source of iron? May have hypotensive and thyroid supporting properties Most studied of all lactogenic herbs U.S. listed GRAS (generally regarded as safe) when used in moderation

26 Mother’s sweat and urine usually smell like maple syrup
Possible side effects: diarrhea (mother or baby), stomach upset, hypoglycemia, allergy. Could worsen asthma. Contraindicated for pregnancy. May lower cholesterol. Research Issues: Difficult to create placebo Form/brand to test Ethics of withholding help

27 Capsules: 2-4 540-650mg caps 3-4x day
Dosage: Capsules: mg caps 3-4x day Max 6gms/day (Frank Nice) BUT some people have used up to 4 qid Tea: 1 tsp seeds/8oz water, steep 5-10 min, x2-3. If seeds crushed, use ¼ tsp Tincture: 1-2ml TID Often combined with Blessed Thistle culinary use…

28 Shatavari (B) Asparagus racemosa Also known as “hundred husbands”
Found in Africa, India, Australia, Asia Considered “the strongest” herb for female issues, is used for infertility, prevent miscarriage, increase milk supply, increase breast tissue Diuretic, nutritive, laxative. Mucilaginous. Considered “anti-oxytocic” for uterine contractions during pregnancy Asparagus racemosa

29 “Regularizes” menstruation, dysmenorrhea and fertility
H.S. Puri, Rasayana: Ayurvedic herbs for Longevity & Rejuvenation “Regularizes” menstruation, dysmenorrhea and fertility Pregnancy: “used for proper breast development, embryonic growth & to rid genital of diseases.” Powder form only first 8 mos Oil for vaginal swab 9th mo for elasticity, “easy and painless delivery” 5-10gm asparagus powder with warm milk recommended for pregnancy/lactation

30 1-2 tsp root powder stirred into warm milk 1-2x a day
Or one capsule twice a day Considered safe for pregnancy and lactation

31 Non-culinary herbal galactogogues
Alfalfa (A-plant) Medicago sativa Actions: estrogenic (weak), nutritive, may stimulate appetite. Parts used: leaves Nutrition: High in chlorophyll beta carotene, calcium. Contains vitamins A,B1,B6,B12,C,E, K1 along with potassium, phosphorus, iron and zinc.

32 Said to increase supply in cows
non-culinary Said to increase supply in cows Report of presence of “TRH-like material” which may in turn stimulate prolactin release Possible diuretic and pituitary function support properties Possible side effects: allergies, diarrhea. May lower cholesterol. Avoid with lupus or rheumatoid arthritis.

33 Dosages 1-2 tablets or capsules 3-4x/day Tea: 1-2T dried leaves/5oz water 2-4x/day Tincture: ½- 4ml 4x/day 1T dried juice powder 2x/day Homeopathic alfalfa: 6 tablets per day (KM) Can be combined with homeopathic Lactuca virosa

34 Blessed Thistle (B) Hale L3
Cnicus benedictus Blessed Thistle (B) Hale L3 Actions: appetite stimulant and digestive aid, hormone balancer, cholagogue Parts used: leaf, stem, flower Often used in conjunction with fenugreek Reputed to “increase the flow of milk” Avoid during pregnancy Safety: considered nontoxic

35 Tea 1-2 tsp crushed seeds in 5oz water (bitter) 5-6x/day
non-culinary Dosage: Tea 1-2 tsp crushed seeds in 5oz water (bitter) 5-6x/day Tincture: 1-3mls 2-4x/day 1-3 caps ( mg) 3x/day when combined with fenugreek or up to 6g total if used alone (per Commission E)

36 Borage - Borago officinalis
non-culinary Borage - Borago officinalis Actions: diuretic, expectorant, anti-inflammatory, nervine, demulcent, diaphoretic, tonic, mucilaginous Parts used: leaf, flower Nutrition: potassium, calcium; oil rich in omega 3 fatty acids

37 Oil (A) reputedly increases creaminess of milk
2-5ml x3 OR 1000mg 1-4x/day Leaves (C) reputed to help milk supply, but must be used judiciously as large amounts can cause liver damage 2 tsp dried herb x3

38 Chasteberry - Vitex agnus castus (B) Actions: Hormone balancer, tonic
non-culinary Chasteberry - Vitex agnus castus (B) Actions: Hormone balancer, tonic Reputed to “normalize” pituitary function, used for luteal phase insufficiency (“shift” in ovarian hormones in favor of progesterone), irregular cycles, PMS. Promotes fertility. May help MER? Parts used: fruit

39 Sometimes used for PCOS
Reputed to “modulate” Prolactin levels 1943 Study found increase in milk production in 80% of 125 patients. 1957 controlled trial of 817 patients claimed that avg milk production 3X that of controls

40 Conflicting info: “May bring on milk flow early” if used in pregnancy. hypoprolactinemic agent, suppressed lactation in rats In men, small dose (120mg/day) increased PRL while large dose (500mg) inhibited it. May take time for effects to kick in?

41 May interfere with Reglan
Tea: 1 tsp ripe berries infused in 8oz water min; drink 3x/day (bitter) Capsules: 2-“00” per day or 30-40mg/day (Humphrey) Tincture: 1ml x3 or up to 5mls daily (1:5 conc)

42 Goat’s Rue (B) – Galega Officinalis
Actions: stimulate breast growth; milk; diuretic; hypoglycemic; emmenagogue; diaphoretic; Parts used: dried aerial parts Contains galegin, upon which phenformin was based non-culinary

43 Reputation for causing breast growth
French dairy farmers noted 35-50% increase in output of milk in their herds Popular among French nursing mothers Controversy: toxicity in sheep No reports of problems in human use Peripheral Receptor Sensitizer?

44 Dosage: No consensus, but consider taking with food
Goat’s Rue Dosage: No consensus, but consider taking with food Tea: 1 tsp leaves/5-8oz water, steep min, 3-5x/day Tincture: 2.5ml X 4 (Wise Woman Herbal) 3-4ml x 4 (Mechell Turner) 1-2ml x3 (MotherLove) 1 tsp in 8oz water TID (LowDog) Capsule: 1 cap 4x/day (Motherlove)

45 Ixbut- Euphorbia lancifolia (C)
From Ix (woman) and but (increase in flow or volume) Ancient Mayan galactogogue used when milk supply insufficient. non-culinary Popular back in the 1940’s, still occasionally used by rural women in Guatemala. Also found in SE Mexico, Belice, El Salvador and Honduras. “Said to double the quantity of milk given by cows that eat it.“ High amounts appeared to cause decrease after several days……. Moderation important?

46 ixbut Claimed “to cause milk to flow after it has ceased normally, or even in women who have not given birth to a child……. That aged grandmothers, after taking Ixbut, have been able to suckle newly born infants through withered breasts….” Aerial parts used– leaves and branchlets Typical “dose” tea made from 5 leaves or sections of stem (~ 5gms) and 1 cup of water, 3x/day Dehydrated leaves high in calcium? Pozo 1949 study: no changes in breast volume or milk composition noted, only milk volume. Galactagogue properties appear higher in November before plant blossomed Euphorbia family (esp. hirta) has many reputed galactagogues, but toxicity concerns have precluded common use

47 Marshmallow root (A) Actions: diuretic; expectorant; anti-inflammatory; demulcent; mucilaginous Parts used: root and leaf Nutrition: calcium Galactogogue effect not direct, perhaps synergistic; one herbalist uses it “when baby isn’t gaining weight well” May help counteract loose bowel effects of alfalfa, fenugreek, blessed th Althaea officinalis

48 Tea: 1T root powder/ 5oz water, let stand 30 min; drink immediately.
Tincture: 1-4 ml 3x/day Capsules: up to 4 caps 3x daily

49 Milk Thistle (A) Actions: Liver, demulcent; cholagogue
Contains silibinin, silydianin, silychristin Parts used: seeds or leaves Mechell Turner says leaves are used for milk supply Possible side effects: mild laxative effect, diarrhea, mild allergen. Silybum marianum

50 Milk thistle Tea: 1 tsp freshly crushed seeds in 5oz water, steep min. 5-6x/day Tincture: 3-5ml 3x/day Capsules: two 500mg 3x/day

51 Nettle (A) Actions: astringent, diuretic, tonic, hypotensive.
Parts used: aerial parts For gastrointestinal disorders High in chlorophyll; also Vit C, iron Possible side or overdose effects: gastritis, edema, burning sensation of skin Urtica dioica, urens

52 Tea: 2-3 tsp herb in 1c water; steep 10 min, 2-3x/day
Leaf Tincture 2.5-5ml 3x/day Capsules: mg 3x/day

53 Red Clover (B) Trifolium pratense
non-culinary Red Clover (B) Trifolium pratense Actions: anti-spasmodic; expectorant; estrogenic (weak) stomachic; cholagogue Parts used: flower head Use in pregnancy considered controversial Use non-fermented only

54 Dosage Tea: 1-3 tsp herb in 5oz water; 3x/day Tincture: 2-6 ml 3x/day

55 Red Raspberry (A) Rubus idaeus
Astringent, tonic, parturient Parts used: leaves, fruit Nutrition: vitamin A, B complex, C, E, calcium and iron, phosphorous, potassium. Galactogogue effect uncertain; one source says it is believed to lower supply long term, but may help if used short term (<1wk) Other sources say it “increases the flow” and “enriches” the milk, use tea to aid milk ejection non-culinary Tea: 1 tsp leaves/5oz water, steep 5-10 min, 2-4x/day Tincture: 3-4mls 3x/day Capsules: 3-300mg caps 3x/day

56 Saw Palmetto (A) Serenoa repens
Historical use includes for treatment of “underdeveloped breasts,” “a galactia;” “increased lactation;” “breast enlargement.” Parts used: fruit Nutrition: The leaves have a very high content of vitamin A as well as moderate amounts of vitamin D, vitamin C, various B vitamins, iron, silicon, magnesium, zinc, and manganese. 

57 Dosage (general) 320mg daily tinc: 1-2ml 3x/day tea: ½-1 tsp berries in 1c water, simmer 5 min, drink 3x/day

58 Vervain: Verbena officinalis (B)
Actions: nervine, anti-spasmodic, diaphoretic, hypotensive, hepatic Reputedly oxytocic and uterotonic Parts used: aerial parts More often found in combinations Dosage: Considered safe in appropriate dosages; not for pregnancy Tea: 1 tsp per 5oz water steep 5-10 min, drink 3x/day European Infusion: 30-60g herb in 1 qt boiling water; steep min Tincture: 2-4ml 3x/day non-culinary

59 Handouts: Herbs by family, Herbs by similar action
Others on the horizon Ashwagandha (C) Black Cohosh (B) hypotensive Chickweed (A) thyroid, ovarian cysts Dandelion (A) diuretic Hops (A) diuretic; bust enhancement? Licorice (B) another aromatic herb Oat Straw (A) iron; diuretic; pituitary Handouts: Herbs by family, Herbs by similar action

60 Commercially available herbal galactogogue tinctures
More Milk, More Milk Plus (Motherlove Herbal): Blessed Thistle, Nettle, Fennel; plus adds Fenugreek. MM+ now 1:3, or also in glycerin form. More Milk Special Blend (Motherlove Herbal): adds goat’s rue to More Milk Plus (1:5) More Milk Two (Motherlove Herbal) : Raspberry leaf, Nettle, Alfalfa. Considered safe for use during pregnancy.

61 Mother’s Lactaflow (Wise Woman Herbals)
other combinations… Mother’s Lactaflow (Wise Woman Herbals) Fennel Blessed thistle Fenugreek Goat’s rue Suggested dosage drops 3-4x per day

62 Commercial Tinctures….
Make Milk (Laura Nevada Lactation): Fenugreek, Blessed Thistle, Borage, Goat’s Rue M&B-A: (Pure Herbs) Marshmallow root, Fenugreek, Blessed Thistle, Universal ER, Plaintain, Fennel

63 Nursing Mother’s Blend (Kerry’s Herbals)
Fenugreek Blessed Thistle Goat's Rue Alfalfa Anise Abundant Milk Tincture (Growing Life) Blessed thistle Fennel Fenugreek Peppermint Lemon grass

64 Commercial tinctures Ancient One’s formula (B&BR): Anise, Dill, Fennel, Fenugreek. Made of kitchen-familiar herbs only, for those not comfortable with the unknown. LC’s proprietary blend (B&BR): Blessed Thistle, Fenugreek. Most commonly demanded herbs. Milk In Formula (B&BR): Blessed Thistle, Borage, Fenugreek, Goat’s Rue, Red Raspberry. When nothing else seems to be working.

65 Commercial tinctures Mega Milk Formula (B&BR): Blessed Thistle, Borage, Red Raspberry. For those who don’t want fenugreek. Anti-Puffy Formula (B&BR): Dandelion, Cornsilk. For postpartum edema. Let-down Formula (B&BR): Black Cohosh, Motherwort, Schizandra berries. Can also get with added fenugreek. When MER seems to be the problem, not available milk

66 Combination Galactogogues in Capsules
More Milk Plus Fenugreek, blessed thistle, nettle, fennel Dosage: capsule QID or caps TID if >175lbs or not working well after 48 hrs

67 “Lactation Blend” (Vitanica**)
capsules… “Lactation Blend” (Vitanica**) Fennel Seed mg Nettles Leaf mg Blessed Thistle mg Vervain mg Hops mg Oat Straw mg Raspberry Leaf mg Goat's Rue aerial parts mg Chaste tree berry mg Fenugreek Seed mg Milk Thistle Seed mg Borage Seed Oil mg Borage Flower & Top mg TOTAL mg per capsule mg *Recommended dosage 1-2 caps per day **formulated by Dr. Tori Hudson, Naturopath

68 Baby Me Now Lactation Ease (Solaray)
Fenugreek, fennel, nettle Mfr reputation?????

69 Nonichai Noni (leaves) Cardamom (seed) Marshmallow herb (root)
Fennel (seed) Fenugreek (seed) Dosage: 2 capsules per day ??????

70 Gactogogue Teas Mother’s Milk Tea (Traditional Medicinals): Fennel, Anise, Coriander, Spearmint, Lemongrass, Lemon verbena, Althea root, Blessed thistle, Fenugreek. Milder than tinctures, usually taken as 1-4 cups a day. Katherine Shealy finds 8 cups a day very effective. Tasty iced tea version: 6 bags MMT + 4 bags Celestial Seasonings Wild Berry Zinger to make 3 qts tea; place in water bottles and sip throughout day.

71 Weleda Nursing Tea (Swiss)
Swiss Formula: Nettle, Aniseed, Caraway and Fennel U.S. Formula: Fenugreek Seed, Anise Seed, Fennel Seed, Caraway Seed, Lemon Verbena Leaves. Directions 1: Combine one level 5ml teaspoon to 1 cup of cold water and bring to the boil. Simmer for one minute, steep 5 minutes. Directions 2: 1 tea bag to a cup of boiling water, cover and steep 5 minutes. Drink 3 cups a day or as directed by your naturopath.   swiss U.S.

72 Yogi Tea – Woman’s Nursing Mom
Fennel, fenugreek, anise, chamomile, lavendar Directions: pour 8 oz boiling water over one tea bag and steep for 5 to 10 minutes. Gently squeeze each tea bag to fully release the active ingredients. Drink 2 cups daily to maintain milk production or 1 cup every 3 hours to stimulate milk flow.

73 Abundant Milk Tea (Growing Life)
other combinations…. Abundant Milk Tea (Growing Life) Blessed thistle, fennel, fenugreek, peppermint, lemon grass

74 “Lactare” from India Asparagus Racemosus (Shatavari) 200mg
Withania Somnifera (Ashwagandha) 100mg Glycyrrhiza glabra (European Licorice) 50mg Fenugreek 50mg Allium sativum (garlic) 20 mg Directions: 2 caps TID for first 14 days after delivery or as needed Studies cited showing Lactare increases prolactin, milk production, creaminess of milk

75 Homeopathics Based on the Law of Similars, or “like treats like.” Counter-intuitive to western thought. Classical approach takes in-depth consititutional history and chooses one remedy only Remedies are diluted until no measurable amount of source remains; can be found in 6x, 12x, 6c, 12c, 30c, 200c, L and M dilution/ potencies; typically used short term, ~ 3 days The greater the dilution, the more potent it is considered Best results when prescribed by practitioner rather than self-diagnosis

76 Advice from herbalist Mechell Turner, IBCLC:
Do not touch the pills or tablets (remedy is on the outside of the pellet) Put the dose—usually 1 tablet or drop—into the lid of the bottle, or even a clean paper cup. (Often placed under tongue for quick absorption) Take the remedy only for the symptoms. If symptoms get worse, stop the dosage. Administer less frequently as symptoms improve. Usually do not take medicine for longer than 3 days. For emergencies use the 30C every 30 minutes to 1 hour for up to 10 doses. Then see above rule. Take the smallest dose for the shortest period of time.

77 Homeopathics more commonly used for low milk supply…..
*Urtica urens Considered a good galactogogue for general use. May be useful when there is a total absence of milk or when milk supply is slow to establish without an obvious cause. May be appropriate when hemorrhage or anemia precede low milk supply. *Lactuca virosa Considered a strong galactogogue overall, good for general use Suggested dosage 4 (30c) pellets QID or 2 (30c or 200c) BID

78 Often used for sudden loss of milk related to shock and grief.
*Ignatia Often used for sudden loss of milk related to shock and grief. “I haven't seen this do much on it's own. However, when it's combined with a mild galactagogue like nettle I've seen amazing results.” -Jay Gordon’s website Suggested dosage: 2 (6x) tablets TID (KM)

79 Helonias (False Unicorn)
Ricinus communis Hemorrhage or anemia preceding low milk supply Galega When anemia or poor nutrition are also variables Helonias (False Unicorn) When caused by extreme maternal exhaustion (super mom syndrome)

80 Dulcamara Agnus Castus
Traditionally used when sudden loss of milk occurs after exposure to cold and damp; may be helpful when low milk supply follows milk stasis (ie, engorgement). Agnus Castus When low milk supply is accompanied by depression. (Note: Patricia Hatherly believes this depression could possibly be related to hormones from retained placental products, the latter of which suppress lactation.)

81 Causticum Calcarea carbonica
Short-term exhaustion leading to drop in milk supply, ie mother up all night with baby. Most appropriate with personality that resists rather than “rolls with the punches.” Calcarea carbonica May be useful when breasts are engorged and milk is not flowing, or when low supply occurs with breast infection that is associated with engorgement. May possibly have application for milk supply when thyroid function is low.

82 Silicea Low milk supply related to poor maternal diet/extreme dieting. May also be appropriate when supply problems preceded by boggy uterus after childbirth, possible retained placental products, or inflamed breast infection Rescue Remedy When the milk is present but not flowing and mother is stressed from pain, fear of pain, etc. Use 4 drops sublingually before nursing or pumping to facilitate milk ejection . Rescue Remedy can have a slight sedative effect, so use caution.

83 Selecting galactogogues
A good maternal health history is important, including any medical conditions, allergies, history of depression, current medications What is the root of the problem? Is there a lactogenic medication or herb that seems to target this issue?

84 For example: (not exhaustive)
Thyroid support: dandelion, chickweed, nettle, vervain High Iron: alfalfa, dandelion, fenugreek, nettle, red raspberry leaf, Pituitary support: alfalfa, chasteberry, Diuretic properties: alfalfa, blessed thistle, borage, coriander, dandelion, dill, fennel seed, goat’s rue, marshmallow, nettle, Milk ejection: anise?, chasteberry?, dill, fennel seed?, red raspberry leaf? Anti-hypertensive: fenugreek, nettle, vervain Nervine: anise, borage, fennel seed, vervain

85 What is mother’s comfort and philosophy regarding medications or herbs?
Are there institutional or HCP restrictions on what can be used? Must work carefully within framework of mother’s HCPs Look for reputable manufacturers or herbalists Rotating herbs may work better for long-term dependence

86 Case Studies Case 1: Two babies, two different results
Primary supply failure (but >50%) with baby #1 Did research, then used herbs for #2: During pregnancy: drank mix of Handfuls of Red Raspberry Leaf & Nettle Slightly less Alfalfa and Red Clover Blossom Heaping handful of the mixture to 1qt of boiling water steeped overnight (drank iced) Postpartum Adjustments: Added hops, blessed thistle, marshmallow root, fenugreek and goat’s rue powder (1 tsp ea/qt) Drank 1qt per day ~anecdotal~

87 Case 2: Break through experience
Primigravida age 33 presented at 8 days pp. due to no BMs in 72 hrs, “brick dust” urine Baby born at home, 8#2, now 7#00.5. Mother feeding almost constantly. Family staunch vegans, opposed to commercial formulas Mildly hypoplastic type 2 breasts spaced 1-1.5” apart mild pregnancy changes only. More palpable gland in L vs R Veining moderate Areolae very large Milk in day 4 ( by color change)

88 Additional maternal hx:
erratic cycles from age 13 with menorrhagia; placed on BCPs during 20’s. Cycles improved 2 yrs ago after starting vegan diet Infant Assessment: good suck, tone, alertness Feeding observation: latched fairly well Intake 8ccs L and 2ccs R Post pumping yielded 20ccs total; good MER Initial lactation dx: infant lack of weight gain secondary to poor supply due to inadequate glandular tissue.

89 Follow-up 1 (4 days later)
Initial Care Plan: Demand feed, breast compressions Pump min after feeds Supplement with 1.5-2oz EBM & AIM Alternate MM+ and Goat’s Rue per mfr’s instructions Follow-up 1 (4 days later) Baby’s wt 7#5.3 up ~5oz/4 days Test feed 10ccs R, 4ccs L, (double before) Pumped 18 ccs after feed (same) Agreed to continue current plan

90 F/U 2 (1 wk, age 19 days) Baby 7#12.5, up 7oz/7days
Baby taking about 2oz suppl. per feed for 14oz AIM + 7oz EBM per day Test intake 8ccs R 9ccs L; switched to football, got 28ccs more = 45ccs total Mom reports taking both herbs 8-10x/day Baby breastfeeds 30 min total Pumping 6-7x/day, 20-35ccs ea Continue plan

91 F/U 3 (1 wk, age ~1mo) Baby wt 8#3, up 6.5oz/7days
Mom still pumping 1oz each time, baby also getting additional 2-3oz/supplement Mom now alternating herbs, total of 8x/day; if supply felt low, she took them together Test feed: baby sleepy & passive, 12ccs R only.

92 F/U 4 (2 wks, age 6 wks) Baby wt 8#15.9 up 13oz/14 days
Test feed: 24ccs R and 80ccs L = 104ccs! AIM down Mom taking herbs 10-12x/day + MM tea Mom also reported some vaginal bleeding

93 F/U 5 (7wks) F/U 6 (8wks) Baby wt 9#5, up 5.5oz/8 days
Mom reports avg 6oz AIM per day Mom reports periodic bleeding past month, passing of clots Test intake: 45ccs R and 30ccs L = 75ccs Suggest monitoring timing of supplements vs “periods” F/U 6 (8wks) Baby wt 9#12.3 up 7oz/6 days Mom stopped pumping Test feed 24ccs R and 28ccs L = 52ccs Mom had not used GR for 2 days 4oz AIM past 2 days vs 2-3 3oz bottles

94 New pregnancy @ 7 mos; baby #1 breastfed 6 mos into new pregnancy
F/U 7 (10 wks) Baby wt 10#4.3 up 8oz/15 days Mom reports using 3oz supplement in evening only; baby sleeping more and eating less at night Stooling every 3-5 days, but large Test feed: 62ccs R 40ccs L = 102 ccs F/U 8 (~ 12 wks) Baby wt 10#14.5 oz up 10oz/12 days Mom reports supplement at 3-6oz Test feed: 38ccs R and 34ccs L= 72 ccs Baby eventually rejected supplements; gain average .5oz/day. Solids started late due to paternal preference. New 7 mos; baby #1 breastfed 6 mos into new pregnancy

95 Baby eventually rejected supplements; gain average. 5oz/day
Baby eventually rejected supplements; gain average .5oz/day. Solids started late due to paternal preference. New 7 mos; baby #1 breastfed 6 mos into new pregnancy

96 At 5 mos: transferred 100ccs, but wt gain not quite .5oz/day

97 Interesting stuff Mom got tired of doing herbs all the time, so decided to try domperidone instead. At first this seemed to work, but then supply dropped and breasts “deflated,” so she added Goat’s Rue back and took them concurrently. Later on, she ran out of the Goat’s Rue for a few days and found that her breast seem to “deflate” again. She quickly got more and things returned to normal Supply was ~95% overall Baby #3……..

98 Web Resources KellyMom.com- LowMilkSupply.org Birth and Breastfeeding: Mongraphs by D. Hoffman, Herbal Materia Medica: Longwood herbal task force: Saw palmetto: Napralert: MOBI: Breastfeeding & herbs discussion group:


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