Breastfeeding and diet are something that many mothers consider before and after a newborn comes along. Of course, both are interlinked and there is much to think about and plan for. Firstly, not all nutrients within breast milk are always linked to diet. Some important vitamins such as B1, B2, B6 & B12 need to be sourced from food. So, if mom isn’t getting enough, unfortunately, neither is the baby.
High amounts of energy are spent on breastfeeding. This can be upwards of an extra 500 calories a day, so a varied and healthy diet is essential to ensuring all additional needs are met. If such nutrients are not consumed or taken in supplement form, then there is a risk that they will be taken in other forms through the mother’s reserve, leaving her more vulnerable. As a result, it is advised to eat a nutrient-dense diet with 2-3 different protein sources per day.
While so many mothers dream of their breastfeeding journey from the very start of their pregnancy, sometimes the reality can be more difficult than what was imagined. Lactation occurs as a result of the hormone prolactin. If this is in low supply, supports may be required to increase its production.
What’s supports are available to help?
A galactagogue, taken from the Greek word “galacta” meaning milk and “gogue” which means leading, refers to food, herbs or drugs taken to drive or increase the supply of breast milk. Most won’t need to consider taking extra measures, but at times, supply can cause issues especially concerning pre-term babies. In these instances, other solutions may be required. While diet may be easier to address, when it comes to taking something extra in the form of a herb or a drug, there is a lot of information out there that can be confusing. You can often be left with more questions than answers. We have put a simple guide together to help you learn more about the most common supplements.
What’s the difference between a herb and a drug?
Galactagogues can be then divided into 2 types, drugs or supplements.
What’s the difference between them? A very popular quote says that “Poison is in everything, and nothing is without poison. The dosage makes it either a poison or a remedy”. This means that drugs can be dangerous and that’s why they need a prescription from a doctor and they should be taken with extreme care. Drugs that you can get without a prescription are generally very safe and it is very difficult to overdose them. Think about the common painkillers available in the store. Generally speaking, drugs are strictly regulated by the government and to be available to the public, they need to be safe and effective, which means that it’s necessary to have scientific evidence of the benefit of a drug. Supplements are not considered drugs, and they are not subject to the same strict regulation and they don’t need to be based on sound evidence to be in the market. In other words, shops are full of supplements that claim any sort of benefits which sometimes are not real. If you need to boost your milk production without wasting time and money, better you get something that works!
What drugs are prescribed to increase milk supply?
When appropriate, there may be a need to look at a pharmaceutical option to increase the milk supply. Several drugs assist with this and are prescribed frequently. They include:
Sulpiride (Eglonyl, Dolmatil, Sulpitil, Sulparex, Equemote).
While sulpiride is an antipsychotic/antidepressant and, is used for schizophrenia, it is also used to increase prolactin and as a result, increase levels of breast milk produced.
This is probably the drug of choice when it comes to galactagogues. Used off label to increase prolactin, it also increases milk supply. Studies have demonstrated its effectiveness in promoting the milk supply. Others argue that such evidence is not very compelling. Either way, it has been listed as a category L1 in ‘Medications and Mothers’ Milk’ in 2017 and is prescribed regularly. It also has fewer side effects than others such as Reglan but it needs to be taken under medical supervision because of the possible side effects on heart function. Because of these potential side effects, domperidone shouldn’t be given to mothers with a history of heart conditions (especially arrhythmias, which is an abnormality of heart beating)
Metoclopramide (Reglan) is used in the U.S. Unfortunately, it has some side effects that can prove to be quite severe. Depression can develop after 3 to 4 weeks of initiation. If prescribed, it is advised to watch very carefully for symptoms. If there has been any previous history of depression, it shouldn’t be given. On top of this metoclopramide has less data confirming its efficacy.
Shatavari (asparagus racemosus) is a herbal supplement (from the asparagus family) that has been proven to be effective at increasing milk supply by enhancing prolactin. Mothers are advised to avoid it in the first trimester due to potential negative side effects. There are other benefits in terms of anxiety reduction and hormonal balance, regulating menstrual cycles. It is also known to increase energy levels as well as immunity through antioxidant action.
Fenugreek (Trigonella foenum-graecum), a spice used in the Indian spice blend garam masala, is one of the most common herbs used to increase milk supply. After first use, most see an improvement in 24 to 72 hours and some studies seems to confirm benefits on milk production. Side effects can include diarrhoea and can lead to sweet-smelling sweat and urine for both mother and baby. Blood-thinning is also a side effect so consult with your doctor, especially if you are taking blood thinners. It should not be taken during pregnancy as it can induce labour or cause miscarriage.
For centuries, this trusted plant has been used to treat various conditions. It has also been used to help with milk supply issues as a galactagogue. Some studies have shown that it can help in the first few weeks after delivery. The active ingredient from this plant is called Silymarin and the purified extract is available on the market. Amongst them, the micronized (which is a way to prepare this chemical) Silymarin has been proven effective in increasing milk production.
Some side effects related to the assumption of this supplement can be nausea, diarrhoea and itchy skin. If you are taking other medications, talk to your doctor before you take milk thistle because some of them can cause side effects if used together.
Garlic is yet another supplement and plant used to help lactating mothers even though the evidence of its efficacy is quite scant.
There does seem to be one downside in that it can change the flavour and taste of a mother’s milk, which can upset the baby. If you notice fussiness at the breast after taking garlic supplements, you might consider stopping it.
Studies have shown ginger to be helpful in terms of increasing milk production and supply with little to no negative side effects. It has long since been known to also help with nausea and digestive issue, relieving morning sickness in pregnancy. It has antiviral properties which can help with immunity such as cold viruses and other infections.
There are other supplements too which have been noted to help with breastfeeding and milk supply. This included goat’s rue and alpha-alpha.
If you are a mother and are having issues with milk supply or fear that your supply is low, always first speak to your qualified health care professional. This is a very delicate issue that we discussed in another blog post. Most of the time your milk supply is perfectly fine and there is no need for any galactagogues. Asking a qualified consultant or a doctor can help you understanding if there is a real problem with the milk supply. As we discussed, most drugs and supplements might have side effects and it’s important to ask a doctor especially if you are taking other medications or having some underlying health issues.
Finally, if you decide to buy supplements, always buy from a fully reputable source so you will be sure about the quality of the ingredients. Nothing worse to buy poor quality products which in the best-case scenario are just a waste of money, but they could give some unpleasant side effects.
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