By Cheryl Taylor, CBE
When in the course of a happy breastfeeding relationship you notice a supply change, it can cause momentary panic. The first course of action should be to assess a few basic things. Are you resting enough? Getting a good night’s sleep? Taking a nap if necessary? Are you drinking at least 64 ounces of water a day? Are you eating a good, healthy diet? These are some of the basics of a nursing relationship that have to be maintained to the very best of your ability. Our bodies aren’t necessarily so forgiving of being pushed to the limit when we’re nursing. They tend to give us a clear signal. One of those ways is with a dip in supply. Listen to your body and take some action.
Make sure you are:
- Resting adequately
- Drinking at least 64 ounces of water a day
- Eating a nutritious diet
- Choosing a night time sleeping arrangement that allows for the best sleep for all involved
- Nursing frequently
Make sure you are not doing things that can inhibit supply:
- Allergy medications
- Sleeping on your stomach – compressing the breasts at night
- Wearing a bra that is too tight
- Wearing a sling with the rings pressing back against the breast instead up near the shoulder
The first and simplest way to increase milk supply is to nurse your baby more often. The extra stimulation will signal your body to increase milk supply to meet the demand. If you are wanting to boost your supply try nursing your baby every 60-90 minutes from beginning of nursing to beginning of next nursing. Most mothers’ supply will respond to this increased nursing stimulation with a supply boost within 24-48 hrs. It can also help for mom to have a “nurse in” and snuggle down on the couch or in bed with the baby with water, snacks and diapers at hand and nurse as often as baby will nurse. This provides not only more nursing, but extra rest for Mom, which also helps to increase milk supply.
Even with all the above steps as it should be for optimal milk supply, you may still find your supply is not what you feel it should be. The next step is to see how often your baby is wetting. Often what is perceived as a supply problem really isn’t a supply problem at all. Observing how much your baby is wetting will tell you whether it is reality or merely a perception. After the first week of life an infant should have 6-8 wettings per day.
Another area to analyze has to do with pumping. There are times when you see a drop in what you are able to get at the pump. This may not be so much a drop in supply as it is a change in your reaction at the pump. The baby may have no trouble at all getting letdown, but the pump just isn’t fooling your body into one as well as it once did. Making some changes at the pump in the way of heat, massage prior to pumping, massaging in long sweeping motions down toward the nipple while pumping or altering positioning may be the trick that works for you.
If you are supplementing, even a single bottle a day, and are struggling with your milk supply, you need to consider ceasing all supplementing. For some women, supplementing even one bottle a day will have a drastic effect on their milk supply due to the reduction of stimulation by suckling with a nursing that is replaced by a pumping.
If all the above has been tried with little success, it may be time to consider using a galactagogue. Galactagogues are a wonderful tool, but should NOT be considered until the above measures have been taken first. It is always prudent to remember that, on the whole, your body knows what it is doing in responding to your baby and providing adequate milk. Galactagogues are a wonderful thing when they are truly necessary but they should be a last resort. There is often an assumption that since herbs are natural, they are safe. That isn’t always the case, and in fact, some herbs can be quite dangerous. Please use caution when using herbs and observe your body’s reaction to them carefully.
Some of the more common galactagogues (and there are many used over the centuries) are:
Fenugreek is one of the most commonly used galactagogues. It works very quickly in most cases. It can be taken in capsule form with the recommended dose being up to three capsules three times a day. It can be used in conjunction with Blessed Thistle, again working up to three capsules three times a day. The dosage needed varies according to the mother, so experimentation with lesser doses and increasing them if needed is a good idea. One capsule three times a day may be enough to boost one mom’s supply when another may need three capsules three times a day.
It is important to be aware that fenugreek can affect blood sugar levels, so much so that it is effectively used to treat diabetes. Knowing this, a nursing mom with hypoglycemia or diabetes needs to watch blood sugar levels if fenugreek is her galactagogue of choice.
The only side effect to make note of is mild gastrointestinal distress when fenugreek is taken in high doses. Typically that would be seen in the mother, but in rare cases it is seen in the infant with an exhibition of some gastrointestinal difficulty which can be as mild as gassiness in the bowels. Animal studies have found fenugreek essentially non-toxic.
Fennel isn’t actually a galactagogue, but rather it assists with triggering the letdown reflex. It is particularly useful for working Moms who have found that they’ve stopped responding well to the pump. Fennel is best as a tincture, 2-4 ml up to three times a day, but can be taken in capsule form. Caution should be used with fennel because it can act as an appetite suppressant. Keep a careful eye on your caloric intake. Also, fennel contains phytoestrogens which if taken in excess can have a negative effect on your supply.
This is a homeopathic remedy that is useful for triggering the letdown reflex. You take four drops under the tongue up to five minutes before pumping or nursing. Rescue Remedy can have a slight sedative effect, so use with caution.
This is a homeopathic remedy that can work well in combination with a mild galactagogue. Dosage would be two tablets three times a day.
Mother’s Milk Tea
This tea is a very mild galactagogue containing fenugreek. Some women find that drinking several cups a day is all that is needed of fenugreek to boost their supply. An easy way to drink it is to brew a few cups very strong and cool it. It can be drunk either iced straight or mixed half and half with apple juice.
As with commercial medications, when taking herbs you should always start with the mildest and work your way up, always starting with the lowest dosage possible. Also, keep in mind that galactagogues should be used for boosting supply, not maintaining. Once your supply has established itself at an adequate level, you should try weaning back off the herbs and see if your supply will maintain where needed. They can always be resumed if necessary, but excessive use can lead to unwanted side effects. If you find that you’re in a situation where you need to take a galactagogue on an extended basis you should do a program of six weeks on and three weeks off. If you do not give your body a break it will become resistant to the herbs and they will become ineffective.
If you are looking into trying a galactagogue, start with things like:
- alfalfa, work up to four capsules three times a day
- marshmallow, work up to four capsules three times a day
- nettle, work up to two capsules three times a day
- dill, use two teaspoons of raw dill seed on your lunch and dinner or use it to brew a tea
- blessed thistle, work up to three capsules three times a day.
These are much safer herbs. Most galactagogues are more effective when used in combination. Combining two or three is much more effective than just using one.
Sometimes a mom finds herself needing to maintain a supply in order to nurse through a pregnancy. In some cases mom finds that the supply and demand system works out nicely and they have no problems nursing right through pregnancy. In other cases mom finds she needs a little help. There are mild galactagogues that are safe to take in pregnancy. These herbs can also be used in combination of two or three.
Nettle up to 2 capsules 3 times a day
Dill up to 2 ml tincture 3 times a day
Marshmallow up to 4 capsules 3 times a day
DO NOT take fenugreek, fennel, or blessed thistle while pregnant.
There are a couple of prescription medications that have been used with success in situations of serious supply problems. (Reglan and Domperidone are two of these meds) They should be used with prudence and never considered until other basic measures of rest, water, nutrition and nursing frequency have been examined and remedied if necessary. We owe it to ourselves and our children to take care of our overall health, which is most cases, allows our bodies to provide breastmilk to our children. These medications are available in those situations in which the mother has adequate rest, good nutrition, frequent nursing and still finds that supply is a problem.
Genotoxicity testing of a fenugreek extract.
Food Chem Toxicol. 2004 Nov;42(11):1769-75.
Fenugreek seeds have been used in traditional medicines as a remedy for diabetes. Rich in protein, fenugreek seeds contain the unique major free amino acid 4-hydroxyisoleucine (4-OH-Ile), which has been characterized as one of the active ingredients in fenugreek for blood glucose control. Current use of fenugreek in foodstuff has been limited to its role as a flavoring agent, and not as an ingredient to help mitigate the blood glucose response for people with diabetes. As part of a safety evaluation of novel ingredients for use in blood glucose control, the potential genotoxicity of a fenugreek seed extract (THL), containing a minimum of 40% 4-OH-ILE, was evaluated using the standard battery of tests (reverse mutation assay; mouse lymphoma forward mutation assay; mouse micronucleus assay) recommended by US Food and Drug Administration (FDA) for food ingredients. THL was determined not to be genotoxic under the conditions of the tested genetic toxicity battery. The negative assay results provide support that addition of THL from fenugreek to foodstuffs formulated for people with diabetes is expected to be safe. A wide safety margin is established, as anticipated doses are small compared to the doses administered in the assays.
Diosgenin, a steroid saponin of Trigonella foenum graecum (Fenugreek), inhibits azoxymethane-induced aberrant crypt foci formation in F344 rats and induces apoptosis in HT-29 human colon cancer cells.
Cancer Epidemiol Biomarkers Prev. 2004 Aug;13(8):1392-8.
Trigonella foenum graecum (fenugreek) is traditionally used to treat disorders such as diabetes, high cholesterol, wounds, inflammation, and gastrointestinal ailments. Recent studies suggest that fenugreek and its active constituents may possess anticarcinogenic potential. We evaluated the preventive efficacy of dietary fenugreek seed and its major steroidal saponin constituent, diosgenin, on azoxymethane-induced rat colon carcinogenesis during initiation and promotion stages. On the basis of these findings, the fenugreek constituent diosgenin seems to have potential as a novel colon cancer preventive agent.
Protective effect of fenugreek (Trigonella foenum graecum) seeds in experimental ethanol toxicity.
Phytother Res. 2003 Aug;17(7):737-43.
The study investigates the effect of aqueous extract of fenugreek seeds (Trigonella foenum graecum) on lipid peroxidation and antioxidant status in experimental ethanol toxicity in rats. The ability of the seed extract to prevent iron-induced lipid peroxidation in vitro was also investigated. Ethanol feeding for 60 days resulted in significant increases in the activities of serum aspartate transaminase, alanine transaminase and alkaline phosphatase. The levels of serum lipid hydroperoxides and thiobarbituric acid reactive substances in liver and brain were also significantly elevated. Significantly lower activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferase and glutathione reductase were observed in liver and brain accompanied by depletion in glutathione, ascorbic acid and alpha-tocopherol concentrations. Activity of Ca(2+) ATPase in brain was significantly lowered. Simultaneous administration of aqueous extract of fenugreek seeds with ethanol prevented the enzymatic leakage and the rise in lipid peroxidation and enhanced the antioxidant potential. The seeds exhibited appreciable antioxidant property in vitro which was comparable with that of reduced glutathione and alpha-tocopherol. Further, histopathological examination of liver and brain revealed that, aqueous extract of fenugreek seeds could offer a significant protection against ethanol toxicity.
Supplementation of fenugreek leaves lower lipid profile in streptozotocin-induced diabetic rats.
J Med Food. 2004 Summer;7(2):153-6.
The present study was undertaken to evaluate the lipid-lowering effect of fenugreek leaves in diabetes mellitus. Albino Wistar rats were randomly divided into six groups: normal untreated rats; streptozotocin (STZ)-induced diabetic rats; STZ-induced rats + fenugreek leaves (0.5 g/kg of body weight); STZ-induced rats + fenugreek leaves (1 g/kg of body weight); STZ-induced rats + glibenclamide (600 microg/kg of body weight); and STZ-induced rats + insulin (6 units/kg of body weight). Rats were made diabetic by STZ (40 mg/kg) injected intraperitoneally. Fenugreek leaves were supplemented in the diet daily to diabetic rats for 45 days, and food intake was recorded daily. Blood glucose, total cholesterol, triglycerides, and free fatty acids were determined in serum, liver, heart, and kidney. Our results show that blood glucose and serum and tissue lipids were elevated in STZ-induced diabetic rats. Supplementation of fenugreek leaves lowered the lipid profile in STZ-induced diabetic rats.
Therapeutic applications of fenugreek.
Altern Med Rev. 2003 Feb;8(1):20-7.
Basch E, Ulbricht C, Kuo G, Szapary P, Smith M.
Fenugreek has a long history of medical uses in Ayurvedic and Chinese medicine, and has been used for numerous indications, including labor induction, aiding digestion, and as a general tonic to improve metabolism and health. Preliminary animal and human trials suggest possible hypoglycemic and antihyperlipidemic properties of oral fenugreek seed powder.
Mechanism of action of a hypoglycemic principle isolated from fenugreek seeds.
Indian J Physiol Pharmacol. 2002 Oct;46(4):457-62.
Mechanism of action of an orally active hypoglycemic principle isolated from water extract of seeds of Trigonella foenum graecum (fenugreek) was investigated in alloxan induced subdiabetic and overtly diabetic rabbits of different severities. The active principle was orally administered to the subdiabetic and mild diabetic rabbits (five in each group) at a dose of 50 mg/kg body weight for 15 days. The fenugreek treatment produced significant attenuation of the glucose tolerance curve and improvement in the glucose induced insulin response, suggesting that the fenugreek hypoglycemic effect may be mediated through stimulating insulin synthesis and/or secretion from the beta pancreatic cells of Langerhans. Prolonged administration of the same fenugreek dose of the active principle for 30 days to the severely diabetic rabbits (n = 5) lowered fasting blood glucose significantly, but could elevate the fasting serum insulin level to a much lower extent, which suggests an extra-pancreatic mode of action for the active principle. The fenugreek effect may also be by increasing the sensitivity of tissues to available insulin. The fenugreek hypoglycemic effect was observed to be slow but sustained, without any risk of developing severe hypoglycemia.
Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study.
J Assoc Physicians India 2001 Nov;49:1057-61.
To evaluate the effects of Trigonella foenum-graecum (fenugreek) seeds on glycemic control and insulin resistance in mild to moderate type 2 diabetes mellitus we performed a double blind placebo controlled study. METHODS: Twenty five newly diagnosed patients with type 2 diabetes (fasting glucose < 200 mg/dl) were randomly divided into two groups. Group I (n=12) received 1 gm/day hydroalcoholic extract of fenugreek seeds and Group II (n=13) received usual care (dietary control, exercise) and placebo capsules for two months. CONCLUSIONS: Adjunct use of fenugreek seeds improves glycemic control and decreases insulin resistance in mild type-2 diabetic patients. Fenugreek also has a favorable effect on hypertriglyceridemia.
Enhancement of circulatory antioxidants by fenugreek during 1,2-dimethylhydrazine-induced rat colon carcinogenesis.
J Biochem Mol Biol Biophys. 2002 Aug;6(4):289-92.
Annamalai University, Annamalai Nagar, Tamil Nadu, India.
We have investigated the modulatory effect of fenugreek seeds (a spice) on circulatory lipid peroxidation (LPO) and antioxidant status during 1,2-dimethylhydrazine (DMH)-induced colon carcinogenesis in male Wistar rats. Enhanced LPO in the circulation of tumor bearing animals was accompanied by a significant decrease in the levels of ascorbic acid, vitamin E, reduced glutathione, glutathione peroxidase, glutathione S-transferase, superoxide dismutase and catalase. Inclusion of fenugreek in the diet significantly decreased LPO with simultaneous enhancement of circulating antioxidants. We report that fenugreek exert its chemopreventive effect by decreasing circulatory LPO and enhancing antioxidant levels.
Effect of fenugreek seeds on blood glucose and serum lipids in type I diabetes.
Sharma RD, Raghuram TC, Rao NS.
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad.
Eur J Clin Nutr. 1990 Apr;44(4):301-6.
The effect of fenugreek seeds (Trigonella foenum graecum) on blood glucose and the serum lipid profile was evaluated in insulin-dependent (Type I) diabetic patients. Isocaloric diets with and without fenugreek were each given randomly for 10 d. Defatted fenugreek seed powder (100 g), divided into two equal doses, was incorporated into the diet and served during lunch and dinner. The fenugreek diet significantly reduced fasting blood sugar and improved the glucose tolerance test. There was a 54 per cent reduction in 24-h urinary glucose excretion. Serum total cholesterol, LDL and VLDL cholesterol and triglycerides were also significantly reduced. The HDL cholesterol fraction, however, remained unchanged. These results indicate the usefulness of fenugreek seeds in the management of diabetes.
Fenugreek Animal Studies
Effect of fenugreek seeds on the fasting blood glucose level in the streptozotocin induced diabetic rats.
Mymensingh Med J. 2004 Jul;13(2):161-4.
In this experiment defatted Trigonella foenumgraecum (fenugreek seeds/methi seeds) has used as the antidiabetogenic herbal medicine. The experiment was carried out in Bangabandhu Sheikh Mujib Medical University and BIRDEM from 1996 to 1998 on a total of 58 Long Evans rats of either sex. They were 50-60 days young rats with average body weight 72-174 gm. Among the total, 10 rats were treated with only vehicle called as non-diabetic control rats, 48 rats were treated with Streptozotocin (STZ) at a dose of 90mg in 1ml of citrate buffer solution per kg body weight, among which 20 were diabetics. Ten (1 died, 1 escaped) diabetic rats were again treated with fenugreek called as Fenugreek-treated diabetic rats and the rest 10 diabetic rats were called as diabetic control rats. The change in the mean fasting blood glucose (FBG) level in different groups of rat from day 5 from streptozotocin injection were higher in diabetic control group and in fenugreek-treated diabetic group than in non diabetic control group. The FBG level on day 13 the mean in non-diabetic control group was 5.21 mmol/L. In diabetic control group and in fenugreek-treated diabetic group the mean FBG level were 24.33 mmol/L and 9.89 mmol/L respectively. So, from this experiment it may be concluded that fenugreek decreases the FBG level considerably by improving diabetes mellitus.
Supplementation of fenugreek leaves to diabetic rats. Effect on carbohydrate metabolic enzymes in diabetic liver and kidney.
Phytother Res. 2003 Dec;17(10):1231-3.
The present study was designed to evaluate the effect of supplementation of fenugreek leaves, an indigenous plant widely used in Indian Ayurvedic medicine for the treatment of diabetes mellitus, in streptozotocin induced diabetic rats. Supplementation of the diet with fenugreek leaves showed a significant effect on hyperglycaemia, hypoinsulinaemia and glycosylated haemoglobin in streptozotocin diabetic rats. Fenugreek leaves improved the body weight and liver glycogen. Fenugreek leaves also showed a significant effect on key carbohydrate metabolic enzymes in diabetic rats. The effect of fenugreek leaves was found to be similar to that of glibenclamide. Thus, fenugreek leaves exhibited antidiabetic action in streptozotocin-induced diabetic rats. Insulin restored all the parameters to near normal levels in diabetic rats.