Abstract
Reports from repeated studies of mothers who terminate their breastfeeding in the early postpartum period or give up any attempt to exclusively breastfeed note that this is a consequence of the mothers’ frequent vocalized concern that they perceive that they are simply are not producing an adequate amount of breast milk to meet their growing infants needs and demands.
Objective evaluation of such mothers has noted that the more common problem is one of breastfeeding technique (i.e., position, latch) rather than one of milk production. Despite these findings, the emphasis in many cultures is on the search for a galactagogue, the holy grail of a preventive and/or therapeutic “magic pill” that will stimulate milk production. 1
For most mothers who have this perceived sense of an insufficiency and/or an objective incapacity regarding supplying an adequate volume of milk, the ideal galactagogue should be a natural substance, easily incorporated into their diet and absent of any adverse side effects for either the mother or the infant. Thus, it is not surprising that every culture has developed its own array of such milk-stimulating foods that include:
oatmeal; dark, leafy greens (alfalfa, kale, spinach, broccoli); chickpeas; nuts, especially almonds; ginger; and papaya.
In addition, food supplements most commonly are herbs or their seeds that do not have classical nutritional value but by nature of the chemical composition can presumably stimulate prolactin production and thus augment milk production. Such products include:
fenugreek, blessed thistle, fennel, stinging nettle, goat’s rue, milk thistle, and garlic.
In this issue of Breastfeeding Medicine, our Pharmacology Editor Dr. Philip Anderson updates us about some of the newer (non-Food and Drug Administration [FDA]-approved) herbal products that are on the markets. Most importantly, Phil detailed the complexity of evaluating the published reports because of their inherent methodological inadequacies. In his own words, common design flaws in the studies “include failure to define the products being tested, use of multi-ingredient mixtures, lack of blinding, lack of placebo control, failure to define the study population, inappropriate endpoints, and failure to use intention-to-treat analysis.” He also pointed out that the products that are available for sale in North America frequently have a different composition from what was tested and sold in the country of origin.
Despite all the limitations, he concluded that Asparagus racemosus and Moringa oleifera have some fair evidence for efficacy as galactagogues, although the studies do not reach the level of evidence required for FDA approval. The other herbal products such as Coleus amboinicus, Galega officinalis, and Sauropus androgynus have little to no good evidence to support their use as galactagogues.
Beyond the discussion of these specific products, the value of Dr. Anderson’s article is his short course in basic pharmacology principles that can serve as a guide for the readers of Breastfeeding Medicine on how to evaluate reports of the supposed efficacy of purported galactagogues.
An example in point is his discussion of the placebo effect as exemplified in the recent survey of “sports drinks” and coconut milk or water as potential efficacious galactagogues. In this study it was reported by mothers that such drinks increase milk supply about as well as fenugreek. Paradoxically, 5% of mothers stated that fenugreek decreased milk supply (!), while none reported a decrease with the sport drinks. 2
So much for evidence-based medicine.