Herbs and Foods as Herbs and Foods as GalactogoguesGalactogogues

Lisa Marasco, MA IBCLC

© Copyright Lisa Marasco 2007

Herbs: the original “medicine”Herbs: the original “medicine”

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

• 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

Example: Herb XHerb 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 0.6-2.0 mlTincture: 1:5 in 45% alcohol, dose 1-5 ml

CONTRAINDICATIONS: Celiac disease.

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, 287-8.

OATS!OATS!

herb X

Understanding the issuesUnderstanding 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.Some brands more reliable than others.

• 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

Targeting:Targeting: the unconsidered problem the unconsidered problem

• We don’t know a lot about how many of the galactogogues act• Little research has been done on reputed Little research has been done on reputed

herbal galactogogues to analyze how they herbal galactogogues to analyze how they may work (exception: Farnsworth)may work (exception: Farnsworth)

• Are they boosting prolactin, or another Are they boosting prolactin, or another part of the equation?part of the equation?

• Inherent difficulties of researching Inherent difficulties of researching galactogoguesgalactogogues

Or are we simply guessing Or are we simply guessing our target and hoping to hit our target and hoping to hit the right one?the right one?

Underlying problems may vary; does the Underlying problems may vary; does the herb even affect the problem system…herb even affect the problem system…

• 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 needTitrate to need

Dosing: No such thing as “the right amount”Dosing: No such thing as “the right amount”

• Teas • Cover to steepCover to steep• Crush seeds Crush seeds • Can use sweetenersCan use sweeteners

• Tinctures• Strengths varyStrengths vary• Some dosed by weight, others by Some dosed by weight, others by

standardsstandards

• Capsules• Check capsule size (mg/grams); Check capsule size (mg/grams);

many suggested dosages do not many suggested dosages do not specify mgs.specify mgs.

Best reference aidBest reference aidHerb ratings:Herb ratings:AA- no safety issues identified;

generally considered safe when used appropriately

BB- May not be appropriate for self-use by some individuals, or may cause side-effects if misused. Seek reliable safety and dose info.

CC- Moderate potential for toxicity, mainly dose related

DD- Use only with supervision of knowledgeable physician

EE- Avoid. Toxic plant with no justifiable medical use. By Sheila Humphrey RN IBCLC

Better known herbs Better known herbs reputed to be galactogoguesreputed to be galactogogues

Anise seed (B) Pimpinella anisum

NOT star anise

• Actions: anti-spasmodic, anti-spasmodic, mildly estrogenic, expectorant, mildly estrogenic, expectorant, carminative, aromatic carminative, aromatic (Handout: Indexing Herbs by Action)

• May also be helpful for MERMay also be helpful for MER• Parts used: seedParts used: seed

“Culinary use”

• Safety: USA:USA: GRAS GRAS

UK:UK: General sales list General sales listCanada: approved as an OTC drugCanada: approved as an OTC drugFrance:France: Traditional Medicine Traditional MedicineGermany:Germany: Comm E approved as an OTC Comm E approved as an OTC

• Not for use in pregnancyNot for use in pregnancy

• Tea: 1-2 tsp crushed seeds in 1 c Tea: 1-2 tsp crushed seeds in 1 c water, cover & steep 10-20min, water, cover & steep 10-20min, 3-6x/day.3-6x/day.

• Tincture: 3ml 2-3x/dayTincture: 3ml 2-3x/day

culinary use…culinary use…• Caraway seed (A)

• Actions: appetite stimulant, appetite stimulant, anti-spasmodic, anti-spasmodic, expectorant, carminative, expectorant, carminative, emmenagogue, astringentemmenagogue, astringent

• Parts used: seedParts used: seed• Has been used for infant Has been used for infant

coliccolic• Safety: considered safe by considered safe by

FDAFDA• Often combined with other Often combined with other

herbsherbs• Tea: 1-2 tsp/5oz water, Tea: 1-2 tsp/5oz water,

steep 10-20 min, 5-6x/daysteep 10-20 min, 5-6x/day• Tincture: 3ml TIDTincture: 3ml TID

Carum carvi

Coriander- Coriandrum sativum

• Seed of cilantro plantSeed of cilantro plant• Popular galactogogue Popular galactogogue

among Chinese and among Chinese and Indian mothersIndian mothers

• Diuretic, nutritive, Diuretic, nutritive, anti-flatulent, anti-anti-flatulent, anti-diabetic (mild)diabetic (mild)

• 1 heaping T seeds to 1 heaping T seeds to 1 mug of hot water, 1 mug of hot water, steep 10-15 min, take steep 10-15 min, take 3-5x per day. Can 3-5x per day. Can sweeten as desired.sweeten as desired.

culinary use…culinary use…Dill (A)- Anethum graveolens

• Actions: anti-spasmodic, anti-spasmodic, diuretic, carminative, diuretic, carminative, emmenagogue, anti-emmenagogue, anti-inflammatory, aromaticinflammatory, aromatic

• Parts used: seedParts used: seed• Used in “gripe water”Used in “gripe water”• May help with MERMay help with MER• Contraindicated for low Contraindicated for low

sodium dietssodium diets• Often combined with other Often combined with other

herbsherbs

Dill Dill culinary useculinary use

• Tea: 2 tsp/8oz Tea: 2 tsp/8oz water, steep 10-water, steep 10-15 min, 2-3x/day15 min, 2-3x/day

• Decoction: Steep Decoction: Steep ½ c dill seeds in ½ c dill seeds in water overnight; water overnight; boil until very boil until very dark in color, dark in color, strain. Drink one strain. Drink one cup of this a day.cup of this a day.

• 2 tsp seeds on 2 tsp seeds on mealmeal

culinary use…culinary use…Fennel Seed (A) Hale L4Fennel Seed (A) Hale L4Foeniculum vulgareFoeniculum vulgare

• Actions: Liver, anti-spasmodic, Liver, anti-spasmodic, diuretic, aromatic, estrogenic diuretic, aromatic, estrogenic (weak)(weak)

• Parts used: seedParts used: seed• Note: has toxic look-alike Note: has toxic look-alike

relatives!relatives!• For gastrointestinal disordersFor gastrointestinal disorders• One source suggests may One source suggests may

promote milk ejection; another promote milk ejection; another suggest may have bust-suggest may have bust-enhancing propertiesenhancing properties

• Also studied for anti-hirsutism Also studied for anti-hirsutism propertiesproperties

• Possible side effects: allergic reactions, Possible side effects: allergic reactions, dermatitis. dermatitis. FennelFennel oil oil can be toxic. Avoid.can be toxic. Avoid.

• Hale: L4 due to concerns regarding Hale: L4 due to concerns regarding estrogenic property effects on lactationestrogenic property effects on lactation

• Safety:Safety: One European case report of 2 One European case report of 2 infants who reportedly became weak and infants who reportedly became weak and lethargic when mom ingested 2 lethargic when mom ingested 2 qtsqts of tea of tea daily made from fennel, licorice, galega. daily made from fennel, licorice, galega. However, plants never ID’d.However, plants never ID’d.

• Not recommended during pregnancyNot recommended during pregnancy

culinary use…culinary use…

culinary useculinary use

• Tea: 1-3 tsp freshly Tea: 1-3 tsp freshly crushed seeds per crushed seeds per 8oz water, steep 10-8oz water, steep 10-15 min, 2-6x/day15 min, 2-6x/day

• Tincture: 3ml X 3Tincture: 3ml X 3

culinary use…culinary use…Fenugreek (B) Hale L3Trigonella foenum-graecum

• Actions: Stimulate breast Stimulate breast growthgrowth,, digestive aid, digestive aid, hypoglycemichypoglycemic, expectorant, , expectorant, emmenagogue, anti-emmenagogue, anti-inflammatory, hypotensive, inflammatory, hypotensive, demulcent, diaphoreticdemulcent, diaphoretic

• Parts used: seedParts used: seed

• Source of iron?Source of iron?

• May have hypotensive and thyroid May have hypotensive and thyroid supporting propertiessupporting properties

• Most studied of all lactogenic herbsMost studied of all lactogenic herbs

• U.S. listed GRAS (generally U.S. listed GRAS (generally regarded as safe) when used in regarded as safe) when used in moderationmoderation

• Mother’s sweat and urine usually smell like Mother’s sweat and urine usually smell like maple syrup maple syrup

• Possible side effects: diarrhea (mother or Possible side effects: diarrhea (mother or baby), stomach upset, hypoglycemia, baby), stomach upset, hypoglycemia, allergy. Could worsen asthma. allergy. Could worsen asthma. Contraindicated for pregnancy. May lower Contraindicated for pregnancy. May lower cholesterol.cholesterol.

• Research Issues:Research Issues:• Difficult to create placeboDifficult to create placebo• Form/brand to testForm/brand to test• Ethics of withholding helpEthics of withholding help

culinary useculinary use……

Dosage: • Capsules: 2-4 540-650mg caps Capsules: 2-4 540-650mg caps

3-4x day 3-4x day • Max 6gms/day (Frank Nice) BUT Max 6gms/day (Frank Nice) BUT

some people have used up to some people have used up to 4 qid 4 qid

• Tea: 1 tsp seeds/8oz water, Tea: 1 tsp seeds/8oz water, steep steep

5-10 min, x2-3. If seeds crushed, 5-10 min, x2-3. If seeds crushed, use ¼ tsp use ¼ tsp

• Tincture: 1-2ml TIDTincture: 1-2ml TID• Often combined with Blessed Often combined with Blessed

ThistleThistle

Shatavari (B) • 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

H.S. Puri, 2003- Rasayana: H.S. Puri, 2003- Rasayana: Ayurvedic herbs for Longevity & RejuvenationAyurvedic 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

• 1-2 tsp root powder 1-2 tsp root powder stirred into warm stirred into warm milk 1-2x a daymilk 1-2x a day

• OrOr one capsule one capsule twice a daytwice a day

• Considered safe Considered safe for pregnancy and for pregnancy and lactationlactation

Alfalfa (A-plant) Medicago sativa

• Actions: estrogenic (weak), estrogenic (weak), nutritive, may stimulate nutritive, may stimulate appetite.appetite.

• Parts used: leavesParts used: leaves• Nutrition: High in chlorophyll Nutrition: High in chlorophyll

beta carotene, calcium. beta carotene, calcium. Contains vitamins Contains vitamins A,B1,B6,B12,C,E, K1 along A,B1,B6,B12,C,E, K1 along with potassium, with potassium, phosphorus, iron and zinc. phosphorus, iron and zinc.

Non-culinary herbal galactogogues

•

non-culinarynon-culinary

• Said to increase supply in cowsSaid to increase supply in cows• Report of presence of “TRH-like material” which Report of presence of “TRH-like material” which

may in turn stimulate prolactin releasemay in turn stimulate prolactin release• Possible diuretic and pituitary function support Possible diuretic and pituitary function support

propertiesproperties• Possible side effects: allergies, diarrhea. May Possible side effects: allergies, diarrhea. May

lower cholesterol.lower cholesterol. Avoid with lupus or rheumatoid arthritis.

Dosages• 1-2 tablets or capsules 1-2 tablets or capsules

3-4x/day3-4x/day• Tea: 1-2T dried Tea: 1-2T dried

leaves/5oz water leaves/5oz water 2-4x/day2-4x/day

• Tincture: ½- 4ml 4x/dayTincture: ½- 4ml 4x/day• 1T dried juice powder 1T dried juice powder

2x/day2x/day• Homeopathic alfalfa: 6 Homeopathic alfalfa: 6

tablets per day tablets per day (KM)(KM)• Can be combined with Can be combined with

homeopathic homeopathic Lactuca virosaLactuca virosa

Cnicus benedictusCnicus benedictusBlessed Thistle (B) Hale L3

• Actions: appetite stimulant appetite stimulant and digestive aid, hormone and digestive aid, hormone balancer, cholagoguebalancer, cholagogue

• Parts used: leaf, stem, Parts used: leaf, stem, flowerflower

• Often used in conjunction Often used in conjunction with fenugreekwith fenugreek

• Reputed to “increase the Reputed to “increase the flow of milk”flow of milk”

• Avoid during pregnancyAvoid during pregnancy• Safety: considered nontoxicSafety: considered nontoxic

non-culinarynon-culinary

Dosage:• Tea 1-2 tsp crushed seeds Tea 1-2 tsp crushed seeds

in 5oz water (bitter) in 5oz water (bitter) 5-6x/day5-6x/day

• Tincture: 1-3mls 2-4x/dayTincture: 1-3mls 2-4x/day

• 1-3 caps (250-300mg) 1-3 caps (250-300mg)

3x/day when combined 3x/day when combined with fenugreek or up to 6g with fenugreek or up to 6g total if used alone total if used alone (per (per Commission E)Commission E)

non-culinarynon-culinaryBorage - Borage - Borago officinalisBorago officinalis

• Actions: diuretic, diuretic, expectorant, anti-expectorant, anti-inflammatory, nervine, inflammatory, nervine, demulcent, diaphoretic, demulcent, diaphoretic, tonic, mucilaginoustonic, mucilaginous

• Parts used: leaf, flowerParts used: leaf, flower• Nutrition: potassium, Nutrition: potassium,

calcium; oil rich in omega calcium; oil rich in omega 3 fatty acids3 fatty acids

• Oil (A) reputedly Oil (A) reputedly increases creaminess increases creaminess of milk of milk

• 2-5ml x3 OR2-5ml x3 OR• 1000mg 1-4x/day1000mg 1-4x/day• Leaves (C)Leaves (C) reputed to reputed to

help milk supply, but help milk supply, but must be usedmust be used judiciouslyjudiciously as large as large amounts can cause liver amounts can cause liver damagedamage

• 2 tsp dried herb x32 tsp dried herb x3

non-culinarynon-culinaryChasteberry - Vitex agnus castus (B)

• Actions: Hormone balancer,Hormone balancer, tonictonic

• Reputed to “normalize” pituitary Reputed to “normalize” pituitary function, used for luteal phase function, used for luteal phase insufficiency (“shift” in ovarian insufficiency (“shift” in ovarian hormones in favor of hormones in favor of progesterone), irregular cycles, progesterone), irregular cycles, PMS. Promotes fertility. May PMS. Promotes fertility. May help MER?help MER?

• Parts used: fruit

• Sometimes used for PCOSSometimes used for PCOS

• Reputed to “modulate” Prolactin Reputed to “modulate” Prolactin levelslevels

• 1943 Study found increase in milk 1943 Study found increase in milk

production in 80% of 125 patients.production in 80% of 125 patients.

• 1957 controlled trial of 817 1957 controlled trial of 817 patients claimed that avg milk patients claimed that avg milk production 3X that of controlsproduction 3X that of controls

Conflicting info: • ““May bring on milk flow May bring on milk flow early” if used in pregnancy. early” if used in pregnancy. • hypoprolactinemic agent, hypoprolactinemic agent, suppressed lactation in ratssuppressed lactation in rats• In men, small dose In men, small dose

(120mg/day) increased PRL (120mg/day) increased PRL

while large dose while large dose (500mg)(500mg)

inhibited it.inhibited it.• May take time for effects May take time for effects

to kick in?to kick in?

• May interfere with May interfere with ReglanReglan

• Tea: 1 tspTea: 1 tsp ripe ripe berries infused in 8oz berries infused in 8oz water 10-15 min; water 10-15 min; drink 3x/day (bitter)drink 3x/day (bitter)

• Capsules: 2-“00” per Capsules: 2-“00” per day or 30-40mg/day day or 30-40mg/day (Humphrey)(Humphrey)

• Tincture: 1ml x3 or Tincture: 1ml x3 or up to 5mls daily (1:5 up to 5mls daily (1:5 conc)conc)

non-culinarynon-culinaryGoat’s Rue (B) – Galega Officinalis

• Actions: stimulate breast stimulate breast growth;growth; milk; diuretic; milk; diuretic; hypoglycemic; hypoglycemic; emmenagogue; emmenagogue; diaphoretic;diaphoretic;

• Parts used: dried aerial Parts used: dried aerial partsparts

• Contains galegin, upon upon which phenformin was which phenformin was basedbased

• Reputation for causing Reputation for causing breast growthbreast growth

• French dairy farmers French dairy farmers noted 35-50% increase in noted 35-50% increase in output of milk in their output of milk in their herdsherds

• Popular among French Popular among French nursing mothersnursing mothers

• Controversy: toxicity in sheepControversy: toxicity in sheep• No reports of problems in

human use• Peripheral Receptor Peripheral Receptor

Sensitizer?Sensitizer?

Goat’s RueGoat’s Rue

• Dosage: No consensus, but consider taking with food

• Tea: 1 tsp leaves/5-8oz water, Tea: 1 tsp leaves/5-8oz water,

steep 10-20 min, 3-5x/daysteep 10-20 min, 3-5x/day• Tincture: Tincture:

• 2.5ml X 4 (Wise Woman Herbal)2.5ml X 4 (Wise Woman Herbal)• 3-4ml x 4 (Mechell Turner)3-4ml x 4 (Mechell Turner)• 1-2ml x3 (MotherLove) 1-2ml x3 (MotherLove) • 1 tsp in 8oz water TID (LowDog)1 tsp in 8oz water TID (LowDog)

• Capsule: 1 cap 4x/day (Motherlove)Capsule: 1 cap 4x/day (Motherlove)

non-culinarynon-culinaryIxbut- Euphorbia lancifolia (C)

• From From IxIx (woman) and (woman) and butbut

(increase in flow or (increase in flow or volume)volume)

• Ancient Mayan Ancient Mayan galactogogue used when galactogogue used when milk supply insufficient. milk supply insufficient.

Popular back in the 1940’s, still occasionally used by Popular back in the 1940’s, still occasionally used by rural women in Guatemala. Also found in SE Mexico, rural women in Guatemala. Also found in SE Mexico, Belice, El Salvador and Honduras.Belice, El Salvador and Honduras.• ““Said to double the quantity of milk given by cows that Said to double the quantity of milk given by cows that eat it.“eat it.“ High amounts appeared to cause decrease after High amounts appeared to cause decrease after several days…….several days……. Moderation important? Moderation important?

ixbutixbut• 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 branchletsAerial parts used– leaves and branchlets• Typical “dose” tea made from 5 leaves or sections Typical “dose” tea made from 5 leaves or sections of stem (~ 5gms) and 1 cup of water, 3x/dayof stem (~ 5gms) and 1 cup of water, 3x/day• Dehydrated leaves high in calcium?• Pozo 1949 study: no changes in breast volume or Pozo 1949 study: no changes in breast volume or milk composition noted, only milk volume.milk composition noted, only milk volume.• Galactagogue properties appear higher in November before plant blossomed• Euphorbia family (esp. hirta) has many reputed Euphorbia family (esp. hirta) has many reputed galactagogues,galactagogues, but toxicity concerns have precluded common use

Althaea officinalisAlthaea officinalisMarshmallow root (A)

• Actions: diuretic; expectorant; diuretic; expectorant; anti-inflammatory; demulcent; anti-inflammatory; demulcent; mucilaginousmucilaginous

• Parts used: root and leafParts used: root and leaf• Nutrition: calciumNutrition: calcium• Galactogogue effect not direct, Galactogogue effect not direct,

perhapsperhaps synergistic;synergistic; one one herbalist uses it “when baby herbalist uses it “when baby isn’t gaining weight well”isn’t gaining weight well”

• May help counteract loose May help counteract loose bowel effects of alfalfa, bowel effects of alfalfa, fenugreek, blessed thfenugreek, blessed th

• Tea:Tea: 1T root 1T root powder/ 5oz powder/ 5oz water, let stand water, let stand 30 min; drink 30 min; drink immediately.immediately.

• Tincture:Tincture: 1-4 ml 1-4 ml 3x/day3x/day

• Capsules:Capsules: up to up to 4 caps 3x daily4 caps 3x daily

Silybum marianumSilybum marianumMilk Thistle (A) • Actions: Liver, Liver,

demulcent; cholagoguedemulcent; cholagogue• Contains silibinin, Contains silibinin,

silydianin, silychristinsilydianin, silychristin• Parts used: seeds or Parts used: seeds or

leavesleaves• Mechell Turner says

leaves are used for milk supply

• Possible side effects: Possible side effects: mild laxative effect, mild laxative effect, diarrhea, mild allergen. diarrhea, mild allergen.

Milk thistleMilk thistle

• Tea:Tea: 1 tsp 1 tsp freshly crushed freshly crushed seeds in 5oz seeds in 5oz water, steep 20-water, steep 20-30 min. 5-6x/day30 min. 5-6x/day

• Tincture:Tincture: 3-5ml 3-5ml 3x/day 3x/day

• Capsules:Capsules: two two 500mg 3x/day500mg 3x/day

Urtica dioica, urensUrtica dioica, urens• Nettle (A) • Actions: astringent, astringent,

diuretic, tonic, diuretic, tonic, hypotensive.hypotensive.

• Parts used: aerial partsParts used: aerial parts• For gastrointestinal For gastrointestinal

disordersdisorders• High in chlorophyll; also High in chlorophyll; also

Vit C, iron Vit C, iron• Possible side or Possible side or

overdose effects: overdose effects: gastritis, edema, burning gastritis, edema, burning sensation of skinsensation of skin

• Tea:Tea: 2-3 tsp herb 2-3 tsp herb in 1c water; in 1c water; steep 10 min, steep 10 min, 2-3x/day2-3x/day

• Leaf TinctureLeaf Tincture 2.5-5ml 3x/day2.5-5ml 3x/day

• Capsules:Capsules: 1-2 1-2 300mg 3x/day300mg 3x/day

non-culinarynon-culinary• Red Clover (B)

Trifolium pratense

• Actions: anti-spasmodic; Actions: anti-spasmodic; expectorant; estrogenic expectorant; estrogenic (weak) stomachic; (weak) stomachic; cholagoguecholagogue

• Parts used: flower headParts used: flower head• Use in pregnancy Use in pregnancy

considered controversialconsidered controversial• Use non-fermented onlyUse non-fermented only

DosageDosage• Tea: 1-3 tsp herb Tea: 1-3 tsp herb

in 5oz water; in 5oz water; 3x/day3x/day

• Tincture: 2-6 ml Tincture: 2-6 ml 3x/day3x/day

non-culinarynon-culinary• Red Raspberry (A) Rubus idaeus

• Astringent, tonic, parturientAstringent, tonic, parturient• Parts used: leaves, fruitParts used: leaves, fruit• Nutrition: vitamin A, B complex, Nutrition: vitamin A, B complex,

C, E, calcium and iron, C, E, calcium and iron, phosphorous, potassium. phosphorous, potassium.

• Galactogogue effect uncertain; Galactogogue effect uncertain; one source says it is believed to one source says it is believed to lower supply long term, but may lower supply long term, but may help if used short term (<1wk)help if used short term (<1wk)

• Other sources say it “increases Other sources say it “increases the flow” and “enriches” the milk, the flow” and “enriches” the milk, use tea to aid milk ejectionuse tea to aid milk ejection

• Tea: 1 tsp leaves/5oz water, steep 5-10 min, 2-4x/dayTea: 1 tsp leaves/5oz water, steep 5-10 min, 2-4x/day• Tincture: 3-4mls 3x/dayTincture: 3-4mls 3x/day• Capsules: 3-300mg caps 3x/dayCapsules: 3-300mg caps 3x/day

• Historical use includes for Historical use includes for treatment of “underdeveloped treatment of “underdeveloped breasts,” “a galactia;” “increased breasts,” “a galactia;” “increased lactation;” “breast enlargement.”lactation;” “breast enlargement.”

• Parts used: fruitParts used: fruit• Nutrition: The leaves have a very Nutrition: The leaves have a very

high content of vitamin A as well high content of vitamin A as well as moderate amounts of vitamin as moderate amounts of vitamin D, vitamin C, various B vitamins, D, vitamin C, various B vitamins, iron, silicon, magnesium, zinc, iron, silicon, magnesium, zinc, and manganese. and manganese. 

Saw Palmetto (A) Saw Palmetto (A) Serenoa repensSerenoa repens

• Dosage (general)• 320mg daily320mg daily• tinc: 1-2ml 3x/daytinc: 1-2ml 3x/day• tea: ½-1 tsp berries in tea: ½-1 tsp berries in

1c water, simmer 5 min, 1c water, simmer 5 min, drink 3x/day drink 3x/day

non-culinarynon-culinary• Vervain: Verbena officinalis (B)

• Actions: nervine, anti-spasmodic, Actions: nervine, anti-spasmodic, diaphoretic, hypotensive, hepaticdiaphoretic, hypotensive, hepatic

• Reputedly oxytocic and uterotonicReputedly oxytocic and uterotonic• Parts used: aerial partsParts used: aerial parts• More often found in combinationsMore often found in combinations

• Dosage:Dosage:• Considered safe in appropriate Considered safe in appropriate

dosages; not for pregnancydosages; not for pregnancy• Tea: 1 tsp per 5oz water steep 5-Tea: 1 tsp per 5oz water steep 5-

10 min, drink 3x/day10 min, drink 3x/day• European Infusion: 30-60g herb in European Infusion: 30-60g herb in

1 qt boiling water; steep 10-15 min1 qt boiling water; steep 10-15 min• Tincture: 2-4ml 3x/dayTincture: 2-4ml 3x/day

Others on the horizonOthers 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

Commercially available herbal galactogogue Commercially available herbal galactogogue tincturestinctures

• 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 More Milk Special Blend

(Motherlove Herbal): adds goat’s (Motherlove Herbal): adds goat’s rue to More Milk Plus (1:5)rue to More Milk Plus (1:5)

• More Milk Two (Motherlove Herbal) : Raspberry leaf, Nettle, Alfalfa. Considered safe for use during pregnancy.

Mother’s LactaflowMother’s Lactaflow (Wise Woman (Wise Woman Herbals)Herbals)

• Fennel• Blessed thistle• Fenugreek• Goat’s rue

Suggested dosage Suggested dosage 30-40 drops 3-4x30-40 drops 3-4x per dayper day

other combinations…

Commercial Tinctures….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

Nursing Mother’s Blend (Kerry’s Herbals)

• Fenugreek • Blessed Thistle • Goat's Rue • Alfalfa • Anise

Abundant Milk Tincture (Growing Life)•Blessed thistle Blessed thistle •Fennel Fennel •Fenugreek Fenugreek •PeppermintPeppermint •Lemon grassLemon grass

Commercial tincturesCommercial 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.

Commercial tincturesCommercial tinctures

• Mega Milk FormulaMega Milk Formula (B&BR): Blessed Thistle, Borage, Red Raspberry. For those who don’t want fenugreek.

• Anti-Puffy FormulaAnti-Puffy Formula (B&BR): Dandelion, Cornsilk. For postpartum edema.

• Let-down FormulaLet-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

Combination Galactogogues in Combination Galactogogues in CapsulesCapsules

More Milk Plus

• Fenugreek, blessed thistle, nettle, fennel

• Dosage: 1 capsule QID or 2 caps TID if >175lbs or not working well after 48 hrs

“Lactation Blend” (Vitanica**) • Fennel Seed -------------------------100 mg • Nettles Leaf -------------------------- 70 mg • Blessed Thistle---------------------- 70 mg • Vervain---------------------------------- 70 mg • Hops------------------------------------- 45 mg • Oat Straw------------------------------ 45 mg • Raspberry Leaf----------------------- 40 mg • Goat's Rue aerial parts------------ 40 mg • Chaste tree berry-------------------- 35 mg • Fenugreek Seed--------------------- 25 mg • Milk Thistle Seed-------------------- 20 mg • Borage Seed Oil--------------------- 20 mg • Borage Flower & Top-------------- 10 mg TOTAL mg per capsule 590 mgTOTAL mg per capsule 590 mg *Recommended dosage 1-2 caps per dayRecommended dosage 1-2 caps per day **formulated by Dr. Tori Hudson, Naturopath**formulated by Dr. Tori Hudson, Naturopath

capsules…capsules…

Baby Me Now Lactation Ease (Solaray)

• Fenugreek, fennel, nettle

• Mfr reputation?????

Nonichai• Noni (leaves)• Cardamom (seed)• Marshmallow herb (root)• Fennel (seed)• Fenugreek (seed)

Dosage: 2 capsules per day

??????

Gactogogue TeasGactogogue 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. Milder than tinctures, usually taken as 1-4 cups a day. Katherine Shealy finds 8 cups a day very effective.Katherine Shealy finds 8 cups a day very effective.–Tasty iced tea version: 6 bags MMT + 4 bags Tasty iced tea version: 6 bags MMT + 4 bags Celestial Seasonings Wild Berry Zinger to make 3 qts Celestial Seasonings Wild Berry Zinger to make 3 qts tea; place in water bottles and sip throughout day.tea; place in water bottles and sip throughout day.

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 Combine one level 5ml teaspoon to 1 cup of cold 5ml teaspoon to 1 cup of cold water and bring to the boil. water and bring to the boil. Simmer for one minute, steep 5 Simmer for one minute, steep 5 minutes.minutes.

• Directions 2:Directions 2: 1 tea bag to a cup 1 tea bag to a cup of boiling water, cover and of boiling water, cover and steep 5 minutes. steep 5 minutes.

• Drink 3 cups a day or as Drink 3 cups a day or as directed by your naturopath.   directed by your naturopath.  

swissswiss

U.S.

• Fennel, fenugreek, anise, chamomile, lavendar

• Directions:Directions: pour 8 oz pour 8 oz boiling water over one boiling water over one tea bag and steep for 5 tea bag and steep for 5 to 10 minutes. Gently to 10 minutes. Gently squeeze each tea bag squeeze each tea bag to fully release the to fully release the active ingredients.active ingredients. Drink Drink 2 cups daily to maintain 2 cups daily to maintain milk production or 1 cup milk production or 1 cup every 3 hours to every 3 hours to stimulate milk flow. stimulate milk flow.

Yogi Tea – Woman’s Nursing Mom

other combinations….other combinations….

• Abundant Milk Tea (Growing Life)Blessed thistle, fennel, Blessed thistle, fennel, fenugreek, fenugreek, peppermintpeppermint, , lemon grasslemon grass

• “Lactare” from India• Asparagus RacemosusAsparagus Racemosus

(Shatavari) 200mg• Withania SomniferaWithania Somnifera

(Ashwagandha) 100mg• Glycyrrhiza glabraGlycyrrhiza glabra

(European Licorice) 50mg• FenugreekFenugreek 50mg• Allium sativumAllium sativum (garlic) 20

mg• Directions: 2 caps TID for first 14 Directions: 2 caps TID for first 14

days after delivery or as neededdays after delivery or as needed• Studies cited showing Lactare

increases prolactin, milk production, creaminess of milk

HomeopathicsHomeopathics• Based on the Law of Similars, or “like treats

like.” Counter-intuitive to western thought.• Classical approach takes in-depth Classical approach takes in-depth

consititutional history and chooses one consititutional history and chooses one remedy onlyremedy 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 The greater the dilution, the more potent it is consideredconsidered

• Best results when prescribed by practitioner rather than self-diagnosis

Advice from herbalist Mechell Turner, IBCLC: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 Put the dose—usually 1 tablet or drop—into the lid of the bottle, or even a clean paper cup. (Often lid of the bottle, or even a clean paper cup. (Often placed under tongue for quick absorption)placed under tongue for quick absorption)

• Take the remedy only for the symptoms.• If symptoms get worse, stop the dosage.If symptoms get worse, stop the dosage.• Administer less frequently as symptoms improve.• Usually do not take medicine for longer than 3 Usually do not take medicine for longer than 3

days.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 Take the smallest dose for the shortest period of

time.time.

Homeopathics more commonly Homeopathics more commonly used for low milk supplyused 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 Suggested dosage 4 (30c) pellets QID

or 2 (30c or 200c) BIDor 2 (30c or 200c) BID

• *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)Suggested dosage: 2 (6x) tablets TID tablets TID (KM)(KM)

• 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)

• Dulcamara• 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.)

• Causticum• 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.

• 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 Use 4 drops sublingually before nursing

or pumpingor pumping to facilitate milk ejectionto facilitate milk ejection . . • Rescue Remedy can have a slight

sedative effect, so use caution.

Selecting galactogoguesSelecting 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?

For example:For example: (not exhaustive) (not exhaustive)• Thyroid support:Thyroid support: dandelion, chickweed,

nettle, vervain• High Iron:High Iron: alfalfa, dandelion, fenugreek,

nettle, red raspberry leaf, • Pituitary support: alfalfa, chasteberry,• Diuretic properties:Diuretic properties: alfalfa, blessed thistle,

borage, coriander, dandelion, dill, fennel seed, goat’s rue, marshmallow, nettle,

• Milk ejection:Milk ejection: anise?, chasteberry?, dill, fennel seed?, red raspberry leaf?

• Anti-hypertensive: fenugreek, nettle, vervain• Nervine:Nervine: anise, borage, fennel seed, vervain

• 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

Case StudiesCase 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~

Case 2: Break through experienceCase 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)

• 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.

• 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/dayMom reports taking both herbs 8-10x/day• Baby breastfeeds 30 min total• Pumping 6-7x/day, 20-35ccs ea• Continue plan

• 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!104ccs!• AIM down• Mom taking herbs 10-12x/day + MM tea• Mom also reported some vaginal

bleeding

• Baby eventually rejected supplements; gain average .5oz/day. Solids started late due to paternal preference.

• New pregnancy @ 7 mosNew pregnancy @ 7 mos;; baby #1 breastfed 6 mos into new pregnancy

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

• Interesting stuffInteresting 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% overallSupply was ~95% overall• Baby #3……..Baby #3……..

Web ResourcesWeb Resources• KellyMom.com-

http://www.kellymom.com/herbal/milksupply/herbal_galactagogue.html

• LowMilkSupply.org http://lowmilksupply.org/increasingmilk-galactagogues.shtml

• Birth and Breastfeeding: http://www.birthandbreastfeeding.com/• Mongraphs by D. Hoffman, Herbal Materia Medica: http://www.healthy.net/clinic/therapy/herbal/herbic/herbs/• Longwood herbal task force: http://www.longwoodherbal.org/• Saw palmetto: http://www.sawpalmetto.com/history.html• Napralert: http://www.napralert.org/

MOBI: http://www.mobimotherhood.org/MM/article-diet.aspx

Breastfeeding & herbs discussion group:Breastfeeding & herbs discussion group: http://health.groups.yahoo.com/group/Bfg-HerbsDiscussion/