Selection and Use of Galactagogues

Frank J. Nice, RPh, DPA, CPHP and Mary Francell, MA, IBCLC

Many breastfeeding mothers worry about making enough milk for their babies. Sometimes these concerns are unfounded and LLL Leaders can reassure mothers by asking about diaper (nappy) output, latching, audible swallows and weight gain and by referring them to many of our resources for further information. Leaders can provide parents with information on supply and demand, and how frequent, effective breast emptying with breast compression and massage is the first milk supply management strategy. But if there truly is a milk supply issue unrelated to management, mothers often turn to galactagogues—teas, supplements and foods that can support milk production. Pharmacist and author Dr Frank Nice discusses popular galactagogues that parents may take to try to help their milk supply.

Galactagogues may be considered to increase a milk supply when non-medical interventions do not help. Some prescription (synthetic) galactagogues typically increase prolactin levels and thus help with milk production when low prolactin is at fault, but some also help to initiate the breast milk let-down (milk ejection reflex). Multiple mechanisms may come into play and we don’t have clear information on how many herbal galactagogues work.

Synthetic galactagogues

Synthetic galactagogues include domperidone and metoclopramide (dopamine antagonists), and miscellaneous agents such as metformin. These three drugs are the most commonly used synthetic galactagogues due to their relative efficacy and safety in breastfeeding women. However, there are a number of caveats. Metoclopramide (Reglan) can have significant side effects, including depression. Metformin may help milk supply in women who have blood sugar issues, but there is no strong evidence of its efficacy. Domperidone is widely available by prescription and even over the counter in many countries. However, it has not been approved for use by the Food and Drug Administration [FDA] in the United States (USA) because the drug manufacturer did not apply for FDA approval. Clinical trials are currently underway which may change that in the future. Parents should always consult with a breastfeeding specialist such as an International Board Certified Lactation Consultant (IBCLC) if they have concerns about low milk supply, and their physician before taking any synthetic galactagogue.

Herbs and food

Many herbs and foods have been used traditionally for their lactogenic (milk-making) properties. The list is quite extensive and includes alfalfa, almonds, anise, asparagus, barley, basil, beets, black seed, borage, caraway, carrots, chaste tree fruit, cherries, chicken broth/soup/stock, chickpeas (garbanzo beans), coconut, coriander seeds, cumin, dandelion, dill, fennel, fenugreek, flax seeds, garlic, ginger, goat’s rue, green beans, hibiscus, hops, lemon balm, lentils, lettuce, malunggay (moringa), marshmallow root, millet, molasses (blackstrap), mung, mushrooms, nettle, oat straw (oats), papaya, peas, pumpkin, quinoa seeds, red clover, red raspberry, rice, sage, seaweed soup, sesame seeds, shatavari, spinach, sunflower seeds, sweet potatoes, thistles, turmeric, and vervain. Fenugreek is one of the most widely known and recommended herbal galactogogues, although there is some anecdotal evidence that it can actually decrease milk supply in some mothers.

The specific foods thought to enhance a new mother’s milk supply vary by culture. In Korea, seaweed soup is fed to mothers after birth, while new parents in India eat dal (split lentils). Lactation cookies made with oats are popular in the United States. Parents in the Phillipines, Africa and other parts of the world eat malunggay (moringa) leaves and other parts of the plant both cooked and raw. These foods tend to be nutrient dense and so can help replenish a mother’s nutrient stores regardless of whether or not they help increase breast milk.

Most knowledge of herbal use comes from the systematic collection of data in Germany by the German Commission E Monographs. While a number of research studies have been done on various combinations of herbs, few have been replicated, so we don’t know much about their effectiveness or side effects from long-term use. Herbal recommendations are generally based on anecdotal evidence of their use in various cultures.

Not all mothers have access to off-label drugs or desire to take prescription medications to increase milk supply. Galactagogue herbals are regulated by the FDA in the USA as foods and not medicines, as long as only “affects body function” claims and not “medical” claims are made. The European Union’s Committee on Herbal Medicinal Products offers three different pathways to bring herbal products to market, including one for traditional use registration. In China, herbal products are readily available through a well established system of traditional medicine. Many other countries have their own system for herbal medicine regulation.

Because there is often easier access to these types of galactagogues, it is important for consumers to be well informed and have a real need for treatment before taking any herb. Some herbs have side effects and can be contraindicated for mothers with underlying medical conditions. Parents should always check with a health professional and herbalist, or physician who practices integrative health before taking lactogenic herbs.

If at all possible, using galactogenic foods along with effective breastfeeding management is the preferred way to help maintain and increase milk supply. Food equivalent amounts of these herbals and many others can be found in the resources below.

LLL Leaders cannot recommend individual herbs or medications

LLL Leaders can provide information on galactagogues, but are not allowed to “prescribe” or advise mothers on which of them to take or eat. A mother may have a medical condition or be taking a medication that could interact adversely with the galactagogue, so we must always recommend that parents consult an individual who is knowledgeable about their’s and their baby’s medical conditions and the use of herbs beforehand. The resources below may be useful resources for a nursing mother interested in exploring lactogenic herbs or foods.

Dr. Frank J. Nice
has practiced as a consultant, lecturer, and author on medications and breastfeeding for 45 years. He holds a Bachelor’s degree in Pharmacy, a Master’s degree in Pharmacy Administration, and Masters and Doctorate degrees in Public Administration. Dr. Nice has worked for the US Public Health Service, the National Institutes of Health and the Food and Drug Administration and has published Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition, The Galactagogue Recipe Book, and Recreational Drugs and Drugs Used To Treat Addicted Mothers: Impact on Pregnancy and Breastfeeding.

Mary Francell and her husband Howard are the parents of three adult children. She has been an LLL Leader for over 25 years and is a contributing editor for Leader Today. Mary is an International Board Certified Lactation Consultant (IBCLC) in private practice in Bellingham, Washington, USA and currently serves as Associate Area Professional Liaison for LLL of Washington, USA.