by on July 3, 2014

in Uncategorized

The use of herbs during breastfeeding has become increasingly popular. Yet many doctors remain unaware that mothers use herbs while breastfeeding, because they only inquire about the use of pharmaceutical products.

One of the main motives for using herbs during lactation is to increase milk production. Herbs that are taken for this purpose are known as galactogogues.

Hippocrates, considered by many to be the father of medicine, suggested that “If the milk should dry up…give her to drink the fruit and roots of fennel”

Galactogogues include herbs such as: fenugreek seed, fennel seed, anise seed, goat’s rue herb, nettle leaf, alfalfa herb, marshmallow root, caraway seed, blessed thistle seed and torbangum herb.
Herbs contain numerous physiologically active constituents in relatively small amounts. The same chemical principles that govern medications and food may be at work when lactating mothers use herbal products.

Many of these herbs have not been adequately studied for its safety and efficiency.
Fenugreek (Trigonella foenum-graecum) is generally regarded as safe by the FDA. Fenugreek is a popular cooking spice in India and the Middle East and it is traditionally used as a galactogogue.
In one study when lactating mothers took 3 capsules three times a day there was an increase in the mean daily milk volume from 207 ml per day in week one to 464 ml per day in week two (Pediatrics In Review, August 2013)

Adverse effects related to the use of fenugreek are diarrhea and abdominal discomfort. In addition, fenugreek can impart a maplelike odor to sweat, milk and urine. This has led to the misdiagnoses of maple syrup disease, a metabolic condition that affects newborns. The high fiber content of the seeds may also predispose infants to a lowering of their blood glucose.
There are a few case reports of a fenugreek allergy where it was thought that it cross-reacted with peanut allergens.

In addition to using herbs to increase milk production, some lactating women also use it to treat breast engorgement, mastitis and other conditions unrelated to breastfeeding.

It is thought that post-partum depression occurs in close to 20% of women and some moms may use St John’s wort (SJW) to treat their depression. This herbal product is generally regarded as safe, although some experts debate its efficacy.

SJW has no clinically significant impact on milk production and there are a few case reports of infants whose mothers were using SJW having colic, drowsiness and lethargy.

Garlic is a popular medicinal herb used to lower blood pressure, to relieve symptoms of colds and flu and to function as a gut antimicrobial. It does not increase milk production, but in one study infants were attached longer to the breast in mothers who consumed garlic. In the same study garlic did not cause an increase in colic.

Some lactating moms use senna leafs to treat their constipation. Senna is thought to add bulk to the stool and to stimulate intestinal mobility. Senna is generally regarded as safe and the American Academy of Pediatrics (AAP) lists senna as a product compatible with breastfeeding. It may cause mild abdominal cramps in mothers but it has no impact on the fecies of the nursing baby.

Lactating moms should be aware that a number of herbal beverages contain caffeine which can cross from the mom into her baby. Mothers who drink coffee, tea, kola nut, yerba mate and guarana may expose their babies to caffeine which is found in breast milk at close to 50% of the maternal serum concentration.

Newborns do not have the enzymes needed to metabolize caffeine until several days after their birth. The metabolic half-life in newborns is three days and if a mom ingested herbal beverages, the infants are at risk for irritability and an increased heart rate.

Herbal preparations sold as tinctures and fluid extracts may contain alcohol which may range from 20 -90 %. These tincture products are used to treat infants who have colic or who fight colds. It should be used with caution.

One study looked at the use of Chinese herbs and the concentration of lead in breast milk. Traditional Chinese herbs included in the study were: Dong quai root, lyceum fruit, jujube fruit and shy wuh tang. The study showed that the concentration of lead in breast milk was higher in the group consuming traditional Chinese herbs compared with the control group.

Dr Tieraona Low Dog MD, a consultant at Weil Lifestyle in Arizona, co-authored a paper on the use of herbal products for the AAP’s continued education publication, Pediatrics In Review (Aug 2013) In it she notes that studies of herbs in breastfeeding mothers are limited due to the ethics involved in doing the studies. It is also complex to assess the chemical composition of breast milk before and after herb ingestion.

This may explain why numerous lactation resources have mixed reports and safety recommendations, making it confusing for both the mother and clinician.

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