Herbs to increase milk supply

Can I use herbs to increase my milk supply?

There is not enough evidence to say that herbs and other plants used by mothers to increase milk supply are safe or effective. There are sporadic reports, however, of adverse reactions in mothers, such as liver damage from kava and allergic reactions from milk thistle and fennel. There are also reports of reactions in babies, such as crying or sleepiness after their mothers took St. John’s wort. Commercial herbal preparations generally are not monitored as closely as prescription medication, and standards vary among countries. Fenugreek is often used to increase milk supply, but there are few studies on its effectiveness and some people are allergic to it. If a mother chooses to use a herb, it should be effective and safe for her and her baby. Traditional herbs and other plants used in foods may have other benefits.

A) Describing herbs and plants to increase milk supply

For millenia, herbs and other plants have been used not only as food but also as medicine and a source of well-being (medicinal plants), and evidence of their benefits is increasing. Most cultures have specific food traditions for mothers after having given birth. Studies of these have included nearly 2,000 plant species and they have shown a range of benefits, including antimicrobial, antioxidant, anti-inflammatory, pain-reducing, and anti-depressant activity (Sibeko 2021).

Some mothers have a low milk supply and wish to increase the amount of milk they make. Medicinal plants and medication can be used for this purpose (galactagogues). Before starting, it is important to ensure that: 

  • The milk supply is truly low.
  • Other approaches have been tried. 
  • The item is safe and appropriate.

Medicinal plants that have been used as galactagogues include:  

  • Fenugreek
  • Goat’s rue
  • Milk thistle
  • Oats
  • Dandelion
  • Millet
  • Anise
  • Basil
  • Blessed thistle
  • Fennel seeds
  • Gossypium
  • Marshmallow
  • Moringa leaf
  • Shatavari
  • Torbangun

There can be important differences between whole or minimally-processed medicinal plants and commercially-produced preparations (herbal preparations). If a mother chooses to use a herbal preparation, it should be effective and safe for her and her baby. More information is available on the Lactmed website (NIH).

Please consult your health-care providers before using any galactagogues. 

B) Effectiveness

There is very little current evidence that medicinal plants can increase milk supply with studies being small or based on animals and human studies missing or showing limited or no benefit (Foong 2020; Sibeko 2021). Nevertheless, by contributing to a mother’s health and well-being, traditional medicinal plants and foods may support breastfeeding indirectly. 

C) Safety of herbal preparations

1) Concerns when using herbal preparations

Using commercially-produced herbal preparations differs greatly from using whole or minimally-processed medicinal plants in foods and drinks. Herbal preparations may (Health Canada 2016):

  • Not provide any benefits as they have low amounts of the actual plant or the active agent.
  • Have an increased risk of side effects as they contain:
    • Concentrated amounts of active agent(s).
    • Unexpected and possibly toxic items.

Herbal preparations are not monitored as closely as prescription medication and monitoring and licensing standards vary among countries. Ideally, any herbal preparations used are made by a reliable manufacturer and in a country that has high standards.

2) Reported side-effects of medicinal plants and herbal preparations

Studies have reported a range of reactions in mothers using medicinal plants and herbal preparations but most are minor (Foong 2020).  

Table: Possible side effects from various herbs

One mother had signs of an inflamed liver when her blood was tested while she was using a popular tea comprised of fennel, anise, coriander, fenugreek, and blessed thistle (Silverman et al. 2018). A small study of the same product did not find any adverse effects (Wagner et al. 2018).

Some herbal preparations can increase or decrease the levels of other medication the mother may be taking. For example, milk thistle can decrease the blood levels of anti-seizure medication (phenytoin) or blood thinners (warfarin).

Most of the adverse effects have been reported in mothers, but there are also reports of reactions in babies when their mothers consumed (NIH 2019):

  • John’s wort: crying, sleepiness
  • Tea from arnica flowers: breakdown of the baby’s red blood cells
  • Tea made from licorice, fennel, anise, and goat’s rue: weakness, sleepiness, vomiting, and poor sucking

D) Fenugreek

1) Describing fenugreek

Fenugreek is a member of the Fabaceae or Leguminosae family of plants. Common names for this family are the legume, pea, or bean family. Peanuts are also in this family.

Fenugreek has been used as a medicine in Indian, Chinese, Persian, and Egyptian medicine. The fenugreek plant and its seeds are used in cooking in many areas of the world. It is common in curry and can be taken directly or as a tea.

Among mothers who come to our clinic, fenugreek is the most common herbal preparation used to increase milk supply.

2) Possible effect of fenugreek

Fenugreek may increase milk supply through its effect on the mother’s genes to increase (Sevrin 2020):

  • Milk hormone (prolactin) levels.
  • Let-down hormone (oxytocin) levels.
  • Insulin levels.
  • The amount of food eaten.
  • Breast milk components.

It may also prevent the death of milk-producing cells (Bahmani 2016).

3) Effectiveness

There are only a few studies of the effectiveness of fenugreek on increasing milk supply and these show mixed results (Brodribb 2018).

One study of mothers who had premature infants and who used fenugreek tea showed that the mothers had increased levels of prolactin and milk production in the first week after delivery, but there was no difference by eight days after delivery (Abdou 2018).

Fenugreek has been reported to increase the amount of milk made in rabbits, buffalo, goats, rats, and sheep. However the doses used varied widely and other studies showed no effect (Servin 2019).

4) Risks

If you are taking this fenugreek, you may notice your body and urine smelling a bit like curry or maple syrup.

People who are allergic to peanuts, chickpeas, soybean and related plants should avoid fenugreek.

Mothers who use fenugreek may have (NIH 2019):

  • Nausea, vomiting, and diarrhea.
  • An increased heart rate.
  • Increases in blood pressure
  • Liver damage and enlargement.
  • Allergic reactions.
  • A worsening of their asthma.
  • Decreases in the levels of potassium in their blood.
  • Severe skin reactions (toxic epidermal necrolysis).
  • Lowering of their blood sugar.
  • Interactions with the blood thinner warfarin causing increased bleeding.

5) Use

Mothers who choose fenugreek should ensure that it is effective and they do not have any side effects.

Capsules generally contain 600 milligrams. Typical doses are 1 to 2 capsules 3 times each day. Mothers may wish to start with lower doses to see how they tolerate it.

E) Moringa

Moringa oleifera (moringa) is a tree that is widely cultivated in the tropics. Its leaves are used in various soups and dishes and are popular for increasing milk supply in Asia, especially in the Philippines, where it is called malunggay. It contains vitamins, minerals, and other nutrients.

There is very little information about its effectiveness or about the safety of moringa in breastfeeding babies. There is a small amount of research showing it is effective in increasing milk supply (Estrella et al. 2000; Raguindin 2014). It has been reported to cause low blood sugar levels and sleepiness (McGuire 2018). One small study (Estrella 2000) showed no ill effects in mothers taking moringa.

Moringa leaves can be dried and taken in capsule form. Commonly used doses are around 1000 mg taken three times each day.

References

Abdou RM, Fathey M. Evaluation of early postpartum fenugreek supplementation on expressed breast milk volume and prolactin levels variation. Egyptian Pediatric Association Gazette 2018;66(3):57-60

Bahmani M, Shirzad H, Mirhosseini M, et al. A Review on Ethnobotanical and Therapeutic Uses of Fenugreek (Trigonella foenum-graceum L). J Evid Based Complementary Altern Med. 2016 Jan;21(1):53-62

Brodribb W. ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018. Breastfeed Med. 2018 Jun;13(5):307-314
 
Co MM, Hernandez EA, Co BG. A comparative study on the efficacy of the different galactogogues among mothers with lactational insufficiency. Presented at the American Academy of Pediatrics Section on Breastfeeding. 2002;NCE. Abstract.
 
Estrella MCP, Mantaring J, David GZ. A double-blind, randomized controlled trial on the use of malunggay (Moringa oleifera) for augmentation of the volume of breastmilk among non-nursing mothers of preterm infants. Philipp J Pediatr. 2000;49:3-6

Foong SC, Tan ML, Foong WC, et al. Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants. Cochrane Database Syst Rev. 2020 May 18;5:CD011505 

Health Canada, Drugs and Health Products, Natural and Non-prescription Health Products Directorate. About Natural Health Products. Ottawa: Health Canada;2016 Mar 14 [cited 2017 dec 3]

McGuire TM. Drugs affecting milk supply during lactation. Aust Prescr. 2018 Feb;41(1):7-9

Raguindin PF, Dans LF, King JF. Moringa oleifera as a Galactagogue. Breastfeed Med. 2014 Jul-Aug;9(6):323-4

Sachs HC; Committee On Drugs, American Academy of Pediatrics. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809

Sevrin T, Boquien CY, Gandon A, et al. Fenugreek Stimulates the Expression of Genes Involved in Milk Synthesis and Milk Flow through Modulation of Insulin/GH/IGF-1 Axis and Oxytocin Secretion. Genes (Basel). 2020 Oct 16;11(10):E1208

Sibeko L, Johns T. Global survey of medicinal plants during lactation and postpartum recovery: Evolutionary perspectives and contemporary health implications. J Ethnopharmacol. 2021 Apr 24;270:113812

Silverman AL, Kumar A, Borum ML. Re: "Herbal Use During Breastfeeding" by Anderson (Breastfeed Med 2017;12(9):507-509). Breastfeed Med. 2018 May;13(4):301
 
United States National Institute of Health (NIH), National Library of Medicine, Toxnet, Drugs and Lactation Database (Lactmed) [Internet]. Bethesda: U.S. National Library of Medicine; [date unknown] [cited 2019 Oct 10]
 
Wagner CL, Boan AD, Marzolf A, et al. The Safety of Mother's Milk® Tea: Results of a Randomized Double-Blind, Controlled Study in Fully Breastfeeding Mothers and Their Infants. J Hum Lact. 2019 May;35(2):248-260