When in the course of a happy breastfeeding relationship
you notice a supply change, it can cause momentary panic. The
first course of action should be to assess a few basic things.
Are you resting enough? Getting a good night's sleep? Taking a
nap if necessary? Are you drinking at least 64 ounces of water
a day? Are you eating a good, healthy diet? These are some of
the basics of a nursing relationship that have to be maintained
to the very best of your ability. Our bodies aren't necessarily
so forgiving of being pushed to the limit when we're nursing.
They tend to give us a clear signal. One of those ways is with
a dip in supply. Listen to your body and take some action.
Make sure you are:
- Resting adequately
- Drinking at least 64 ounces of water a day
- Eating a nutritious diet
- Choosing a night time sleeping arrangement that allows for
the best sleep for all involved
- Nursing frequently
Make sure you are not doing things that can inhibit supply:
- Smoking
- Allergy medications
- Sleeping on your stomach - compressing the breasts at night
- Wearing a bra that is too tight
- Wearing a sling with the rings pressing back against the breast
instead up near the shoulder
After having gone through the above steps and getting those things
in line, you may still find your supply is not what you feel it
should be. The next step is to see how often your baby is wetting.
Often what is perceived as a supply problem really isn't a supply
problem at all. Observing how much your baby is wetting will tell
you whether it is reality or merely a perception.
Another thing to remember has to do with pumping. There are times
when you see a drop in what you are able to get at the pump. This
may not be so much a drop in supply as it is a change in your
reaction at the pump. The baby may have no trouble at all getting
letdown, but the pump just isn't fooling your body into one as
well as it once did. Making some changes at the pump in the way
of heat, massage prior to pumping, positioning, or several other
options may do the trick for you.
If you are supplementing, even a single bottle a day, and are
struggling with your milk supply, you need to consider ceasing
all supplementing. For some women, supplementing even one bottle
a day will have a drastic effect on their milk supply.
If all the above has been tried with little success, it may be
time to consider using a galactagogue. Galactagogues are a wonderful
tool, but should NOT be considered until the above measures have
been taken first. It is always prudent to remember that, on the
whole, your body knows what it is doing in responding to your
baby and providing adequate milk. Galactagogues are a wonderful
thing when they are truly necessary but they should be a last
resort. There is often an assumption that since herbs are natural,
they are safe. That isn't always the case, and in fact, some herbs
can be quite dangerous. Please use caution when using herbs and
observe your body's reaction to them carefully.
Some of the more common galactagogues (and there are many used
over the centuries) are:
Fenugreek
Fenugreek is one of the most commonly used galactagogues.
It works very quickly in most cases. It can be taken in
capsule form with the recommended dose being up to three capsules
three times a day. It can be used in conjunction with Blessed
Thistle, again working up to three capsules three times a day.
The dosage needed varies according to the mother, so experimentation
with lesser doses and increasing them if needed is a good idea.
One capsule three times a day may be enough to boost one mom's
supply when another may need three capsules three times a day.
It is important to be aware that fenugreek can affect blood sugar
levels, so much so that it is effectively used to treat diabetes.
Knowing this, a nursing mom with hypoglycemia or diabetes needs
to watch blood sugar levels if fenugreek is her galactagogue of
choice.
The only side effect to make note of is mild gastrointestinal
distress when fenugreek is taken in high doses. Typically
that would be seen in the mother, but in rare cases it is seen
in the infant with an exhibition of some gastrointestinal difficulty
which can be as mild as gassiness in the bowels. Animal
studies have found fenugreek essentially non-toxic.
Fennel
Fennel isn't actually a galactagogue, but rather it assists with
triggering the letdown reflex. It is particularly useful
for working Moms who have found that they've stopped responding
well to the pump. Fennel is best as a tincture, 2-4 ml up to three
times a day, but can be taken in capsule form. Caution should
be used with fennel because it can act as an appetite suppressant.
Keep a careful eye on your caloric intake. Also, fennel contains
phytoestrogens which if taken in excess can have a negative effect
on your supply.
Rescue Remedy
This is a homeopathic remedy that is useful for triggering the
letdown reflex. You take four drops under the tongue up to five
minutes before pumping or nursing. Rescue Remedy can have a slight
sedative effect, so use with caution.
Ignatia 6x
This is a homeopathic remedy that can work well in combination
with a mild galactagogue. Dosage would be two tablets three times
a day.
Mother's Milk Tea
This tea is a very mild galactagogue containing fenugreek.
Some women find that drinking several cups a day is all that is
needed of fenugreek to boost their supply. An easy way to
drink it is to brew a few cups very strong and cool it.
It can be drunk either iced straight or mixed half and half with
apple juice.
Continued Use
As with commercial medications, when taking herbs you should always
start with the mildest and work your way up, always starting with
the lowest dosage possible. Also, keep in mind that galactagogues
should be used for boosting supply, not maintaining. Once your
supply has established itself at an adequate level, you should
try weaning back off the herbs and see if your supply will maintain
where needed. They can always be resumed if necessary, but
excessive use can lead to unwanted side effects. If you find that
you're in a situation where you need to take a galactagogue on
an extended basis you should do a program of six weeks on and
three weeks off. If you do not give your body a break it will
become resistant to the herbs and they will become ineffective.
Milder Galactagogues
If you are looking into trying a galactagogue, start with things
like:
-
alfalfa, work up to four capsules three times a day
-
marshmallow, work up to four capsules three times a day
-
nettle, work up to two capsules three times a day
-
dill, use two teaspoons of raw dill seed on your lunch and
dinner or use it to brew a tea
-
blessed thistle, work up to three capsules three times a
day.
These are much safer herbs. Most galactagogues are more effective
when used in combination. Combining two or three is much more
effective than just using one.
Pregnancy
Sometimes a mom finds herself needing to maintain a supply in
order to nurse through a pregnancy. In some cases mom finds that
the supply and demand system works out nicely and they have no
problems nursing right through pregnancy. In other cases mom finds
she needs a little help. There are mild galactagogues that are
safe to take in pregnancy. These herbs can also be used in combination
of two or three.
Nettle up to 2 capsules 3 times a day
Blessed Thistle up to 3 capsules 3 times a day
Dill up to 2 ml tincture 3 times a day
Marshmallow up to 4 capsules 3 times a day
DO NOT take fenugreek, fennel, or alfalfa while pregnant.
There are a couple of prescription medications that have been
used with success in situations of serious supply problems. (Reglan
and Domperidone are two of these meds) They should be used with
prudence and never considered until other basic measures of rest,
water, nutrition and nursing frequency have been examined and
remedied if necessary. We owe it to ourselves and our children
to take care of our overall health, which is most cases, allows
our bodies to provide breastmilk to our children. These
medications are available in those situations in which the mother
has adequate rest, good nutrition, frequent nursing and still
finds that supply is a problem.
Genotoxicity testing of a
fenugreek extract.
Food
Chem Toxicol. 2004 Nov;42(11):1769-75.
Fenugreek
seeds have been used in traditional medicines as a remedy for
diabetes. Rich in protein, fenugreek seeds contain the unique
major free amino acid 4-hydroxyisoleucine (4-OH-Ile), which has
been characterized as one of the active ingredients in fenugreek
for blood glucose control. Current use of fenugreek in foodstuff
has been limited to its role as a flavoring agent, and not as
an ingredient to help mitigate the blood glucose response for
people with diabetes. As part of a safety evaluation of novel
ingredients for use in blood glucose control, the potential genotoxicity
of a fenugreek seed extract (THL), containing a minimum of 40%
4-OH-ILE, was evaluated using the standard battery of tests (reverse
mutation assay; mouse lymphoma forward mutation assay; mouse micronucleus
assay) recommended by US Food and Drug Administration (FDA) for
food ingredients. THL was determined not to be genotoxic under
the conditions of the tested genetic toxicity battery. The negative
assay results provide support that addition of THL from fenugreek
to foodstuffs formulated for people with diabetes is expected
to be safe. A wide safety margin is established, as anticipated
doses are small compared to the doses administered in the assays.
Diosgenin,
a steroid saponin of Trigonella foenum graecum (Fenugreek), inhibits
azoxymethane-induced aberrant crypt foci formation in F344 rats
and induces apoptosis in HT-29 human colon cancer cells.
Cancer Epidemiol Biomarkers Prev. 2004 Aug;13(8):1392-8.
Trigonella
foenum graecum (fenugreek) is traditionally used to treat disorders
such as diabetes, high cholesterol, wounds, inflammation, and
gastrointestinal ailments. Recent studies suggest that fenugreek
and its active constituents may possess anticarcinogenic potential.
We evaluated the preventive efficacy of dietary fenugreek seed
and its major steroidal saponin constituent, diosgenin, on azoxymethane-induced
rat colon carcinogenesis during initiation and promotion stages.
On the basis of these findings, the fenugreek constituent diosgenin
seems to have potential as a novel colon cancer preventive agent.
Protective
effect of fenugreek (Trigonella foenum graecum) seeds in experimental
ethanol toxicity.
Phytother Res. 2003 Aug;17(7):737-43.
The
study investigates the effect of aqueous extract of fenugreek
seeds (Trigonella foenum graecum) on lipid peroxidation and antioxidant
status in experimental ethanol toxicity in rats. The ability of
the seed extract to prevent iron-induced lipid peroxidation in
vitro was also investigated. Ethanol feeding for 60 days resulted
in significant increases in the activities of serum aspartate
transaminase, alanine transaminase and alkaline phosphatase. The
levels of serum lipid hydroperoxides and thiobarbituric acid reactive
substances in liver and brain were also significantly elevated.
Significantly lower activities of superoxide dismutase, catalase,
glutathione peroxidase, glutathione S-transferase and glutathione
reductase were observed in liver and brain accompanied by depletion
in glutathione, ascorbic acid and alpha-tocopherol concentrations.
Activity of Ca(2+) ATPase in brain was significantly lowered.
Simultaneous administration of aqueous extract of fenugreek seeds
with ethanol prevented the enzymatic leakage and the rise in lipid
peroxidation and enhanced the antioxidant potential. The seeds
exhibited appreciable antioxidant property in vitro which was
comparable with that of reduced glutathione and alpha-tocopherol.
Further, histopathological examination of liver and brain revealed
that, aqueous extract of fenugreek seeds could offer a significant
protection against ethanol toxicity.
Supplementation
of fenugreek leaves lower lipid profile in streptozotocin-induced
diabetic rats.
J
Med Food. 2004 Summer;7(2):153-6.
The
present study was undertaken to evaluate the lipid-lowering effect
of fenugreek leaves in diabetes mellitus. Albino Wistar rats were
randomly divided into six groups: normal untreated rats; streptozotocin
(STZ)-induced diabetic rats; STZ-induced rats + fenugreek leaves
(0.5 g/kg of body weight); STZ-induced rats + fenugreek leaves
(1 g/kg of body weight); STZ-induced rats + glibenclamide (600
microg/kg of body weight); and STZ-induced rats + insulin (6 units/kg
of body weight). Rats were made diabetic by STZ (40 mg/kg) injected
intraperitoneally. Fenugreek leaves were supplemented in the diet
daily to diabetic rats for 45 days, and food intake was recorded
daily. Blood glucose, total cholesterol, triglycerides, and free
fatty acids were determined in serum, liver, heart, and kidney.
Our results show that blood glucose and serum and tissue lipids
were elevated in STZ-induced diabetic rats. Supplementation of
fenugreek leaves lowered the lipid profile in STZ-induced diabetic
rats.
Therapeutic
applications of fenugreek.
Altern Med Rev. 2003 Feb;8(1):20-7.
Basch E, Ulbricht C, Kuo G, Szapary P, Smith M.
Fenugreek
has a long history of medical uses in Ayurvedic and Chinese medicine,
and has been used for numerous indications, including labor induction,
aiding digestion, and as a general tonic to improve metabolism
and health. Preliminary animal and human trials suggest possible
hypoglycemic and antihyperlipidemic properties of oral fenugreek
seed powder.
Mechanism
of action of a hypoglycemic principle isolated from fenugreek
seeds.
Indian J Physiol Pharmacol. 2002 Oct;46(4):457-62.
Mechanism
of action of an orally active hypoglycemic principle isolated
from water extract of seeds of Trigonella foenum graecum (fenugreek)
was investigated in alloxan induced subdiabetic and overtly diabetic
rabbits of different severities. The active principle was orally
administered to the subdiabetic and mild diabetic rabbits (five
in each group) at a dose of 50 mg/kg body weight for 15 days.
The fenugreek treatment produced significant attenuation of the
glucose tolerance curve and improvement in the glucose induced
insulin response, suggesting that the fenugreek hypoglycemic effect
may be mediated through stimulating insulin synthesis and/or secretion
from the beta pancreatic cells of Langerhans. Prolonged administration
of the same fenugreek dose of the active principle for 30 days
to the severely diabetic rabbits (n = 5) lowered fasting blood
glucose significantly, but could elevate the fasting serum insulin
level to a much lower extent, which suggests an extra-pancreatic
mode of action for the active principle. The fenugreek effect
may also be by increasing the sensitivity of tissues to available
insulin. The fenugreek hypoglycemic effect was observed to be
slow but sustained, without any risk of developing severe hypoglycemia.
Effect
of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control
and insulin resistance in type 2 diabetes mellitus: a double blind
placebo controlled study.
J Assoc Physicians India 2001 Nov;49:1057-61.
To evaluate the effects of Trigonella foenum-graecum (fenugreek)
seeds on glycemic control and insulin resistance in mild to moderate
type 2 diabetes mellitus we performed a double blind placebo controlled
study. METHODS: Twenty five newly diagnosed patients with type
2 diabetes (fasting glucose < 200 mg/dl) were randomly divided
into two groups. Group I (n=12) received 1 gm/day hydroalcoholic
extract of fenugreek seeds and Group II (n=13) received usual
care (dietary control, exercise) and placebo capsules for two
months. CONCLUSIONS: Adjunct use of fenugreek seeds improves glycemic
control and decreases insulin resistance in mild type-2 diabetic
patients. Fenugreek also has a favorable effect on hypertriglyceridemia.
Enhancement of circulatory antioxidants by fenugreek during
1,2-dimethylhydrazine-induced rat colon carcinogenesis.
J Biochem Mol Biol Biophys. 2002 Aug;6(4):289-92.
Annamalai University, Annamalai Nagar, Tamil Nadu, India.
We have investigated the modulatory effect of fenugreek seeds
(a spice) on circulatory lipid peroxidation (LPO) and antioxidant
status during 1,2-dimethylhydrazine (DMH)-induced colon carcinogenesis
in male Wistar rats. Enhanced LPO in the circulation of tumor
bearing animals was accompanied by a significant decrease in the
levels of ascorbic acid, vitamin E, reduced glutathione, glutathione
peroxidase, glutathione S-transferase, superoxide dismutase and
catalase. Inclusion of fenugreek in the diet significantly decreased
LPO with simultaneous enhancement of circulating antioxidants.
We report that fenugreek exert its chemopreventive effect by decreasing
circulatory LPO and enhancing antioxidant levels.
Effect
of fenugreek seeds on blood glucose and serum lipids in type I
diabetes.
Sharma RD, Raghuram TC, Rao NS.
National Institute of Nutrition, Indian Council of Medical Research,
Hyderabad.
Eur J Clin Nutr. 1990 Apr;44(4):301-6.
The
effect of fenugreek seeds (Trigonella foenum graecum) on blood
glucose and the serum lipid profile was evaluated in insulin-dependent
(Type I) diabetic patients. Isocaloric diets with and without
fenugreek were each given randomly for 10 d. Defatted fenugreek
seed powder (100 g), divided into two equal doses, was incorporated
into the diet and served during lunch and dinner. The fenugreek
diet significantly reduced fasting blood sugar and improved the
glucose tolerance test. There was a 54 per cent reduction in 24-h
urinary glucose excretion. Serum total cholesterol, LDL and VLDL
cholesterol and triglycerides were also significantly reduced.
The HDL cholesterol fraction, however, remained unchanged. These
results indicate the usefulness of fenugreek seeds in the management
of diabetes.
Fenugreek Animal Studies
Effect of fenugreek seeds on the fasting blood glucose
level in the streptozotocin induced diabetic rats.
Mymensingh Med J. 2004 Jul;13(2):161-4.
In
this experiment defatted Trigonella foenumgraecum (fenugreek seeds/methi
seeds) has used as the antidiabetogenic herbal medicine. The experiment
was carried out in Bangabandhu Sheikh Mujib Medical University
and BIRDEM from 1996 to 1998 on a total of 58 Long Evans rats
of either sex. They were 50-60 days young rats with average body
weight 72-174 gm. Among the total, 10 rats were treated with only
vehicle called as non-diabetic control rats, 48 rats were treated
with Streptozotocin (STZ) at a dose of 90mg in 1ml of citrate
buffer solution per kg body weight, among which 20 were diabetics.
Ten (1 died, 1 escaped) diabetic rats were again treated with
fenugreek called as Fenugreek-treated diabetic rats and the rest
10 diabetic rats were called as diabetic control rats. The change
in the mean fasting blood glucose (FBG) level in different groups
of rat from day 5 from streptozotocin injection were higher in
diabetic control group and in fenugreek-treated diabetic group
than in non diabetic control group. The FBG level on day 13 the
mean in non-diabetic control group was 5.21 mmol/L. In diabetic
control group and in fenugreek-treated diabetic group the mean
FBG level were 24.33 mmol/L and 9.89 mmol/L respectively. So,
from this experiment it may be concluded that fenugreek decreases
the FBG level considerably by improving diabetes mellitus.
Supplementation
of fenugreek leaves to diabetic rats. Effect on carbohydrate metabolic
enzymes in diabetic liver and kidney.
Phytother Res. 2003 Dec;17(10):1231-3.
The
present study was designed to evaluate the effect of supplementation
of fenugreek leaves, an indigenous plant widely used in Indian
Ayurvedic medicine for the treatment of diabetes mellitus, in
streptozotocin induced diabetic rats. Supplementation of the diet
with fenugreek leaves showed a significant effect on hyperglycaemia,
hypoinsulinaemia and glycosylated haemoglobin in streptozotocin
diabetic rats. Fenugreek leaves improved the body weight and liver
glycogen. Fenugreek leaves also showed a significant effect on
key carbohydrate metabolic enzymes in diabetic rats. The effect
of fenugreek leaves was found to be similar to that of glibenclamide.
Thus, fenugreek leaves exhibited antidiabetic action in streptozotocin-induced
diabetic rats. Insulin restored all the parameters to near normal
levels in diabetic rats.
06/04/2006
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