What is a galactagogue?
The technical definition is a food or drug that promotes or increases the flow of a mother’s milk. Galactagogues can be pharmaceuticals, herbals, and dietary (food). What do we know about them? Not much.
There has been very little research done on these. The few research articles that have been done have small sample sizes and the studies were not done well. Does that mean they don’t work? Not necessarily, it means we don’t know… yet.
First, let’s think about how milk is produced. You take milk out of the body and body makes more… (rinse, repeat). That’s about it. There are some things that can interfere with this process. Your lactation expert (that’s us at the BRC) are trained in looking for those answers. So, the first thing you do, is seek help from a professional.
There is likely an underlying reason for low milk supply that they can help you with. Once you’ve determined a course of action, some mothers want to increase their chance of building supply by using galactagogues.
Common galactagogue suggestions (and the theories behind them):
1. “Are you drinking enough water?” “Have you tried Gatorade?”
Keeping hydrated is important. Breastfeeding mothers should be taking in about 100 oz. of water per day. And… the electrolytes in Gatorade may help to hydrate the body also. Unfortunately, Gatorade has a lot of other junk in it too like food coloring and sugar… so it’s not really the healthiest of drinks. Instead, you can eat foods high in electrolytes such as high potassium fruits like bananas, dates, raisins, coconuts, and avocado. Vegetable sources include spinach, beans, lentils, and potato.
2. “Try eating oatmeal every day.” “Put flax seeds in your smoothies.” “Have you tried alfalfa sprouts?”
We’re looking for roughage! There weren’t many studies on breastfeeding when the field of lactation first began. We turned to the dairy industry for their knowledge on milk production. The dairy industry would increase roughage for milk production. It makes sense… fiber helps to stabilize blood sugars and promotes digestive health.
3. Herbs and Pharmaceuticals are used medicinally. Some medical conditions associated with low supply are PCOS, thyroid problems, insufficient glandular tissue, previous breast surgery, and low prolactin levels. Herbs like Fenugreek and Goat’s rue can impact your blood sugar levels, as do some medications commonly used to increase prolactin levels.
Now, we’ll go through galactagogue options.
Pharmaceuticals: There are few options for pharmaceutical galactagogues. Domperidone is the number one choice in the world, but here in the US, we do not have ready access to it. Domperidone is not currently a legally marketed human drug and it is not approved for sale in the U.S. On June 7, 2004, FDA issued a public warning that distributing any domperidone-containing products is illegal. Domperidone is used for GI concerns, but it also increases prolactin levels. Mothers with low prolactin levels may benefit from its use. Over 100 other countries use Domperidone regularly and some even sell it over the counter.
The other option is Reglan. It works the same way as Domperidone. It’s a GI drug that increases prolactin levels. Reglan has some pretty nasty side effects, can only be used short term, and should not be used if you have a history or depression or anxiety. Anecdotally, some mothers have reported that their supply increased with its use but dropped after they stopped taking it. Some may consider Metfomin a galactagogue. Metformin is used to stabilize blood sugar levels, therefore its sometimes prescribed for mothers with PCOS or non insulin dependent diabetes. Some mothers with these health concerns have reported an increase in production when using Metformin.
There are many herbs suggested to increase milk production. The problem with herbs is that they’re not regulated, they have side effects, and they can interact with other medications. Fenugreek, for example, is a popular one. Fenugreek can impact blood sugar levels and interact with other medications. So, I beg you, if you’re going to use herbs, please consult your physician!! The FDA may classify herbs as Generally Recognized As Safe (GRAS), but there isn’t a lot of regulation when it comes to what exactly is in the products. Some of the more common herbs are Fenugreek, Blessed Thistle, Fennel, Alfalfa, Goats Rue, Milk Thistle, and Brewers Yeast.
At the BRC we regularly get questions about what foods will increase milk production. One of my favorite quotes is from Tipper Gallagher, IBCLC in response to, “What foods should I eat/avoid when breastfeeding?
Foods to eat:
1. Foods you like.
2. Foods you can eat with one hand.
3. Food someone else cooks for you.
Foods to avoid:
1. Foods you don’t like.
2. Foods you don’t want to eat.
So, in summary, we don’t know if galactagogues work. The theories behind them make sense, but it’s important to remember that the key to increasing milk supply is increasing the frequency of feedings or pumping sessions.