Title(s): Fenugreek Drug Levels and Effects The Use, Perceived Effectiveness and Safety of Herbal Galactagogues During Breastfeeding: A Qualitative Study Authors: Bethesda (MD) Tin Fei Sim 1,, H. Laetitia Hattingh 1 , Jillian Sherriff 2 and Lisa B.G. Tee 1 1 School of Pharmacy, Curtin University, Perth, WA 6845, Australia; E-Mails: l.hattingh@curtin.edu.au (H.L.H.); l.tee@curtin.edu.au (L.B.G.T.) 2 School of Public Health, Curtin University, Perth, WA 6845, Australia; E-Mail: j.sherriff@curtin.edu.au Published: 2006 [Updated Jul 20, 2020] September 7, 2015 Read or download the PDF: https://www.ncbi.nlm.nih.gov/books/NBK501779/pdf/Bookshelf_NBK501779.pdf Available from: https://www.ncbi.nlm.nih.gov/books/NBK501779/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586661/pdf/ijerph-12-11050.pdf Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586661/ Summary: Fenugreek has been used in a number of geographical regions worldwide as a galactogogue to increase milk supply and is included in numerous proprietary mixtures promoted to increase milk supply. The galactogogue effect of fenugreek may be primarily psychological. Evidence for a galactogogue effect is mostly anecdotal. A limited number of published studies of low to moderate quality have found mixed results for a galactogogue effect for fenugreek. A meta-analysis of controlled studies found fenugreek to have a mild galactogogue effect and unknown safety profile. Some evidence indicates that fenugreek might be more effective in the first few days pospartum than after 2 weeks postpartum. Some of these studies used a multi-ingredient combination products in which fenugreek was only one component, so the results might be different from studies in which fenugreek was used alone. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.¹ Limited scientific data exist on the safety of fenugreek in nursing mothers or infants, although it has a long history of use as a food and medicine in India and China. When used as a medicinal, it is generally well tolerated in adults, but gastrointestinal side effects such as nausea, vomiting, diarrhea and flatulence may occur. Cross-reaction with chickpeas, peanuts, and other legumes is possible. Dosages typically used to increase milk supply are 1 to 6 grams daily; in dosages of about 25 grams or more daily, fenugreek may cause lowering of cholesterol and blood sugar. Caution should be used in giving high dosages to women with diabetes mellitus or those taking warfarin. Perhaps its most unusual side effect is the imparting an odor of maple syrup to the urine, sweat, feces, and possibly breastmilk by the sotolon in fenugreek.¹ In a survey of 188 nursing women from 27 states (52% from Louisana), 85 (46%) had used fenugreek as a galactogogue. Of those who used it, 54% felt that it increased their milk supply and 45% reported side effects, including a maple syrup smell emitted from the mother's body, gassiness in the baby, or breastmilk oversupply.¹ Galactagogues are a group of substances or medicines either proven or believed to aid lactation during initiation and maintenance stages, thereby increasing human breast milk supply. In other words, galactagogues are substances which may be used by women to induce, increase or maintain milk production. Galactagogues are available in Australia in the form of either conventional medicines or of herbal origin. Dopamine D2 receptor antagonists, such as metoclopramide and domperidone, are conventional galactagogues that are most commonly used in clinical practice with supported evidence. These agents increase milk supply and production by increasing the levels of prolactin in the maternal plasma.² Throughout the world, women have used many alternative approaches in an attempt to increase milk production such as following special diets and the use of herbal or natural substances. Mothers of different cultural and ethnic backgrounds often choose different approaches according to their tradition or experience. Herbal medicines commonly believed to aid lactation include fenugreek (Trigonella foenum-gracum), blessed thistle (Cnicus benedictus), milk thistle (Silybum marianum), goat’s rue (Galega officinalis), marshmallow (Althaea officinalis), fennel (Foeniculum vulgare), torbangun (Coleus amboinicus Lour), nettle (Urtica dioica) and black seed (Nigella sativa). Many of these herbal medicines, in particular fenugreek, have gained popularity in the Western world as galactagogues. Fenugreek is the herbal remedy that is most commonly recommended for deficient milk supply and has been listed as L3 (moderately safe) by Hale.² The study revealed that women perceived herbal galactagaogues, especially fenugreek, to be effective in enhancing their breastfeeding adequacy. ² [For more journal articles & inspiration check out National Library of Medicine & The International Journal of Environmental Research and Public Health]
