Alternative remedies, vitamins, and minerals

Experience

Numerous surveys in the literature report widespread use of alternative remedies with no knowledge of the risks. The interest in, and experimentation with, alternative remedies has increased in the last decades. Just as in pregnancy, there are minimal evidenced-based safety data for the use of alternative remedies and herbs in lactation; however, also as in pregnancy, history and traditional data in general support their safe use. There have, though, been case reports of unfortunate outcomes. In the United States, the Food and Drug Administration ( ) has no jurisdiction if the material is labeled with the following statement: “This product is not intended to diagnose, treat, cure or prevent any disease.”

Plant preparations (in high doses) are not always harmless; contamination with pesticides and heavy metals (e.g. lead in Ayurvedic medicine or traditional Chinese herbs) has been observed (see Chapter 4.18 ). There are many herbs which may be used by the nursing mother for a variety of ailments, and there are very few studies regarding their efficacy. The most serious concern (beyond the obvious purity, toxicity, and efficacy) is the problem of self-diagnosis and failure to get the proper medical diagnosis and treatment. Herbs that are most commonly used include valerian , hops , and kavain ( kava-pyrone from the kava-kava root ), for nervousness and sleep disturbances; echinacea as an immunostimulant; Gingko biloba to improve general circulation; ginseng to improve performance; aescin preparations (horse-chestnut extract) for vein problems; agnus castus ( monk’s pepper ) for gynecological indications; and hypericin ( St John’s wort ) for depression. Black cohosh ( Cimicifuga racemosa ) is not recommended during lactation due to estrogenic effects ( ). Systematic studies on these drugs during breastfeeding are lacking, but no damage to the infant via the mother’s milk has been described, except for Kava ( Piper methysticum). The has issued a warning that links Kava to severe liver damage.

An example of a preparation that has now been banned in many countries is comfrey ( Symphytum officinale ), which is available both as a leaf or a root. Root preparations in general are more potent. It has the potential for causing venocclusive disease, liver failure, and death. Two neonatal deaths were reported in Canada after mothers used comfrey as a cream on the nipples; after this it was banned in Canada.

Although ethnobotanists have studied specific plant species in depth and noted some of their pharmacological properties, there are no studies, regarding herbals used during lactation, that meet pharmaceutical standards. Most of the information is derived from hearsay and experience without controls. These plants and herbals are being used, and it is important to be aware of possible side effects or even toxicities. The has reported that 26 of 40 herbal supplements were found to have residual pesticides.

Ginkgo, echinacea, and ginseng have all been studied in blinded placebo controlled studies which failed to show a therapeutic effect. There are no known studies during lactation. Because of the disclaimer on the container, there is no guarantee that the contents are the real plant; they may not be a true mixture, or may be contaminated. Therefore, it is unwise to experiment with these products during lactation. There are many chemicals in one plant ( ).

St John’s wort ( Hypericum perfortum ) has been shown to be effective against mild depression. It contains 26 identifiable chemicals, one of which is 10% hypercin , a red dye originally credited for the therapeutic effect. For its use during lactation, see Chapter 4.9 , , and .

Chastetree ( Vitex agnus-castus ) is not recommended during lactation as it may increase or decrease lactation ( ).

Dandelion ( Taraxcum officinate ) has been used for acute mastitis and agalactia. No studies or reports have proven its effectiveness. Dandelion contains lactones, sterols, flavonoids, and mucilages. It has been used for dysperic symptoms, liver and gall bladder disturbances and loss of appetite. Side effects are super acidic gastric complaints due to its secretion stimulant effects, and it is reported to have laxative effects although for problems in lactation there are no reports of symptoms in the infant ( ). Fennel is in the same family, Compositae , and is reported to have similar effects.

Guarana ( Paullinia cupana ) is sold commercially as seeds, flowers, and roots to make a paste that is astringent and smells a bit like chocolate. It is used as a tonic for fatigue, headache, and dysmenorrhoea, and as a diuretic. It is a stimulant much like caffeine. When lactating women use it, it has been observed to cause stimulation of their infants with irritability and wakefulness. It is possible to overdose when other sources of caffeine such as coffee, tea, coke and chocolate are added ( ).

Ginseng ( Panas ginseng ) has been reported to cause heart rate and rhythm changes ( ) and other cardiac disorders. Ginsenosides have also been reported to cause mild oestrogen-like effects and clearly are contraindicated during lactation ( ). It has also been associated during pregnancy and lactation with reports of fetal and neonatal androgenization ( ). Mastalgia with diffuse breast nodularity has been reported with Ginseng use ( ), which is an important effect to be aware of at any time.

Liqorice ( Glycyrrhiza glabra ) is well known to be associated with hypertension, hyperkaliemia, and rhabdomyolysis. It is popular as a tea, as are many herbs especially during lactation. It is advised that no one take it longer than 6 weeks. Adverse effects have been reported in infants breastfed by mothers consuming liqorice tea. It is not recommended for use in lactation according to the PDR for Herbal Medicine ( ).

There is no systematic study of homeopathy as it relates to lactation. The doses of active principles in homeopathy, however, are minute.

Experience

Dozens of herbals are used as galactogogues , and these are the most frequently used herbals during lactation, to improve milk supply. They are usually ingested as teas, where several seeds, leaves, flowers or roots are steeped in a cup of boiling water. Taken in large quantities, some are anticoagulants and others can cause veno-occlusive disease, as with comfrey.

The best known of the herbal galactogogues is fenugreek ( Trigonella foenum-graecum ), also known as greek hayseed . It is a member of the Leguminosac family of plants, which includes peanuts, soy, and chickpeas. It has the odor of maple syrup, and is used as artificial maple flavoring. When the mother takes the usual dose (1–4 capsules 580–610 mg, 3 to 4 times daily), her milk, sweat, tears, and urine, and even her baby, smell of maple syrup. Fenugreek has been known for centuries to help some women but not all. It can cause colic in the infant, which is believed to be an allergic response. It can aggravate asthmatic symptoms. It has also been documented to lower blood sugar, and is used as a natural treatment for diabetics. In pregnancy, it can cause uterine cramps. It is available in capsule form or as seeds for teas and decoctions. It probably appears in the milk, as this usually smells of maple syrup. It is given a rating of B (minimal potential for toxicity), which is dose-related, by herbalists ( ).

Reports of several clinical trends involving Fenugreek were reported by to increase milk supply. A randomized double blind placebo-controlled trial was described in Turkey. In this study clearly the fenugreek groups increased their milk supply and their babies gained more weight than the placebo (apple juice) group and the control group. No side effects were reported ( ).

Goat’s rue ( Galega officinalis ) is another plant credited as a galactogogue, but is rarely used alone. The only studies were in cows in 1900, when it was added to their feed. Raspberry leaf ( Rubus idaeus ) is mentioned in several mixtures, but it is astringent and may, over time, decrease milk supply. Red clover ( Trifolium pretense ) is also used, but often contains coumadin, which can cause bleeding. Fennel ( Foeniculum vulgare ) is a common constituent of galactogogue teas, and appears in the milk. The dried ripe fruit or seeds have some estrogenic effects, which have been demonstrated by increasing menses and increasing libido, and could actually decrease milk. The oil is toxic.

Alfalfa ( Medicago sativa , a member of the pea family), which comes in tablet form, is also credited with being a galactogogue. It can cause diarrhea in both mother and baby, although it is otherwise non-toxic and increases milk production. The plant is benign, but the seeds have a potential for toxicity ( ).

Blessed thistle ( Cnicus benedictus ) is different from milk thistle ( Sitybum marianum ). It has an unjustified reputation as a galactogogue, but is not known to be toxic except for some reported gastrointestinal symptoms and allergic reactions. It contains many chemicals and volatile oils. It has many “uses,” including bacteriostatic and antiseptic, and for dyspepsia. Experiments show antibacterial effects against a number of bacteria.

Milk thistle ( Silybum marianum ), however, has again become popular as a galactagogue, although the lactogenic mechanism of action is unknown ( ). It is commercially available as silymarin which consists of B flavonolignans ( ). Milk thistle has hepatoprotective effects that have been verified. Therapeutically the seeds also have an anti-inflammatory effect and a liver regenerative effect. It is known to be hepatoprotective in cirrhosis and has a regenerative ability of the liver in Deathcap mushroom poisoning from Amanita .

There are no known toxic effects when taken as a tea two to three times a day. A placebo controlled trial of milk thistle in the form of BIO-C ¹ (micronized silymarin at 420 mg/day) was used in 50 healthy women when given 63 days of treatment. Quantity of milk was measured on days 0, 30, and 63. By day 30 milk production was increased 64% compared to the placebo group who increased from days 0 to 30 by 22%. At 63 days the silymarin group increased 86% and the control 32%. No silymarin was found in the milk nor was the composition of the milk changed. Historical evidence suggests silymarin has few side effects with a low incidence of nausea, flatulence, and diarrhea. Raw allergic reactions are reported when individuals are allergic to other plants in the Asteraceae/compositae family.

Borage ( Borage officinalis ) is a powerfully active plant that has been used to treat pain. It contains amabiline, which is a hepatotoxic pyrrolizidine alkaloid that can cause veno-occlusive disease. It should not be used in pregnancy or lactation, or as a galactogogue.

There are several herbs recommended for their effect in decreasing milk supply in cases of over-abundance or when weaning is desired. Occasionally, they are used inadvertently for other reasons and result in a decreased milk supply. These are peppermint , sage , parsley , and agnus castus ( monk’s pepper ) ( ). Peppermint oil ( Menthax pierita ) contains menthol, which is the active ingredient. The oil should not be used on or near the infant. Sage ( Salvia officinalis ) should not be used as an essential oil, as it is concentrated thujone, which can cause seizures. Use of the cut or powdered leaves available as an herb for cooking, in small amounts, is safe, and does reduce milk supply. In larger amounts, it can cause tachycardia, dizziness, and hot flashes.

Parsley ( Petroselinium crispum ) will also lower milk supply when taken as leaves or juice in large amounts. The oil is toxic, as are the seeds. The popular tabbouleh salad is half parsley, and can affect milk supply.

Chasteberry ( Vitex agnus-castus ) from the Chaste tree is a known dopaminergic and FSH suppressive. It is also known to inhibit lactation due to the active principles aucubin and agnoside which suppress prolactin. It is used to treat PMS for this reason but is not recommended during pregnancy and only in small doses to decrease lactation postpartum. It has been used therapeutically in hyperprolactinemia.

Jasmine petals ( Jasminum officinale ) are very fragrant and are used to freshen rooms and people. They have been used for centuries to treat postpartum engorgement especially when the mother is not going to breastfeed. The petals and essential oils are recorded to reduce prolactin levels and are effective in decreasing milk supply.

Bromelain /trypsin complex was found to improve significantly the symptoms of painful breast engorgement during lactation ( ).