Lactogogues

This is a presentation on lactogogues or galactogogue foods or medicines.

1. LACTOGOGUES AKSHATHA BANDARI MSc Nutrition and Dietetics Sarojini Naidu Vanita Mahavidhyalaya Hyderabad, India.

2. INTRODUCTION The process of secretion and production of milk in alveolus of breast after the birth of child is called lactation . Low milk supply is a common concern among breastfeeding mothers. It is also called lactose insufficiency which can be caused due to several reasons. It may be due to maternal causes which include stress, anxiety, hypertension, poor diet, smoking etc. The infant causes include CNS defect, small for gestational age, poor latch etc. The use of galactogogue helps to increase the prolactin levels and thereby increasing the milk production.

3. What are Lactogogues? A lactogogue or galactogogue is a word derived from Greek language which means milk leading substance . It is a food that increases the milk production in lactating mothers. This kind of food is used when there is an insufficiency of milk supply in lactating mothers . Galactogogues are medications that aid in initiating and maintaining adequate milk production. Most exert their pharmacologic effects through interactions with dopamine receptors, resulting in increased prolactin levels and thereby augmenting milk supply.

4. TYPES LACTOGOGUES There are many agents which are galactopoietic and cause increase in prolactin levels. They may be synthetic or herbal. The synthetic medications include metoclopramide, domperidone, thyrotropin releasing hormone, oxytocin etc. The herbal or natural lactogogues include fenugreek, goat’s rue, shatavari, fennel, alfalfa etc.

5. METOCLOPRAMIDE Metoclopramide is the most commonly used synthetic galactogogue. Metoclopramide remains the galactogogue of choice due to its documented record of efficacy and safety in women and infants. Most studies demonstrate an increase in basal prolactin levels and a 60% to 100% increase in milk volume.  It antagonizes the release of dopamine and by inhibiting the effect of PIF, increases the prolactin production Side effects may include headache, diarrhoea, nausea and severe depression.

6. DOMPERIDONE Domperidone, an agent like metoclopramide, blocks dopamine receptors. It increases prolactin level and thereby acts as a galactogogue. The side effects maybe few and may include headache, skin rashes, GI disturbances. The FDA issued a warning against importing and using domperidone which was based on reports of cardiac arrhythmias and sudden death in patients treated with intravenous domperidone.

7. FENUGREEK The best known of herbal galactogogue is FENUGREEK. It belongs to fabaceae family and is very commonly recommended as a supplement to increase lactation. An increase in milk production occurs within 24-72 hours after using the herb but it can take over two weeks for females in order to see a change. The active ingredient is found in the seed and should to used in small amounts. It can be included in the diet as methi pulao, methi paratha or as fenugreek tea. Side effects include maple syrup odor in urine, sweat, diarrhea and flatulence.

8. ALFALFA Alfalfa is a common, mild galactogogue that is often used along with other more powerful galactogogues like fenugreek. It is highly nutritive plant which is very high in essential vitamins and minerals. It is perhaps, these nutrients that may boost milk supply in breastfeeding mothers. Alfalfa leaves and sprouts contains saponins and isoflavonoids which causes increase in milk yield. It is generally well tolerated and is G enerally R ecognized A s S afe (GRAS) as a food by the FDA.

9. SHATAVARI Shatavari is a well-known galactogogue. It has galactagogue properties that makes it a recommended herb to increase milk production in breastfeeding mothers. It increases the production of corticoids and prolactin, which improve the quality and the amount of breast milk produced by a lactating mother. Shatavari also stimulates the secretion of steroid hormones that improve milk production and also increases breast weight. Shatavari or wild asparagus for lactation is thus very beneficial.

10. FENNEL The consumption of fennel during lactation is prevalent for its purported lactogenic effects . The herb contains phytoestrogens that may increase milk supply. Fennel is commonly used in India and is a highly effective herbal lactogogue. It can be consumed as fennel tea or as fennel water.

11. GOAT’S RUE Goat’s Rue belongs to fabaceae family and is a traditionally used as a galactologue for centuries. The main components responsible for lactogenesis is saponins. Goat’s Rue is considered as a lactogogue by increasing milk production by 30-50% within 24 hours. It stimulates the growth of breast tissue.

12. BLESSED THISTLE It belongs to Asteracea family. Blessed thistle is another herb which is used to enhance lactation. It has an unjustified reputation as a galactogogue, but is not known to be toxic except for some reported gastrointestinal symptoms and allergic reactions.

13. LACTOGOGUES There are many other lactogogues like fish, mutton and goat’s meat. Herbal lactogogues like garlic has been used for centuries as a beneficial food to increase lactation. Cumin seeds, moringa powder, garden cress seeds, carrots, dark green leafy vegetables, nuts and seeds and lactational cookies help in milk production.

14. Survey in Experience and Use of Galactogogues - A n online, cross-sectional survey was distributed between September and December 2019 in Australia. Women were eligible to participate if they lived in Australia and were currently/previously breastfeeding . Among 1876 respondents, 60% of women (n = 1120) reported taking one or more galactagogues during breastfeeding. Women who had preterm births, saw a lactation consultants, had perceived low milk supply, had a Caesarean section, or required supplemental feeding with infant formula were more likely to use galactogogues. The most commonly used galactagogue included lactation cookies (47%), brewer’s yeast (32%) and fenugreek (22%). \

15. SIDE EFFECTS Domperidone had the highest proportion of women reporting one or more side effects (45%), compared to less than 20% of women using herbal galactagogues . For domperidone and metoclopramide, 9% and 19% of women respectively stopped taking the medication due to side effects. Greater than 20% of domperidone users experienced two or more side effects .

16. EFFECTIVENESS The perceived effectiveness of galactagogues is reported for eight of nine galactagogues was rated as being between ’slightly’ (2) and ’moderately’ (3) effective except for domperidone which users reported as having the highest perceived effectiveness.

17. REFERENCES Researchgate.net-role of lactogogues in milk production/January 2021. Sciencedirect.com/pharmacology/galactogogue/2015. Ncbi.nlm.nih.gov/pmc articles/plosone journal in use and experience of galactogogues/July 2021.

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