Science vs. Grandma
Lactation Boosters: What Experts Want Breastfeeding Parents To Know
My galactagogue brings all the boys to the yard.
For Karissa Whitman, a mother of two in Temecula, California, breastfeeding her first baby after his stint in the neonatal intensive care unit (NICU) was a challenge. Whitman’s milk didn’t come in for days, and her son, who had medical challenges, had trouble latching. For three months, breastfeeding was incredibly painful, even causing her nipples to bleed. Whitman spiraled into postpartum depression — she says for a time, she didn’t even want to hold the baby. Assuming her breastfeeding woes were because she wasn’t making enough milk, she turned to lactation boosters.
These products, such as cookies and drinks that contain herbal supplements that claim to promote breastfeeding, totaled around $50 for just three items. “I found them to be pricey,” says Whitman, who works as a manager at a small business. “Definitely not an affordable option for every mom.” Worst of all, over the next few weeks, they were totally ineffective. “They didn’t do anything at all. There was absolutely zero difference,” Whitman says. What they did do was make her nauseous and her baby gassy.
Whitman is part of a cohort of parents who believe their milk supply is insufficient and are hoping a supplement is the solution. At least 15% of breastfeeding parents in the United States — and 43% internationally — have tried a lactation supplement in an effort to increase milk supply. In one University of Chicago study from 2013, 40% of women reported concerns about milk quantity, with many citing those concerns as an eventual reason they stopped breastfeeding, while another 2017 survey of 188 parents found that 76% of breastfeeding mothers believed they weren’t making enough milk. A 2021 research review looked at reasons women quit breastfeeding and found that half of mothers do so because they believe they are underproducing. This phenomenon even has a name — perceived insufficient milk supply (PIMS). Yet only 5% of the breastfeeding population actually has a medical or physiological reason they can’t make enough milk.
This perception by lactating parents that they have a low supply is one of the many complicated reasons the Centers for Disease Control and Prevention (CDC) reports many parents stop breastfeeding. In 2019, 83.2% of infants in the United States started out receiving some breast milk. Six months later, only 55.8% still were breastfeeding some of the time, and only 24.9% were still exclusively breastfeeding. And now, in the shadow of an ongoing formula shortage, some parents are more determined to “succeed” at nursing, with many turning to a postnatal supplements market worth about $100 million offering cookies, teas, capsules, and powders that claim to help increase milk supply.
“I have had some patients tell me they are concerned with protecting their supply due to the shortage,” says Melissa Cole, a board-certified lactation consultant (IBCLC) and clinical herbalist at Luna Lactation and Wellness. “Some have expressed a desire to perhaps lactate/breastfeed longer given the shortage.”
But, experts say that very few of the supplements have been proven to work. So what should a new parent worried about milk production do, how do they navigate a world of confusing promises, and do lactation boosters even work?
What is a lactation booster?
Lactation boosters, called “galactagogues” among scientists, are supplements, foods, and medication intended to boost milk supply. According to La Leche League, an international breastfeeding resource, nursing mothers have consumed products like oatmeal, fennel seed, goat’s rue, moringa, and more than 50 others for decades and even centuries.
Fenugreek, for example, which tastes like maple syrup, is a Mediterranean herb from southern Europe and western Asia, according to the National Institutes of Health (NIH). It was traditionally used for diabetes and is still promoted as a supplement for menstrual cramps and milk production.
Another common herbal galactagogue is fennel (as a seed or oil), which has also been used to treat colic in newborns, breast inflammation, and as a nursing supplement. Goat’s rue, found in the Eastern United States, was used by Seminole Indians to improve milk production in goats.
Herbs like these supposedly work through a variety of mechanisms: interacting with sweat glands, stimulating prolactin, or increasing blood flow to the mammary glands, among others.
Foods like oats and beer have also been said to be galactagogues — oats because they have high levels of iron (generally important for milk production) and beer because of folklore. Kathleen Kendall-Tackett, Ph.D., a psychologist and IBCLC in Amarillo, Texas, explains that, aside from supplements, some breastfeeding doctors prescribe medications, called pharmaceutical galactagogues — such as Reglan (which is Food and Drug Administration approved) and domperidone (not FDA approved for any purpose) — but they have risks of side effects (more on that below).
Do lactation supplements work?
Evidence on the efficacy of most herbal or food-based galactagogues is mixed. Most studies are either too small or poorly controlled, putting health providers in a difficult position over whether or not to recommend them, according to a 2016 research review. This can be seriously confusing for parents in an already trying and sleep-deprived time.
“The problem is there’s never really very much good research done on this,” says Kendall-Tackett, who is the author of Breastfeeding Doesn’t Need to Suck.
For example, one study shows fenugreek has no more effect than a placebo. Other studies suggest goat’s rue might have limited efficacy. A 2013 review paper examined 63 studies testing seven herbal lactation supplements like shatavari and milk thistle, but researchers couldn’t recommend them because of issues such as variable breastfeeding practices among participants.
“There’s no proof any of these over-the-counter treatments actually help the mother increase her supply,” says Dr. Jack Newman, M.D., a pediatrician and founder of the International Breastfeeding Centre in Toronto. Mothers email him every day asking if various lactation supplements are “any good.”
“There are so many and so many of them,” he says, and often they won’t even have any research on their impacts on lactation, despite marketing claims. He says the placebo effect is strong, resulting in incomplete and inconclusive research, especially since breastfeeding confidence plays an important role in success. “I doubt fenugreek decreases milk supply. I doubt it increases it either,” he says.
A 2016 research review concludes that health providers face a challenge in whether or not to prescribe supplements “without the benefit of robust evidence.”
In fact, lactation supplements are “only one small piece of the equation,” says Dr. Jessica Madden, M.D., an IBCLC and neonatologist at University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, and medical director at Aeroflow Breastpumps. She says social media promises the solution of “teas or tinctures or capsules” ready to solve supply issues, but boosters are “only part of what you should be doing if you are struggling to make milk for your baby.” She joked there’s no label on cookies pushing women toward professional help. “A lot of women are very disappointed,” she said, when products fall short of their promises to increase breast milk supply.
A Federal Trade Commission spokesperson told Romper this is an issue across many supplement products, where parts of studies are used to support claims without examining the overarching evidence.
While Madden is skeptical of many supplements (especially when used without additional support from a lactation consultant), she says that two galactagogues have shown promise of short-term benefits: ginger and moringa, a plant native to India. She sometimes recommends these if a mother is already integrating other interventions with professional guidance.
Lisa Marasco, IBCLC, a lactation consultant in Santa Maria, California, agrees there is a place for lactation boosters for some nursing parents but that too many parents turn to them first, rather than addressing the underlying problem. For instance, some of her clients need to empty their breasts more often. “If your low supply is due to simply not breastfeeding enough, no galactagogue can completely compensate for that,” says Marasco, who wrote the book Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production. (La Leche League recommends nursing up to 12 times per 24-hour period, especially in the beginning, to establish steady milk production.)
However, Marasco thinks there’s still a potential role for supplements in some cases, along with additional support. Even though the evidential support for natural galactagogues, or a particular one, may not reach “gold-level status” (which, she explains, is the scientific standard for having strong enough evidence on which to base general recommendations or to create policies or procedures), there is often still evidence at a lower grade level. “And that isn’t nothing,” she says. Why do parents keep trying them? Because, she says, new moms have heard that they have worked for so many other people.
Will they cause side effects?
Like many supplements, some lactation boosters might indeed cause side effects, and parents with medical conditions should be careful. Marasco notes that people with a history of low thyroid hormone production should avoid fenugreek, which can further reduce hormone levels. Researchers from China warned mothers in a 2016 study of the potential for hypoglycemia with fenugreek complicating preexisting conditions. The NIH cites side effects like digestive tract problems and an increased risk of birth defects if fenugreek is taken during pregnancy.
“I actually got a lot of stomach cramps and a lot of diarrhea. It was awful,” says Pilar Scratch, 31, a Newark, New Jersey, mom who took fenugreek capsules for about three months. Breastfeeding her first child was difficult. “He would latch on, and it just wouldn’t take — nothing would come out,” she says. Though fenugreek, in capsule form, claims to increase supply, instead it made things worse. “It didn’t work. I felt like it dried [me] up more, and I felt like I had a knot [in my breast].” Now pregnant with her second, she is more aware of supplements to avoid. “I’m not taking the capsule again.”
Another study suggests goat’s rue can cause hypoglycemia, in addition to not proving to increase supply.
Despite this, research on the potential side effects of lactation supplements is just as mixed as the research on their efficacy. To understand possible side effects of any herbal supplements, Cole recommends databases like HerbMedPro. The NIH Herbs at a Glance database is also a good resource.
How can supplements help establish a breastfeeding-friendly diet?
Lactation products might not boost your milk supply, but some can play a part in developing a more nutritious diet, according to Stephanie Lauri, a dietitian and lactation educator counselor who works with perinatal parents and infants in Thousand Oaks, California. However, a box of oatmeal is less expensive than a lactation cookie and just as good at providing the nutrients your body needs to breastfeed.
“Eating enough, as well as maintaining adequate hydration, is really important for Mom’s breastfeeding supply,” she says. She encourages parents to focus on nutrient-dense foods, like flaxseed (rich in omega 3 fatty acids) because what you eat can impact the nutrient levels in your breast milk.
The detriment in delaying other solutions, and what to try instead
All of the experts pointed to a secondary problem that often comes along with supplement experimentation: wasted time before getting professional help. Madden says not to spend more than a week trying lactation supplements before calling in an expert, like a lactation consultant or your pediatrician. (You can find a local resource or support group here.) Kendall-Tackett agrees that properly establishing supply has a finite window of opportunity. “If you don’t do it in the first couple of weeks, it’s sometimes hard to get it back.” She says instead, mothers should be questioning “Is it really low supply?”
Organizations like the newly formed Low Milk Supply Foundation seek to further educate families on this issue and solutions. And medical professionals like the experts cited here urge breastfeeding women not to jump to conclusions. “It could be biological; it could be physiological; it could be hormonal; it could be a functional reason,” Lauri says. She encourages clients to address the root problem instead of “putting a Band-Aid over it.”
That was the case for Karissa Whitman. She eventually found a new lactation consultant, and her baby was diagnosed with a tongue tie at around 10 weeks old, an anatomical condition in the baby’s mouth that sometimes prevents them from properly latching and drawing out milk. Her therapist recommended she put her thoughts in a journal as a part of her recovery and the resulting blog grew into a postpartum resource to help other moms.
At best, lactation supplements should be a “very last resort,” she says. “There are so many ways you can boost your supply and actually effectively increase it. You just need someone that’s knowledgeable to teach you those tips that actually work.”
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Kathleen Kendall-Tackett, Ph.D., psychologist and IBCLC
Jack Newman, M.D., founder and first pediatrician of the International Breastfeeding Centre.
Jessica Madden, M.D., associate program director of the neonatal-perinatal medicine fellowship program at University Hospitals Rainbow Babies & Children’s Hospital and UH Cleveland Medical Center
Lisa Marasco, M.A., IBCLC, FILCA (Fellow of the International Lactation Consultant Association)
Stephanie Lauri, registered dietitian