By Kristine Miles - reproduced from her article published in Nurture - Australia's Natural Parenting Magazine Dec 2016
Breastfeeding is the ideal method of feeding a baby, and though it is completely natural and women are built with boobs for this purpose, it isn't always easy. Aside from possible difficulties with getting baby to latch on well in the early days, issues with reflux in some bubs, and coordinating how often and how much to feed - one of the problems most nursing mothers report are issues with supply, for some oversupply, but mostly undersupply.
Low supply difficulties with breastmilk can frequently be remedied quite simply and can include the use of galactagogues, which are substances ingested (medication, foods, drinks, herbs, spices) that help boost breast milk production. Before I present suitable galactagogues, it's important to discuss how to know when they are needed.
The single most important factor when it comes to breast milk production is supply and demand. The more a baby suckles at and drains the breasts (or use of a breast pump) the more milk is produced. Suckling stimulates the production of the hormone prolactin which primarily drives milk production. Additionally, when breasts are full, a hormone called FIL (feedback inhibitor of lactation) signals that more milk is not required. Hence frequent feeds and/or regular feeds that drain the breast well, continue to signal that more milk is needed. Hence waiting for your breasts to fill up, or leaving lengthy gaps between feeds is one way supply can be reduced.
Conducted in 2010–11, the Australian National Infant Feeding Survey reported breastfeeding was initiated in 96 percent of infants. Only 39 percent were exclusively breastfed by 3 months, and 15 percent by 6 months. In many cases there is a perception that supply is reduced when really it isn't, potentially resulting in unnecessary early weaning or introduction of formula. Commonly when babies are around 3 months and 4-5 months old, they are going through huge developmental changes (check out The Wonder Weeks for more on this), which can make them fuss at the breast and be easily distracted. This doesn't mean they have lost interest in breastfeeding, it simply requires patience and persistence. Also around this time, a mothers breasts will have softened a lot and babies have become very efficient feeders, so it can seem as if there is less milk/not enough milk, but there will be milk, and baby is just quicker at sucking it out. A 4-5 minute feed can be the same as 30-40 minutes as a newborn. Many mothers give up breastfeeding around this time or start adding bottles of formula because they think that they don't have enough milk, but greater understanding of these facts would see breastfeeding rates improve. In these situations galactagogues are usually not needed - just keep feeding and trust your body will produce the right amount of milk for your baby. If your baby is steadily gaining weight, has plenty of wet and dirty nappies, is active, has plump skin and a sparkle in their eye, they are getting enough milk.
The following circumstances are appropriate for using galactagogues, but only in combination with frequent and thorough removal of milk from the breast, which usually requires breastfeeding or pumping more often.
Galactagogues or substances that are lactogenic i.e. milk producing may include food, herbs, spices or medication.
Domperidone (Motilium) and metoclopramide (Maxolon) are medications that are used to treat gastrointestinal disorders, but have also been shown to increase milk supply. They act by blocking dopamine, which is a hormone that inhibits prolactin release. These medications can have unpleasant side effects and should only be used under medical supervision and ideally as a last resort.
Fenugreek is well known as a curry spice, and is frequently recommended to help boost milk supply, often in combination with blessed thistle. Caution should be taken with fenugreek, because at the dosages recommended they can cause an upset tummy (for both mother and baby), reduce blood sugar, and reduce thyroid function. Furthermore, it can stimulate contractions of the uterus, and hence it is contraindicated in pregnancy (except at the end if nothing is happening and you are told to eat a curry - this is why!), and conceiving while breastfeeding is certainly possible. So if you have coexisting medical conditions such as allergies, an underactive thyroid, or diabetes, or there is a chance you could be pregnant, it is not wise to take it, or only under supervision of an appropriate health professional. Goat’s rue, alfalfa, anise, ashwagandha, astragalus, burdock, red raspberry leaf, nettle, marshmallow root, shatavari, lemon verbena, and borage are further examples of herbs that claim to boost milk supply. Herbal remedies should not be self-prescribed, but rather under the guidance of an herbalist or naturopath.
Galactagogues that are food based are the simplest and safest to implement as you need to eat and drink anyway! Generally speaking a diet rich in wholefoods that includes nuts, seeds, wholegrains, leafy greens and root veg is very supportive of breastmilk production. Certain foods have stronger lactogenic properties due to one or more factors, from being mineral rich (especially calcium and iron), B vitamin rich, containing phytoestrogens, healthy fats, saponins, the amino acid tryptophan, or the essential oil anethol, or by nature of being blood building or liver cleansing. Certain foods feature frequently in the various categories of galactagogues and some are considered the key lactogenic foods to consume if milk supply is waning. These include:
Grains: oats, quinoa
Nuts: peanuts, Brazil nuts, almonds
Seeds: ground flax, chia, sunflower, hemp, tahini (ground sesame)
Veg: carrots, beets, green leafy veg especially spinach, fennel
Fruit: apricots, bananas, figs, citrus, avocado
Other: brewer’s yeast, coconut, dates, eggs, blackstrap molasses, ginger, dairy
A popular postpartum snack for milk supply is the ‘lactation cookie’. There are numerous variations in recipes, though the three key ingredients are oats, flax meal, and brewer’s yeast. These are combined with butter, sugar, vanilla, eggs, and dried fruit such as apricots and dates, or seeds such as sunflower. Some recipes use ground fennel seed, blackstrap molasses and/or cinnamon, and coconut oil could be used instead of butter. It is suggested to eat a cookie with each breastfeed or have as a snack between main meals—the former results in eating a lot of cookies and will likely add many calories more to your diet than is needed! Alternatively, try drinking this Lactation Cookie Smoothie.
This recipes makes around 1 litre / 4 cups and I suggest drinking a cup as a snack 4 times a day, not unlike eating a lactation cookie semi-regularly.
Lactation Cookie Smoothie Base Recipe
1½ cups dairy or almond milk
4 tablespoons raw rolled oats plus ¾ cup water or milk, or 1 cup porridge*
1 tablespoon brewer’s yeast
2 tablespoons ground flax seed
2 raw eggs (optional)
2 teaspoons vanilla extract or paste, or 1 vanilla bean, halved
1 teaspoon cinnamon
2 bananas, fresh or frozen and sliced
4 medjool dates, pitted
Variations on the base recipe:
*cooked grains in this recipe are cooled before use. If making this recipe often and the taste of the cooked grains over the raw oats is preferred (it will taste smoother and nicer) then cook up a batch of the grain and freeze in ½ or 1 cup portions and thaw overnight in the fridge before use.
Kristine Miles is the Author of the best-selling book 'The Green Smoothie Bible', physiotherapist, and breastfeeding mum to a very active 2 year old. You can find her on Facebook (KristineMilesAuthor), Instagram (kristine_miles) and at www.kristinemiles.com
Low supply difficulties with breastmilk can frequently be remedied quite simply and can include the use of galactagogues, which are substances ingested (medication, foods, drinks, herbs, spices) that help boost breast milk production. Before I present suitable galactagogues, it's important to discuss how to know when they are needed.
The single most important factor when it comes to breast milk production is supply and demand. The more a baby suckles at and drains the breasts (or use of a breast pump) the more milk is produced. Suckling stimulates the production of the hormone prolactin which primarily drives milk production. Additionally, when breasts are full, a hormone called FIL (feedback inhibitor of lactation) signals that more milk is not required. Hence frequent feeds and/or regular feeds that drain the breast well, continue to signal that more milk is needed. Hence waiting for your breasts to fill up, or leaving lengthy gaps between feeds is one way supply can be reduced.
Conducted in 2010–11, the Australian National Infant Feeding Survey reported breastfeeding was initiated in 96 percent of infants. Only 39 percent were exclusively breastfed by 3 months, and 15 percent by 6 months. In many cases there is a perception that supply is reduced when really it isn't, potentially resulting in unnecessary early weaning or introduction of formula. Commonly when babies are around 3 months and 4-5 months old, they are going through huge developmental changes (check out The Wonder Weeks for more on this), which can make them fuss at the breast and be easily distracted. This doesn't mean they have lost interest in breastfeeding, it simply requires patience and persistence. Also around this time, a mothers breasts will have softened a lot and babies have become very efficient feeders, so it can seem as if there is less milk/not enough milk, but there will be milk, and baby is just quicker at sucking it out. A 4-5 minute feed can be the same as 30-40 minutes as a newborn. Many mothers give up breastfeeding around this time or start adding bottles of formula because they think that they don't have enough milk, but greater understanding of these facts would see breastfeeding rates improve. In these situations galactagogues are usually not needed - just keep feeding and trust your body will produce the right amount of milk for your baby. If your baby is steadily gaining weight, has plenty of wet and dirty nappies, is active, has plump skin and a sparkle in their eye, they are getting enough milk.
The following circumstances are appropriate for using galactagogues, but only in combination with frequent and thorough removal of milk from the breast, which usually requires breastfeeding or pumping more often.
- Dropping of night feeds and late feeds either from a baby that sleeps really well and/or the use of a formula bottle instead at the late feed. Because prolactin is stimulated most at night-time, 10-12 hours of no breast stimulation overnight may see a drop in supply
- Returning to work - even if pumping, you probably won't pump as often as you breastfeed and babies are more efficient than a pump
- Baby is sick with a blocked nose and not draining the breast - this could also lead to engorgement and mastitis if not careful, especially in the newborn days, but with older babies and toddlers a drop in supply more likely
- Baby is having a growth spurt and demands feeds more often - not so much a drop in supply but you will feel you need more milk than usual
- Supplementing breastfeeds with bottles of formula - this will extend time between breastfeeds and less prolactin is produced. It's a vicious cycle of adding the supplement because you think you have a low supply, then you do end up with a reduced supply and early full weaning due to milk drying up is inevitable
- Hormone imbalances such as PCOS, diabetes or thyroid disorders - these conditions depending on severity and control may influence milk producing hormones. Professional advice should be sought to deal with these conditions if breastfeeding is a struggle, by a lactation consultant in partnership with your treating health practitioner. Many women in these situations need to use multiple galactagogues including medication, food and herbs.
Galactagogues or substances that are lactogenic i.e. milk producing may include food, herbs, spices or medication.
Domperidone (Motilium) and metoclopramide (Maxolon) are medications that are used to treat gastrointestinal disorders, but have also been shown to increase milk supply. They act by blocking dopamine, which is a hormone that inhibits prolactin release. These medications can have unpleasant side effects and should only be used under medical supervision and ideally as a last resort.
Fenugreek is well known as a curry spice, and is frequently recommended to help boost milk supply, often in combination with blessed thistle. Caution should be taken with fenugreek, because at the dosages recommended they can cause an upset tummy (for both mother and baby), reduce blood sugar, and reduce thyroid function. Furthermore, it can stimulate contractions of the uterus, and hence it is contraindicated in pregnancy (except at the end if nothing is happening and you are told to eat a curry - this is why!), and conceiving while breastfeeding is certainly possible. So if you have coexisting medical conditions such as allergies, an underactive thyroid, or diabetes, or there is a chance you could be pregnant, it is not wise to take it, or only under supervision of an appropriate health professional. Goat’s rue, alfalfa, anise, ashwagandha, astragalus, burdock, red raspberry leaf, nettle, marshmallow root, shatavari, lemon verbena, and borage are further examples of herbs that claim to boost milk supply. Herbal remedies should not be self-prescribed, but rather under the guidance of an herbalist or naturopath.
Galactagogues that are food based are the simplest and safest to implement as you need to eat and drink anyway! Generally speaking a diet rich in wholefoods that includes nuts, seeds, wholegrains, leafy greens and root veg is very supportive of breastmilk production. Certain foods have stronger lactogenic properties due to one or more factors, from being mineral rich (especially calcium and iron), B vitamin rich, containing phytoestrogens, healthy fats, saponins, the amino acid tryptophan, or the essential oil anethol, or by nature of being blood building or liver cleansing. Certain foods feature frequently in the various categories of galactagogues and some are considered the key lactogenic foods to consume if milk supply is waning. These include:
Grains: oats, quinoa
Nuts: peanuts, Brazil nuts, almonds
Seeds: ground flax, chia, sunflower, hemp, tahini (ground sesame)
Veg: carrots, beets, green leafy veg especially spinach, fennel
Fruit: apricots, bananas, figs, citrus, avocado
Other: brewer’s yeast, coconut, dates, eggs, blackstrap molasses, ginger, dairy
A popular postpartum snack for milk supply is the ‘lactation cookie’. There are numerous variations in recipes, though the three key ingredients are oats, flax meal, and brewer’s yeast. These are combined with butter, sugar, vanilla, eggs, and dried fruit such as apricots and dates, or seeds such as sunflower. Some recipes use ground fennel seed, blackstrap molasses and/or cinnamon, and coconut oil could be used instead of butter. It is suggested to eat a cookie with each breastfeed or have as a snack between main meals—the former results in eating a lot of cookies and will likely add many calories more to your diet than is needed! Alternatively, try drinking this Lactation Cookie Smoothie.
This recipes makes around 1 litre / 4 cups and I suggest drinking a cup as a snack 4 times a day, not unlike eating a lactation cookie semi-regularly.
Lactation Cookie Smoothie Base Recipe
1½ cups dairy or almond milk
4 tablespoons raw rolled oats plus ¾ cup water or milk, or 1 cup porridge*
1 tablespoon brewer’s yeast
2 tablespoons ground flax seed
2 raw eggs (optional)
2 teaspoons vanilla extract or paste, or 1 vanilla bean, halved
1 teaspoon cinnamon
2 bananas, fresh or frozen and sliced
4 medjool dates, pitted
Variations on the base recipe:
- Substitute cooked quinoa or cooked millet for oats*
- Add a tablespoon of blackstrap molasses
- Substitute maple syrup for dates
- Substitute coconut milk for dairy or almond
- Substitute chia seeds for flax or use a combination of both
- Substitute carrot juice for milk
- Add more spices, including any or all of
- ¼ teaspoon cardamom
- 1 teaspoon ground turmeric
- 1cm piece fresh ginger
- 2 teaspoons ground fennel seeds
- Use more fat, such as
- 2 tablespoons peanut butter or tahini,
- 3 tablespoons sunflower, hemp, or pumpkin seeds
- ½ avocado
- Substitute soaked, dried figs or apricots for bananas
- Add some leafy greens, especially spinach
*cooked grains in this recipe are cooled before use. If making this recipe often and the taste of the cooked grains over the raw oats is preferred (it will taste smoother and nicer) then cook up a batch of the grain and freeze in ½ or 1 cup portions and thaw overnight in the fridge before use.
Kristine Miles is the Author of the best-selling book 'The Green Smoothie Bible', physiotherapist, and breastfeeding mum to a very active 2 year old. You can find her on Facebook (KristineMilesAuthor), Instagram (kristine_miles) and at www.kristinemiles.com
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