What is Fenugreek?
Fenugreek (Trigonella foenum-graecum) is an herbal supplement that is claimed to be useful for a broad range of various conditions, without any substantial scientific evidence, from baldness, constipation, and heartburn to diabetes, cholesterol and erectile dysfunction. The focus here, is the widely held belief among lactation advisors, nursing mothers and other birth professionals that fenugreek helps to stimulate milk production and supply.
The fact is, there is not enough evidence to suggest that fenugreek is effective for any use. Of the few studies that have been done, they have been small and inconclusive. So, does the fact that there is no data or research mean that fenugreek has no benefit? No, not inherently. Similarly, just because it is an herb and “natural”does not mean that it is safe.
Milk Supply and Galactagogues
First, let’s explore the idea of increasing milk supply. Initially establishing supply is a specific and balanced dance of hormones and receptors that begins the moment the placenta is delivered. Milk supply is determined by the removal of milk from the breasts and the interplay of prolactin (which produces the milk) and oxytocin (which releases the milk). Frequent nursing is directly associated with greater infant weight gain. (DeCarvalho)1
As Americans, we often look to something outside of us to find a solution, often that’s in the form of a pill, whether prescribed or purchased at a health food store. Often, the answers lie within us or in behaviors such is the case with breastfeeding. It is far more effective for a mother struggling with supply to work with a lactation professional and look at all aspects of her nursing relationship. For example: How often is the baby being fed? Is the mother expressing her milk and how? How much milk is being removed from her breast at each feeding (determined by weighing baby before and after a feed)? Most important is a mother’s confidence. With desire, confidence and early breastfeeding support, a healthy, rewarding nursing relationship with a sufficiently plentiful supply is more likely.
Millions of women across nations and generations, living under impoverished conditions, famine, holocaust and natural disasters, are able to produce and supply their infants with their own human milk regardless of the mother’s nutritional status. Advice that guides nursing mothers to drink more to be able to produce more milk is erroneous: “Encouraging women to drink excessively has no effect upon lactation, either in terms of yield or composition of milk.” (Dearlove)2 Healthy eating and balanced nutrition are good advice throughout the life cycle, however, this directive during lactation benefits the mother and her long term health but does not impact milk supply.
Is there really such a thing, then, as a galactagogue, an external substance believed to increase milk supply? The American Heritage Medical Dictionary defines galactagogue as “an agent that promotes the secretion and flow of milk.” Many elements that are believed to help milk supply are based in cultural lore and not supported through research. In a literature review of galactagogues, Anderson and Valdes3 concluded that “If mothers are provided education and practice techniques that support lactation physiology, galactagogues appear to have little or no added benefit.” It has long been purported that fenugreek is a galactagogue, but it has never been proven to help milk supply and may have worrisome side effects.
Some reported side effects of fenugreek include diarrhea, gas, indigestion, heartburn and unusual smelling skin and urine (like maple syrup). More serious, but more rare, side effects can indicate internal bleeding such as black, tarry or bright red stools, or vomiting blood or can indicate a bleed in the brain (hemorrhagic stroke) such as vision or speech changes, severe headache or weakness or numbness in the arms or legs. As with any herbs, always be aware of allergic reactions.
It’s important to note that fenugreek is a legume and those who have peanut allergies may experience a cross-reaction. Dr. Frederick Leickly, an allergist, writes in his blog about a study published in the Journal of Allergy and Clinical Immunology (JACI) which concluded that a sensitization to fenugreek was believed to have been caused by a peanut allergy in patients. He also noted in his practice a reverse effect, “that the fenugreek may have worked in the opposite direction – fenugreek exposure causing sensitization to the other legumes,” meaning it is possible that the use of fenugreek may create an allergy to peanuts or other legumes.
In Mosby’s Handbook of Herbs and Natural Supplements, by Linda Skidmore-Roth, it states that Fenugreek “may cause reduced absorption of all medications used concurrently.” This could cause harm in a mother taking medication for thyroid function, blood pressure or birth control pills.
Traditionally, fenugreek has been used to stimulate labor, so it could potentially cause preterm labor or miscarriage if taken during pregnancy. Fenugreek is classified as category 4 for pregnancy which is defined as “no increase in frequency of malformation or other harmful effects on the fetus from limited use in women. Evidence of increased fetal damage in animal studies exists, although the relevance to humans in unknown.” It is classified as a category 2A for breastfeeding which is defined as “compatible with breastfeeding.”
As with all herbs, fenugreek has not been tested or verified by the FDA for safety, effectiveness or purity; there have been cases when herbal supplements have been contaminated with toxic metals or other drugs. There is no official standard or oversight of manufacturing.
It is not fully known whether fenugreek can harm a nursing infant and it is not proven to have any positive effect on milk supply or nursing. Focusing on breastfeeding support and education as well as working with nursing moms to empower them and build confidence are effective ways to help a mother establish and maintain a nursing relationship.
1. De Carvalho, M et al: Effect of frequent breastfeeding on early milk production and infant weight gain. Ped 72(3) Sep 1983.
2. Dearlove, J C & Dearlove, B M: Prolactin fluid balance and lactation. Br J Obstet Gyn 88:652-54, 1981.
3. Anderson and Valdes, 2007, A Critical review of Pharmaceutical Galactagogues. Breastfeeding Medicine, 2(4), 229-242.