Lactation Supplements: Do They Work and Are They Safe to Use?

Breast milk is considered to be the optimal food source for newborns through one year of age. Specialists recommend that your baby should be breastfed at least for the first six months. Many parents who want to achieve all the benefits of breastfeeding may struggle to produce enough breast milk to make up their baby’s whole diet. To feed your baby only breast milk for the time recommended, you need to produce increasing amounts of breast milk as the baby grows. If you are ever concerned about the ability to produce enough milk, you should consult with your healthcare provider to see if lactation supplements could be of benefit to you.

What are lactation supplements?

Lactation supplements, also called galactagogues, are substances that stimulate milk production in your body. They may be pharmacological (medication) or non‐pharmacological (natural). Pharmacological treatments include drugs like domperidone, metoclopramide, and sulpiride. Natural galactagogues are usually botanical and include herbs, roots, seeds, or other food agents. The choice between pharmacological or natural galactagogues is often influenced by familiarity, advice, experience, or reviews on the internet.

Before using any of it, it's important to know the most common benefits and harms of galactagogues and seek support from a healthcare professional for advice tailored to you.

How do lactation supplements work?

First, let's take a look at the mechanisms behind breastfeeding. When you breastfeed, your body releases two hormones: prolactin and oxytocin. Prolactin promotes the growth of mammary glands, where the actual production of milk occurs. More prolactin is produced at night (usually between 2–6 a.m.), so breastfeeding at night is especially helpful for keeping up with milk supply. Oxytocin makes the milk flow from the mammary glands to the nipple. Dopamine (another chemical messenger) may inhibit prolactin release, potentially affecting milk supply. However, oxytocin suppresses dopamine, which means your dopamine levels decrease.

Lactation supplements are yet to be fully understood. However, in theory, they interact with hormones such as dopamine, oxytocin, and prolactin, which results in an increase in milk production. More specifically, it is believed that galactagogues interact with dopamine receptors by blocking them and boosting prolactin levels in the blood.

When talking about these theories, it is crucial to note that safety and efficacy studies are lacking, and since the Food and Drug Administration (FDA) does not regulate supplements, it is important to be informed about the risks.

Are lactation supplements safe?

Studies show little evidence to support the safety of lactation supplements. Findings suggest that botanical supplements have not been evaluated in high-quality clinical trials, and there is limited evidence supporting the safety of their use.

One of the most popular botanical galactagogues, fenugreek, is listed as generally recognized as safe (GRAS) as a flavoring by the FDA. However, the safety of amounts higher than those found in foods has not been fully established. Fenugreek has been reported to have adverse effects in certain thyroid conditions. So, if you have thyroid problems or any other underlying health conditions, it is always best to consult your obstetrician/gynecologist or healthcare provider.

Different types of lactation supplements

As mentioned before, lactation supplements can be divided into pharmacological and non-pharmacological.

Most common pharmacological galactagogues (they stimulate prolactin release by blocking dopamine receptors):

• Domperidone
• Metoclopramide
• Sulpiride
  

Most common natural galactagogues:

Thirteen studies included 962 participants and a variety of supplements (banana flower, fenugreek, ginger, moringa, ginger, turmeric mix, ixbut, mixed botanical tea, silymarin, and palm dates). The analysis for each intervention suggested some benefit or very little difference in milk volume. Such mixed results provide minimal support for the effect of galactagogues in breastfeeding.

How to use lactation supplements

There is no specific time during the day when you need to take lactation supplements. Always follow the instructions from the manufacturer and seek professional advice. It is suggested to pair your supplements with your meals in the morning, afternoon, or evening.

When talking about pharmacological galactagogues, your doctor will prescribe you the accurate dose and tell you when to use it. For example, domperidone is usually advised to take 30 minutes before meals three times a day.

How long does it take for lactation supplements to work?

From previous studies, an increased milk supply was noticed within 24 to 72 hours after consuming fenugreek tea. However, it must be noted that the study has its limitations, and the results were self-reported by the participants. Generally, the maximum effect may take up to 4–6 weeks. Plus, there are more factors that play a role in lactation — frequency of breastfeeding or pumping and adequate hydration of the mother.

There is no specific time frame, as each person can respond differently to various supplements. In addition, the existing evidence supporting the effectiveness of lactation supplements is lacking, so more high-quality research is needed.

Alternatives that help to increase breast milk

There are many alternatives to increase the production of breast milk without taking any pharmacological or natural remedies. Here are some other natural ways to promote milk supply:

• Eat a healthy nutritional diet
• Drink plenty of fluids (water is the most important one)
• Practice skin-to-skin care with your baby
• Pump and massage your breasts between feedings
• Don't forget to feed with both breasts
  
• Manage anxiety
• Rest and sleep as much as you can
• Take your prenatal vitamins
• Take care of your own mental and physical well-being
  

Always remember to evaluate simple factors, including the baby's attachment to the breast for effective suckling, frequency of feeding or pumping, and thoroughness of breast emptying. A lactation consultant can be invaluable in identifying if there are underlying issues contributing to low milk supply.

Risks and side effects of lactation supplements

There were limited reports of adverse effects. The main and mostly mentioned side effects were:

• Tiredness
• Nausea
• Headaches
• Dry mouth
• Increased gas
• Gastrointestinal motility with loose stools

Mothers with thyroid problems should consult their doctor before taking fenugreek as it can affect thyroid hormone levels. Prescription medication such as domperidone is not recommended for use in mothers with cardiac arrhythmias (irregular heartbeat) or mothers taking any medication that may cause cardiac arrhythmias.

Taking supplements without the right guidance can be risky and lead to negative side effects for you and your little one. It is reasonable to be advised by your doctor or lactation consultant about any of the lactation supplements.

To sum up, galactagogues stimulate milk production in lactating mothers. The exact mechanisms of how lactation supplements work are not fully understood, but it is believed that they may increase milk production. It is essential to follow recommended doses and consult a healthcare professional, especially for mothers with underlying health conditions. The evidence supporting the benefits and risks of lactation supplements is not robust, therefore, it is essential to be informed before making any decisions about your health.