Fenugreek use while Breastfeeding

Fenugreek Levels and Effects while Breastfeeding

Summary of Use during Lactation

Fenugreek (Trigonella foenum-graecum) seeds contain mucilage, trigonelline, 4-hydroxyisoleucine, sotolon, diosgenin, phenolic acids, and protodioscin. Fenugreek has been used in a number of geographical regions worldwide as a galactogogue to increase milk supply,[1][2][3][4][5][6][7][8][9][10] and is included in numerous proprietary mixtures promoted to increase milk supply. Evidence for a galactogogue effect is mostly anecdotal. A limited number of published studies of low to moderate quality have found mixed results for a galactogogue effect for fenugreek.[11][12][13][14] Some of these studies used a multi-ingredient combination products in which fenugreek was only one component, so the results might be different from studies in which fenugreek was used alone. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[15]

Fenugreek is "generally recognized as safe" (GRAS) as a flavoring by the US Food and Drug Administration. Limited scientific data exist on the safety of fenugreek in nursing mothers or infants, although it has a long history of use as a food and medicine in India and China. When used as a medicinal, it is generally well tolerated in adults, but gastrointestinal side effects such as diarrhea and flatulence may occur. Allergic reactions, exacerbation of asthma, and a 14% decrease in serum potassium have been reported. Cross-reactions with chickpeas, peanuts, and other legumes are possible. Dosages typically used to increase milk supply are 1 to 6 grams daily; in dosages of about 25 grams or more daily, fenugreek may cause lowering of cholesterol and blood sugar. It can also interact with warfarin to cause bleeding. Caution should be used in giving high dosages to women with diabetes mellitus or those taking warfarin. Perhaps its most unusual side effect is the imparting an odor of maple syrup to the urine, sweat, feces, and possibly breastmilk by the sotolon in fenugreek.[6][16][17]

Dietary supplements do not require extensive pre-marketing approval from the US Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

A study in mothers of preterm infants less than 31 weeks gestation compared the use of fenugreek (product and dosage not stated) 3 capsules 3 times daily for 21 days to placebo. No adverse effects were noted in the infants given the breastmilk.[18]

Possible Effects on Lactation

Forty women who complained of an insufficient milk supply at 5 days postpartum were given a combination herbal supplement as 2 capsules of Lactare (Pharma Private Ltd., Madras, India) 3 times daily. Each capsule contained wild asparagus 200 mg, ashwagandha (Withania somnifera) 100 mg, fenugreek 50 mg, licorice 50 mg, and garlic 20 mg. By day 4 of therapy, no infants required supplementary feeding. Infants were weighed before and after each feeding on the fifth day of maternal therapy to determine the amount of milk ingested. On the day of the test weighing, infants' milk intake averaged 388 mL, and the fluid and caloric intake was considered adequate.[19] This study cannot be considered as valid evidence of a galactogogue effect of these herbs because it lacks randomization, blinding, a placebo control, and maternal instruction in breastfeeding technique. Additionally, infants were breastfed only 6 to 8 times daily, which is insufficient to maximize milk supply.

A study of healthy women who delivered a fullterm infant and desired to breastfeed for at least 4 months compared fenugreek, torbangun (Coleus amboinicus) and a product containing placental extract and vitamin B12 (Molocco+B12) for their effects on breastmilk volume. No mention was made of any breastfeeding support provided to the women. Participants were randomly assigned to receive one of the products for 30 days and followed for another 30 days. Capsules containing powdered fenugreek seeds 600 mg (Bullivants Natural Health, Auckland, New Zealand) were given 3 times daily. Infants were weighed before and after each nursing at 2-week intervals during the study to measure 24-hour milk volume. At no time point during the study was milk volume in the fenugreek group (n = 22) statistically different from the reference group (n = 22) who received Molocco+B12, although the torbangun group did have a statistically significant increase. The daily volume of milk actually decreased in the fenugreek group over time, although the change was not statistically significant.[20] The dosage of fenugreek used in this study was lower than that typically recommended by most sources.[4][21][22]

A study was performed in 10 postpartum women who delivered preterm infants (24 to 38 weeks gestation) and had been pumping their milk for at least 14 days, but usually 3 to 4 weeks. The women recorded their baseline pumped milk volumes during one week and then took one 610 mg fenugreek capsule (Nature's Way) 3 times daily for a second week during which they recorded milk volumes. Average daily milk volumes increased from 207 mL in week 1 (range 57 to 1057 mL) to 464 mL (range 63 to 1140 mL) in week 2.[14] This study was neither randomized nor blinded and did not have a placebo control group, so the result is questionable. A study in 26 mothers of preterm infants less than 31 weeks gestation compared fenugreek (product and dosage not stated) 3 capsules 3 times daily for 21 days to placebo. Mothers began pumping within 12 hours of delivery and recorded pumping frequency and milk volume. Maternal serum prolactin was also measured weekly during the 21 days. No statistical differences were found in milk volumes or serum prolactin values between the two groups.[18] The study is thus far published only in abstract form, so many study details are missing.

Sixty-six postpartum mothers (22 in each of 3 groups) with no concurrent illnesses were randomly assigned to receive an herbal tea, placebo, or nothing after delivering healthy, fullterm infants. Mothers in the herbal tea group received at least 3 cups daily of 200 mL of Still Tea (Humana-Istanbul, Turkey; containing hibiscus 2.6 grams, fennel extract 200 mg, fennel oil 20 mg, rooibos 200 mg, verbena [vervain] 200 mg, raspberry leaves 200 mg, fenugreek 100 mg, goat's rue 100 mg, and, vitamin C 500 mg per 100 grams, per manufacturer's web site November 2011). A similar-looking apple tea was used as the placebo. All women were followed by the same nurse and pediatrician who were blinded to what treatment the mothers received. Mothers who received the Still Tea produced more breastmilk with an electric breast pump on the third day postpartum than mothers in the other groups. The infants in the Still Tea group had a lower maximum weight loss, and they regained their birth weights sooner than those in the placebo or no treatment arms. No long-term outcome data were collected. Because many of the ingredients in Still Tea are purported galactogogues, no single ingredient can be considered solely responsible for the tea's effects, although the authors attributed the action to fenugreek.[23]

An herbal tea containing fenugreek, hibiscus, fennel, rooibos, vervain, raspberry, goat's rue, and vitamin C (Humana Still-Tee, Humana GmbH, Herford, Germany) or water was randomly given to nursing mothers in a dosage of 3 cups daily beginning on the day of delivery. Several markers of antioxidant capacity were measured in breastmilk on day 1 and again after 7 to 10 days. No difference was found in the markers between mothers who received the tea and the water.[24]

References

1. Allaire AD, Moos MK, Wells SR. Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives. Obstet Gynecol. 2000;95:19-23. PMID: 10636495

2. Ayers JF. The use of alternative therapies in the support of breastfeeding. J Hum Lact. 2000;16:52-6. PMID: 11138225

3. Scott CR, Jacobson H. A selection of international nutritional and herbal remedies for breastfeeding concerns. Midwifery Today Int Midwife. 2005;75:38-9. PMID: 16320878

4. Low Dog T. The use of botanicals during pregnancy and lactation. Altern Ther Health Med. 2009;15:54-8. PMID: 19161049

5. Fleiss P. Herbal remedies for the breastfeeding mother. Mothering. 1988;Summer:68-71.

6. Ulbricht C, Basch E, Burke D, Cheung L, Ernst E, Giese N et al. Fenugreek (Trigonella foenum-graecum L. Leguminosae): an evidence-based systematic review by the natural standard research collaboration. J Herb Pharmacother. 2007;7:143-77. PMID: 18928139

7. Sayed NZ, Deo R, Mukundan U. Herbal remedies used by Warlis of Dahanu to induce lactation in nursing mothers. Indian J Tradit Knowl. 2007;6:602-5.

8. Abascal K, Yarnell E. Botanical galactagogues. Altern Complement Ther. 2008;14:288-94.

9. Alachkar A, Jaddouh A, Elsheikh MS et al. Traditional medicine in Syria: folk medicine in Aleppo governorate. Nat Prod Commun. 2011;6:79-84. PMID: 21366051

10. Winterfeld U, Meyer Y, Panchaud A, Einarson A. Management of deficient lactation in Switzerland and Canada: A survey of midwives' current practices. Breastfeed Med. 2012;7:317-8. PMID: 22224508

11. Mortel M, Mehta SD. Systematic review of the efficacy of herbal galactogogues. J Hum Lact. 2013;29:154-62. PMID: 23468043

12. Forinash AB, Yancey AM, Barnes KN, Myles TD. The use of galactogogues in the breastfeeding mother. Ann Pharmacother. 2012;46:1392-404. PMID: 23012383

13. Zapantis A , Steinberg JG, Schilit L. Use of herbals as galactagogues. J Pharm Pract. 2012;25:222-31. PMID: 22392841

14. Berens P, Swafford S. Effect of fenugreek on breast milk volume. Presented at the 5th International Meeting of the Academy of Breastfeeding Medicine. 2000;1113. Full text of paper obtained from Pamela Berens, MD, May 2011.

15. The Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #9: use of galactogogues in initiating or augmenting the rate of maternal milk secretion (First revision January 2011). Breastfeed Med. 2011;6:41-9. PMID: 21332371

16. Betzold CM. Galactagogues. J Midwifery Womens Health. 2004;49:151-4. PMID: 15010670

17. Tiran D. The use of fenugreek for breast feeding women. Complement Ther Nurs Midwifery. 2003;9:155-6. PMID: 12852932

18. Reeder C, Legrand A, O'Conner-Von S. The effect of fenugreek on milk production and prolactin levels in mothers of premature infants. J Hum Lact. 2011;27:74. Abstract. DOI: doi:10.1177/0890334410391059

19. Sholapurkar ML. 'Lactare' for improving lactation. Indian Pract. 1986;39:1023-6.

20. Damanik R, Wahlqvist ML, Wattanapenpaiboon N. Lactagogue effects of Torbangun, a Bataknese traditional cuisine. Asia Pac J Clin Nutr. 2006;15:267-74. PMID: 16672214

21. Gabay MP. Galactogogues: medications that induce lactation. J Hum Lact. 2002;18:274-9. PMID: 12192964

22. Bonyata K. Fenugreek seed for increasing milk supply. http://www.kellymom.com/herbal/milksupply/fenugreek.html (accessed March 11, 2011)

23. Turkyilmaz C, Onal E, Hirfanoglu IM et al. The effect of galactagogue herbal tea on breast milk production and short-term catch-up of birth weight in the first week of life. J Altern Complement Med. 2011;17:139-42. PMID: 21261516

24. Kavurt S, Bas AY, Yucel H, Aydemir O, Is Koglu S, Demirel N. The effect of galactagogue herbal tea on oxidant and anti-oxidant status of human milk. J Matern Fetal Neonatal Med. 2013;26:1048-51. PMID: 23363373

Fenugreek Identification

Substance Name

Fenugreek

Scientific Name

Trigonella foenum-graecum

CAS Registry Number

68990-15-8

Drug Class

  • Complementary Therapies
  • Galactogogues
  • Phytotherapy
  • Plants, Medicinal

Administrative Information

LactMed Record Number

870

Information from the National Library of Medicine's LactMed Database.

Last Revision Date

2014-07-03

Disclaimer

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