Garlic use while Breastfeeding
Drugs containing Garlic: Garlic Oil
Garlic Levels and Effects while Breastfeeding
Summary of Use during Lactation
Garlic (Allium sativum) contains alliin, which is metabolized by the enzyme alliinase to allicin, thought to be responsible for most of garlic's medicinal properties and odor. Garlic has been used to lower cholesterol and blood pressure. It has no specific indications for use during lactation in western countries. Garlic has been used as a galactogogue in India, although no scientific data could be located on its use alone as a galactogogue. Garlic's odor is transmitted to breastmilk, which may increase infant sucking time acutely and might enhance the breastfed infant's food choices in the long term. Garlic has a long history of use as a food and medicine and is "generally recognized as safe" (GRAS) as a food flavoring by the US Food and Drug Administration, including during lactation. Limited scientific data found that a few days of oral garlic supplementation caused no adverse effects in nursing mothers or infants. When used as a medicinal, garlic is generally well tolerated in adults, but gastrointestinal side effects and bad breath and body odor may occur. Garlic has anti-platelet effects and should be used cautiously by women at risk for bleeding. Garlic can cause allergies and should be avoided by persons allergic to garlic or other members of the lily family, such as hyacinth, tulip, onion, leek, and chives. Topical application of garlic can cause dermatitis and burns and should be used with caution, especially in infants. One nursing mother received severe burns to the breast from prolonged (2 days) application of a poultice of raw, crushed garlic to treat a self-diagnosed Candida infection.
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Maternal Levels. Mothers given placebo or 1.5 g of garlic (General Nutrition Center, Pittsburgh, PA) in capsules once daily extracted about 20 mL of breastmilk every hour for 4 hours after garlic ingestion. A panel of 11 men and women who were blinded to maternal product ingestion rated the perceived odor of garlic in each sample. Garlic odor was most strongly perceived at 2 hours after maternal garlic ingestion. The odor remained equally perceptible at 3 hours after ingestion in some mothers' milk.
Six nursing mothers 22 to 51 weeks postpartum each ate 3 grams of raw garlic and donated 3 milk samples via breast pump, 1 before ingesting the garlic and 2 afterwards at 2 to 3 hour intervals. Garlic-derived metabolites were measured over a period of up to 5.2 hours after the ingestion of garlic. A panel of sensory evaluators identified odors present in milk samples and several known metabolites were detected in the milk by high-resolution gas chromatography-olfactometry. The panelists identified a garlic or cabbage-like odor in breast milk about 2.5 hours after maternal consumption of garlic. Out of 13 possible garlic-derived metabolites, laboratory analyses found only allyl methyl sulfide, allyl methyl sulfoxide, and allyl methyl sulfone in breastmilk. Only allyl methyl sulfide had a garlic-like odor; the other two metabolites were odorless. Measured levels of the metabolites had peak concentrations between 2 and 3 hours after maternal garlic ingestion.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
Maternal garlic ingestion has a reputation for causing colic in breastfed infants. Two papers tend to refute this claim. In one, 153 mothers who answered a questionnaire were no more likely to report colic in their infants in the previous week if they had ingested garlic than if they had not. In another, mothers who were given either 1.5 grams of garlic or placebo capsules once daily in a blinded fashion for 3 days were asked if their infants had exhibited any signs of colic after capsule ingestion (were fussier, cried more or had more gas). Four of 20 women who ingested garlic thought their infants had colic; however, 4 of 10 women who received placebo thought they had received garlic and reported colic in their infants.
Effects on Lactation and Breastmilk
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. 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.
In two studies conducted by the same investigators, capsules containing 1.5 g of garlic extract (General Nutrition Center, Pittsburgh, PA) were given to nursing mothers. In the first experiment, 8 mothers receive a garlic capsule or placebo once daily in a crossover fashion. Garlic-naive infants whose mothers ingested garlic capsules spent more time (33 vs 27 minutes) attached to the nipple during the time period of 1.5 to 3 hours after garlic ingestion when garlic odor in milk was maximal than in those whose mothers received a placebo; however, total number of nursings or total amount of milk ingestion did not differ between groups. A study randomized nursing mothers to receive garlic capsules or placebo for 3 days before testing with a single capsule as in the study above. Infants who received garlic in the milk for the first time spent 30% more time nursing than after placebo. Infants who had been previously exposed to garlic in milk, did not spend more time nursing after subsequent garlic exposure in milk. The authors interpreted the results of these studies as having a positive effect on infants' later food choices (i.e., being less "picky" about foods).
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