>>I recently heard from another lactation professional that attended the CLC
course that new research is showing that Fenugreek is unsafe. It thins the
blood, causes blood sugar issues and other dangerous outcomes. I have always
known there are some concerns about blood sugar and that there are people
that Fenugreek might not be good for, but "dangerous" and no longer
recommended? She also said a study showed that it did not increase milk
supply at all.

Is it that serious? Wouldn't we be seeing a lot more problems?

Also, she said Reglan is now considered useless as well. It was shown in a
study not to increase milk.<<

Micky,
Fenugreek has possible side-effects, but let's talk about how often they
occur, let alone at the common dosages used for lactation. There has been a
lot of laboratory analysis of fenugreek, breaking it down into chemical
constituents and then speculating on possible consequences. But plants are
more than just the sum of their chemistry, just as human milk is superior to
the chemical imitation called formula. There are also animal studies, which
typically use large dosages. But what about actual human usage?  

Fenugreek is a *food* used in middle-eastern cooking. The mothers in India
call it "methi" and they know to chew the seeds directly to increase
lactation; they don't even make it into a tea per se. Now in large doses
fenugreek does have medicinal properties, but how often do you even see it
used in real life for any of the potential things you listed? How often do
these things actually occur? Find me some articles beyond diabetic
applications. 

It is important to be aware of potential interactions and to screen
appropriately. Heck, people with gluten intolerance need to be careful of
what foods they eat, too! And anyone can be allergic to anything; my own son
is allergic to rice, which is commonly prescribed for the "caveman"
elimination diet. We certainly need to keep track of reactions, but call it
dangerous?

All this hysteria over fenugreek has far more to do with lack of cultural
familiarity and ignorance more than anything. It would help to have more
human research to "prove" safety, but in essence the common usage and
relatively small number of people experiencing mild adverse effects is a
proof of its own kind. 

Effectiveness: I'd like to see the study proving that fenugreek doesn't work
for milk supply. I recently reviewed an article comparing fenugreek to two
other potential galactogogues that reached this conclusion, but much to my
amusement noted that the amount used was something like two ~600mg pills a
day, while we typically use 6-9!  Apparently the authors weren't familiar
with appropriate dosages so I don't respect their conclusions.

Other potential pitfalls of research include study populations: are we
looking at the ability to boost supply in women with normal supplies
already, or are we looking at women with low supply of various origins? If
the study group comes from the latter, fenugreek may or may not be able to
address the underlying cause, which is no reflection on its general
galactogogue properties. How about the brand used, and the form? I find
Nature's Way and Vitamin Shoppe to be more effective, GNC and Solaray to be
less effective (pill form).  Are the people conducting the research
well-versed in all these variables?  Pamela Berens MD and a colleague
conducted a study using mothers as their own controls, and found varying
degrees of increase in milk production with the addition of fenugreek. I
think that study was a good start.

Reglan: If the study being referenced is from a family medicine journal, you
ought to pull it and read it. They started the Reglan within the first few
days after birth. I discussed this study with Tom Hale, who said, "I can
explain those results! They started the Reglan too early, when prolactin was
still very high. Of course it didn't make a difference!"  Again, study
protocols, when conducted ignorantly, can result in bad conclusions. Other
studies have shown the effectiveness of Reglan, and certainly many mothers
can vouch for it as well. Now I don't particularly like the drug due to its
side effect profile, but please don't tell me it isn't an effective
galactogogue for general purposes!  

In summary: While your program is trying to be "research-based," there may
be a lack of familiarity and experience with these issues leading to the
presentation of research that may not be legitimate. Just because something
is in print doesn't make it valid. Now I may stand corrected if you dig up
something I have not read, but I do try to keep up on these particular
issues. I will also comment, since I'm on a soapbox here for a moment, that
each course director has their own personal philosophy (as we all do) that
is reflected in what they teach. They also respond to the political climate,
and right now IBLCE's recent attempt at a Standards of Practice certainly
leaned away from the recommendation or usage of any
substances/modalities/galactogogues. So the presentation you received may be
a reflection of the political situation as well as personal bias.

Okay, off my soapbox.

~Lisa Marasco MA IBCLC

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