Hi Therese,

Others have posted about the fenugreek pilot study - see lactnet archives
for the abstract; it is the only published recent or experimental study of
fenugreek as a galactogogue.  Other scientific study of fenugreek's actions
on the body are available through a medline search of fenugreek ( see in
particular the interaction of fenugreek's unique amino acid,
4-hydroxyisoleucine, with the insulin receptor when high blood sugar is
present).

Although there is no shortage of modern anecdotes about fenugreek's
galactogogue activity ( see lactnet archives), I believe Jack Newman's
descriptions of clinical use in his books are a little more weighty than
mere anecdote, considering the expert source ( MD, paediatrician,
well-recognized lactation expert with extensive clinical practice with
breastfeeding mothers). Other detailed descriptions of clinical use by
experienced and respected IBCLC clinicians are also to be found published in
reliable places; many of such accounts are on the internet in their
entirety.

There are detailed descriptions of  traditional use of fenugreek as a
galactogogue in the ethnobotanical literature.  Detail include plant parts
and preparation, dose, route used.  This literature is scientific: source
information collected and evaluated by scientists using strict criteria, and
published in peer-reviewed scientific journals. "Traditional" is a defined
term in ethnobotany; it is obviously important to distinguish commercial
hype in an advertisement from what a folk healer in the field reports to a
trained ethnobotanist.

Ethnobotanical information is a form of scientific evidence, not the best or
highest form, that being random controlled trials (RCTs), but a valid form
playing an important role in medicinal plant investigations nonetheless.
RCTs are not the only form of scientific evidence nor are capable of
answering all research questions. The information from expert clinical and
bona fide traditional sources cannot be overlooked, whether safety or
efficacy is the question. The Cochrane evaluations do not overlook these
categories, btw.

And on a pragmatic level, why should clinical practices that in the
experience of practitioner work reliably for mothers while causing few
adverse effects be automatically excluded for lack of RCTs?  Or, to set the
bar even higher, large-scale RCTs?  As is often said, stewed prunes have not
a shred of RTC-level evidence that they will relieve constipation, a status
they share with a large portion of current clinical medical practices. You
are neither the first nor the last to suggest fenugreek, a conservative
position, and legally defensible, when new therapies are gaining acceptance.

Following the established criteria for ethnobotanical evidence used to
evaluate potential efficacy, fenugreek is one of many herbs who meet these
criteria ( see Bingel and Farnsworth); properly conducted experimental
research is very likely to validate it's ethnobotanical use. Enough
information on fenugreek constituents exist to at least hazard a speculation
on it's mechanisms of action.  A pilot human study has now been done, and
another is in progress.

Numerous anecdotes show allergic response to be the most troublesome
potential side effect of fenugreek, something it shares with other foods
from the same plant family, most notoriously, peanuts. (Of course peanuts
have shown to be much more hazardous at this point in time.)  So far,
allergy is only documented in mothers or direct ingesters, not infants,
though the recent report of peanut allergens entering breast milk shows
potential for risk to a sensitive baby. Diarrhea in mother or baby sometimes
occurs, usually relieved by reducing the dose.  It is not clear if this
response can sometimes be allergic in nature or due to other factors; many
medicinal herbs and drugs for that matter can cause diarrhea.  For an
allergenic mother or history of family allergy to nuts, beans, peanuts in
particular, fenugreek should conservatively be avoided and a non-allergenic
galactogogue  be considered.

There are at least 2 hospitals (California) that have a written
galactogogue protocol clearly outlining when fenugreek and/or other herbal
galactogogues are to be suggested. You can email me privately for contacts.

Good luck with your talk - such short notice to become familiar with this
plant, so just a little unfair, seems to me.

Regards,
Sheila Humphrey
BSc RN IBCLC
bucolic Marine on St. Croix, Minnesota

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