Julie asks, "I am wondering if there is any benefit to taking multiple herbs for milk production.  For example, fenugreek and blessed thistle often go together, but would there be even more benefit to adding goat's rue or mulunggay?  I realize there are combination capsules available, but what if two types of combinations are taken together?  Go Lacta with More Milk Plus, for example.  Or even Domperidone taken with fenugreek, which Newman says is not helpful.  What about risks?"  

I'm going to put my thoughts (not science) out there....

1. Why take more than necessary to achieve the goal?  Every item does potentially carry risk, even if small. Every item carries a cost.  Every item carries another burden of appropriate maternal daily action (right dose, right time, etc). 

2. If one ingests multiple items simultaneously, the process of gradual item-by-item elimination to 'effect' can take a long time, be more expensive (as all un-eliminating substance/s must still be ingested at constant "dose" until it is their "turn" to be trial weaned),  and therefore provide longer exposure to an un-needed substance unnecessarily.  

When introducing one item at a time, effect (or non-effect) is often apparent after just a few days of use.  If no effect is gained, stop all use and move on to the next item.  Once an item is creating desired effect, continue use and titrate dosing to lowest amount necessary to achieve desired effect.  If desired effect has been created, is there still a need to move on and add more?  Perhaps, that is the question - synergistic effect?  As far as I am aware, simple trial-and-error introduction of another item would provide a case-by-case answer.  And, by carefully controlling each new item's introduction, same logic as establishing first item (cost, risk, unnecessary use, compliance, etc) with extra opportunity to thoroughly compare potential side-effects to each other, could be followed.  Many women eventually do identify a less commonly utilized galactagogue which ultimately stimulates a better outcome for them.  This could ultimately turn out to be nutritional or herbal component ingested via diet, tincture, tea or capsule.  

3.  Over time (usually months of sustained use), the effect of most herbs can become blunted. Tolerance response?  When it occurs, the game begins again...back to the beginning. Time to switch and find a new trigger item.  If everything potentially effective for a particular woman is already in use at one time, what other options may be available when a change is eventually needed? (These are the things I constantly do ask myself when working with a tough case.)

4.  If an item is a nutritional galactagogue, it generally has less risk and does not foster daily dependency such as an herbal or prescriptive might.  If the item is ingested, everything works better.  When it is not ingested, there is no added benefit or loss (mulunggay is a nutritional galactagogue).  Like medication, herbal galactagogues must be ingested daily.  The continual ingestion of the substance maintains a therapeutic level capable of continually creating the desired effect.  Doses can be titrated to effect.  Variable, constantly changing daily doses can be self-limiting in achieving desired outcomes.  

5.  My goal is to always first address the basics (non-separation from baby, good latch, frequency of milk removal, thoroughness of milk removal, etc) and then utilize appropriate galactagogues to stimulate increase (or maximum milk yields) so that the newly increased milk yields can then be enjoyed and maintained by the baby and/or good pumping practices.  I trial challenge my clients off supplements as soon as possible and return to them periodically only if/when again clinically indicated.  Not everyone can be successfully challenged off of them.  The longer the sustained use of galactagogues, the more likely the mother is to eventually report a side effect or adverse experience attributed to the use of the item.  

6. I see moms often mixing herbals and nutritionals simultaneously with good effect and no problem.  I often meet women taking large doses of herbals unnecessarily (usually without skilled lactation support or guidance).  I often meet women ingesting the same herbs simultaneously in different routes (pills, teas and a commercially prepared supplement), potentially ingesting much more than necessary or safe.  When prescriptive galactagogues are being utilized successfully, I absolutely encourage weaning of daily, ingested herbal supplements.  

The 'art' of helping a woman navigate successfully through the world of galactagogues can be frustrating, rewarding, or both.  It seems difficult to clearly "teach" or establish blanket protocols because there is limited 'science' to base.  Exhausted, discouraged moms often desire a ‘magic pill’ and have difficulty accepting the importance of modifying foundational lactation practices simultaneously.  Whether it's undocumented science or a mere placebo effect, the use of a nutritional/herbal galactagogues often does helps.  If it helps her believe that everything is getting better, then that alone is a powerful ‘magic pill’ after all.

Shannon, RN, IBCLC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome