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Lactation Information and Discussion <[log in to unmask]>
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Tue, 24 Jun 2014 09:41:04 -0500
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My personal OPINION which I try to base on as much evidence as is available, is that a natural precursor of an extracted supplement should be superior to the supplement unless one has some type of barrier to appropriate breakdown and absorption.  Think caffeine.  Which is better - a caffeine pill or a cup of coffee?   I believe research has shown that there is more to a cup of coffee than just caffeine.   Now, I'm not extolling the virtues of coffee, mind you, I’m just saying there is MORE to coffee.   IN the same way, I'm not a proponent of dehydrated fruits and vegetables in a capsule - eat the real thing!  There are reports of hypervitaminosis in children this morning from too much vitamin a and c in breakfast cereals.   I noted that goat's rue is possibly a precursor to metformin - no wonder it helps with women with insulin resistance and other blood sugar issues.   Herbs should be considered as REAL medicine and I think the term "alternative" medicine should be discarded.   When it comes to measuring results from herbs,  one needs to consider what pathway is involved in milk production.  There is more than just prolactin involved.  When you only measure prolactin response as your indicator of effectiveness of an herb, when your protocol does not control for type of pump, length of pumping, frequency of pumping OR breastfeeding efficiency (which can be highly subjective), how can you declare a particular herb as not useful?   I HAVE found herbs and combinations of herbs VERY effective in my 28 years of practice.  But that's anecdotal.     



-----Original Message-----

From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Jennifer Tow, IBCLC

Sent: Saturday, June 21, 2014 12:38 PM

Subject: Re: combining herbs



I have probably used far more herbs in my practice than almost any other IBCLC and have done so for 20 years. What concerns me in this comment is the reductionist, Western perception of herbs as well as the dismissal of clinical history as a foundation for knowledge. We are not discovering these herbs (many of which are foods--if you have not read Motherfood, I suggest you do); there is a rich human history of consumption of a lactogenic diet and the use of herbs for breastfeeding--the presumption that women will routinely act to support their milk quantity and quality--seeking out certain foods and herbs specific to lactation already exists. I have learned from herbalists, because that is where the wisdom and knowledge of herbs resides. 



I do not take a less is more approach and I find it fails most women to do so. It is an assumption that still looks at the constituents in herbs, not their full properties. When I recommend galactogogues, I begin with a complex infusion that often means mothers can avoid medication and in fact that is one important goal that I have. I often combine many different herbs and foods, based on the woman's comprehensive nutritional profile. Or, I work with mothers to replace medication with herbs, usually very successfully. If you are going to consider risks, consider that these herbs are nourishing--they are additive from a health perspective--meds are the opposite. I have made some comments throughout this post. 

 





Date:    Thu, 19 Jun 2014 01:29:47 -0400

From:    "Shannon, RN, IBCLC" <[log in to unmask]>

Subject: Re: combining herbs



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?"  





Why are you presuming any expertise on herbs from medical doctors? Yes, there are exceptions, but otherwise, they are not a source of information. That would be like asking a podiatrist about breastfeeding. Herbalists are the experts on herbs. 



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). 





Really? It is a burden for the mother? I only find mothers feel that way when they have been misguided by folks who do not understand herbs and they do not work. Otherwise, they are happy for the results. 





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. 





Given that most herbs work best synergistically--I rarely ever recommend only one herb--you cannot assess them in the way you propose.  You are approaching herbalism in a reductionist way that does not apply. Again, consider that an engineer came along and decided that their assessment process is the only valid one and until they develop ways to determine the value of breastfeeding, the "safety of STS" and the efficacy of hand expression, they have none. 





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.)

I have never seen everything in use at one time. There are a vast number of lactogenic foods, herbs, homeopathic remedies and more. I have never run out of options. 



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.  





What do you mean by "daily dependency"? Aren't we dependent upon the nutrients from food on a daily basis? Doesn't ingesting too little of a nutrient maintain deficiency? 



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.  





I have not see this long-term risk of side-effects you describe from herbs, only drugs. Do we see long-term risk from eating foods? I do not always rush to wean mothers from these herbs--often they are the most nutritious foods the mother is consuming and I let her know that much of their value is in the nutrients. 





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.  





Why would you suggest weaning off the more beneficial herbs than the more risky meds? IMO that is absolutely backwards--like weaning off human milk to AIM rather than the other way around. I help wean my clients off meds asap. 





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



I don't understand the placebo comment here. Herbs are not placebos. How can you both address their "risk" and refer to them as placebos at the same time? 





I teach courses for IBCLCs in the use of foods, herbs, homeopathy and home remedies for breastfeeding. It can absolutely be taught, just as art can be taught (the undergrad degree I have), but you have to be willing to accept the nature of foods and herbs (which is most aligned with the nature of wellness) and not try to wedge it into another paradigm.  





Jennifer Tow, IBCLC, USA & France

Intuitive Parenting Network, LLC











 



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