background - breastfeeding coalition of san joaquin county€¦ · foods vs herbs: lactogenic foods...

Lactogenic Foods for Milk Production

© Lisa Marasco 2015

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Lisa Marasco, MA, IBCLC, FILCA© 2015 Lisa Marasco [email protected]

I have no disclosures of financial or otherconflicting interests to make.

1. Define the term functional foods2. List at least 3 nutrients essential for

good milk production3. Name 2 foods that have research

support for their galactogogueproperties

Background

Nutrients

Cultural Foods

LactogenicDrinks

Wisdom fromthe dairy?

Fats

Malunggay

Placental Extract

Today’s mother is sowell-nourished that wedon’t have anything toworry about

Good nutrition is goodfor breastfeeding but itisn’t that important

Most traditional societiesview foods as part of theirhealth strategy

Women have always hadtraditional foods forreproduction, andespecially for milkproduction

Experience based- littleresearch

Foods vs Herbs:



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“It is well known that diet hasa profound effect on lactationand that the satisfactorysecretion of milk is onlypossible in the presence ofcertain known dietary factorsin adequate quantities.”

– Folley, 1938

“Insufficiency of food must produce insufficiency of milk.”-Routh, 1879, p.57

Foods that have apotentially positive effect onhealth….. are generallyconsidered to offeradditional benefits that mayreduce the risk of disease orpromote optimal health…

-MayoClinic.com

Some diagnoses aremade by exclusion:

What happens ifnutrient X is missing?

Governing RationalesPoor diet affects gut health → immune system →infections/mastitis → decreased productionPoor diet affects gut health → nutrient uptake →inadequate substrates → decreased production

Adams, R. S., Hutchinson, L.J. and Ishler, V.A. . (1998). Trouble shooting problems with low milk production.Penn State Dairy and Animal Science Fact Sheet 98-16.

ProteinIronIodineOmega-3 fatty acidsB-vitaminsCalciumZinc

Essential building blocksVenkatachalam, J Nutr, 1964. Effect of Protein Deficiency

during gestation and lactation on body weight andcomposition of offspring. Severely affected quantity ofmilk. Pups born to control moms but suckled bydeficient dams had high mortality.

Edozien, J Nutr 1976. “…supplement was fed to lactatingwomen to raise the protein content of their energyadequate diet from 25 or 50m to 100mg/d…. Amountof milk secreted… increased significantly.”

Donnen, Trop Med & Int’l Health, 1997. Results in asituation where protein rather than energy deficiencyoccurs show that supplementation during lactationis…unlikely to increase breast-milk output.



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Anemia is a risk factor for low supplyHenly et al, Birth, 1995. “study results suggest that

anemia is associated with the development ofinsufficient milk….”

Toppare et al, Indian J of Ped, 1994. “low PRL, lowserum iron and ferritin levels…. Were associatedw/significantly increased risk of deficient lactation”

Mathur et al, Indian Pedr, 1992. “out of 4 cases ofcomplete lactational failure, 1 had severe anemiaw/hypoproteinemia…”

O’Connor, British J Nutr, 1988. Impact of maternal irondeficiency on quality and quantity of milk ingestedby neonatal rats. Lower fat content of milkneeded more milk to compensate

Essential for proper thyroid function-Thyroid directly affects pituitary, prolactin,oxytocin

Good Fats/Omega-3s

Affect fat composition

Koletzko, B., Rodriguez-Palmero, M., Demmelmair, H., Fidler, N.,Jensen, R., & Sauerwald, T. (2001). Physiological aspects ofhuman milk lipids. Early Hum Dev, 65, S3-S18.

Dairy Research: inducing milk fat depression Diets high in simple carbs and low roughage/

fiber (including chopped) Diets high in PUFAs (polyunsaturated fatty acids) TFAs (Trans fatty acids) >pattern of trans

isomers, was related to low roughage Biohydrogenation theory- certain conditions

result in fatty acids that inhibit milk fat synthesis(Griinari 2001)

-Trans-10, cis-12 CLA (conjugated linoleic acid)

RCT NRCT Text Unpub Case Anecdote

Fats: human research

Mixed results of CLA supplementationon milk fat content

BUTReg margarine vs low TFA margarine vs butter TFAs matter for lean women

Obese women pull from fat stores

Manipulation of mat’l diet for infant… Hatherly 1994


Part of building blocks of milk synthesis

Sure, B. Dietary requirements for fertility andlactation, J of Nutr, 1941. Rat study: “Lactationfactor…may properly be described as associated with Bcomplex.”



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Lamberts, S. W., & Macleod, R. M. (1990). Regulation ofprolactin secretion at the level of the lactotroph. PhysiolRev, 70(2), 279-318.Merritt, J. E., & Brown, B. L. (1984). An investigation of theinvolvement of calcium in the control of prolactinsecretion: studies with low calcium, methoxyverapamil,cobalt and manganese. J Endocrinol, 101(3), 319-325.Collier, R. J., McNamara, J. P., Wallace, C. R., & Dehoff, M.H. (1984). A Review of Endocrine Regulation ofMetabolism during Lactation. J. Anim Sci., 59(2), 498-510.

Calcium/Magnesium When supply seems to dip around

time of period

May be related to lower calciumlevels

1500mgCa/750mgMg daily Start mid-cycle, continue through

periodPatricia Gima IBCLC


Mutch, P. B., & Hurley, L. S. (1974). Effect of Zinc Deficiencyduring Lactation on Postnatal Growth and Development ofRats. J. Nutr., 104(7), 828-842.

“Zinc deficiency during lactation rapidlyreduced maternal blood plasma zincconcentration and caused an impairmentin milk production which was specificallydue to the lack of zinc rather than toinanition.”

Provide iron, vitamins, fiber

Roughage-Manipulated for milk volume, cream content

Galactogogue property found in polysaccharide*in barley plant, appears to increase prolactin

Koltezko 2000; Farnsworth

*Nguyen, US patent 4948785, 3/14/90. Plant polysaccharide fractionsinducing prolactin in mammals



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http://www.whfoods.com/genpage.php?dbid=142&tname=foodspice#nutritionalprofile

Quinoa

“Special soaked grain preparations of high mineral content--particularly millet and quinoa--were fed to lactating women toincrease milk supply.” -Fallon, 1999

Oats-High in iron, fiber-Listed as a galactogogue in botanical surveys

Properties:AntidepressantAntianxietyDiureticThyroid/pituitarysupportive

RCT NRCT Text Case Unpub Hist Use Anec Animal st

Abu-Rabia, 2005: Herbs as a Food andMedicine Source in Palestine

Acharya 2010: Traditional Knowledge onmedicinal plants used for the treatmentof livestock diseases in Sarkikhola VDC,Kaski, Nepal

Acharya, 2010; J of Medicinal Plants Research. Cited for increasing

Oats/Oatmeal (proteins, vitamins,minerals and trace elements)

Cultural Favorite Foods RCT NRCT Text Unpub Case Anecdote

Sesame seed, TahiniCalcium

High in fiber, protein, iron, B-1, folate, magnesium

Piechulek, H., Aldana, J. M., Engelsmann,B., & Hasan, M. N. (1999). Dietarymanagement during pregnancy,lactation and common childhoodillnesses in rural Bangladesh. SoutheastAsian J Trop Med Public Health, 30(2),299-306.

Bnouham, M. (2010). Medicinal Plantswith Potential Galactagogue ActivityUsed in the Moroccan Pharmacopoeia.Journal of Complementary andIntegrative Medicine, 7(1), 52.

Lentils

Green papaya (B) Carica papaya

Traditional use across Asia, frequently in soupsVitamins & minerals including C, A, B, & EMust be hard, unripe, then cookedOr can be taken as supplementCaution for women taking warfarin or allergic to

latexY- Sayed, 2006. Herbal remedies used by Warlis of Dahanu to induce lactation in

nursing mothers. Indian J of Traditional KnowledgeN- Tennakoon, K., Jeevathayaparan, S., & Karunanayake, E. (1992). Evaluation of

possible galactagoguic activity of a selected group of Sri Lankan medicinalplants. Journal of the National Science Council of Sri Lanka, 20(1), 33-41.




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CulturalFoods

Torbangun soup

(Bataknese traditional soup)Seaweed soup(iodine, iron)

Chicken soup(calcium)

Coleus amboinicus Lour

Tinola soupChicken, green papaya,malunggay leaves

Torbangunresearch

Three groups of 25 each (Moloco reference)Moloco+B-12 (placental extr 15mg, B-12 20μg) 1 TIDTorbangun soup- 150g leaves/day of soupFenugreek capsules – 1 600mg cap TID

30 day supplement started day 2, 60 day tracking

Reported results:Fenugreek group ↑ 20%Moloco group up ↑ 10%Torbangun ↑ 65%


Damanik, 2006

Beer:MythorFact?

Grossman, E. (1988). Beer, breast-feeding, and thewisdom of old wives. JAMA, 259(7), 1016.

Koletzko, B., & Lehner, F. (2000). Beer and breastfeeding.Adv Exp Med Biol, 478, 23-28.

Mennella, J. A., & Beauchamp, G. K. (1993). Beer, breastfeeding, and folklore. Dev Psychobiol, 26(8), 459-466.

Milligan, S. R., Kalita, J. C., Heyerick, A., Rong, H., DeCooman, L., & De Keukeleire, D. (1999). Identification ofa Potent Phytoestrogen in Hops (Humulus lupulus L.)and Beer. J Clin Endocrinol Metab, 84(6), 2249-.

Sawagado, L., & Houdebine, L. M. (1988). Identificationof the lactogenic compound present in beer. Ann BiolClin (Paris), 46(2), 129-134.

Hops (B) Humulus lupulus

PropertiesDiureticEstrogenic & Bust-enhancement Cassia, 2005

Considered sedatingLactogenic ability tested, not proven; does

not stimulate prolactinCaution: do not use too much or for too

long; contraindicated w/depression


Brewers Yeast Saccharomycescerevisiae

One-celled fungus used to make beer Good source of many B-Vitamins, but not B-12. May help with fatigue, depression, irritability Rat lactation studies in 30’s & 40’s Some recent dairy studies show increase in milk yield, milk fat

“Proposed complex method of hypogalactiatreatment does not exclude possibility ofsimultaneous use of the such products aswalnuts (when there is no allergy to them),brewer yeast, etc that are commonly used forthe stimulation of lactation…..” Zeits 1990


Cultural Favorite DrinksGreen drinks- reputed to

increase fat in milk. Mayinclude barley-grass,malt, alfalfa leaf,spirulina, kelp, oat-straw,etc. Chlorophyll supplements



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Barley Water

½ cup barley in 3 cups water overnightOr Boil 20 min

StrainPour 1 cup over 1 tsp fennel seeds &

steep 30 minCan sweeten with cinnamon

Coffee substitutes

Common ingredient:Barley

Properties: highly nutritive,estrogenicFound in the Philippines,India, AFIncreases prolactinDecreased T4→T3 conversionin rats, may not be goodw/hypoT Tahiliani 2000


The Miracle Treeor

The Tree of Life

Goal: Increased milk in earlypostpartum to reduce earlysupplementation

RCT. Enrolled pg women >35wks; gave placeboplacebo or Prolacta (malunggay leaves) 350mg 2 TID tillbirth. No bfg first 2d- Pumped at 6th hr then q4hrs to 46th

Potential risks noted: some toxicity of root extract-hepatic; anti-fertility, oxytocic from roasted seeds

Briton-Medrano, G., & Perez, L. (2002). The efficacy of malunggay(moringa oleifera) given to near term pregnant women in inducingearly postpartum breast milk production-a double blindrandomized clinical trial.

Co & Co (2002).A comparative study on the efficacy of thedifferent galactogogues among mothers with LactationalInsufficiency.

RCT trial: 40 mothers who delivered <37wks withbaseline milk volume <100mL on day 2. Nodosage info or PRL results available in abstract

Milk volume day 7 Milk volume day 14

Metoclopramide 2 2

Domperidone (best) 1 1

Malunggay 3 3

Pumping only 4 4

Yabes-Almirante, C., & Lim, C. (1996).Enhancement ofbreastfeeding among hypertensive mothers.

Double-blind RCT, (BP>140/90) pg moms 28-40wks gestation. Caps given after delivery thenq12hrs for 4 months

30 hypertensive

Similar distribution of gestational age at birth inboth groups, but more IUGR in M group

15 placebo

15 Malunggay caps (Natalac)



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Estrella, M., Mantaring, J., & David, G. (2000).A double blind,randomised controlled trial on the use of malunggay(Moringa oleifera) for augmentation of the volume ofbreastmilk among non-nursing mothers of preterm infants.

Mothers deliveringinfants <37 wks

*No other maternalor fetal issues

37 Controls

31 Malunggay 250mg

q12 hours startingon day 3

Pumped q4hrs

Goal: Increased milk in earlypostpartum to reduce earlysupplementation

RCT. Enrolled pg women >35wks; gave placeboplacebo or Prolacta (malunggay leaves) 350mg 2 TID tillbirth. No bfg first 2d- Pumped at 6th hr then q4hrs to 46th

Potential risks noted: some toxicity of root extract-hepatic; anti-fertility, oxytocic from roasted seeds

Briton-Medrano, G., & Perez, L. (2002). The efficacy of malunggay(moringa oleifera) given to near term pregnant women in inducingearly postpartum breast milk production-a double blindrandomized clinical trial.

Espinosa-Kuo, C. (2005). A randomized controlled trial on the useof Malunggay (Moringa oleifera) for augmentation of the volumeof breastmilk among mothers of term infants.

Subjects: 82 full term moms forsingle-blind RCT

Dosage: 2 x 350mg (moringa orflour) daily day 3pp for 8 days

Method: Mothers used manualpump q4hrs for >5 minutes

*Did not say if babies nursed

*Interesting comment: “The state of the prolactin receptors number and degree of sensitivityto stimulation are said to be the controlling factor in the amount of breastmilk rather thanthe amount of serum prolactin. After age 35, these receptors become less sensitive tostimulation. Increased number of receptors is found among multiparous women.

BalahiboM, B. J., BaldovinoZ,BaquiranP,BarillosC,BarredoC,MadarcosF,Mendoza S. (200?). A randomized, double-blinded parallel-controlled clinicaltrial on the effectiveness of different doses ofMoringa oleifera (Malunggay) inpromoting growth in infants of breastfeeding mothers from UERMMMC anddifferent hospitals in Metro Manila from June 2000 to January 2001.

Subjects: health exclusively bfg mothersDesign: Double blind RCTDosage: 250mg (Natalac or placebo) either once or twice dailyOutcome measurement: infant weight and length gainMothers used manual pump q4hrs for >5 minutes *Did not sayif babies nursedResults: In one month, average infant weight increase was 59%for one of capsule Natalac and 72% for 2 capsules daily.

Interesting comment: Length and weight are valid outcome measurements until6 months of age, after which genetic factors begin to exert their effect.

Co & Co (2002).A comparative study on the efficacy of thedifferent galactogogues among mothers with LactationalInsufficiency.

RCT trial: 40 mothers who delivered <37wks withbaseline milk volume <100mL on day 2. Nodosage info or PRL results available in abstract

Milk volume day 7 Milk volume day 14

Metoclopramide 2 2

Domperidone (best) 1 1

Malunggay 3 3

Pumping only 4 4

Capsules, powder fornutritional supplement &

lactogogue

http://asanafoods.com/products/organic-supplements/organic-moringa-oleifera-leaf-powder/Malunggay products



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http://whitepinehealingarts.org/topicsblog/?p=1135

Kim, M.-K., Shin, J.-S., Patel, R. A., Min, Y. S., Song, H. J., Sohn, U. D., . . . Kim, D.-S. (2013).The Effects of Pigs' Feet Consumption on Lactation. Ecol Food Nutr, 52(3), 223-238.

Fennel Cumin

Dill

Caraway

CorianderAnise

• FIRST line of defense for milk production isfrequent & effective milk removal

• Lactogenic Foods support milk production inthe context of good management

• Lactogenic Foods are NOT a substitute forgood management

• Lactogenic foods can help increase milksupply for some women

• Lactogenic foods are low risk and nutritivelybeneficial

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