Herbs and breastfeeding
Ruth A. Laurence, M. D. Professor of Pediatrics, Obstetrics &
Gynecology University of Rochester School of Medicine & Dentistry
Herbs are marketed as natural remedies to cure many ailments,
including sleeplessness, depression, and cardiac disease.
Herbs come in natural forms (i.e. roots, leaves, flowers,
seeds, and berries), and can be purchased at almost every
supermarket, health food store, and over the Internet. Herbal
teas, such as peppermint tea, are very pleasant tasting and are
often sipped to relax. Many well-known brands of vitamins and
food supplements also contain herbs.
Although herbs are natural, they are not always safe, especially for
breastfeeding mothers. Many herbals contain ingredients that
have effects similar to certain medications that pass through the
breastmilk and potentially could be dangerous to a nursing mother
and her infant. The compounds coumarin and nicotinic acid
found in fenugreek, for example, can have very potent effects on
heart rate, blood pressure, blood sugar, and other bodily functions.
If a mother consumes fenugreek regularly in large amounts, her baby
can experience these symptoms as well. Because the effect and
concentration of different herbs found in teas, liquids, pills, and
food supplements may vary, breastfeeding mothers should be cautious
and selective in their use of any herbal preparations.
The Lack of Regulation of Herbal Preparations
There are no rules or regulations for the distribution of herbs,
making it difficult for consumers to distinguish safe versus
potentially dangerous herbal preparations. The Food and Drug
Administration (FDA) is mandated to control the safety of all
medications and infant formula in the United States, but herbs are
not included in this definition. Because herbal preparations
are not regulated by the FDA, there is no requirement to list the
ingredients of such preparations on the label. Perhaps more
dangerous is the fact that many herbal preparations list some of the
ingredients, but not others that may be potentially dangerous.
There also is no requirement to list the dose of active ingredients
found in herbal preparations. Because herbs occur in natural
forms, rather than being carefully measured in a laboratory, the
amount of an active ingredient may vary from leaf-to-leaf or from
plant-to-plant. This is particularly important when using
potentially dangerous herbs, such as the leaves of the foxglove
plant that were once prescribed to treat heart failure. When
leaves of the foxglove plant, which contain digitalis, were ground
up and rolled into pills, one pill was not the exact same strength
as another, making it extremely difficult to control the dose of the
herbal and its effect on the disease. Fortunately, in our
modern-day pharmaceutical industry all medications are carefully
measured and tested for quality in the laboratory before being
distributed to the public.
Nonetheless, new mothers should be aware of herbs that are safe (and
maybe even beneficial) while breastfeeding, and what herbs should be
avoided.
Breastfeeding Mothers Can Enjoy Many Herbal Teas
Many herbs found in herbal teas are safe for breastfeeding mothers
and some companies that make herbal preparations, such as Celestial
Seasonings, label their products accurately so that consumers know
exactly what they are getting. The accurate labeling of
ingredients in herbal preparations also makes it possible for poison
control centers to know what they are dealing with in the case of
overdose. So, reliable brands of herbal tea like Celestial
Seasonings should be safe, as long as the ingredients included are
okay for breastfeeding mothers to ingest.
Breastfeeding mothers should stick with herbal teas that are not
full of potent pharmacologic preparations. Orange cinnamon,
lemon lift, and raspberry teas are good choices. Another fine
choice is tea made from rose hips (the berry-like formation
left after the rose pedals drop away), which contains a lot of
Vitamin C.
Some herbs that are found in teas should be avoided. There is
a native plant in Mexico, for example, that has a vanilla-like
flavor and tinctures of the root of this plant are sold as imitation
vanilla. Small amounts of this preparation used in cooking are
safe, but drinking large amounts of tea with this ingredient could
cause serious bleeding over time, because of the native
anticoagulant in this plant. There are other teas native to
the Southwest that contain compounds called pyrrolizide alkaloids
known to cause occlusion of the veins, especially the liver, and
finally liver failure. A cup of tea now and again is
reasonably safe, but drinking several cups on a daily basis could
lead to serious cardiovascular and liver disease. Comfrey
(Symphytum officinale), an herb used to heal wounds topically or to
heal ulcers internally contains alkaloid substances associated with
occlusion of the veins. Comfrey is often confused with the
plants nightshade and foxglove by inexperienced herbalists, and it
has been banned in Canada because of its dangerous side effects.
Be Cautious About Taking Herbal Dietary Supplements While
Nursing
Some herbs are touted as excellent dietary supplements, particularly
because they contain microminerals such as selenium and zinc.
While most herbs are safe in small amounts, there is no quality
control mechanism to guarantee the dosage or exact ingredients of
herbal dietary supplements. Because a variety of herbs -
including pharmacologically active herbs such as ginkgo, ginseng,
kava, and valerian - often are added to dietary supplements, taking
them can be risky for breastfeeding mothers. The danger
associated with these herbs is that they can cause side effects if
ingested in large quantities over time. For example, large
doses of ginseng can give you a "buzz", and when it is discontinued
there is a significant withdrawal - similar to that of caffeine
withdrawal. This is often called "ginseng syndrome." A
good rule of thumb is that a nursing mother should not consume a
dietary supplement if it is unlabeled, if ingredients are not
measured accurately, or if it contains any pharmologically active
substances.
The Effect of Herbs on Milk Production is Questionable
Breastfeeding mothers are often interested in increasing their milk
supply, particularly when mother and baby have been separated
because of illness and the baby has been unable to nurse at the
breast. The herbal literature suggests that some herbs
increase milk production. Number one on this list is fenugreek
(Trigorvella foenum-graecuml), an herb that can cause low blood
sugar (hypoglycemia) and has been tried in the management of
diabetes, albeit unsuccessfully. Diabetics must monitor their
blood sugar and measure the dosage of medication to manage their
illness very carefully, making it very difficult to control the
disease with natural substances.
Fenugreek probably has little effect on milk supply until a mother
takes large amounts of (about three capsules, three times per day,
but this varies from pill-to-pill) and her milk and urine begin to
smell like maple syrup, though no clinical trials have been
conducted to prove or disprove this relationship. When a
mother takes large quantities of fenugreek, the baby begins to smell
like maple syrup too, and some babies have been misdiagnosed as
having "maple syrup urine disease," a serious metabolic disorder.
Another danger associated with fenugreek is that the herb is related
to peanuts, the food most likely to cause an allergy. The
possibility of an allergic reaction in a baby is quite high, and
many cases of colic, stomach upset, and diarrhea have been reported
among babies whose mothers take fenugreek.
My own experience counseling women to use fenugreek to enhance milk
production has been mixed. Many mothers at our lactation
center report that fenugreek had no effect on their milk supply,
while others are quite laudatory about its effect on the amount of
milk they produce.
Another popular herb to enhance milk production is Blessed Thistle,
an herb first described by the monks in the Middle Ages as a cure
for smallpox. Today, it is most commonly used in herbal
medicine as a contraceptive and to treat infections or fever.
There is no scientific evidence to support that Blessed Thistle
stimulates milk production, nor are there studies that report a safe
dosage of this herb. In modest amounts, however, it is
probably safe for breastfeeding mothers.
Fennel (Foeniculum vulgare), a licorice flavored herb that has been
used since the Middle Ages, also has gained a reputation for
promoting lactation. Although there is no scientific evidence
that fennel increases milk production, it is safe for breastfeeding
women when used in small amounts. Fennel is commonly used to
season fish and vegetable dishes. Herbalists still recommend a
tea made from crushed fennel seeds (fruits) as a remedy for
stomachache and cramps, and some people use fennel to relieve colic
and gas. Historically, fennel was thought to have
appetite-suppressing effects, though this has not been proven.
Although small amounts of fennel are safe when the seeds or fruits
from the fennel plant are used, oil from the fennel plant should be
avoided. This volatile oil is toxic and can cause seizures and
respiratory problems in doses as small as 1 to 5 milliliters (less
than 1 teaspoon).
Other Herbal Therapies Should Be Used Only After Checking
With Your Physician
Echinacea (Echinacea angustifolia), an herb thought to boost the
immune system, has become popular to treat cold symptoms.
Evidence of the effectiveness of Echinacea has been mixed. One
recent clinical trial found that Echinacea lessened symptoms of the
common cold compared to a placebo, when it was taken at the onset of
symptoms. Another clinical trial found no benefit associated
with taking Echinacea on a regular basis to avoid such infections,
however. Although its effectiveness is questionable, these
studies suggest that Echinacea is probably safe when taken for short
periods of time, except in individuals who are allergic to ragweed,
chrysanthemums and related plants. The Echinacea plant itself
is a commonly recognized, purple cone flower that is a member of the
daisy family.
St. John's Wort (hypericum perforatum), a plant once considered to
have supernatural powers, is probably the best-known therapeutic
herb used today. The ancient Greeks believed that the
fragrance of St. John's Wort would drive evil spirits away, and the
ancient Christians considered it a symbol of St. John the Baptist
because its flowers bloom on June 24, the day designated as St.
John's Day.
St. John's Wort has been used as a treatment for sadness and
depression for many years. Today, it is widely used as an
antidepressant in Europe, where it has been approved for sale as a
medicine. A few small clinical trials have found that St.
John's Wort has a therapeutic effect not unlike other pharmacologic
antidepressants. Like Prozac and Zoloft, for example, it is a
serotonin reuptake inhibitor, which means that it blocks the
utilization of the brain chemical serotonin.
Breastfeeding mothers should not take St. John's Wort without
consulting their physician first. Although it is a natural
substance, St. John's Wort works like many other antidepressants and
can be dangerous if not used appropriately. It can reduce the
effect of some prescription drugs, for example, and should not be
taken with other antidepressants. Because St. John's Wort can
be purchased without a prescription, people may use it to treat
self-diagnosed symptoms of depression independently, and they may
not seek necessary medical advice.
For some individuals, St. John's Wort can have other very unpleasant
side effects. The combination of St. John's Wort and ragweed
exposure can cause a very serious allergic reaction in individuals
who have allergies, especially asthma. The herb also can cause
skin burns in light-skinned people because is contains hypersen, a
photosensitizing substance that reacts with light. Even though
a prescription is not required, it is wise to talk with your
physician before taking St. John's Wort regularly.
Recommendations
Avoid the pharmacologically active herbal teas. Drink any
herbal teas only in moderation.
Limit intake of any herbal preparation that combines several active
ingredients.
Always check the label. Even vitamins and simple echinacea may
contain herbs that should not be used by breastfeeding mothers, such
as ginkgo or ginseng.
Use only reliable brands that have ingredients and concentrations
clearly marked on the label, as well as the expiration date and the
name of the manufacturer and distributor.
Be sure to check with your physician before taking any natural
remedy, since it could interact with other medications you take or
need.
