by Anne Eglash MD, IBCLC, FABM
Why do certain supplements help increase the milk supply for some mothers, but not others? The science of obesity and lactation is still in its infancy, yet we observe that women who are overweight have an increased risk of a delay in lactation and low milk supply, particularly if they are insulin resistant.
Insulin is a hormone from the pancreas that regulates blood sugar. Obesity can cause insulin resistance, making it harder for individuals to control their blood sugars because their bodies do not response to what are considered normal levels of insulin. Insulin resistance leads to pre-diabetes and eventually type 2 diabetes mellitus. For most individuals, changes in behavior such as increasing exercise and losing weight can resolve and prevent insulin resistance.
According to a 2016 review entitled ‘Does Insulin Explain the Relation between Maternal Obesity and Poor Lactation Outcomes?’ Dr. Laurie Nommsen-Rivers explains the current evidence for the link between insulin resistance and low milk supply. She explains that 23% of reproductive-aged women in the USA are pre-diabetic, so this is a very relevant issue in the field of lactation.
The interesting fact is that many herbs used as galactogogues in the USA are known to improve insulin sensitivity, and improve blood sugar control.
For today’s question, the Natural Medicines Database was reviewed to determine which popular galactogogues have evidence demonstrating effectiveness in blood sugar control.
Which of these commonly used galactogogues do you think have been shown to improve blood sugar control? (choose 1 or more)
- Hops
- Brewers Yeast
- Fenugreek
- Goats Rue
- Fennel
See the Answer
The answers are B, C and D
Does Insulin Explain the Relation between Maternal Obesity and Poor Lactation Outcomes? An Overview of the Literature
Nommsen-Rivers LA
It is well established that obese women are at increased risk of delayed lactogenesis and short breastfeeding duration, but the underlying causal contributors remain unclear. This review summarizes the literature examining the role of insulin in lactation outcomes. Maternal obesity is a strong risk factor for insulin resistance and prediabetes, but until recently a direct role for insulin in milk production had not been elucidated. Over the past 6 y, studies in both animal models and humans have shown insulin-sensitive gene expression to be dramatically upregulated specifically during the lactation cycle. Insulin is now considered to play a direct role in lactation, including essential roles in secretory differentiation, secretory activation, and mature milk production. At the same time, emerging clinical research suggests an important association between suboptimal glucose tolerance and lactation difficulty. To develop effective interventions to support lactation success in obese women further research is needed to identify how, when, and for whom maternal insulin secretion and sensitivity affect lactation ability.
IABLE Comment by Anne Eglash MD, IBCLC, FABM
In addition to the herbs listed above, other galactogogues have been shown to improve insulin resistance, including alfalfa and cinnamon.
In her article, Dr. Nommsen-Rivers reports that we have no evidence that improving insulin resistance during pregnancy and lactation will increase milk supply.
Although we have very little research demonstrating that galactogogues improve milk supply in women with insulin resistance, from personal experience I believe they help considerably for some women. As many in the lactation field have observed, breastfeeding mothers respond very differently to galactogogues, with some having a marvelous response, while others notice no response to the same substances. Mothers have different reasons for a low supply, so the varying response to herbs is likely due to the mechanism of action of the herbs, with some herbs being a better fit than others for particular mothers.
Because not all galactogogues lower insulin resistance, it may be reasonable to recommend herbs known to improve insulin resistance for those mothers with a low supply who are known to have had gestational diabetes, obesity, polycystic ovarian syndrome, or pre-diabetes before pregnancy. It is important to have the mother talk to her physician or other provider about the safety of using galactogogues, especially if she is taking other medications. The National Library of Medicine Lactmed Database has information regarding herbs during lactation, as does E-Lactancia
linda kennedy
could this some how be related in the same vein with conception. I know a gal that is unable to conceive “because of her weight” that is not morbidly obese but has been on clomid. just a curious thought.
MilkMob
Yes, some people who have trouble conceiving also have trouble with a low supply. A common thread for both can be insulin resistance.
Sophie Siwerski
There is research to suggest that babies who weren’t breastfed have a higher rate of diabetes in adulthood. Given the information here that IR can lead to poor milk supply (and therefore early weaning) perhaps there is more of a genetic tendency to pass IR on to offspring which has nothing to do with the consumption of breast milk as an infant.