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First Years Pregnancy Dec 19, 2019
9 Minutes

The science behind increasing your milk supply

Many new mothers give up breastfeeding before they would like to. Many of them do so because of low supply. There are a lot of theories as to why this can happen. There are lots of suggestions of things to help. However, what really works? We turn to the science and evidence to have a look at what, how and why. Plus, as always most importantly some evidence-based things you can do to help. 

Milk Supply

The majority of new mothers have the best intentions when it comes to breastfeeding. We all know the health benefits. However, it is not easy for everyone. In fact, the statistics show that only about 50% of mothers reach their breastfeeding goals and below 20% of women manage to exclusively breastfeed for six months. The recommended minimum. (1)

We also know there can be many reasons behind why this happens. Luckily new technology like Elvie’s portable and silent breast pump makes it a bit easier practically (no, they are not sponsoring this post!). Particularly when women have constraints like going back to work. However, outside of things like tongue-tie and latching issues physiologically there can be other factors. With low supply being the most common reason women give for stopping. (1)

So, if production is such a problem, how can we increase milk supply? 

There are lots of theories out there. However, as always, we want to turn to the science and evidence to see what are the main factors. Particularly those that you can potentially have influence over. 

The two most effective and evidence backed ways are well known. You have probably heard of these already. They are: increasing the frequency of feeding and emptying the breast as much as possible to stimulate supply.

So – to give you an idea as to what that means: most breastfed newborns feed at least 8-12 times per day. It also means that you want to be pumping or feeding during the night too. It’s tough, but here’s some inspo to give you the motivation through! Click here. 

However, what happens if you’re doing all of this but you’re concerned you still have low milk supply? 

One emerging section of research relates to issues with insulin resistance and low supply (1, 4, 6, 7). Interestingly enough insulin resistance in our society is becoming more and more common. 

How does this work and what can you do? 

Animal studies have shown evidence that having higher insulin levels (which is what happens when you have insulin resistance) in the blood can contribute to lower supply. Part of this is down to insulin impacting Prolactin levels (key lactation hormone). It has also shown an impact in human studies with differences in the milk fat layer within breastmilk (6,7). 

Insulin has also been shown to promote androgen production (ie. testosterone) which have been shown to limit milk supply. (6) 

So how can you combat insulin resistance? How do you know if you have it? 

There has been a huge amount of research on this over the last few years. Principally because diabetes and prediabetes (which often has no symptoms) is such a growing problem in our society. It is also something that happens when you get Gestational Diabetes which will be flagged in your pregnancy. There are a few clear areas however where science is suggesting can have a positive impact:

Maintaining a normal BMI:

We know a high BMI contributes to most bad things health wise. It also seems to play a role in trouble with breastfeeding and insulin resistance. Ensuring you put on an appropriate amount of weight during your pregnancy is something that should be monitored by your doctor. If in doubt ask. Working to keep BMI at normal levels can be a very positive way to improve insulin resistance.

PCOS and low milk supply: 

Unfortunately for women with polycystic ovarian syndrome two thirds – regardless of weight – will have some form of insulin resistance. That being said, interestingly research is not entirely conclusive around it’s impact on breastfeeding. However, linked to insulin resistance, there is evidence to suggest that women with PCOS may have a tougher time. Once again back to androgen levels impacting milk production. 

Positive things you can do (even with PCOS) to control your insulin levels and help your milk supply: 

That being said there are positive things that women with PCOS can do to control their insulin levels with lifestyle:

Avoiding Refined Carbs: 

Activity: 

What you eat and milk supply… 

Are you eating and drinking enough? 

What about supplements for milk supply? Does Fenugreek work? 

We are always a bit wary of herbal supplements as typically there is a big variance in quality/amount and evidence-based research can be sparse. Click here for more. However, here is what we do know:

Drugs or supplements to stimulate breast milk supply are known as Galactogogues. There are a couple of prescription drugs used currently. The most common that are prescribed are Metaclopramide and Domperidone. However, these drugs are being used ‘off-label’ which means this is not what they were intended or cleared to do from a regulatory stand point. Therefore there are questions remaining and not a lot of clarity on dosage. 

Most people would prefer to go down the route of avoiding prescription drugs. Particularly where questions remain around side effects and dosage. Fenugreek is something that is often cited as a supplement used to stimulate milk production. 

Does it actually work? 

Based on current research not a lot is known about the mechanism as to how it works. One theory is that fenugreek can stimulate the production of sweat. The breast is a modified form of a sweat gland and therefore the theory goes that fenugreek might be able to stimulate the breast to supply more milk. (5) There is not a lot of evidence around this though. 

There have however been anecdotal reports of fenugreek having an increase in milk supply. One study looking at 1200 women did show benefits 24-72hrs after consumption. Clearly more work needs to be done. (5) 

Be smart: 

However, as with any supplement it is imperative to talk to your doctor before you take it. Especially if you are on any other medication as this can interfere or if you have blood clotting issues. There are also concerns that it can worsen asthma symptoms so those with asthma should absolutely avoid. If in doubt just have a conversation. 

Fenugreek does have some other benefits however. It has been shown to be an antioxidant and to contribute to weight loss and immune health. (5) 

So, taking it all together, what does science suggest for milk supply? 

Actually, once again the conclusion isn’t really rocket science. Being as healthy as possible pre and during your pregnancy will help. That means keeping a healthy BMI, keeping active and a diet away from highly processed refined foods focusing on whole foods. Plus a good intake of quality fats and protein. Calorie intake during breastfeeding is important as is water intake. Studies suggest 500 extra calories per day. 

There is some evidence behind Fenugreek. However, talk to your doctor first ESPECIALLY if you have any other medical conditions or concerns as it can potentially interfere.

The science really does back up frequency and emptying the breast as much as possible particularly as you’re getting established as a good route. That of course means giving yourself the time and having the support to do this.

Support: 

Many women can find the early days challenging. Particularly if you are struggling with breastfeeding. It is a super emotional time not only in terms of changes you’re going through in your lifestyle but also hormonal changes. It is really important to ask for help and support and to be kind to yourself during this time. It can be really overwhelming. 

Research has shown that biochemical changes associated with depression will also have an impact on your milk production so don’t be afraid to ask for help. Click here for more on managing anxiety from our resident psychotherapist. 

Lactation consultants and your milk supply: 

Lactation consultants are also a good idea if you’re struggling. They are good at diagnosing issues like tongue-tie and making sure your latch is right. Something that you should check out if you’re struggling and Common issues that need to be dealt with by a professional. So PLEASE speak up if you’re struggling. You’re not alone and it is more than ok to ask for help! 

Here is a link to Lactation Consultants of Great Britain directory.

Also here for a list from KellyMom in the US

References:

  1. Riddle S, Nommsen-Rivers LA: A Case Control Study of Diabetes During Pregnancy and Low Milk Supply: Breastfeeding Medicine. Mar 2016
  2. Vanky E, Isaksen H, Moen MH, Carlson SM: Breastfeeding in polycystic ovary syndrome: Acta Obsetricia et Gynecologica Scandinavia: Dec ‘10
  3. Gunderson EP, Hedderson MM, Selby JV: Lactation Intensity and Postpartum Maternal Glucose Tolerance and Insulin Resistance in Women with recent GDM: American Diabetes Association: Jan 2012. 
  4. Schwarz EB, Brown JS, Thom D: Lactation and Maternal Risk of Type-2 diabetes: a population-based study. The American Journal of Medicine.
  5. Shawarna R, Qiblawi S, Ghanayem H: Which Benefits and Harms of Using Fenugreek as a Galactogogue Need to be discussed during Clinical Consultation? Evidence-Based Complementary and Alternative Medicine: 2018. 
  6. Stuebe AM, Horton BJ, Meltzer-Brody S: Prevelance and Risk Factors for Early, Undesired Weaning Attributed to Lactation Dysfunction. Journal of Women’s Health. 2014 May. 
  7. Lemay DG, Ballard OA, Nommsen-Rivers LA: RNA Sequencing of the Human Milk Fat Layer Transcriptome Reveals Distinct Gene Expression Profiles at Three Stages of Lactation: PLoS One: 2013. 
  8. Gower BA, Chandler-Laney PC, Bates GW: Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS: Clinical endocrinology: Oct 2013. 

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This article is for informational purposes only. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information on this website has been developed following years of personal research and from referenced and sourced medical research. Before making any changes we strongly recommend you consult a healthcare professional before you begin.

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