Fenugreek: Overlooked but Not Forgotten
by Rima Jensen, MD
Fenugreek is an herb we, as lactation consultants, have heard about, and some of us have prescribed. In this article, I would like to describe my own experiences with fenugreek and then summarize some of the literature about it. I wish I had known about fenugreek while nursing my first two children. I was able to provide enough breast milk only with constant attention to my fluid level, fatigue level and availability for every 2 to 3 hour nursings day and night. Just as certain dairy cows produce better than others, I felt I was a poor milk producer. With my third child, a "tight baby," I had such severe pain with nursing that my milk production dropped below demand and could not catch up. I heard about fenugreek from Dr. Paul Fleiss and Dr. Carolyn Waters, and decided to try it.
With fenugreek I was able to bring the milk supply up to demand. My milk supply dropped every time I missed a few doses, so I continued it until she was weaned. Currently I am nursing my fourth child, the second with the help of fenugreek. Soon after Alex, my fourth child, was born, I knew I had another "tight baby." This time I did not wait as long to start treatment. Alex is much easier to nurse when I take fenugreek. Without fenugreek, the baby has to keep the breasts drained nearly dry to keep up the supply. Any minor growth spurt or delayed feeding time causes the milk supply to drop significantly below demand, and requires two days of every 1 to 2 hour feedings to build back up. With fenugreek, there is enough milk even with every 3 to 4 hour feedings. Also, the flow is faster, which corrects some of the tight jaw response. With my busy lifestyle, I can allow myself to get tired now and then without having to nurse a baby continuously for the next two nights.
With fenugreek, the breasts seem to increase production with only emptying. It is as if a new baseline is created. The milk response to fenugreek seems to be somewhat dose-dependent. Three capsules of ground fenugreek seeds bought at a local health food store and taken twice daily seems to be an adequate dose for me. Fifteen capsules taken all at once causes
moderate engorgement about 36 hours later. Three capsules a day are not enough. The dose may need to be adjusted for each mother. Fenugreek can also be taken in tea form, although I don't care for the taste of it and I find making tea a nuisance. Fenugreek's mechanism of action seems to be related to its' propensity to increase sweat production. As you may remember, the breasts are modified sweat glands. I am one who almost never sweats and that may be why I am a poor milk producer. The sweat that is produced while taking fenugreek smells of maple syrup. If there is no sweet odor, the fenugreek dose is not high enough to affect milk production. Changes in fenugreek dosing affect milk production about 1 to 2 days after the change.
I started this article with my own experiences because research about fenugreek as a galactogogue is painfully missing from the medical literature. In an article written in Mother to Mother (Apr/May, 1990), Dr. Paul Fleiss references an Egyptian study done in 1945 that reported an increase in breastmilk production by as much as 900% with fenugreek. In the article, Dr. Fleiss also describes two women who were able to breast-feed infants with the help of fenugreek. One woman was finally able to breast-feed her fourth child with fenugreek tea, after being unable to provide enough breastmilk for the first three. The other was able to exclusively breast-feed an adopted baby. I could not find a single medical research article written in the last 20 years to support the use of fenugreek for human milk production. While searching through the medical literature, I found that fenugreek has some interesting properties other than increasing milk production.
There are several research centers studying fenugreek's hypoglycemic and lipid-lowering effects. Fenugreek may turn out to be useful as an adjunct treatment for diabetes. Fenugreek also appears to lower cholesterol, although it takes a lot of fenugreek seeds to achieve this effect. Fenugreek seeds contain about 12% by weight steroidal saponins, including diosgenin and yamogenin. Steroidal saponins are the building blocks for various steroids, including cholesterol and male and female sex hormones. Fenugreek may eventually have commercial value for purification of the saponins to make birth control pills. About 30% of the fenugreek seed consists of mucilage, protein, lecithin and vitamins that are valued ingredients in skin care products.
Fenugreek (Trigonella foenum-graecum) is one of the oldest medicinal plants, dating back to Hippocrates and ancient Egyptian times. The name, foenum-graecum, is the Latin for Greek hay. There is a lot of folk medicine about fenugreek. Fenugreek has been used medicinally to treat everything from bronchitis, fevers, and digestive disturbances, to rheumatic pains and boils. An early 20th century cure-all for "women's problems", "Lydia Pinkham's Vegetable Compound", was available in every American drugstore. It's principal ingredient was fenugreek. In China, fenugreek is recommended for menopausal sweating and depression and is also prescribed for impotence in men. It has been used in large amounts to treat tuberculosis. Vermont folk medicine literature describes using fenugreek as fodder for dairy cows to increase milk production. Fenugreek is an annual herb used all over the world as a food, cultivated extensively in Southern Europe, Northern Africa,
and India. It is a legume, in the same plant class as soybeans, peas, and garbanzos. Like other legumes, it restores nitrogen to the soil where it is grown. The Arabs roast fenugreek seeds and use them as a kind of "coffee." Fenugreek is a frequent ingredient in curries and chutneys. It smells of maple syrup with a hint of celery, and is in fact the active ingredient in artificial maple syrup.
Folklore and anecdotal evidence suggests that fenugreek is a safe and easy to use galactogogue. It is a food product, used for centuries. I have recommended to my patients to increase breast milk production and have no reservations about its safety in lactation. I continue to use it myself. I have not noticed any side effects, although I am told some women get loose stools from fenugreek. There is no question about the need for more research in the use of fenugreek to increase milk supply. Any takers?
Rima Jensen, M.D. is a family practice physician in private practice in Mexia, TX.
Jensen, R (1992). Fenugreek, Overlooked but not Forgotten. UCLA Lactation Alumni Newsletter 1, 2-3.