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There are multiple drugs and dozens of herbs for starting and stopping breast milk production. Only a few of them work really well.

When nursing mothers can't produce enough breast milk to feed their baby, their doctors can't do a lot to help. A drug that works reliably, domperidone (which is not to be confused with Dom Pérignon champagne), is illegal in the US, strictly regulated in Australia and Canada, and available over the counter in much of the rest of the world. Domperidone is more often used to treat vomiting, and it has relatively few side effects in adults. In infants, it can in rare instances cause neuroleptic malignant syndrome, a potentially fatal problem causing fever, stiffness, and nervous system dysregulation. A drug that can kill your baby is not a good choice to help you feed your baby.

An approved drug for failure to produce breast milk is metoclopramide.

It's safe for women who are pregnant or breasfeeding. It has a relatively good success rate for treating morning sickness, and a condition of "slow stomach" called gastroparesis. It can be used to treat migraines. But five out of six clinical trials of its use as a galactogogue, a stimulant to lactation, failed.

That's why many women turn to traditional herbal remedies when they want to increase breast milk production. Herbal galactagogues, however, also have their limitations and side effects.

Milk thistle is an herb nowadays more often associated with diabetes and liver health, but its original use was for increasing breast milk production. Clinical trials have found that it can be very helpful for women whose problem is "borderline" milk production. In a group of women who were able to produce a minimal amount of breast milk each day, using the herb for a month increased breast milk production on average 64 percent, and using the herb for two months increased breast milk production on average 85 percent. In women who already have some breast milk production, milk thistle can help them produce adequate amounts for their baby.

An effective dose of milk thistle is standardized to 420 mg (usually three capsules) silymarin per day. Women who have a problem with diarrhea may have worse diarrhea for a few days when they start using the herb. Paradoxically, the herb can cause constipation in women who have had their gallbladders removed.

Malunggay leaf is a popular remedy for inadequate milk production in the Philippines, although the plant from which the leaf is harvested, the moringa or drumstick tree, is used in herbal medicine all over the world. The leaf relieves pain from a variety of conditions, including mastitis. Sometimes the problem is not so much that a woman can't produce enough breast milk as it is that breastfeeding is painful. Relieving inflammation helps. Malunggay leaf is mildly antiviral.

Exactly how malunggay stimulates lactation is not know, but two clinical trials in the Philippines found that it more than doubled milk production in 10 days of use. It is a safe herb, and in the Philippines, it literally grows on trees. It is also a good source of vitamins A, B, C, and K, as well as magnesium, manganese, and potassium.

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