Article

The Effect of Fenugreek on Milk Production and Prolactin Levels in Mothers of Preterm Infants

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Abstract

Since 1980, the incidence of preterm birth has increased in the United States. The health importance of human milk is well-known. However, mothers of preterm infants are often concerned that they may not produce enough milk for their infants who are frequently too immature to breastfeed. The herb fenugreek (Trigonella foenum-graecum) is purported to be an effective galactagogue. This double-blind placebo-controlled study sought to determine if fenugreek increased breast milk volume and prolactin (PRL) levels in mothers of preterm infants. The sample included 26 mothers of infants less than 31 weeks gestation. Commencing on the fifth postpartum day, each mother consumed 3 capsules of fenugreek (or placebo), 3 times per day for 21 days. Data analysis revealed no statistical difference between the mothers receiving fenugreek or those receiving placebo in terms of milk volume or PRL. No adverse effects were noted in the mothers or infants.

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... Although in the control group, there was no significant difference between the mentioned variables (p > .05). Reeder et al. (2013) USA To determine if fenugreek increased breast milk volume and prolactin (PRL) levels in mothers of preterm infants 26 mothers of infants less than 31 weeks gestation Double-blind placebo-controlled trial 21 days No adverse events were observed or reported by participants Data analysis revealed no statistical difference between the mothers receiving fenugreek or those receiving placebo in terms of milk volume or PRL. ...
... After final scrutiny, only five randomized control trials were found eligible ( Figure 1). The results reported in these studies were collected from the participating women from Egypt ( El Sakka, Salama, & Salama, 2014), Iran ( Ghasemi, Kheirkhah, & Vahedi, 2015), USA ( Reeder, Legrand, & O'connor-Von, 2013), Turkey ( Turkyilmaz et al., 2011), and Indonesia (Damanik, Wahlqvist, & Wattanapenpaiboon, 2006; ...
... None of the included studies reported any side effects associated with the use of fenugreek or other galactagogues. Reeder et al. (2013) 3 capsules of fenugreek 3 times a day for 21 days served as experimental group; placebo group Note. Minimum feeding frequency of 8 times a day was used to convert the total volume of milk per day in to volume per feed. ...
Article
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A systematic review and network-meta analysis (NMA) were performed to test significance of the galactagogue effect of fenugreek administrated to lactating women vs other comparators (i.e. placebo/ control/ other galactagogues). A pair-wise comparison for the treatment effect was carried out to generate the forest plot for the NMA. League tables were generated using treatment effect, WMD (95% CI) for all pairwise comparisons, where WMD > 0 favors the column-defining treatment. Five studies were identified with total 122 participants receiving treatment with fenugreek. The NMA results of four studies indicated that consumption of fenugreek significantly increased amount of the produced breast milk [11.11, CI 95% 6.77 - 15.46] vs placebo. The pairwise comparison revealed that fenugreek was effective as a galactagogue compared to placebo, control and reference groups WMD 17.79 (CI 11.71- 23.88). However, the effect of fenugreek was substantially inferior to Coleus amboinicus Lour (CA) and Palm date. The NMA using pairwise comparison demonstrated the effect of CA and Palm date in the stimulation of the breast milk production was comparable and superior to all comparators.
... The chemical compounds present in fenugreek like diosgenin, luteolin and apigenin stimulate anterior pituitary to enhance milk production (Bumrungpert et al., 2018) [95] . Fenugreek increases breast milk volume and prolactin levels in mother (Reeder et al., 2013) [96] . Stimulating sweat production may be another possible way by which it increases milk production (Gabay, 2002) [97] . ...
... The chemical compounds present in fenugreek like diosgenin, luteolin and apigenin stimulate anterior pituitary to enhance milk production (Bumrungpert et al., 2018) [95] . Fenugreek increases breast milk volume and prolactin levels in mother (Reeder et al., 2013) [96] . Stimulating sweat production may be another possible way by which it increases milk production (Gabay, 2002) [97] . ...
Article
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The leaves and seeds of fenugreek (Trigonella foenum-graecum L), an annual herb, are common condiments used in India, Mediterranean and North African regions. Fenugreek has a long history of its use in traditional medicine. It is one of the oldest medicinal plants used in traditional medicine that contains many natural chemical compounds like trigonellin, diosgenin, quercetin, 4-hydroxyisoleucine, galactomannan, and scopoletin. Several studies on identification of different chemical compounds present in fenugreek and their therapeutic effects have revealed its hypocholesterolemic, antidepressant, galactagogues, antidiabetic, immunomodulatory, and hepatoprotective properties suggesting their potential use in prevention and treatment of many diseases in human and animals. This article summarizes recent research findings regarding the therapeutic potential and safety profile of fenugreek.
... No significant difference was found between total scores of BFS before and after the intervention in the "fenugreek" group. Reeder and colleagues reported also no significant difference between the milk volume of mothers taking fenugreek and mothers receiving a placebo [43]. However, this result is not consistent with the results of some other studies [10,11,27,[44][45][46]. ...
Article
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Objective: Herbal galactagogues are usually recommended to be sweetened with honey. Despite the high nutritious value of honey for lactating women and extensive studies on the effects of herbal galactagogues, no investigation was made to compare galactagogue effects of using herbal galactagogues with and without honey so far. The present study aimed to compare the effect of a combination of "honey and fenugreek" with "fenugreek" on breastfeeding success (BFS). Methods: This study is a triple-blind randomized clinical trial on 75 breastfeeding mothers referred to a Tehran-Iran health center. The participants were randomly divided into two intervention (fenugreek and honey users) and control (fenugreek users) groups. These women had infants of 1-5 months and had exclusive breastfeeding practice. Tools for data collection were (1) the personal and maternal-infant information, (2) the breastfeeding success, and (3) the complications questionnaires. Participants received 30 liquid drops, three times daily for four weeks. The BFS questionnaire was completed twice, before and 4 weeks after the intervention. The CONSORT checklist was followed. Results: Before and after comparison showed no significant difference in the BFS score in the "fenugreek" group, while there was a significant increase in the BFS score in the "honey and fenugreek" group (P=0.035). Between groups, comparison demonstrated a significantly higher score of BFS in the intervention group than in the control group (P=0.023). There were no significant differences between the two groups regarding the possible complications. Conclusion: The combination of honey with fenugreek showed a significant effect on BFS, while there was no improvement in BFS after fenugreek only uses. Trial registration: the study was approved in the Iranian registry of clinical trials with IRCT ID: IRCT20120122008801N23 on 2019-12-30 (https://www.irct.ir/).
... Many preclinical studies have demonstrated the safety and health beneficial pharmacological effects of fenugreek seeds, most importantly the hypoglycaemic, hypolipidemic, gastroprotective and phytoestrogenic properties (Sreeja and Anju, 2010;Nathiya et al., 2014;Yadav and Baquer, 2014). Human clinical trials have also been reported on its beneficial effects in the management of primary dysmenorrhoea (Younesy et al., 2014), hot flashes and related menopausal discomforts (Hakimi et al., 2005;Hakimi et al., 2006;Abedinzade et al., 2015), breast milk-enhancing effects (galactogogue) (Reeder et al., 2013), libido enhancement (Rao et al., 2015) and for aphrodisiac effects (Steels et al., 2011). ...
Article
Despite the widespread use of hormone replacement therapy, various reports on its side effects have generated an increasing interest in the development of safe natural agents for the management of postmenopausal discomforts. The present randomized, double-blinded, placebo-controlled study investigated the effect of 90-day supplementation of a standardized extract of fenugreek (Trigonella foenum-graecum) (FenuSMART™), at a dose of 1000 mg/day, on plasma estrogens and postmenopausal discomforts. Eighty-eight women having moderate to severe postmenopausal discomforts and poor quality of life (as evidenced from the scores of Greene Climacteric Scale, short form SF-36® and structured medical interview) were randomized either to extract-treated (n = 44) or placebo (n = 44) groups. There was a significant (p < 0.01) increase in plasma estradiol (120%) and improvements on various postmenopausal discomforts and quality of life of the participants in the extract-treated group, as compared with the baseline and placebo. While 32% of the subjects in the extract group reported no hot flashes after supplementation, the others had a reduction to one to two times per day from the baseline stages of three to five times a day. Further analysis of haematological and biochemical parameters revealed the safety of the extract and its plausible role in the management of lipid profile among menopausal women. Copyright © 2016 John Wiley & Sons, Ltd.
... One study examining the effects of singleingredient fenugreek in mothers delivering at <31 weeks of gestation (3 capsules, three times daily, for 21 days) found no significant difference in milk production between mothers receiving the fenugreek versus a placebo. 34 Conversely, another placebo-controlled trial found that mothers drinking a multiingredient herbal tea containing fenugreek three times per day had a significantly greater milk supply on the third postpartum day and their infants had a more rapid return to birthweight; the individual effect of fenugreek in this study could not be determined, however. 35 Other herbal supplements with some evidence of a positive singular effect on milk supply include wild asparagus (Asparagus racemosus), 36 garlic (Allium sativum), 37 and micronized silymarin (Silybum marianum). ...
Article
Background: Complementary and alternative medicine (CAM) could be one option to address perceived insufficient milk (PIM), but there are few data comparing the effectiveness, acceptability, and safety of various CAM therapies. The purpose of this study was to describe and compare, among women delivering at 34-376/7 weeks, the feasibility and acceptability of two CAM interventions for treatment of PIM: (1) a meditation/relaxation intervention via an MP3 (Apple iPod Shuffle©) player and (2) a commercially available combination-blend herbal supplement (Motherlove: More Milk Plus Alcohol Free®). Materials and Methods: After randomization, over 9 days, women received three home visits from a lactation consultant, recorded pre/post intervention test weights and expressed milk volume, tracked daily breastfeeding behavior, and completed an end-of-study interview about the interventions. Women in each group were offered the other group's intervention on study day 9. Breastfeeding status and intervention continuation were assessed at 2 months. Results: Of 183 women screened, 11 were eligible, enrolled into, and completed the 9-day trial. Six women were randomized to the herbal supplement and 5 to meditation. One participant (meditation) stopped breastfeeding on study day 8. At 2 months, 3 of 6 women assigned to the herbal supplement and 3 of 5 women assigned to meditation were still breastfeeding; 1 (herbal supplement) was exclusively breastfeeding. Most participants were adherent to the prescribed protocols for both interventions. Interventions were generally perceived as safe, with benefits not necessarily related to increased milk supply. Conclusion: Mothers of late preterm and early term infants who had PIM found the CAM interventions acceptable and safe. The effect of CAM therapies on breastfeeding outcomes, with and without in-home lactation assistance, requires further investigation.
... 42 The scientific literature documenting the efficacy of herbal galactagogues, such as fenugreek, fennel, blessed thistle, and goat's rue, is quite limited. 21,22,24,26,28,32,37,[39][40][41][43][44][45][46][47][48][49] Galactagogues are assumed to enhance milk supply and production by increasing the level of the hormone prolactin, but ultimately the biological mechanisms by which they may or may not function are not well understood. 48 Though numerous intervention studies have aimed at supporting breastfeeding continuation and exclusivity through lactation-consultant support, [50][51][52][53][54][55][56][57][58][59] fewer have examined the use of pharmacological or herbal supplements as an additional lactation aid. ...
Article
Full-text available
An increase in the marketing and use of herbal galactagogues among breastfeeding mothers in the US has raised the issue of how best to provide support and information on the use of these products, particularly in light of limited availability of certified lactation counselors and continued suboptimal rates of breastfeeding globally. Currently, no cross-sectional data are available on the experiences and attitudes of mothers regarding the use of herbal and pharmaceutical galactagogues for lactation in the US. The findings of an online survey of 188 breastfeeding mothers on experiences with and sources of information on galactagogues are presented. Most mothers (76%) reported that while breastfeeding, they felt as though they were not making enough milk to meet the needs of their child, and yet 54% also indicated that they had not supplemented with formula. A large proportion of respondents reported utilizing galactagogues to increase lactation and finding them useful. The results indicated that most women learned about galactagogues from the Internet or by word of mouth through friends. Lactation consultants were the third-most reported sources of information on these products. While many respondents reported perceiving galactagogues as innocuous, more evidence on safety and efficacy is needed to support women properly who seek out and use them. Large-scale studies of the prevalence of galactagogue use in the US and rigorous evaluation of use globally are needed to ensure that mothers who choose to breastfeed may safely avail themselves of all options when counseling support is insufficient.
... Risks associated with peanut allergy have been noted (53). In a small (n = 26) convenience-sampled study conducted on the effects of fenugreek supplementation on prolactin levels and milk production in mothers of preterm infants, a dosage of 1,725 milligrams daily failed to yield statistically significant changes to either metric (88). ...
Article
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Lactation and breastfeeding support the short- and long-term health of both mother and infant, yet the success of these processes depend upon individual and combined factors of the pair. Complications during pregnancy and delivery greatly affect the likelihood that a mother will be capable of breastfeeding for at least the recommended 6 months. Guidelines for women regarding postpartum diet and lifestyle management also fail to reflect the diversity of mother-infant pairs and their circumstances. In our analysis of the literature, we have identified a categorical deficit in modern scientific discourse regarding human lactation; namely, that postpartum involves full-body contribution of resources and thus requires the application of nutrition from a systemic perspective.
... Maternal galactagogue effect of herbal supplementation herbal tea containing fenugreek significantly enhanced breast milk production in mothers and enhanced fetal weight gain (67)(68) . ...
Article
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Milk production is essential for optimal feeding of infants. The most common lactogenic drugs are dopamine 2 antagonists, oxytocin, recombinant bovine somatotropin (rBST), thyrotropin releasing hormone (TRH) and estrogenic drugs. However, many medicinal plants possess lactogenic effects in humans and animals. The current review focused on medicinal plants with lactogenic effect as natural sources of galactogogues characterized by efficacy and safety.
Article
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Chapter
When a baby is born, breastfeeding should be assessed just like every other measure of neonate health. As discussed in previous chapters, what happens during the first week of nursing has a direct bearing on long-term breastfeeding success. But evaluation isn’t enough. Mothers who have trouble breastfeeding are offered many overlapping and contradictory treatments, depending on the accuracy of the evaluation and diagnosis, and on where the treatment information comes from. In this chapter I discuss treatment options, along with the background and intent of each treatment. Different and overlapping treatments are often utilized, and sometimes there is more than one option. Treatments are listed with research supporting (and sometimes refuting) recommendations that are commonly given. I then give my recommendations for how treatments are best utilized.
Article
Introduction Breast feeding is the best nutrition for infants. Most of the postnatal mothers face the problem of insufficient breast milk which affects the health and well-being of an infant. Objective The aim of the study was to evaluate the effect of fenugreek on enhancing breast milk production and weight gain of infants in the first week of life. Methods An experimental study with two groups ie, experimental and control group was conducted in a maternity centre, Bangalore. Sixty postnatal mothers were selected for the study and thirty each were randomly assigned to both experimental and control group. 7.5 g of fenugreek was soaked overnight and the subjects of experimental group were administered with this fenugreek water, daily once in the morning for a period of 7 days. The frequency of urination and weight of the babies both in experimental and control group were assessed and compared on first, third, fifth and seventh day. Results There was an associate improvement in the signs of breast milk sufficiency within the fenugreek subjects when compared to the control group. The impact of fenugreek on breast milk was evident on the frequency of urination and weight gain in infants throughout their initial week of life. Conclusions The study concluded that fenugreek enhances breast milk production among postnatal mothers and facilitates birth weight of infants within the initial week of life.
Article
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Background: Fenugreek and Fennel seed has galactogogues properties due to phytoestrogen structure and can increase the volume of breast milk. Objective: The aim of this study was to comparison the effect of herbals teas containing Fenugreek seed and Fennel seed on the signs of breast milk sufficiency in girl infants with 0-4 months of age. Methods: This study was a triple blind clinical trial with placebo group. 117 mothers with 0-4 month’s girl infants randomly were placed in one of the three groups: herbal tea containing Fenugreek seed powder, herbal tea containing Fennel seed powder and placebo group. Before and during 4 weeks of study, the signs of breast milk sufficiency were evaluated through measurement of weight, height and head circumference and follow-up forms for measuring the number of wet diapers in a day, Frequency of defecation and infant breastfeeding times. Results: Before and after the intervention there was no significant difference in the signs of breast milk sufficiency between Fenugreek and Fennel groups. While before the intervention there was no significant difference in signs of breast milk sufficiency between three groups (P>0.05), but the number of breastfeeding times of placebo group was more than interventions groups (P
Article
Background: Many women express concern about their ability to produce enough milk, and insufficient milk is frequently cited as the reason for supplementation and early termination of breastfeeding. When addressing this concern, it is important first to consider the influence of maternal and neonatal health, infant suck, proper latch, and feeding frequency on milk production, and that steps be taken to correct or compensate for any contributing issues. Oral galactagogues are substances that stimulate milk production. They may be pharmacological or non-pharmacological (natural). Natural galactagogues are usually botanical or other food agents. The choice between pharmacological or natural galactagogues is often influenced by familiarity and local customs. Evidence for the possible benefits and harms of galactagogues is important for making an informed decision on their use. Objectives: To assess the effect of oral galactagogues for increasing milk production in non-hospitalised breastfeeding mother-term infant pairs. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Health Research and Development Network - Phillippines (HERDIN), Natural Products Alert (Napralert), the personal reference collection of author LM, and reference lists of retrieved studies (4 November 2019). Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs (including published abstracts) comparing oral galactagogues with placebo, no treatment, or another oral galactagogue in mothers breastfeeding healthy term infants. We also included cluster-randomised trials but excluded cross-over trials. Data collection and analysis: We used standard Cochrane Pregnancy and Childbirth methods for data collection and analysis. Two to four review authors independently selected the studies, assessed the risk of bias, extracted data for analysis and checked accuracy. Where necessary, we contacted the study authors for clarification. Main results: Forty-one RCTs involving 3005 mothers and 3006 infants from at least 17 countries met the inclusion criteria. Studies were conducted either in hospitals immediately postpartum or in the community. There was considerable variation in mothers, particularly in parity and whether or not they had lactation insufficiency. Infants' ages at commencement of the studies ranged from newborn to 6 months. The overall certainty of evidence was low to very low because of high risk of biases (mainly due to lack of blinding), substantial clinical and statistical heterogeneity, and imprecision of measurements. Pharmacological galactagogues Nine studies compared a pharmacological galactagogue (domperidone, metoclopramide, sulpiride, thyrotropin-releasing hormone) with placebo or no treatment. The primary outcome of proportion of mothers who continued breastfeeding at 3, 4 and 6 months was not reported. Only one study (metoclopramide) reported on the outcome of infant weight, finding little or no difference (mean difference (MD) 23.0 grams, 95% confidence interval (CI) -47.71 to 93.71; 1 study, 20 participants; low-certainty evidence). Three studies (metoclopramide, domperidone, sulpiride) reported on milk volume, finding pharmacological galactagogues may increase milk volume (MD 63.82 mL, 95% CI 25.91 to 101.72; I² = 34%; 3 studies, 151 participants; low-certainty evidence). Subgroup analysis indicates there may be increased milk volume with each drug, but with varying CIs. There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints, such as tiredness, nausea, headache and dry mouth (very low-certainty evidence). No adverse effects were reported for infants. Natural galactagogues Twenty-seven studies compared natural oral galactagogues (banana flower, fennel, fenugreek, ginger, ixbut, levant cotton, moringa, palm dates, pork knuckle, shatavari, silymarin, torbangun leaves or other natural mixtures) with placebo or no treatment. One study (Mother's Milk Tea) reported breastfeeding rates at six months with a concluding statement of "no significant difference" (no data and no measure of significance provided, 60 participants, very low-certainty evidence). Three studies (fennel, fenugreek, moringa, mixed botanical tea) reported infant weight but could not be meta-analysed due to substantial clinical and statistical heterogeneity (I2 = 60%, 275 participants, very low-certainty evidence). Subgroup analysis shows we are very uncertain whether fennel or fenugreek improves infant weight, whereas moringa and mixed botanical tea may increase infant weight compared to placebo. Thirteen studies (Bu Xue Sheng Ru, Chanbao, Cui Ru, banana flower, fenugreek, ginger, moringa, fenugreek, ginger and turmeric mix, ixbut, mixed botanical tea, Sheng Ru He Ji, silymarin, Xian Tong Ru, palm dates; 962 participants) reported on milk volume, but meta-analysis was not possible due to substantial heterogeneity (I2 = 99%). The subgroup analysis for each intervention suggested either benefit or little or no difference (very low-certainty evidence). There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints such as mothers with urine that smelled like maple syrup and urticaria in infants (very low-certainty evidence). Galactagogue versus galactagogue Eight studies (Chanbao; Bue Xue Sheng Ru, domperidone, moringa, fenugreek, palm dates, torbangun, moloco, Mu Er Wu You, Kun Yuan Tong Ru) compared one oral galactagogue with another. We were unable to perform meta-analysis because there was only one small study for each match-up, so we do not know if one galactagogue is better than another for any outcome. Authors' conclusions: Due to extremely limited, very low certainty evidence, we do not know whether galactagogues have any effect on proportion of mothers who continued breastfeeding at 3, 4 and 6 months. There is low-certainty evidence that pharmacological galactagogues may increase milk volume. There is some evidence from subgroup analyses that natural galactagogues may benefit infant weight and milk volume in mothers with healthy, term infants, but due to substantial heterogeneity of the studies, imprecision of measurements and incomplete reporting, we are very uncertain about the magnitude of the effect. We are also uncertain if one galactagogue performs better than another. With limited data on adverse effects, we are uncertain if there are any concerning adverse effects with any particular galactagogue; those reported were minor complaints. High-quality RCTs on the efficacy and safety of galactagogues are urgently needed. A set of core outcomes to standardise infant weight and milk volume measurement is also needed, as well as a strong basis for the dose and dosage form used.
Article
Background Preterm mothers face unique challenges—the stress of preterm delivery and their premature babies’ inability to suckle directly from the breasts, culminating in poor milk supply. Galactogogues are substances believed to enhance human milk production. Evidence for their use in preterm mothers is insufficient. Research aims To (a) evaluate the influence of galactogogues on milk production among mothers with preterm birth, and (b) assess the safety of galactogogues for mother-infant dyads. Methods A systematic search was conducted between January 2018 and May 2019 in nine electronic databases, with manual searches through reference lists of included articles. Randomized controlled trial studies addressing outcome measure of milk quantification were selected. Seven trials met the inclusion criteria and, using the Clinical Appraisal Skills program checklists and the modified Cochrane Collaboration tool for assessing risk of bias, each trial was critically appraised for content, bias in methodology, and reporting. Results Four herbal substances (fenugreek, silymarin, silymarin/galega, and stinging nettle) and domperidone used in intervention studies were analyzed. Fenugreek and silymarin used in isolation did not yield significant increase in milk production, while the combination herbal mixtures silymarin/galega and stinging nettle herbal tea increased milk production. Domperidone use resulted in an acute increase in milk production, which was not sustained with prolonged use. The reviewed studies reported no serious adverse effects on mother-infant dyads. Conclusion Herbal galactogogues may be more effective for longer term use, although there is still limited evidence to support its prescription to preterm mothers. Larger studies are required.
Chapter
Based on published information, potential health benefits of fenugreek (Trigonella foenum-graecum), one of the oldest medicinal plants, are reviewed in this chapter. The scientific data are summarized for potential health benefits including management of blood glucose in type II diabetics, cholesterol-lowering effect, effect on growth hormone leading to modulation of metabolic syndrome, antiinflammatory and anticancer effects, enhancement of milk production in new mothers, increase in male libido, safety, and toxicity. These benefits are analyzed in terms of the weight of evidence for efficacy, effective human dose, extrapolation of animal data to humans, and the safety margin at the projected clinical dose. Effects of not only the whole seed or plant but also the main active components, such as diosgenin, trigonelline, 4-hydroxyisoleucine, and galactomannan, are identified and summarized. The advantages of using the aqueous or alcoholic extract(s) instead of whole-seed powder, thus mitigating any coumarin-associated potential dermal or anticoagulation-related adverse effects, are also discussed. There appears to be strong preclinical-based evidence for most of the benefits listed here, but the clinical data appear to be not robust and need stronger evidence by conducting well-controlled clinical trials, as performed for human pharmaceuticals. Overall, the effective dose for the whole-seed powder is too high to be practical but does not pose a safety concern with respect to dose-limiting toxicity, even after repeated dosing. The use of fenugreek should be avoided during pregnancy until safety of the developing fetus is established based on quality (GLP) embryo/fetal developmental toxicity studies in appropriate animal species. Also, fenugreek, as a member of the Leguminoseae family, could be allergenic to some subjects, particularly those known to be allergic to peanuts. Further research for reducing the clinically effective dose has been proposed by using the bioactive components alone or in combination.
Article
Purpose The goal of this study was to review the role of human milk in shaping the infant intestinal microbiota and the potential of human milk bioactive molecules to reverse trends of increasing intestinal dysbiosis and dysbiosis-associated diseases. Methods This narrative review was based on recent and historic literature. Findings Human milk immunoglobulins, oligosaccharides, lactoferrin, lysozyme, milk fat globule membranes, and bile salt–stimulating lipase are complex multifunctional bioactive molecules that, among other important functions, shape the composition of the infant intestinal microbiota. Implications The co-evolution of human milk components and human milk–consuming commensal anaerobes many thousands of years ago resulted in a stable low-diversity infant microbiota. Over the past century, the introduction of antibiotics and modern hygiene practices plus changes in the care of newborns have led to significant alterations in the intestinal microbiota, with associated increases in risk of dysbiosis-associated disease. A better understanding of mechanisms by which human milk shapes the intestinal microbiota of the infant during a vulnerable period of development of the immune system is needed to alter the current trajectory and decrease intestinal dysbiosis and associated diseases.
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This article reviews the necessary skills required for clinicians to make informed decisions about the use of medications in women who are breastfeeding. Even without specific data on certain medications, this review of kinetic principles, mechanisms of medication entry into breast milk, and important infant factors can aid in clinical decision making. In addition, common medical conditions and suitable treatments of depression, hypertension, infections and so forth for women who are breastfeeding are also reviewed.
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