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Help – My Doctor is a Crank!

I often receive e-mail from SBM readers (or SGU listeners) who have had the experience of their doctor, nurse, dentist, physical therapist, or other health care provider recommending to them a treatment option that seems dubious, if not outright pseudoscientific. They want advice on what to do.  There are common themes to the e-mails – the writer often feels very uncomfortable in the situation. They do not feel comfortable confronting their provider directly, yet they do not want to acquiesce to the advice either. They are also often asking my opinion about the advice – is it really as wacky as it seems. This uncertainty saps them of their resolve, leaving them feeling a bit helpless.

Here is one such e-mail:

Ten days ago, my wife and I welcomed our first child into the world. She was born a couple weeks early, which left her mouth a bit too small and week to breastfeed effectively. To prevent her from losing too much weight, we were referred to a lactation consultant (who works out of the pediatrics department at the hospital where our daughter was born). This consultant (who is also an RN) suggested a regimen of supplementing nursing with pumped breast milk.

This was working great until my wife’s milk production dropped the day before our follow-up appointment. When we asked what to do about this, the nurse recommended that my wife take fenugreek, an herbal supplement. I was a bit skeptical of this advice, so I asked what it was about fenugreek that helped with milk production. The lactation nurse’s answer was vague — she said things like, Herbs can be helpful for lots of health issues, and, a lot of women I see seem to think it helps (oh, the logical fallacies). When we pushed her on this a little more, she handed us a flyer, printed by the hospital about fenugreek. The flyer seemed to support the use of the supplement, but mentioned that there was no scientific research demonstrating that fenugreek increases milk supply. When we asked why it hadn’t been researched, the nurse responded that there wasn’t a lot of money in lactation and that scientists generally aren’t interested in the kind of things she does (basically, that she was doing the good work that cold-hearted scientists refused to do).

She also mentioned that there was a prescription drug that boosts milk supply, but it carries with it the risk of a pretty serious side effect (depression), so she prefers her patients to try the supplement first. I asked how we could be sure the supplement didn’t also carry the risk of negative side effects if it hadn’t been studied, she simply said that it worked out fine for the patients she’s seen.

My wife and I decided to let it go for the time being and decide later whether or not to go the supplement route (it’s hard to argue with a nurse when you’re under-slept, one of you is topless, and the baby is screaming for food). Fortunately, her milk supply picked up a bit on its own, so we didn’t have to resort to using an untested therapy (yet).

First, let’s address the recommendation – fenugreek to increase breast milk production. Substances that increase milk production are called galactogogues. There are a number of drugs that have been shown to increase milk production, although the levels of evidence varies. For many there are only case series. Oxytocin is supported by double-blind placebo controlled trials, and is both safe and effective. Other commonly used drugs, like metoclopramide, are supported by unblinded case series only.

Fenugreek is a common spice and medicinal herb used in India. Among its putative effects is increased lactation, however, there are no clinical trials to support its use. Recommendations are based upon anecdotes only. This 2010 review article reports:

The side effects most commonly reported are a maple-like smell of the urine, breast milk, and perspiration, diarrhea, as well as the worsening of symptoms in individuals with asthma or hypoglycemia. The potential for transfer to milk or side effects in the infant are unknown. As is the case for most herbal products, the dose necessary to obtain a galactogogic effect has not been defined. Only one study on the effect of fenugreek on lactation has been reported. Swafford asked 10 mothers to maintain a diary of the quantity of milk produced with a pump for a period of two weeks. In the first week, baseline milk production was evaluated; in the second week, mothers took fenugreek, 3 cups, three times daily. In the first week average quantities were 207 ml/day, whereas, milk production in the second week averaged 464 ml/day (p = 0.004). Unfortunately, the report excluded any information regarding the characteristics of the mothers enrolled in the study or the postpartum period during which the study was done. Nevertheless, the daily milk quantities reported during treatment do not seem to be particularly high (reference: Swafford S, Berens P. Effect of fenugreek on breast milk production. Abstract 5th International Meeting of the Academy of Breastfeeding Medicine September 11-13, 2000, Tucson, Ariz Academy of Breastfeeding Medicine News and Views 2000;6(3).)

So – there are side effects, even potentially serious side effects like exacerbating asthma and hypoglycemia. The dosing is unknown, and the one small efficacy study that was done was unimpressive.

There is nothing implausible about the claim that an herb can be an effective galactogogue – herbs can be drugs with pharmacological activity. What is disturbing about the nurse’s recommendation is the double standard. She seems to believe that herbs are inherently safer than drugs, which is a false dichotomy based on the naturalistic fallacy, but not logic or evidence. She essentially recommended an untested drug with uncertain dosing, side effect, or efficacy over drugs with better evidence for both safety and efficacy.

It should also be noted that the e-mailer’s mild production spontaneously increased after the consultation. If she had taken fenugreek, that would have been one more anecdotal report apparently supporting its efficacy.

But onto the real question of the e-mail – how to respond in this situation. My advice is to first not be intimidated. Feel free to express your concerns or uncertainty about the recommendations being made. I commend this e-mailer for asking for published evidence, but don’t take an evasive answer as adequate. Ask for published evidence or authoritative reviews. If they do not have any handy, they can certainly prepare this material for the next visit or simply e-mail it to you.

If you feel up to the task, you can research the question yourself and then ask your health care provider to comment on the material you find (but don’t overwhelm them with mounds of material).

Depending on how egregious the pseudoscientific advice was, you should also consider simply leaving that provider for someone with whom you feel more comfortable and confident. I do recommend, whether or not you stay with the provider, to give them feedback. Express your exact concerns about their advice. How they respond will also tell you a great deal about their approach and dedication to evidence-based practice.

In short, I think patients should feel empowered to push back against practitioners who stray from science and reason as a basis for health care recommendations and practice. Those pushing for anti-science in medicine are certainly vocal, and their agenda will advance if others simply do nothing. In fact – if a practitioner recommended an outright anti-scientific treatment (like homeopathy, say) I would go beyond giving them individual feedback. I would write to the head of their clinic, hospital, or department and express your concerns. You are a consumer as well as a patient, and administrators listen to their consumers.

The above situation is becoming distressingly common, and it is not easy to deal with. It is one more type of harm that is caused by the infiltration of anti-science into medicine. I had a similar experience myself. My wife and I were referred to a practitioner to address a problem with one of our children (I am being deliberately vague on details). At the first visit the practitioner made a comment (as an aside, not directly related to the visit) about vaccines and autism. I, of course, politely challenged her on that statement, and she backpeddled – I think just to end the confrontation. My wife thought that I was inappropriate to challenge her – she was concerned about my accepting the role as patient rather than physician.

At the next visit, however – the visit when the practitioner was giving us her actual recommendations, my wife had a change of heart. The practitioner’s recommendations were entirely limited to “natural” interventions like diet and herbs, and she shied away from any medications. Her recommendations were ideology-based, not evidence-based, and in the end the consultation was entirely useless. My concerns at the first visit – that perhaps this practitioner does not have a firm grasp on the concepts of science-based medicine, were entirely vindicated.

This is an important point – if a practitioner recommends something that is blatantly against the science and evidence, how can you have confidence in any of their recommendations? I am not talking about not being up on one bit of latest evidence – no one can know everything. A serious lapse, however, can reveal a systematic bias in a practitioner’s approach to evidence and practice.

Unfortunately, patients cannot take for granted that a licensed professional is necessarily science-based.

Posted in: Science and Medicine

Leave a Comment (73) ↓

73 thoughts on “Help – My Doctor is a Crank!

  1. adenacb says:

    I am always a bit reluctant to comment on this site, which I find both interesting, useful, and infuriating at times. However, I feel strongly about the issue of insufficient milk supply. I agree that there probably hasn’t been very good research done on this issue. It would be hard if not impossible to devise an RCT because you would have to wait until the women were postpartum and had insufficient milk supply, and then assign them to different groups (i.e. fenugreek, other medications, other strategies etc.). When I experienced insufficient milk supply — which is terrifying, I might add — fenugreek was one of the things that was recommended to me, and I did find it helped somewhat. The thing that really helps is increasing nursing time, since nursing is a supply-demand activity. Eventually I needed to supplement with formula. I guess what I’m trying to say here is: when people are emotionally exhausted (new parents) and trying to do something very important (feed child) it’s hard to critically evaluate all the advice you are given especially if there aren’t good studies on the topic (breastfeeding, insufficient milk supply) because you are exhausted (no sleep). Yes, we need more good research in this area, and yes, sometimes the advice you are given isn’t evidenced based, and yes, sometimes you just have to do the best you can with the information you are given. I wish this father good luck.

  2. chaos4zap says:

    Question: I have several old college roommates are now doctors and they both complain about how Nurses are constantly pushing to be able to do more, to be more involved in the diagnosis/treatment process. I certainly don’t mean to lump all nurses into a single category and I admire their work and dedication, but it does seem to me from my experience and from the anecdotes above, that this appeal to the naturalistic fallacy seems to be more prevalent with nurses. Do you think there is anything to this? Since they don’t usually have the training to prescribe medications, perhaps these pushes towards natural treatments are part of a desire to feel as if they are more involved in the process, I don’t mean for this to sound as insensitive as it will, but to make themselves feel more important. Clearly, the pseudoscience is not just limited to nurses (there are well documented cases of MD’s crossing into that realm), but do you think this is more prevalent for nurses? Are nursing schools in general pushing these ideas more to try and get the profession more “involved”? I just want to stress again that I certainly don’t think this is limited to; or inclusive of, all those in the nursing profession, I’m simply pointing out a trend that seems to be forming and asking the crowd if they think there is anything to it?

  3. Kylara says:

    You know, beer is another folk remedy for increasing milk supply and tastes a hell of a lot better than fenugreek.

    I went to urgent care (on a weekend) when I was breastfeeding with an ear infection, and the nurse practitioner was reluctant to give me an antibiotic I had had before while breastfeeding (also for an ear infection) and felt comfortable with, because she was concerned about possible side effects while breastfeeding; instead, she wanted to prescribe me a homeopathic remedy. I said, “If it’s really homeopathic, it won’t work. And if it isn’t, there are possible side effects that are unlisted and probably untested.” She just stared at me like I was high and got upset when I refused to take it, even though she admitted there was no data about it in breastfeeding women and could not tell me what the active ingredient was, but insisted homeopathic medicines were “safe.” I went home with nothing and had to call my doctor on Monday.

    This has been on my mind lately because one of the four doctors in my ob/gyn practice (that like everyone I know goes to) just left to open up a “holistic” center for women’s health, and now has one of my friends on a colon cleanse and has therapeutic touch at her office and all kinds of things. She never gave any evidence of woo while she was with the main practice, and in fact the main practice was respected for its “hard-science” and “research-based” (and up-to-date! Not research from 1985!) practice. I feel sort-of upset and cheated by the fact that she was secretly hiding all this woo all that time … but I guess I should feel good that when she insisted on being woo-ish, she and the main practice parted ways rather than letting her practice her woo in the main practice. Still. It’s upsetting.

  4. windriven says:

    “mothers took fenugreek, 3 cups, three times daily.”

    NINE cups of fenugreek daily??? It isn’t clear from the citation but I presume that is an infusion.

    I wonder what the effect of increasing daily fluid intake by more than half a gallon might be on lactating mothers?

    @chaos4zap -

    There simply aren’t enough physicians – or health care dollars to pay more of them – to handle all of the lower level health care demands. The answer isn’t preventing nurses from expanding their role, the answer is educating them appropriately to that expanded role.

  5. chaos4zap says:

    @ windriven -

    I have no problem with that, anyone doing what they are properly trained to do, is fine by me. I also agree that this is the ideal response to the shortage of MD’s. My question was, in the absence of that additional training, are nurses jumping the gun and substituting non-evidence interventions to simply involve themselves more in the process?

  6. DND says:

    As someone who is in nursing school, my experience has been that we had our “required” chapeter on alt-med in first quarter, it was quick and stupid, and then has never been formally touched on since.

    The clinical instructors seem to be the most “woo-friendly”, but I have had some success offering a differing, science-based view. It’s tricky ground, though, because I have limited power right now, and a whole lot of other skills to learn and master.

  7. WilliamLawrenceUtridge says:

    @adenacb

    The whole point of science based medicine is to do the studies, so you are giving those terrified parents the best advice available. It’s quite possible fenugreek helps, it’s possible it doesn’t, it’s possible it’s actually harmful – you don’t know until you test. The best advice is rarely “I heard from someone it worked” or “it’s a folk remedy”; if a doctor or nurse is essentially giving advice with no scientific basis and serves only to bide time until normal milk production kicks back in, that’s fine – but it shouldn’t be portrayed as well-founded and substantiated.

    @windriven

    I had the same reaction – that’s a lot of volume if it were water, let alone solid food.

  8. Roberta says:

    @chaos4zap

    I’ve wondered the same thing, but I have another suggestion for motive – the desire to help. My mom was an RN and I have great respect for their general commitment to patient care; BUT I wonder sometimes if that desire to help pushes them more easily into the realm of woo. Some of the practices that RNs of my acquaintence have advocated include drinking hydrogen peroxide, magnetic therapy, ear candling and a host of herbal remedies.

    Medicine must be intensely frustrating at times and I can see why the front-line providers might grasp at anything that might give succor. That being said, if I were in the hospital and someone came to do Reiki on me, I’d be hard-pressed not to smack them.

  9. SarahContrara says:

    I’d be curious as to your thoughts about domperidone. It’s kind of a puzzling situation, banned by the FDA but used in most other developed nations for low milk supply.

    It works *extremely* well for many women–I went from having zero milk with both of my babies to having almost a full supply, within a few days of starting it. I noticed a difference the very next day, and with my first baby, it was the first time I ever even *saw* milk. (Both babies were seen by lactation consultants and weighed regularly before and after feeds, and the first was getting less than a tenth of an ounce of milk out of me, the second about a quarter ounce. After the domperidone kicked in, the first baby got about 2 oz per feed and the second got 3 – 4.)

    However I was always anxious about taking it (since it’s not legal in the US!) and I have often wondered if it was appropriate for me to take, since I have mitral valve prolapse and it has some heart-related side effects.

    Fenugreek did nothing for me, and Reglan wasn’t appropriate because of a history of depression. I had no changes in my breasts during pregnancy or in the first week postpartum, with either child.

    Domperidone seems to have helped me long-term in some way, because my body produce a little more milk on its own, and twice as much taking it during the second baby’s first year as compared to the first baby’s. When nursing my second, I actually increased from a C to a D, whereas with my first it was much less noticeable.

    It also seems to have permanently “matured” the appearance of my breasts, because prior to the first baby, they always appeared slightly underdeveloped (more triangular than round).

    There is unfortunately very little information about why some women have insufficient milk (and plenty of people who think the problem doesn’t really exist!).

  10. AlexisT says:

    Adena: You’d also need to sort any trial by causes of low supply and what the supplement is supposed to do–and I’m not even sure we even have the ability to do that. At best, you could exclude women with insufficient glandular tissue, and you might restrict trials of prolactin-boosting supplements to women who had low prolactin.

    I am going to assume that the drug mentioned by the LC was Reglan, since that’s the galactagogue available here and which can cause depression. I have never taken Reglan and I didn’t ask about it when I had low supply, but my understanding is that doctors as well as nurses are reluctant to prescribe Reglan for lactation, regardless of whether they recommend herbs or not. Even physicians who are supportive of low supply mothers and encourage attempts to increase supply may be reluctant to prescribe it. Outside the US, domperidone is preferred, but the FDA pulled it from the US market.

    The recommendation of herbal supplements for lactation is fairly common in my experience–there are certainly plenty of sources (LCs, LLL leaders, webpages…) recommending fenugreek, blessed thistle, and goat’s rue.

    As for lactation woo, go find Dr. Jack Newman’s website. It’s very unfortunate because a lot of the information there is good, but then he goes and endorses homeopathy on the herbal supplements page.

  11. jpmd says:

    Articles like this are upsetting to me as a physician. There are not enough hours in the day to talk people out of using this crap. i usually just tell them,”I wouldn’t use it, but it’s a free country.”

    In the end, this stuff is sold because of greed, and used out of ignorance by well intentioned but gullible people. The story above of the OB-GYN is especially disturbing, as you know he is just an opportunistic leech since you know he know better.

  12. chaos4zap says:

    @Roberta

    I agree entirely that RN’s, by and large, are well intentioned and want to help. In fact, I believe that most people that push “natural” remedies (as opposed to those that sell them) are well intentioned. I think frustration and desperation are probably the single leading cause of anyone pushing or using these non-evidence based “treatments”. Even well intentioned non-sense is still non-sense and false hope is not necessarily better than no hope.

  13. chaos4zap says:

    I want to go ahead correct myself. I do not actually think that frustration and desperation are the single leading cause of pushing and using alt med. There are plenty of people out there that are just misguided or subject to some ideology that, by default, tends to push them in that direction for no good reason at all. Wish I would have caught that before I hit send. We can put a man on the moon, send rovers to mars and eradicate small pox…..where is my “un-send” button for blog comments?

  14. Nurses presumably offer the help they can the same way anyone else offers the help they can. The range of things they have access to is just different from the range of things an MD has access to.

    Lots of doctors give advice they know is marginal because they have nothing better. “It’s plausible, I don’t know if it will work, but I know some practitioners swear by it. Let me know how it goes.” If it’s a drug prescribed by an MD we are unlikely to treat this as a non-science-based scandal and write offended letters to the administration; we are likely to treat it as an appropriate experiment.

    If a nurse suggests a tea using the same rationale, however, we worry about the wooiness of nurses and are encouraged to complain.

    Yes there are differences between the two (the doctor is likely to be more aware of the contraindications for the prescription drug than the nurse is for the tea) so we can think about what makes them different and how to recognize a nurse’s suggestion as insufficiently science-based.

    There are also similarities, so we can put the nurse’s recommendation into context and relax a (little) bit.

    We can also wonder when to be scandalized by non-science-based practices by doctors. Should we write to the administration if we are offered an antibiotic prescription for an apthous ulcer? How do we as patients judge when our doctors are cranks if they aren’t actually homeopaths?

  15. Scott says:

    I’ve experienced a slightly different situation, and wonder what people here think about it.

    Talked to my doctor about back pain. She asked what I thought about chiropractic. I answered (honestly, at the time, though I know far more now) that I didn’t know much about it. She then referred me to a chiropractor.

    The interesting question is not the referral itself, or what happened afterwards. The interesting factor is that (as I learned later) the chiropractor in question was the husband of the doctor’s office manager.

    Conflict of interest? Ethical? What do those here think?

  16. Dr Benway says:

    Listening to the prolonged cries of a newborn when your breasts aren’t producing enough milk –that’s enough to make you crazy.

    If I were in that situation and faced with a doctor or nurse pretending tarted up herbs were just as good as science, I would be chargin’ mah lazORS!!!

  17. tanha says:

    What about this:

    J Hum Lact. 2002 Aug;18(3):274-9.
    Galactogogues: medications that induce lactation.
    Gabay MP.

    Drug Information and Medication Use Outcomes Section, University of Illinois at Chicago, USA.
    Abstract
    Galactogogues are medications that aid in initiating and maintaining adequate milk production. Most exert their pharmacologic effects through interactions with dopamine receptors, resulting in increased prolactin levels and thereby augmenting milk supply. Metoclopramide remains the galactogogue of choice due to its documented record of efficacy and safety in women and infants. Domperidone crosses the blood brain barrier and into the breast milk to a lesser extent than metoclopramide, decreasing the risk of toxicity to both mother and infant possibly making it an attractive alternative. Traditional antipsychotics, sulpiride and chlorpromazine, have been evaluated, but adverse events limit their use. Human growth hormone, thyrotrophin-releasing hormone, and oxytocin have also been studied. Finally, a natural product, fenugreek, has been purported to be effective in anecdotal reports. Use of this agent may be warranted after considering risks versus benefits.

    PMID: 12192964

  18. SarahContrara says:

    @Dr Benway – so true. What still kills me to remember is the way my first baby’s eyes looked frantic and scared, like a wild animal, for the first week of his life. Fortunately every doctor and nurse knew by just looking at him that something was very wrong, and it was way too far gone to send us home with just fenugreek.

  19. chaos4zap says:

    @ Allison Cummins

    I think the difference in your examples between the MD and Nurse, is plausibility. Sure, off label use of prescription medicine can be a major concern, but it’s not as if MD’s are just winging it. I would hope that is a medication is prescribed for an off label use that the MD is familiar with research that points in this direction for that use; or, at least, the intervention has sound plausibility for treatment. Anything less would be irresponsible. My point being, if a MD prescribes something for off label use, he should be able to clearly point to the reason why he is doing so by citing research or explaining the mechanism by which it should work. If you ask the nurse about their tea, chances are probably pretty good that they will not be able to offer much in the way of real support for their recommendation. This is why the alt med pushers tend to resort to the “big pharma doesn’t care enough about this…” or “there is no real money in this for the pharmaceutical companies, so they don’t care to research” responses. These responses are, as we should all no, not really answers at all….they are cop-out’s and should be a major red flag. If your MD has no good recommendation and resorts to long-shot maybe recommendations for the sake of telling you something, then you should probably find a new doctor. To answer your question, in my very unprofessional opinion….yes. If your doctor is prescribing things for off label uses and he has no real justification for doing so other than wanting to tell you something rather than nothing, then yes, I would certainly think it a good idea to let the administration know about that. No one is talking about creating a double standard for nurses and MD’s. Both should work within their respective training and both should be held accountable for recommendations that don’t hold up to the standards of evidence and care.

  20. tanha says:

    Lactation consultants do so much more than say “give expressed milk and take this untested, suspicious herb”. They are supposed (and likely did in this case) assess latch, assess swallowing and quantify actually milk production. Then they advice more pumping to stimulate breast milk production and take care of yourself (diet, hydration). It’s somewhat hard to believe that all this couple got was advice to give expressed breast milk and take fenugreek. Maybe they just needed or wanted to hear “it’s ok to supplement with formula if you’re not making enough milk despite adequate latch and nursing on demand”

  21. tanha – I saw that review, but decided to go for one from 2010 because it is more up to date. That review just says that there are anecdotes for fenugreek – no evidence. And in fact I could find not published studies of controlled trials of fenugreek – just reviews citing the same anecdotal evidence.

  22. SarahContrara says:

    @tanha – if you re-read the post, it says that they were first given the normal advice of nursing, pumping, supplementing with pumped milk, for a baby who wasn’t gaining or nursing well because of prematurity. Presumably this included the typical evaluation of latch and positioning, but it’s not uncommon for early babies to need a few weeks to catch on.

    The day before their next appointment, his wife couldn’t pump enough (as much as before?), so they inquired about that and were offered fenugreek.

    Sounds pretty typical, IME. Nowhere does the email suggest she didn’t offer any other suggestions, just that they’d used those between the initial consult and the milk production drop. At that point, the nurse’s suggestion was fenugreek and/or Reglan. The emailer found it strange that she’d prefer something largely untested (fenugreek) over something proven but with known side effects (Reglan).

  23. SarahContrara says:

    @Stephen Novella – Having talked with other moms who have severely limited milk production, I’m of the mindset that most of the natural galgactalogues may help in mild cases (most women notice fluctuations in their supply based on eating certain foods or not drinking enough), they’re rarely enough to help a woman with a serious milk production problem.

    Some of their benefit may well come from helping the woman relax and know that “help” is on the way, because we know for sure that stress inhibits let down and lowers milk supply. It may also explain why women who aren’t “naturally minded” rarely seem to report that it worked for them…

  24. tmac57 says:

    Kudos to the emailer for asking all the right questions in a difficult setting. On two separate occasions,my GP ask me if I was taking vitamins,and suggested that I get on Juice Plus+ ,an expensive MLM supplement which her practice conveniently sold.I politely took the pamphlet that she gave me,but I wish I had voiced what I really felt,which was that I thought that this was inappropriate,and possibly a conflict of interest.Also,after checking up on the product,it seemed like it just amounted to a very pricey vitamin supplement.
    On a different note,does anyone else think that ‘Fenugreek The Galactogogue’ would make a kick ass title for a Sci-Fi movie?

  25. qetzal says:

    Last year I planned to switch primary docs to someone who had more availability. I made an appt. with someone my daugther & her family had been using. While signing in, I noticed a big display case next to the counter, full of colonics, homeopathy, and other woo. I immediately told the receptionist that I was cancelling my appt., and I told her why: I would not patronize a doc that promoted such unscientific ‘treatments.’ She was somewhat shocked.

    This was a sole practitioner, so there wasn’t much else to do. I was confident the doc would hear of my displeasure (and his loss of business) from the receptionist. However, if this had been a larger clinic or something, I would probably have tried to call the manager as well.

    I suspect a large fraction of docs who promote this kind of crap do so in part because they think patients like it. The more people like us express our rejection of medical woo, and take our business elsewhere, the more such docs may abandon it as well. At least, that’s my hope.

    I also want to respond to a couple of comments up-thread.

    adenacb, you wrote:

    When I experienced insufficient milk supply — which is terrifying, I might add — fenugreek was one of the things that was recommended to me, and I did find it helped somewhat.

    No, what you found was that your milk supply increased somewhat after you took fenugreek. That does not necessarily mean that fenugreek helped somewhat. Your milk supply might have increased spontaneously, or due to something else you were doing.

    SaraContrara, the same applies to some of your statements. There is some double-blind randomized clinical data to indicate that domperidone does increase milk supply in the short term. However, there’s no good reason to think that taking it with your first baby had anything to do with ‘maturing’ your breasts or having a better supply with your second baby. I suspect most women would attest that their breasts ‘matured’ after having a baby, even if they took no drugs or even breast-fed at all.

    The overall point is that we all need to guard against fallacious thinking. Just because we take a drug (or herbal supplement or homeopathic prep or whatever) and then something happens, doesn’t mean the drug caused the change. It may have caused the change, but there are many, many other explanations. That’s why randomized blinded trials are so important. Without them, it’s often difficult or impossible to know whether a drug truly works.

  26. tanha says:

    Steven: yea you are right. There doesn’t seem to be much new info on fenugreek’s use as a galactagogue.

    Do you have access to this:

    Neonatal Netw. 2010 Jul-Aug;29(4):225-30.
    Complementary and alternative methods of increasing breast milk supply for lactating mothers of infants in the NICU.
    Jackson PC.

    School of Nursing and Dental Hygiene, Department of Nursing, University of Hawaii at Manoa, Honolulu, HI 96822, USA. jacksonpc@bellsouth.net
    Abstract
    “Breastfeeding” an infant in the NICU means that the mother must manually pump her breasts for milk for weeks to months until the infant is physiologically mature enough to suckle at the breast. Complementary and alternative therapies have been proposed to assist with lactation in NICU mothers. These methods for increasing breast milk supply include herbal galactagogues, kangaroo mothering, and relaxation therapies.A review of the literature was performed using PubMed and CINAHL databases. Twenty-four sources were chosen for inclusion in this article. Search terms included the following: galactagogues, breastfeeding, kangaroo care, and lactation, among others. The state of the science of alternative therapies in the management of inadequate breast milk supply is summarized here. The evidence is discussed and adverse side effects related to these therapies is addressed.

    PMID: 20630837

  27. sciberdog says:

    My wife likes her GP, finds her very personable and someone who really listens. Over the last year I began to realize she (the doctor) has been mixing normal medical advice with a healthy heaping of woo.

    First she convinced my wife to buy Juice Plus for a while, through a MLM setup. I did some research and recommended my wife stop because it seemed pretty worthless. Recently my wife asked the doctor about losing a little weight (we recently had two kids), and the doctor recommended HCG diet for a hefty price, non-insurance covered. The pamphlet she gave my wife touted nothing but anecdotal evidence and had the doctor’s name stickered on it as an authorized practitioner of this diet, i.e., I’m sure she gets a good cut.

    Some quick research on this showed HCG to be completely worthless and borderline dangerous. There were a couple other woo recommendations by this doctor, but HCG was the last straw. I convinced my wife to dump her and find someone new. We also spoke to our pediatrician who first recommended the GP and works across the hall, and told her our decision and why. I think this opened the pediatrician’s eyes a bit, when she got the details, and hopefully she won’t be recommending this GP as much.

    But should or can I take it further? I was so incensed by the HCG recommendation, I really want to confront my wife’s GP and give her a piece of my mind. I wanted to report her to a medical board or something. How much woo can a doctor peddle before her license is revoked?

  28. sashen says:

    When my GP recommended Vitamin D supplements for me, I said to her, “Don’t you think all the excitement about Vitamin D is the same as all the previous excitement about Vitamin E, A, C, and fish oil? In other words, don’t you think it’s just hype?”

    Amazingly she actually considered the question. And sadly she then said, “No, this is something we can really measure and it makes a difference.”

    For the fun of it, I tried some for a few months. Didn’t notice a thing.

  29. Joe says:

    @tanha on 16 Mar 2011 at 11:56 am quoted (near the end of the post) “Finally, a natural product, fenugreek, has been purported to be effective in anecdotal reports. Use of this agent may be warranted after considering risks versus benefits.

    This is always an absurd statement when there is no data on risk or benefit.

  30. aeauooo says:

    From the American Nurses’ Association website:

    “Although the increased liberalization of licensing laws may increase the usage of complementary therapies by registered nurses, few studies have begun to address this practice. Until large-scale studies are conducted, it appears that it will be necessary to draw conclusions about these nursing practices from a variety of other sources. Some answers may lie within the states, as State Boards of Nursing (BONs) are required to monitor scope of practice issues. Though employers have a role in the safe practice of complementary therapies by nurses, it is the BON that protects the public through licensure and practice acts.”

    “Forty-seven percent (25) of the BONs who permitted practice had statements or positions that included specific complementary therapies or examples of these practices; thirteen percent (7) were in the process of discussing the topic and, forty percent (21) had not formally addressed the topic, but did not necessarily discourage these practices.”

    “It is becoming clear that BONs understand that the very nature of nursing lends itself to a framework that welcomes these non-invasive complementary practices.”

    “It is the responsibility of state BONs not only to identify what is within the scope of nursing practice in the state, but also to identify the basic education and competencies that are required for that practice. A central theme highlighted by states having a described scope of care related to complementary therapies was for licensed nurses to have documented knowledge, skills and competency in application of the therapy. Also mentioned is the need for credentialing that will further assure the nurses’ competence when such credentialing is available. Not only would credentialing help assure safe practice, but it would also communicate a strong message to other health professionals that the practice of nursing is based on a learned body of knowledge.”

    Sparber, A. (2001). State Boards of Nursing and Scope of Practice of Registered Nurses Performing Complementary Therapies. OJIN, 6(3).
    http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No3Sept01/ArticlePreviousTopic/CmplementaryTherapiesReport.aspx

    FYI – I do not condone nursing practice that is not supported by evidence.

    aeauooo, RN, MPH

  31. AlexisT says:

    This reminds me of something I found a while back: The University of Pennsylvania’s nurse-midwifery program has a required CAM course. http://www.nursing.upenn.edu/academic_programs/grad/masters/program_detail.asp?prid=10

  32. Anthro says:

    I have dozens of stories about medical people (MD, nurse, PA, etc.), advising me to use one or another woo potion. I have found this especially with female gynecologists. They have the Estroven and other herbals right on the counter in the exam room. The excuse is that “people want it” and it “can’t hurt”. I never hesitate to tell any of them exactly what I think of these practices before I leave in a huff. Why would anyone hesitate to confront these people?

    As to nursing. As the mother of four, all breast fed, I truly wonder at all this whining about “exhaustion” and lack of sleep. Honestly, I stuck them in bed with me (I do not want to hear about it), fed them constantly on demand, drank LOTS of water, ate all I wanted (decent food) and didn’t worry about the house, laundry, or getting my “figure” back. I could have fed triplets and actually quit nursing a couple of them before the first year because I was sick to death of being sopping wet all the time and having my clothes stuck to my skin. I don’t recall any extreme exhaustion even though I was completely on my own except for my older children’s help with the younger two. But them, I was in my twenties for the first three.

    I can’t say enough about the rest, the water, the food–and if you want to get some sleep, put the kid in bed with you, at least some of the time. Not on the pillows, not under a lot of blankets–use common sense, prop yourself up and keep him in the crook of your arm–you will get more rest this way than sitting in a chair. At least try the couch if you’re afraid of the co-sleeping.

    I am sure there are medical reasons some women don’t make much milk (hormone-related?), but that doesn’t account for the seeming epidemic of failed breast feeding. All my OB’s advised me to supplement and some got miffed when I refused, but I think supplements are the quickest way to reduce your own supply. I also never used a pump–tried it once–felt like a cow in a stall. I never left my babies for the first six months, except briefly with their father. If you want to “go out” for the whole day/evening and such, of course you are going to have trouble nursing! Maybe that is why you get “exhausted” as well.

    Yes, medical people advising woo and women who won’t take nursing seriously enough to simply follow simple advice irritate me. So shoot me. Note. I realize that a baby born early has extra challenges and am addressing full-term babes here.

  33. aeauooo says:

    RE: UP CAM course

    “The dramatic rise in the use of complementary and alternative medicine (CAM) by the American public requires that the contemporary health care practitioner have an awareness of CAM therapies and modalities currently available. The end result of this is course will not be proficiency in the practice of any of these modalities in particular, but rather a basic understanding of each approach to common conditions and their potential contribution to health and well being.”

    NURS688 – Complementary/Alternative Therapies in Women’s Health

  34. ConspicuousCarl says:

    I don’t have a regular doctor, but lately I have been wondering how to find a good one now before I am stricken with something so I don’t have to take whomever is available when the time comes.

    Most doctors’ websites are either lacking any data to suggest anything, or contain red flags of nonsense. Google review rankings don’t help, because some of the nuttiest docs have high patients’ ratings.

    I might have to start interviewing them.

    “tmac57on 16 Mar 2011 at 12:25 pm
    On a different note,does anyone else think that ‘Fenugreek The Galactogogue’ would make a kick ass title for a Sci-Fi movie?”

    Hmmm, let me think… UH, YES!!!

  35. daedalus2u says:

    Lactation is a physiological process that is highly coupled to metabolic as well as psychological status. There is a very strong placebo effect in lactation.

    Stress is something that has a large (and negative) effect on lactation. There are very good evolutionary reasons for this. If you are someplace that is not safe and are stressed because you know you are not safe, that is also a bad place to try and nurse your infant. Enough stress and you won’t be able to lactate at all.

    My understanding is that a lot of the “trick” to being able to lactate and “let down” milk is the same as what is called the Relaxation Response. It is getting your body to understand that you are in a safe place where you can give milk to your infant. Practicing being able to be relaxed like that before you get pregnant might help the way practice helps with everything.

    Lactation is a substantial metabolic load. The components of milk (protein, lactose and fat) need to be synthesized and that takes metabolic energy to do so. Lactose is the major osmolyte and has to be synthesized as fast as milk is produced (pretty much). Some of the other components can be synthesize over time, but lactose pretty much has to be made as it is excreted. Lactose is synthesized from glucose which is made in the liver.

    Alcohol does interfere with glucose production in the liver, so alcohol is likely to interfere (acutely) with milk production. It might have a counter-regulatory effect via stress relief and via compensation to the inhibitory effects on glucose production.

    Body fat is negatively related to lactation capacity. Glucose can’t be made from even numbered carbon molecules (lipids and ketone bodies). Going into ketosis would make lactation much more difficult if not impossible.

    Nitrate might help. The mechanism for fenugreek might be via nitrate. Many vegetables have nitrate in them, I wasn’t able to find figures for fenugreek. Nitrate is reduced to nitrite which is reduced to NO which does trigger mitochondria biogenesis. Increasing liver capacity for gluconeogenesis will require more mitochondrial biogenesis. Any source of nitrate would work, lettuce, beets, spinach, other green leafy vegetables are usually pretty high in nitrate.

    The mechanism by which oxcytocin increases lactation probably involves nitric oxide, so increased nitrate consumption might help upregulate that pathway too.

    Depression is an early sign of metabolic stress. If you do start to get depressed while lactating, that is a very important symptom to make others aware of and to deal with appropriately. Reducing metabolic load (going to formula) should be considered carefully. An infant consuming formula is not the worst thing that can happen. Depending on the severity, maternal depression (or psychosis) can be much worse.

  36. SarahContrara says:

    “SaraContrara, the same applies to some of your statements. There is some double-blind randomized clinical data to indicate that domperidone does increase milk supply in the short term. However, there’s no good reason to think that taking it with your first baby had anything to do with ‘maturing’ your breasts or having a better supply with your second baby. I suspect most women would attest that their breasts ‘matured’ after having a baby, even if they took no drugs or even breast-fed at all.”

    This is kind of silly. The study I think you’re referring to was of women who had no known milk supply problems, over 7 days, and it showed that moms who took the domperidone increased milk supply by 44.5% compared to 16.6% increase in the moms who didn’t take it. That’s a pretty impressive increase for a seven day trial!

    The women noticed their milk increasing after 48 hours–exactly my experience both times. I never experienced Lactogenesis I or II, so that’s pretty darned remarkable to suddenly be producing a ton of milk!

    (I started domperidone at 3 months with my first, and anyone can tell you that you don’t just start lactating 3 months postpartum. When you say pregnancy increases the size of breasts, you’re exactly right. {Lactogenesis I} But the point is that *didn’t happen* with me. With either pregnancy.)

    Here’s another study’s results:
    “Maternal and infant characteristics, serum prolactin level, and breast milk volume and composition were not significantly different between domperidone and placebo groups on day 0. By day 14, breast milk volumes increased by 267% in the domperidone-treated group and by 18.5% in the placebo group (P = .005). Serum prolactin increased by 97% in the domperidone group and by 17% in the placebo group (P = .07).”
    http://pediatrics.aappublications.org/cgi/content/full/125/1/e107

    I don’t exactly think the domperidone “matured” my breasts with my first baby, but if I had insufficient glandular tissue (and a big red flag is a complete lack of breast changes during pregnancy and after birth), then it makes sense that continuing to nurse (which was only possible by taking domperidone) could develop more mammary tissue (which is exactly what seems to have happened to me, if we’re judging by physical changes). I’m not sure what effect prolactin has on any of that, except that clearly it has a strong relationship to milk production, and domperidone raises it significantly.

    I also know that I had every test done, saw every high profile lactation specialist in the Southeast, and no one had any idea why I wasn’t producing milk. Especially the second time around, when I worked with one specialist from the start. She knew I hadn’t done anything wrong, and she herself saw the physical changes that occurred several months after having my first baby (and starting domperidone) and that those changes remained even before lactation was induced the second time (with domperidone, at around 1 week pp).

    Honestly, I get that there need to be long term double blind studies to “prove” it. But I’m hard pressed to give you any explanation for my experiences other than domperidone works very well. I didn’t drink more water. I had no expectation that I’d have no milk come in, even with my second pregnancy! (In fact I had convinced myself that *something* was done wrong the first time, and everyone was really optimistic that the second time things would go really well. But the first time in particular, it never even *occurred* to me that I wasn’t producing milk. I didn’t even know that was a possibility!)

  37. ConspicuousCarl says:

    aeauoooon 16 Mar 2011 at 2:32 pm

    From the American Nurses’ Association website:

    “Until large-scale studies are conducted, it appears that it will be necessary to draw conclusions about these nursing practices from a variety of other sources. [....]“

    Wow. “we have no evidence, so let’s find ways to draw conclusions anyway”

    “Some answers may lie within the states, as State Boards of Nursing (BONs) are required to monitor scope of practice issues.”

    Yeesh. Appealing to authority is worth even less than normal after it has been acknowledged that there is no research to support any of it. Exactly what special knowledge does the ANA suppose politicians to have?

    “Though employers have a role in the safe practice of complementary therapies by nurses, it is the BON that protects the public through licensure and practice acts.”

    This is starting to get near creepy territory. Rather than working for the hospital, it sounds like they consider themselves to be an independent stealth network with their own medical standards (standards unsupported by clinical trials, as they admit).

  38. ccbowers says:

    All this talk about increasing milk production is overlooking the main problem with the premise: how is the individual deciding that their milk production is inadequate? The main marker should be the weight gain of the infant, but often the conclusion is obtained from feelings unrelated to whether or not the infant is gaining weight sufficiently. If the problem is a crying infant who is gaining weight, then lets realize that we are not treating a lack of milk production.

    Many of the people who are looking to increase their milk production with galactogogues do not need to because they have no problem with producing enough milk. There is also milk formula which can be used for supplementation in cases that require it. I do not know of any clinical evidence that suggests that milk produced with galactologues is superior to formula supplementation in the cases that require it.

  39. aeauooo says:

    @ConspicuousCarl

    You misinterpreted the reason I posted those quotes.

    “we have no evidence, so let’s find ways to draw conclusions anyway”

    The evidence in question is regarding nursing practice, not evidence supporting CAM.

    “Appealing to authority is worth even less than normal after it has been acknowledged that there is no research to support any of it. Exactly what special knowledge does the ANA suppose politicians to have?”

    I was not appealing to authority. The point is that nursing practice is regulated, and it is regulated by boards of nursing – i.e., it is regulated by nurses, not politicians, who set the standards for practice within each state.

    “Rather than working for the hospital, it sounds like they consider themselves to be an independent stealth network with their own medical standards.”

    Nurses are independent practitioners who may or may not be employees of health care systems. We are licensed health care professionals. As long as a registered nurse stays within the scope of practice defined by the board of nursing of the state in which he or she is practicing, we do not require oversight to practice our profession (I’m not referring to the prescriptive authority of nurse practitioners).

  40. ConspicuousCarl says:

    aeauoooon 16 Mar 2011 at 5:20 pm

    @ConspicuousCarl

    You misinterpreted the reason I posted those quotes.

    “we have no evidence, so let’s find ways to draw conclusions anyway”

    The evidence in question is regarding nursing practice, not evidence supporting CAM.

    Immediately preceding the issue of seeking “other sources” besides “large-scale studies”, they stated the subject of “complementary therapies by registered nurses”. They are not talking about nursing in general, they are specifically talking about CAM.

    “Appealing to authority is worth even less than normal after it has been acknowledged that there is no research to support any of it. Exactly what special knowledge does the ANA suppose politicians to have?”

    I was not appealing to authority. The point is that nursing practice is regulated, and it is regulated by boards of nursing – i.e., it is regulated by nurses, not politicians, who set the standards for practice within each state.

    THEY were appealing to authority (of various states’ boards of nursing). Given that state boards are generally selected by politicians, AND given that the ANA has already stated that “large scale studies” have not been done, they are indeed appealing to political authority.

    “Rather than working for the hospital, it sounds like they consider themselves to be an independent stealth network with their own medical standards.”

    Nurses are independent practitioners who may or may not be employees of health care systems. We are licensed health care professionals.

    The ANA sentence I replied to specifically mentioned employers. Had they been referring to independent self-employed nurses, there would be no need to limit employers to “playing a role” and then stating that the state nursing boards (which, again, were brought up specifically as an way of allowing unproven medical care) were the authority on protecting patients.

    As long as a registered nurse stays within the scope of practice defined by the board of nursing of the state in which he or she is practicing,

    That sounds great on its own, but remember that the ANA is specifically mentioning state nursing boards as a way of getting an OK on methods lacking evidence.

    Also, I don’t know how narrow of a definition you meant by “scope”, but one interpretation might mean that staying within the “scope” of any practice can be done while applying quackery to medical conditions which are within their profession’s range of practice. For example, a doctor might go nuts and tell a patient to take penicillin to cure their tumor. Neither prescribing penicillin nor treating tumors is outside of their scope of practice, but it still adds up to quackery.

  41. qetzal says:

    @SarahContrara,

    I wasn’t disputing that domperidone helped improve your milk supply while you were taking it. As I said, it’s supported by blinded randomized trials that show significant effects, so it likely does work.

    What I objected to was your apparent conclusion that domperidone taken for your first baby had long term effects. I.e., you suggested that taking it for Baby 1 explained why your milk supply was even better for Baby 2, and that domperidone matured your breasts. Perhaps those long-term changes were due to domperidone, but perhaps not.

    Again, all of us humans have a tendency to fall into the post hoc ergo propter hoc fallacy. If we take a drug, and something happens, we tend to conclude the drug caused it. In the case of your milk supply increasing while you were on dom, that’s a reasonable conclusion because it’s supported by the clinical trial data. For the long-term changes, such a conclusion is much less certain.

  42. Dr Benway says:

    Help — American Psychiatry has gone to the Cranks!

    I went to the APA site, which I pretty much never visit, to look up S & R recommendations. I wanted to find out why SAMSHA decided to outlaw prone restraints. But the APA let me down. I clicked on all the search results for “restraint” and got “file not found.”

    Double you tee eff.

    Maybe the Neurology side of the ABPN can lean on mah higher ups?

    Do not want “modern science of mental health” aka the abreaction model enshrined as troofs. Do not want 1950s science.

  43. SarahContrara says:

    @qetzal – I follow you now. Yes, I agree, it’s not much more than a theory. :) And not particularly sound, since I know many anecdotes about moms with insufficient supply who had better luck the second time around and never took domperidone. Any time you go through a pregnancy, you have hormones working in your favor for milk production (though obviously not for everyone, every time).

    Forgive me if I’m less than 100% rational on the subject. It was a very hard time in my life and there’s a lot of blame-the-mother stuff that goes along with insufficient milk supply, so it’s hard to separate my emotions out of it.

  44. ConspicuousCarl says:

    Dr Benwayon 16 Mar 2011 at 7:15 pm

    Help — American Psychiatry has gone to the Cranks!

    I had to look, and what do I find among the goals of the APA CAIM?

    “beyond (i.e. in addition to) treatment modalities whose mechanisms of action fit “neatly and comfortably” into the Newtonian paradigm of a modern day medical education, but which modern day Physics has shown is clearly outdated. “

    OK, here’s what we need to do… build a time machine… send a cybernetic organism back in time to find Albert Einstein and all of the other physicists before they discover anything, and… BAM!, all of this will go away.

    I know it will suck not having relativity and quantum physics and all that good stuff, but at least we won’t have to hear quacks making metaphors out of it.

  45. AlexisT says:

    Anthro, your advice is dangerous. The couch is more dangerous than co-sleeping in bed. Many of the deaths ascribed to co-sleeping are from an adult falling asleep with an infant on the couch. As for “I stayed home for 6 months”, that’s simply impractical.

    There are many reasons that nursing fails. In fact, there’s an entire book devoted to it (Making More Milk, by Lisa Marasco and Diana West).

    BTW: Most of the women I know who used supplements or galactagogues had babies who were not gaining as expected, which is how any LC will tell you to judge it (along with number of wet/dirty diapers). They may try to estimate milk transfer (weigh the baby, nurse, weigh again). If they can exclude other causes for poor intake, they may conclude that supply is poor.

    I had severe low supply with my first. I found it extremely difficult to access good help and was told to formula feed.

  46. Davdoodles says:

    Excellent timing: I went to see my doc yesterday (#manubrium following a fall from a roof), and he told me that he’s just returned from 2 weeks ‘voluntary work’ in India for…. Sai Baba!!!!

    He even had a little shrine-y picture thing of the afro-haired, creepy, alleged pederast ultra-crank magician billionaire cult leader on his desk.

    Now, my doc has never said a word (to that point at least), nor prescribed a treatment, that I consider wacky, but the thought that my medical health is in the hands of someone who ‘voluntarily works’ for Sai Baba is, frankly, unnerving.

    Not sure wheter it warrants shifting docs, but I’m strongly tempted…
    .

  47. nybgrus says:

    tanhaon 16 Mar 2011 at 1:16 pm:

    “Breastfeeding” an infant in the NICU means that the mother must manually pump her breasts for milk for weeks to months until the infant is physiologically mature enough to suckle at the breast. Complementary and alternative therapies have been proposed to assist with lactation in NICU mothers. These methods for increasing breast milk supply include herbal galactagogues, kangaroo mothering, and relaxation therapies.A review of the literature was performed using PubMed and CINAHL databases. Twenty-four sources were chosen for inclusion in this article. Search terms included the following: galactagogues, breastfeeding, kangaroo care, and lactation, among others. The state of the science of alternative therapies in the management of inadequate breast milk supply is summarized here. The evidence is discussed and adverse side effects related to these therapies is addressed.

    There is nothing about this that is “CAM.”

    Herbal galactagogues – pharmacognosy. Just because it is herbal does not mean that it is CAM. Unless, like fenugreek, there is simply no data on it. Herbs are bioactive, hence why pharmaceutical companies like to investigate them for potential drugs. But taking an herb over a proven drug is woo and CAM because that is unproven and falls into the naturalistic fallacy. I suggest you watch this:

    http://www.youtube.com/watch?v=r3yzXXPeLo0

    Kangaroo care – a mother holding an infant regularly is not CAM either. We have good scientific rationale and studies as to why that works.

    “…and lactation, among others.” What does that even mean?

    “…state of the science of alternative therapies in the management of inadequate breast milk supply…”

    If there is science then it is not CAM. That only serves to further the false dichotomy.

  48. aeauooo says:

    @ ConspicuousCarl

    Read the title of the paper that I cited: State Boards of Nursing and Scope of Practice of Registered Nurses Performing Complementary Therapies

    “I don’t know how narrow of a definition you meant by “scope”, but one interpretation might mean that staying within the “scope” of any practice can be done while applying quackery to medical conditions which are within their profession’s range of practice.”

    The scope of practice of a nurse is defined in the Nurse Practice Acts of each state.

    I currently practice in Washington State. These are the laws and regulations that govern my practice:

    Revised Code of Washington
    http://apps.leg.wa.gov/rcw/default.aspx?cite=18.79

    Washington Administrative Code
    http://apps.leg.wa.gov/wac/default.aspx?cite=246-840

  49. Dr Benway says:

    Conspicuous Carl, it is so much worse than even “quantum.”

    Here’s the APA home page: http://www.psych.org

    On the left under “Inside the APA” you see, “Interest groups.” From there you go to the CAIM site. So CAIM is an OFFICIAL caucus or subdivision within the APA as of 2004.

    At the APA CAIM site, when you click on “integrative modalities” you see this:


    While the conventional medical treatment for mental illnesses is the use of medications and/or counseling, potential alternative and complementary options are listed below [adapted from Textbook of Integrative Mental Health Care, James Lake MD, Thieme, 2007.]

    Biological Treatments:

    -Nutrition & Diet
    -Elimination Diets (e.g. elimination of caffeine, sugar, additives)
    -Macrobiotic Diet
    -Natural Supplements (e.g. SAMe, Omega-3 fatty acids)
    -Herbals, Western (e.g. St. John’s wort, Valerian)
    -Herbals, non-Western (e.g. Chinese, Ayurvedic, Tibetan, Kampo)

    Energetic Treatments:

    -Biofeedback (including EEG & EMG)
    -Light Therapy (i.e. the use of light boxes)
    -ECT (electroconvulsive therapy or “shock” therapy), TMS (transcranial magnetic stimulation), VNS (vagus nerve stimulation)

    ^WHAT THE F_CK!!!! ECT IS NOW AN “ENERGY TREATMENT??”

    -Cranioelectrotherapy Stimulation (i.e. alpha-stimulation)
    -Virtual Reality Exposure Therapy
    -Music or Sound Therapy (including binaural sounds)
    -Thermography
    -Acupuncture
    -Homeopathy
    -Qigong
    -Therapeutic Touch
    -Healing Touch
    -Reiki
    -Prayer & directed intention
    -Bach flower essence therapies
    -Polarity Therapy

    Somatic Mind & Body Approaches:

    -Exercise
    -Massage
    -Yoga
    -Aromatherapy
    -Animal-Assisted Therapy (domestic pets, horses, dolphins)
    -Heart-Rate Variability
    -Craniosacral Therapy
    -Ayurveda
    -Applied Kineseiology
    -Alexander Technique
    -Trager Approach to Psychophysical Integration
    -Rolfing
    -Rubenfield Synergy Method

    APA, you break my heart.

  50. Dr Benway says:

    I’m sorry for going off topic but I’m on an anti-anti-psychiatry raeg.

    I have to manage very aggressive clients with TBI or developmental problems in a residential program. Prone restraints are the best way to keep everyone safe when a big, strong, angry client is intent on killing or maiming someone else. If you think I’m wrong about this, please tell me a better way short of mechanical restraints, which we are not going to do outside of a hospital.

    The people who run the program eliminated prone restraints some months ago. Yay! Oh wait, staff and clients are getting hurt on a regular basis. One suffered toe frostbite after chasing staff around outside in the snow. And for many, the process of slowly extinguishing violence and threats of violence as an habitual behavioral strategy has been sabotaged. NOT YAY.

    So what is going on? Why did someone far away decide that we were so stupid and cold hearted that we had to be stopped? SAMHSA is mentioned (aside: SAMHSA’s logo is way to much like Narconon’s. That’s just ew.).

    I managed to find this pdf, and on page 161 I read:

    Seclusion & Restraint Program Description and Accomplishments
    This program supports States/Tribes in their efforts to adopt best practices to reduce and ultimately eliminate the use of restraint and seclusion in institutional and community based settings that provide mental health services including services for people with co-occurring substance abuse and mental health disorders.

    In FY 2010, SAMHSA awarded the National Technical Assistance Center for Trauma and Justice: Promoting Alternatives to Seclusion and Restraint and Implementation of Trauma Informed Care. The overall purpose of the technical assistance center is to provide national leadership* in reducing the pervasive, harmful, and costly health impact of violence and trauma by integrating trauma-informed approaches throughout health and behavioral healthcare systems, and to divert people with substance use and mental disorders from criminal and juvenile justice systems into trauma-informed treatment and recovery.

    *”Leadership” lately seems to mean willpower over matter. This is why Wall Street. Also mortgage crisis. Also Iraq.

    “Trauma informed treatment” is starting to really piss me off. It looks like Dianetics or abreaction or some kind of political thing. It has very little to do with Joey deciding to bite off Eric’s fingers because Eric won’t STFU with that constant moaning thing he does.

  51. Dr Benway says:

    Holy crap they now have “Chinese Medical Psychiatry.”

    Using an all-natural diagnostic procedure*, it has been discovered that one of the authors of the Chinese Medical Psychiatry textbook, a Mr. Bob Flaws, is a total dick.
    _________________
    *see the 5-star review he gives his own book, lol

  52. Enkidu says:

    tmac said: “On a different note,does anyone else think that ‘Fenugreek The Galactogogue’ would make a kick ass title for a Sci-Fi movie?”

    I vote yes!!!

    As for the topic at-hand, I suffered from no milk supply. In that, I would pump (and pump and pump) and get less than an ounce per session. I couldn’t breastfeed directly b/c my daughter was premature and lived in the NICU for 2 months. The lactation consultant at the hospital worked with me for the first two weeks, and no matter what “tricks” I tried (pumping every 2 hours, pumping in front of the baby’s isolette, drinking tons of water) it was like getting blood from a stone. She did eventually suggest both Fenugreek and Reglan. Fenugreek she said would only help if I had a supply in the first place, which I obviously didn’t. And as distraught as I was over not producing milk, I wasn’t distraught enough to think that a tea that I could find zero scientific info about would help me, so I didn’t take it. I find it weird that with no evidence on the effectiveness of Fenugreek, my consultant made such a statement. I guess it’s just a perpetuating ancedote that everyone tweeks to their personal experiences.

    Reglan I rejected because of the possible side effects (I was already crying every two hours, did I need to make myself more miserable? How would this help my baby?). In the end my milk wasn’t more important than my time and sanity. I only had so many hours to visit and hold my baby, I didn’t want to waste them being holed up in a pumping room getting only drops at a time.

  53. weing says:

    I think that this is another example of how the US is sinking as a leader in science and technology. We are doing China in reverse. Back in the days of Uncle Mao, the barefoot doctors were sent out with some herbs and needles to give the unwashed masses something that looked like medical care. That has been changing as China has advanced its standing and been able to educate and deliver enough real doctors to meet the needs. In the US, we can’t afford to educate enough qualified docs, so what do we do? Lower the standards, make woo acceptable, and then anyone can be a doctor and dispense it. Problem solved. Sometimes I think I’m a conspiracy theorist.

  54. Kylara says:

    “Lactation consultants do so much more than say “give expressed milk and take this untested, suspicious herb”.”

    My lactation consultant told me to go off drugs my ob/gyn prescribed, tried to tell me not to take my C-section pain killers the day after the C-section, gave me a 20-minute lecture on the evils of alcohol a propos of nothing in particular, and informed me I was FAILING MY BABY on the SECOND DAY OF HIS LIFE because I refused to commit to nursing for a full year RIGHT THEN AND THERE. (She told me only mothers with a strong commitment “make it” and “produce adequate milk” and I told her that kind of thing stressed me out and I preferred to take it a few weeks at a time so if it got hard, I didn’t feel discouraged but could instead say, “It’s okay, I just have to make it to next Wednesday” and by next Wednesday things are usually better. She informed me this plan ALWAYS failed and I would fail at breastfeeding unless I PROMISED. RIGHT NOW. And did I really want to FAIL MY CHILD? I refused. She pushed for a while, then shrugged and said, “Well, if you don’t want what’s best for him …”)

    My only regret about the whole situation is that I was so tired, emotionally overwhelmed, and in pain that I didn’t throw her the hell out of my room but let her finish her spiel.

    The maternity nurse helped me figure out latching, and I made it a whole year. On MY system.

    Only two women I know have had good lactation consultant experiences. While I know there are good ones out there, the profession is unfortunately saturated with wild-eyed ideologues and crazy, unscientific nonsense. Like fenugreek!

  55. dclb says:

    I had a very abundant milk supply so when it seemed to dwindle a bit I was also told to use Fenugreek and Blessed Thistle by many people. I took it and noticed an immediate abundance of breast milk again, but I certainly can accept that it may have been unrelated to the herbs for a number of other reasons.

    I cannot remember if the Fenugreek advice came from the hospital folk, but I *was* frustrated that every nurse in the (very respectable research) hospital in Toronto had a different opinion and piece of advice and none seemed to be consistent with each other nor based on research (about how to soothe baby, nursing advice, etc.). It really made me mistrust anything any of them said. As a first-time naive mother, I expected there would be a set standard of instructions on what to do. ha!

    A huge problem with modern mothering is that what’s best for baby is not convenient for working mothers and/or difficult in today’s type of world. Lucky for me, not only did I have an entire year off work, but I was granted extended unpaid leave. In addition – unfortunately a lot of the natural mothering types are attracted to all of the woo which seems to give natural mothering techniques such as keeping baby close and extended nursing a bad name.

    @Anthro
    I was happy to read what you said about your 4 children as ours still sleeps with us nursing around the clock, even now at 22 months old. He was not the smiling calm baby who slept through the night since day 1 as our mothers said we were! He was attached to my husband or me, literally, for his first 8 months otherwise he shrieked his head off – from day 1 – so much he would work himself up almost instantaneously to a gag and throw up fit if we tried to put him down to sleep before he fell asleep on us. Him and I have still never been apart for more than 3 hours to this day.

    The advice our pediatrician gave us was to stop nursing after 10 minutes and let him cry! Where is the science-based research behind that “tip”?! We have not put our conveniences first and letting baby cry it out so his sleeping fits with ours just did not gel with me. Instincts guided me completely and seem to have worked out best for us, especially for my comfort level with the difficult and inconvenient practices I’ve kept up, despite the huge amount of criticism from everyone (all the nursing, co-sleeping, carrying him almost constantly well after he started walking). What we’ve done has resulted in a super sweet, bright, trusting child who listens and is co-operative despite his current excessive dependence on me to sleep which I expect he’ll outgrow on his own with reassurance and gentle & gradual changing of routines.

    I guess my point is that it`s way harder than I ever imagined to do what your child needs you to do and I don`t feel any support for raising him this way from most people who usually laugh and think I`m spoiling him or that I should just coerce him into being calmer by forcing him to scream himself into oblivion before collapsing to sleep. What works for some babies certainly wouldn`t work with ours and I think that as much as “wooey” recommendations for Fenugreek exist among doctors and nurses, so do random pieces of advice on what’s best for taking care of a fussy baby.

  56. Kimbo Jones says:

    What stuck out for me wasn’t necessarily the herb recommendation (which, without appropriate supporting evidence, is unfortunate), but that the nurse seemed to be exceeding her scope of practice by making that recommendation at all. With such gray area around herbal supplements, what’s to stop anyone from recommending them despite lack of expertise? There’s no professional consequence (that I’m aware of, correct me if I’m wrong) to giving that sort of advice.

  57. dclb “I guess my point is that it`s way harder than I ever imagined to do what your child needs you to do and I don`t feel any support for raising him this way from most people who usually laugh and think I`m spoiling him or that I should just coerce him into being calmer by forcing him to scream himself into oblivion before collapsing to sleep.”

    Sorry, this is swerving off-topic – Just to represent the other side of that issue, It seems doubtful to me that a baby “needs” to sleep with mom or dad. The baby might enjoy it and it may be soothing enough to help them sleep longer (or it may be distracting enough to make them sleep shorter), or it may be much more convenient for the parents, but I’ve seen ton’s of children who spent their first year or two in an orphanage who are also happy, smart, friendly kids. Should we throw all babies in 24 hour communal care? No, but unless a child has a real health, cognitive or emotional impairment, their natural resilience should enable them to accommodate different safe sleep arrangements, depending upon the parent’s wishes or needs.

    When it comes to parenting advice, I suspect that advice having to do with the typical issues (putting baby down to sleep, potty training, eating, discipline, etc) just depend upon the individual children so much that you can’t have a standard set of “rules”. I generally take all advice that is non-medical with a grain of salt, but give it a try if I feel comfortable with it and it might be useful.

  58. dclb,

    No, there is no standard set of instructions. Babies are different; parents are different; the circumstances in which they are raising them are different. Anyone experienced with children and parenting will acknowledge a wide range of ways to “get it right” as well as the risks and downsides associated with any given approach — because they all have risks and downsides.

    I love Penelope Leach. (I’m not enamoured of her nutrition chapters, but they aren’t completely wrong either.) If you can track down some secondhand copies of any of her books, please do. She’s science-based and cites her sources, and even if the science is quite old by now babies and parents haven’t changed much from her day. She talks clearly about parenting styles and a small set of common mistakes (that are actually mistakes without upsides) in ways that are actually helpful for parents trying to figure out what they are doing.

    If you have a clingy, shrieky baby your approach will vary depending on how heavily you sleep; how easily you go back to sleep when woken up; whether you have the build to carry your baby for long periods during the day; whether you work outside the home; the kind of work you do inside the home; whether you have help; how able you are to maintain a zen distance from a baby’s cries; whether you are an experienced parent confident in your abilities or new at this and terrified; whether you enjoy cuddling babies; whether you have other children and how old they are… and so on and so on. There are a few approaches that just aren’t good (shaking the baby in frustration is one that comes to mind) but most of the rest have pros and cons and will eventually result in healthy, normally neurotic grownups.

    One of the things I like about Penelope Leach is that she doesn’t focus on what’s “best for baby” in isolatiion, but looks at the familial environment the baby is growing up in and looks at ways of thinking what is best for everyone. A resentful, desperate parent is not “best for baby.”

    Letting the baby cry it out will absolutely work for some people, but that’s no reason for those people to be smug when it isn’t appropriate for someone else. Especially since they have no way of knowing how clingy and shrieky your baby is compared to theirs.

    If you’re looking for guidance on parenting, seek out people whose company you enjoy and who seem to enjoy their kids and ask for feedback. You are never going to get a single consistent answer so you shouldn’t look for one. Just keep your antennae up for stuff that seems reasonable and possible and fun to implement.

  59. alison cummins – I have never read Penelope Leach, although now I wish I had.

    Your response to dclb is much better than mine, very coherent, too. ;)

  60. Chris says:

    Let me second that advice for Penelope Leach. She made common sense recommendations (my favorite were the sleepers that were enclosed sacks so toddlers could not get a foot up and over to escape the crib, I put zippers at the bottom so that I could diaper and later turn them into nightshirts).

    Enkidu, I understand the stress of having a child in the NICU. Mine was only in for a day, and then to the intermediate infant care unit for a week. Breast pumps are annoying, but it was necessary.

  61. My issue is not so much the advice my doctors gives me, it seems I’ve been lucky in that department. It’s the advice some of my friends seem to be getting from doctors.

    I just had a friend touting the HCG – 500 calorie a day diet to me. Also saying well that recent death of a man on the diet, didn’t happen from the REAL HCG, that was some sort of fake HCG from another manufacturer.

    I kept think HCG? why is that familiar? Once I checked online I found out it’s one of the drugs I took for fertility treatments…that has several contraindications and side effects. Not sure on the dosage they are using for weight loss, but it doesn’t sound good to me. Luckily, this woman doesn’t need the diet, but still it concerns me.

    How do you tell friends, who are obviously invested in some treatment or product that you think it’s a bad idea. Without offending them to the point of not hearing from them anymore.

  62. Christy says:

    Usually I love to talk about breastfeeding, but in this case I’m going to ignore the tangent and talk about the post topic.

    My daughter’s therapist started teaching her meridian tapping (known as Emotional Freedom Technique, evidently). She also notes on her website that she uses Eye Movement therapy for trauma. I had seen it on there, but primarily she talked about Cognitive Behavioral Therapy, and (I feel a bit ashamed to admit this) she was the only person we knew of who takes our insurance. But when she actually started to teach my kid this claptrap, I finally decided to fire her. There were other issues that pointed toward ending therapy, but this was a big part of it.

    I told her we were stopping and she asked why. I was vague, and she pressed, so I let her have it. Not angrily, but very frankly I told her I was concerned she believed in anti-scientific nonsense and it made me doubt her qualifications.

    Of course, it’s a lot easier to do that when you’re never going to see someone again. And even then, it was really hard – I was sweating and really nervous. But in the end it felt really good to have stated things honestly. If we all walk on eggshells and never challenge anyone forthrightly on this stuff, it’s much less likely to go away.

  63. ConspicuousCarl says:

    OK, I’ve got it…

    FENUGREEK THE GALACTOGOGUE!
    Directed by Roger Corman.

    Severely wounded in intergalactic battle, starship captain Fenugreek recovers from a head wound and uncovers a repressed memory of his grandmother telling him of his secret heritage: Fenugreek is a descendant of the highly-productive ancient race known as the Galactogogues!

    But is it true? Follow Fenugreek as he jumps from planet to planet seeking the wisdom of the noble RCTs, the sole keepers of truth and deduction. Is Fenugreek truly a Galactogogue? Are the RCTs secretly confounded by the evil Mean Regressors? You MUST WATCH to find out!

  64. CC – I love it. Maybe you should send it on the Joss Whedon and see if he’ll produce it.

  65. nybgrus says:

    CC – I love it too! Cracked a big smile.

    @michele: I actually had a friend not too long ago put up on her facebook that she wanted to try the HCG diet. I quickly looked it up (having never heard of it before) and was horrified. I then posted a response, saying essentially that I didn’t think it was a great idea and that in my research I had found some very negative outcomes. I then proceeded to follow up with some alternatives in regards to dieting and addressed her specific concern that if she didn’t have a “structured enough” diet plan to follow she knew she would fail. I said to follow most of what the diet said, eschew the HCG, and to use a couple of the other tips I’d said. I had to leave it at that. She decided to go ahead and skip the HCG diet and try something different. I think the fact that I myself lost 75lbs a few years back (and have kept it off) lent me some credibility – sadly more than my science education.

    My point being is that I believe the only way to handle something like the situation you have described is to either ignore it entirely and wait for them to specifically come to you or to be understanding, do your research, explain your reasons, and (most importantly) offer concrete alternatives that meet the needs and desires the individual expresses.

  66. Dr Benway says:

    Christy,

    Having pseudoscience mixed up with a science-based profession is awful on so many levels.

    EMDR was the first psychological therapy to arise apart from the rough-and-tumble of a university setting. But now we are up to our ears in these trademarked copyright cottage industry things.

    Some might ask, “What’s the harm of EMDR?” But that’s the wrong question. We should ask, “What’s the harm in breaking the back of sound scientific standards? What’s the harm in adding trade barriers to the free exchange of information within our professional schools?’

    Your daughter’s therapist likely doesn’t realize that her expensive EMDR certificate is comparable to a Scientology course completion (eye movement is a command-response cycle analogous to the “feel my finger” of Scientology’s “touch assists” which are used to reorient a thetan dissociated from its body due to trauma).

    Heh. It wouldn’t surprise me if you can get CMEs at Yale for EMDR these days.

  67. dclb says:

    Thanks guys/gals. I ordered a few used copies of Penelope Leach on Amazon. Looking forward to checking them out.

    Back to the topic at hand…I had gone to a nutritionist health person (CAM) before getting pregnant who recommended Juice Plus. I asked for research and she emphatically said there were studies and that the babies born were SO much healthier from the mothers who took Juice Plus and showed me the study blurb…I later checked and it was the Juice Plus study. Not so convincing. This woman was completely convinced though and said also as evidence that her hair turned natural again from grey after being on Juice Plus for awhile.

  68. tmac57 says:

    ConspicuousCarl- That was truly inspired! Now if you could just work in the ominous and ubiquitous “In a world…” in there…that would be great!

  69. Calli Arcale says:

    windriven:

    “mothers took fenugreek, 3 cups, three times daily.”

    NINE cups of fenugreek daily??? It isn’t clear from the citation but I presume that is an infusion.

    I wonder what the effect of increasing daily fluid intake by more than half a gallon might be on lactating mothers?

    Yes, that leaped out at me too. They need to control for total fluid intake. My babies had only breastmilk until 6 months, and continued having breastmilk until they were over a year old and were no longer interested in nursing. But I returned to work after 8 weeks, and so I got familiar with my friend the breast pump. It’s amazing how much affect this has on your perception of breastfeeding. For one thing, you can actually tell how much you’re producing. They say “weigh the baby” but this is actually a poor substitute for pumping and measuring the quantity produced — a baby who is nursing well but not digesting properly may fail to thrive despite adequate milk production on the mother’s part, with undigested milk passing out in the stool.

    One thing I noticed was that if I was not adequately hydrated, the milk was thicker. (It was also thicker in the morning, but for different reasons.) By the afternoon, when I’d collect the bottles from the fridge to take them to the daycare facility, the milk would have separated, and there was often a dramatic difference. I collected metrics on time and quantity, and I wish I’d also collected metrics on the cream-to-whey ratio. It makes me wonder whether among the existing problems with insufficient real science on breastfeeding, the problem of milk *quality* isn’t being overlooked. If a product (pharmaceutical or “herbal”) is increasing milk production, is it actually increasing the overall milk production or just adding to the fluid content?

    The baby’s side of the equation can’t be forgotten either. A woman can’t produce milk without the appropriate stimulation. Breastpumps have gotten much better at it, but a baby is the best. Usually. Some babies never suckle very well, sometimes because of oddly shaped mouths, and no herbal remedy will fix that. Yet the woman will seem to produce insufficient milk, because her breasts aren’t getting enough stimulation. As far as they’re concerned, the baby is weaning.

  70. Zoe237 says:

    Would be interesting to look at the non-scientific advice some obstetricians give breast-feeding mothers. Like 4 hour feeding schedules. Or saying “you can’t breastfeed” after taking this or that drug (my anethesiologist for knee surgery did this, until I showed him the evidence). Woo abound with breastfeeding from both “sides.” Getting better though.

  71. Steve says:

    chaos4zap
    I know I am a little late to the party.
    Nursing has a lot woo in it.
    I am a Nurse practitioner in the north east. I can faithfully tell you that I prescribe and have the training and legal right to do so. I have great issues with CAM and alternative crap pushed in nursing. I try to work within the field to teach critical thinking. I will say I was trained exclusively, undergrad and Grad, with science based medicine/nursing. My person opinion and experience has given me the impression that academic nurses IE university professors have pushed a great deal of this crap in a attempt to divorce nursing from the vision of “Handmaiden of the physician”. Woo should be combated on all levels and I do not tolerate pseudoscience in my students or colleagues. I do get the the impression of being a minority especially at national conferences.
    That said, nursing woo is not as dangerous as medical woo.
    The average person has no idea what is the difference between an LPN/RN/NP is. A fair portion of doctors don’t understand. People do know doctors/dentists/even chiropractors. A significant number of them support Woo. IE: Oprah never kicked off the career of Nurse Phil, or the Nurse Oz television show. Once, one of my dentists seriously told me that aspartame had “Pickled a person post mortem”. I looked at her and said “Really” and asked her three questions I thought would start the ball rolling, it didn’t. Needless to say I never let her touch me again. However it does make me question dental training on some level. My point is with recognition and respect comes greater responsibility. So don’t nail my profession to the cross, but don’t let them get away with it either.

  72. CLK says:

    Also late to chime in, but I am a nurse and also a lactation specialist, so this discussion peaked my interest.
    First, not all certified lactation consultants are nurses. Many are, but many are also folks with no medical background at all. Of note, the requirements for sitting the exam and also being certified are changing in 2012 to include more science based course work, I believe in response to the concern that IBCLC’s are not concerned with SBM or EBM. You can check out the new requirements to see what I am talking about.
    People may believe they are working with an IBCLC when in fact they are working with a maternity nurse, a peer counselor or another kind of BF helper. In my experience, IBCLC’s tend to have more extensive training, have verified that training, and in general they are going to be more up to date with BF research. Not always though.

    Fenugreek. Parents ask about it ALL the time. They are told about it by a friend, they read about it on the internet. The traditional use of fenugreek for BF mothers is as a tea. Basically, a simple food. Not a tincture, not an extracted component of the plant, not compounded with other plants. When families ask about traditional food recommendations for pregnancy and lactation, I feel differently than when families ask about using supplements or herbal remedies. Most cultures have taboos against eating certain kinds of foods or using certain spices at key times in peoples lives. Illness for example, and most definitely around pregnancy and lactation. There are also traditional foods recommended at these times. As long as there is no risk of calorie or nutrient restriction from food beliefs, it seems unwise to discourage people from following their family or cultures practices. In fact, I have learned that there may be a cost to the patient when they shirk at such taboos or food prescriptions in the form of family stress, or social and cultural isolation. We don’t often talk about that issue in SBM discussions but nurses encounter it frequently since we are often the people addressing the “how” part of getting the patient to comply with the plan for care.
    So what to do with western families who are reading about a culture that is not their own and wanting to try out a traditional galactagogue.
    The first is to clarify what people are actually doing- in this case making a beverage from fenugreek seeds. The same seeds we put in to many recipes for flavoring. A teaspoon in 6 oz of hot water steeped to taste. It’s food, and as such isn’t a risk as it is GRAS to consume foods for the most part. Fenugreek tea has never been shown to pose a health hazard, and it has also not been shown to increase milk supply. But it also has not been studied in any scientifically rigorous way, nor do I think resources should be spent in doing so. If you like the tea and you want to try it, then by all means go ahead.
    Once a plant becomes extracted for weeks in alcohol, or someone extracts “active ingredients” from it and puts them in pills, or compounds it with other plants you are talking about a whole different issue. I personally, advise caution when dealing with supplements and tinctures marketed to BF women. There is no way to guarantee the sourcing of the materials used, the manufacturing practices, or even that what the label says is in them is accurate, or in the quantities they claim. Further, unlike eating food, a supplement allows you to ingest the equivalent of several days worth of some active compounds present in a single dose leading to concerns about negative side effects that people wouldn’t see from eating the food in regular quantities. So this is how I respond to the fenugreek question. It’s also how I respond when people come in and report on anecdotes about eating oatmeal for breakfast increasing supply or increasing fluid intake. Eating breakfast is a good idea, oatmeal is a nutritious option if you like it, go for it. Since I am unaware of any good research on the question you will have to see how it goes.
    Drinking alcohol is a bit different. Women need to know that there is research showing decreased milk production from alcohol consumption, though quantity and frequency seems to matter. They also need to know that it passes through to the baby, rather well actually. I don’t feel comfortable making a patient comfortable with a pint of Guinness thrice daily as a plan. I think there are risks we can quantify with that one, and there is also a reasonable expectation it could be harmful.
    Domperidone works for a large number of women who have demonstrated low supply despite stimulation of the breasts and regular removal of milk. I think it would absolutely be worth researching in more depth.
    I am often conflicted about what to recommend or not to a woman struggling with low supply. Obviously, we focus first on frequent and complete removal of milk as the single greatest influencing factor. By fixing the pumping, or the babies latch and suck. After that, I am often left with encouraging them to “talk to their doctor” about medications that might help milk production, and then eventually talking with their MD about domperidone if they don’t already have experience with it.

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