Lactation is the process of milk production and secretion from the mammary glands, which are exocrine glands located in the breasts. In female adult humans, milk production begins during pregnancy, and lactation continues throughout the postpartum period. Initially, hormones (like progesterone and prolactin) regulate milk production. Milk removal takes on a greater role in stimulating ongoing lactation by four days postpartum, and by ten days postpartum, ongoing lactation is entirely stimulated by removal of milk from the breasts. Lactation insufficiency occurs when the parent does not produce enough milk to meet the nutritional needs of their infant.
Moderate levels of exercise do not appear to affect milk production or impair infant growth. However, intense or exhaustive exercise may temporarily alter milk composition (e.g., increased lactic acid and decreased secretory IgA concentrations), but milk composition usually returns to baseline within one hour postexercise. Moreover, infants can safely drink milk produced immediately postexercise despite the change in composition.
Many supplements have been studied for lactation, including fenugreek seed, Coleus amboinicus (torbangun) extract, and moringa leaves. However, there is no robust or consistent data to support the effectiveness of supplements in increasing milk supply for lactating parents. Some trials examining single or multi-ingredient supplements and teas have reported positive findings, like increased milk volume and higher infant weight. However, other trials have found no effect on lactation, and the evidence is too limited to make strong conclusions about efficacy.
It is important for lactating parents to speak with a healthcare provider who is knowledgeable about lactation medicine before using a supplement while breastfeeding. Some herbal supplements may suppress lactation, including jasmine, licorice extracts in high doses, peppermint, and sage, although the evidence for this is limited and sometimes anecdotal. It is also possible for supplements to pass into human milk and change its taste, color, and/or composition. Some of these changes may affect the infant.
Although diet can affect lactation, human milk volume and composition are resilient and remain relatively consistent across a wide variety of diets. Eating enough calories and staying hydrated builds an important dietary foundation for milk production. The additional energy demand of lactation is estimated at about 450 to 500 kcals per day (see below). Lactating people also have an increased requirement for protein, choline, many vitamins (including A, C, E, and most B vitamins), and the minerals iodine, selenium, and zinc. However, if a parent’s diet is deficient in the nutrients required to make milk, their body will mobilize and (if necessary) deplete fat, vitamin, and mineral stores to meet the demands of lactation, even at the expense of the parent’s health. A balanced, nutrient-dense diet can protect the parent from dietary deficiencies while also supporting ongoing lactation.
How many more calories should I consume while lactating?
Can I actively try to lose weight while breastfeeding and maintain supply?
Are there any foods I cannot eat while breastfeeding?
Is it safe to have caffeine while breastfeeding?
Can diet change the composition of milk?
Can I breastfeed while maintaining a vegetarian or vegan diet?
Can I breastfeed while maintaining a ketogenic diet?
Is it okay to consume artificial sweeteners while breastfeeding?
Should I take a multivitamin while breastfeeding?
The primary driver of lactation past 10 days postpartum is milk removal. If the breasts aren’t emptied (i.e., the stored milk is removed to the point that the breasts feel soft and/or hand-expressing more is difficult) at feedings, the body makes less milk to compensate. Optimizing breastfeeding techniques is therefore important for sustained and bountiful milk production (see below).
Stress/anxiety, medications (e.g., oral birth control), menstruation, fatigue, hormonal conditions, genetics, and breast surgery can also affect lactation. Many prescription and over-the-counter medications and recreational drugs, including alcohol, can be expressed in human milk, but not all of them are expressed at levels that could be harmful to the breastfeeding infant.
If planning or needing to take medications or recreational drugs while breastfeeding, it’s wise to check with a knowledgeable healthcare provider, such as a doctor or pharmacist.
Can I still drink alcohol while breastfeeding?
How to optimize breastfeeding techniques to support milk supply
Are there factors that mean that parents should not breastfeed?
What factors mean that parents should temporarily suspend breastfeeding?
What factors mean that parents should feed expressed breastmilk, instead of directly from the breast?
- ^Daley AJ, Thomas A, Cooper H, Fitzpatrick H, McDonald C, Moore H, Rooney R, Deeks JJMaternal exercise and growth in breastfed infants: a meta-analysis of randomized controlled trials.Pediatrics.(2012-Jul)
- ^Be'er M, Mandel D, Yelak A, Gal DL, Mangel L, Lubetzky RThe Effect of Physical Activity on Human Milk Macronutrient Content and Its Volume.Breastfeed Med.(2020-Jun)
- ^McCrory MA, Nommsen-Rivers LA, Molé PA, Lönnerdal B, Dewey KGRandomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance.Am J Clin Nutr.(1999-May)
- ^Lee S, Kelleher SLBiological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology.Am J Physiol Endocrinol Metab.(2016-Aug-01)
- ^Vida Ghasemi, Masoomeh Kheirkhah, Mohsen VahediThe Effect of Herbal Tea Containing Fenugreek Seed on the Signs of Breast Milk Sufficiency in Iranian Girl InfantsIran Red Crescent Med J.(2015 Aug 15)
- ^Siew Cheng Foong, May Loong Tan, Wai Cheng Foong, Lisa A Marasco, Jacqueline J Ho, Joo Howe OngOral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infantsCochrane Database Syst Rev.(2020 May 18)
- ^Ravi, R et alEffect of fenugreek on breast milk production and weight gain among Infants in the first week of lifeClinical Epidemiology and Global Health.
- ^Anderson PODrugs that Suppress Lactation, Part 2.Breastfeed Med.(2017-May)
- ^Naor N, Fridman E, Kouadio F, Merlob P, Linder NGreen Breast Milk Following Ingestion of Blue-Green Algae: A Case Report.Breastfeed Med.(2019-Apr)
- ^Yazgan H, Demirdöven M, Yazgan Z, Toraman AR, Gürel AA mother with green breastmilk due to multivitamin and mineral intake: a case report.Breastfeed Med.(2012-Aug)
- ^Bravi F, Wiens F, Decarli A, Dal Pont A, Agostoni C, Ferraroni MImpact of maternal nutrition on breast-milk composition: a systematic review.Am J Clin Nutr.(2016-Sep)
- ^Leghi GE, Netting MJ, Lai CT, Narayanan A, Dymock M, Rea A, Wlodek ME, Geddes DT, Muhlhausler BSReduction in Maternal Energy Intake during Lactation Decreased Maternal Body Weight and Concentrations of Leptin, Insulin and Adiponectin in Human Milk without Affecting Milk Production, Milk Macronutrient Composition or Infant Growth.Nutrients.(2021-May-31)
- ^Allen LHMultiple micronutrients in pregnancy and lactation: an overview.Am J Clin Nutr.(2005-May)
- ^Leung AM, Pearce EN, Braverman LE, Stagnaro-Green AAAP recommendations on iodine nutrition during pregnancy and lactation.Pediatrics.(2014-Oct)
- ^Sultana, A. et alClinical Update and Treatment of Lactation InsufficiencyMedical Journal of Islamic World Academy of Sciences.(2013)
- ^Medications - A Quick Guide for Parents: La Leche League International, cited November 3, 2022
- ^Thomas W. Hale, Kaytlin KrutschMedications and Mother’s Milk
- ^Neville MC, Morton J, Umemura SLactogenesis. The transition from pregnancy to lactation.Pediatr Clin North Am.(2001-Feb)
- ^Pang WW, Hartmann PEInitiation of human lactation: secretory differentiation and secretory activation.J Mammary Gland Biol Neoplasia.(2007-Dec)
- ^Brownell E, Howard CR, Lawrence RA, Dozier AMDelayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding.J Pediatr.(2012-Oct)
- ^Ballard O, Morrow ALHuman milk composition: nutrients and bioactive factors.Pediatr Clin North Am.(2013-Feb)
- ^Breastfeeding and the use of human milk.Pediatrics.(2012-Mar)
- ^Andreas NJ, Kampmann B, Mehring Le-Doare KHuman breast milk: A review on its composition and bioactivity.Early Hum Dev.(2015-Nov)
- ^Frank NM, Lynch KF, Uusitalo U, Yang J, Lönnrot M, Virtanen SM, Hyöty H, Norris JM,The relationship between breastfeeding and reported respiratory and gastrointestinal infection rates in young children.BMC Pediatr.(2019-Sep-18)
- ^Peres KG, Cascaes AM, Peres MA, Demarco FF, Santos IS, Matijasevich A, Barros AJExclusive Breastfeeding and Risk of Dental Malocclusion.Pediatrics.(2015-Jul)
- ^Güngör D, Nadaud P, LaPergola CC, Dreibelbis C, Wong YP, Terry N, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O'Brien KO, Oken E, Pérez-Escamilla R, Ziegler EE, Spahn JMInfant milk-feeding practices and diabetes outcomes in offspring: a systematic review.Am J Clin Nutr.(2019-Mar-01)
- ^Horta BL, Loret de Mola C, Victora CGLong-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis.Acta Paediatr.(2015-Dec)
- ^Bergman NJBirth practices: Maternal-neonate separation as a source of toxic stress.Birth Defects Res.(2019-Sep-01)
- ^Rameez RM, Sadana D, Kaur S, Ahmed T, Patel J, Khan MS, Misbah S, Simonson MT, Riaz H, Ahmed HMAssociation of Maternal Lactation With Diabetes and Hypertension: A Systematic Review and Meta-analysis.JAMA Netw Open.(2019-Oct-02)
- ^Appiah D, Lewis CE, Jacobs DR, Shikany JM, Quesenberry CP, Gross M, Carr J, Sidney S, Gunderson EPThe Association of Lactation Duration with Visceral and Pericardial Fat Volumes in Parous Women: The CARDIA Study.J Clin Endocrinol Metab.(2021-May-13)
- ^Ho Kyung Sung, Seung Hyun Ma, Ji-Yeob Choi, Yunji Hwang, Choonghyun Ahn, Byoung-Gie Kim, Yong-Man Kim, Jae Weon Kim, Sokbom Kang, Jaehoon Kim, Tae Jin Kim, Keun-Young Yoo, Daehee Kang, Suekyung ParkThe Effect of Breastfeeding Duration and Parity on the Risk of Epithelial Ovarian Cancer: A Systematic Review and Meta-analysisJ Prev Med Public Health.(2016 Nov)
- ^Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease.Lancet.(2002-Jul-20)
- ^Butte NF, King JCEnergy requirements during pregnancy and lactation.Public Health Nutr.(2005-Oct)
- ^Lambrinou CP, Karaglani E, Manios YBreastfeeding and postpartum weight loss.Curr Opin Clin Nutr Metab Care.(2019-Nov)
- ^Lovelady CBalancing exercise and food intake with lactation to promote post-partum weight loss.Proc Nutr Soc.(2011-May)
- ^Brown KH, Akhtar NA, Robertson AD, Ahmed MGLactational capacity of marginally nourished mothers: relationships between maternal nutritional status and quantity and proximate composition of milk.Pediatrics.(1986-Nov)
- ^Strode MA, Dewey KG, Lönnerdal BEffects of short-term caloric restriction on lactational performance of well-nourished women.Acta Paediatr Scand.(1986-Mar)
- ^Dórea JGExposure to mercury during the first six months via human milk and vaccines: modifying risk factors.Am J Perinatol.(2007-Aug)
- ^James J, Lawrence R.Can Consuming Caffeine Harm your Baby? An interview with Ruth Lawrence, PhDJournal of Caffeine Research.(Dec 2011)
- ^CaffeineDrugs and Lactation Database (LactMed®).(2006-08)
- ^Griffin IJ, Abrams SAIron and breastfeeding.Pediatr Clin North Am.(2001-Apr)
- ^Spahn JM, Callahan EH, Spill MK, Wong YP, Benjamin-Neelon SE, Birch L, Black MM, Cook JT, Faith MS, Mennella JA, Casavale KOInfluence of maternal diet on flavor transfer to amniotic fluid and breast milk and children's responses: a systematic review.Am J Clin Nutr.(2019-Mar-01)
- ^Zhang Z, Wang Y, Yang X, Cheng Y, Zhang H, Xu X, Zhou J, Chen H, Su M, Yang Y, Su YHuman Milk Lipid Profiles around the World: A Systematic Review and Meta-Analysis.Adv Nutr.(2022-Dec-22)
- ^Di Maso M, Bravi F, Ferraroni M, Agostoni C, Eussen SRBM, Decsi T, Quitadamo PA, Tonetto P, Peila C, Profeti C, Salvatori G, Kazmierska I, Decarli A, Vacca E, Bertino E, Stahl B, Moro GEAdherence to Mediterranean Diet of Breastfeeding Mothers and Fatty Acids Composition of Their Human Milk: Results From the Italian MEDIDIET Study.Front Nutr.(2022)
- ^Innis SMImpact of maternal diet on human milk composition and neurological development of infants.Am J Clin Nutr.(2014-Mar)
- ^Giorgia Sebastiani, Ana Herranz Barbero, Cristina Borrás-Novell, Miguel Alsina Casanova, Victoria Aldecoa-Bilbao, Vicente Andreu-Fernández, Mireia Pascual Tutusaus, Silvia Ferrero Martínez, María Dolores Gómez Roig, Oscar García-AlgarThe Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and OffspringNutrients.(2019 Mar 6)
- ^Nnodum BN, Oduah E, Albert D, Pettus MKetogenic Diet-Induced Severe Ketoacidosis in a Lactating Woman: A Case Report and Review of the Literature.Case Rep Nephrol.(2019)
- ^Alkhayat A, Arao K, Minami T, Manzoor KKetoacidosis associated with ketogenic diet in a non-diabetic lactating woman.BMJ Case Rep.(2020-Jun-30)
- ^Sloan G, Ali A, Webster JA rare cause of metabolic acidosis: ketoacidosis in a non-diabetic lactating woman.Endocrinol Diabetes Metab Case Rep.(2017)
- ^Allison C Sylvetsky, Alexandra L Gardner, Viviana Bauman, Jenny E Blau, H Martin Garraffo, Peter J Walter, Kristina I RotherNonnutritive Sweeteners in Breast MilkJ Toxicol Environ Health A.(2015)
- ^Archibald AJ, Dolinsky VW, Azad MBEarly-Life Exposure to Non-Nutritive Sweeteners and the Developmental Origins of Childhood Obesity: Global Evidence from Human and Rodent Studies.Nutrients.(2018-Feb-10)
- ^Ella Schaefer, Hans Demmelmair, Jeannie Horak, Lesca Holdt, Veit Grote, Karoline Maar, Christoph Neuhofer, Daniel Teupser, Nadja Thiel, Erwin Goeckeler-Leopold, Silvia Maggini, Berthold KoletzkoMultiple Micronutrients, Lutein, and Docosahexaenoic Acid Supplementation during Lactation: A Randomized Controlled TrialNutrients.(2020 Dec 16)
- ^Ho E, Collantes A, Kapur BM, Moretti M, Koren GAlcohol and breast feeding: calculation of time to zero level in milk.Biol Neonate.(2001)
- ^Haastrup MB, Pottegård A, Damkier PAlcohol and breastfeeding.Basic Clin Pharmacol Toxicol.(2014-Feb)
- ^Common Breastfeeding Challenges:BreastfeedingOASH/Office on Women’s Health; Rockville, MD: U.S. Department of Health and Human Services, cited January 9, 2022.
- ^Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants: CDC, cited November 3, 2022
- ^Gerard T BerryClassic Galactosemia and Clinical Variant Galactosemia, cited November 2, 2022
- Milk Production - Atena Mohammadpour, Mahboubeh Valiani, Alireza Sadeghnia, Sedigheh TalakoubInvestigating the Effect of Reflexology on the Breast Milk Volume of Preterm Infants' MothersIran J Nurs Midwifery Res.(Sep-Oct 2018)
- Milk Production - Seyhan Çankaya, Gülay RatwischThe Effect of Reflexology on Lactation and Postpartum Comfort in Caesarean-Delivery Primiparous Mothers: A Randomized Controlled StudyInt J Nurs Pract.(2020 Jun)
- Milk Production - Ping Lu, Zhi-Qi Ye, Jin Qiu, Xiao-Yu Wang, Juan-Juan ZhengAcupoint-tuina therapy promotes lactation in postpartum women with insufficient milk production who underwent caesarean sectionsMedicine (Baltimore).(2019 Aug)
- Milk Production - Mitra Savabi Esfahani, Shohreh Berenji-Sooghe, Mahboubeh Valiani, Soheila EhsanpourEffect of acupressure on milk volume of breastfeeding mothers referring to selected health care centers in TehranIran J Nurs Midwifery Res.(Jan-Feb 2015)
- Milk Production - Vida Ghasemi, Masoomeh Kheirkhah, Mohsen VahediThe Effect of Herbal Tea Containing Fenugreek Seed on the Signs of Breast Milk Sufficiency in Iranian Girl InfantsIran Red Crescent Med J.(2015 Aug 15)
- Milk Production - Siew Cheng Foong, May Loong Tan, Wai Cheng Foong, Lisa A Marasco, Jacqueline J Ho, Joo Howe OngOral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infantsCochrane Database Syst Rev.(2020 May 18)
- Milk Production - Reena Ravi, Jasmine JosephEffect of fenugreek on breast milk production and weight gain among Infants in the first week of lifeClinical Epidemiology and Global Health.()
- Milk Production - Francesco Di Pierro, Alberto Callegari, Domenico Carotenuto, Marco Mollo TapiaClinical efficacy, safety and tolerability of BIO-C (micronized Silymarin) as a galactagogueActa Biomed.(2008 Dec)
- Milk Production - Peila C, Coscia A, Tonetto P, Spada E, Milani S, Moro G, Fontana C, Vagliano L, Tortone C, Di Bella E, Bertino EEvaluation of the galactogogue effect of silymarin on mothers of preterm newborns (<32 weeks).Pediatr Med Chir.(2015-Dec-29)
- Milk Production - Mradu Gupta, Badri ShawA Double-Blind Randomized Clinical Trial for Evaluation of Galactogogue Activity of Asparagus racemosus WilldIran J Pharm Res.(Winter 2011)
- Milk Production - S Sharma, S Ramji, S Kumari, J S BapnaRandomized controlled trial of Asparagus racemosus (Shatavari) as a lactogogue in lactational inadequacyIndian Pediatr.(1996 Aug)
- Milk Production - Rizal Damanik, Mark L Wahlqvist, N WattanapenpaiboonLactagogue effects of Torbangun, a Bataknese traditional cuisineAsia Pac J Clin Nutr.(2006)
- Milk Production - S. Manjula, Arshiya Sultana, Khaleequr RahmanClinical efficacy of Gossypium herbaceum L. seeds in perceived insufficient milk (PIM) supply: A randomized single-blind placebo-controlled studyOriental Pharmacy and Experimental Medicine.()
- Milk Production - Corazon P. Estrella, Jacinto Bias. Man taring, Grace Z. David, Michelle A. TaupA double blind randomised controlled trial on the use of malunggay (Moringa oleifera) for augmentation of the volume of breastmilk among non-nursing mothers of preterm infantsThe Phillipine Journal of Pediatrics.()
- Pain - Kee WH, Tan SL, Lee V, Salmon YMThe treatment of breast engorgement with Serrapeptase (Danzen): a randomised double-blind controlled trialSingapore Med J.(1989 Feb)
- Nipple Cracks - Manizheh Sayyah Melli, Mohammad Reza Rashidi, Abbas Delazar, Elaheh Madarek, Mohammad Hassan Kargar Maher, Alieh Ghasemzadeh, Kamran Sadaghat, Zohreh TahmasebiEffect of peppermint water on prevention of nipple cracks in lactating primiparous women: a randomized controlled trialInt Breastfeed J.(2007 Apr 19)
- Thyroid-Stimulating Hormone - Mulrine HM, Skeaff SA, Ferguson EL, Gray AR, Valeix PBreast-milk iodine concentration declines over the first 6 mo postpartum in iodine-deficient womenAm J Clin Nutr.(2010 Oct)