POTENTIAL OF HERBS AS GALACTOGOGUES - A REVIEW

Abstract

Given that approximately 130 million babies are born worldwide each year, this study aims to help both, pregnant and breastfeeding women, to overcome the first impasse, namely the decrease or lack of lactation. To sustain this purpose, over the years were used many methods to improve lactation. A galactogogue is a substance, a food or a plant that has the ability to stimulate or increase lactation. Plants as fenugreek, fennel, anise, lemon balm, thyme, cumin, milk thistle and many others are widespread all over the globe and known as galactogogues. These plants can be used as ingredients in food or consumed in the form of herbal teas, which in turn can be obtained by different extraction methods. Even though these herbs possess many other beneficial properties for the human body, the main purpose of their use, alone or in combination, is to maintain or increase breast milk production. The purpose of this paper is to review and summarize data regarding the efficacy of galactogogues available worldwide for increasing breast milk production in food and feed nutrition.

Headnote

Abstract

Given that approximately 130 million babies are born worldwide each year, this study aims to help both, pregnant and breastfeeding women, to overcome the first impasse, namely the decrease or lack of lactation. To sustain this purpose, over the years were used many methods to improve lactation. A galactogogue is a substance, a food or a plant that has the ability to stimulate or increase lactation. Plants as fenugreek, fennel, anise, lemon balm, thyme, cumin, milk thistle and many others are widespread all over the globe and known as galactogogues. These plants can be used as ingredients in food or consumed in the form of herbal teas, which in turn can be obtained by different extraction methods. Even though these herbs possess many other beneficial properties for the human body, the main purpose of their use, alone or in combination, is to maintain or increase breast milk production. The purpose of this paper is to review and summarize data regarding the efficacy of galactogogues available worldwide for increasing breast milk production in food and feed nutrition.

Keywords: plants, lactation, galactogogue, breastfeeding, herbs

Introduction

This review contains information regarding the importance of breastfeeding, possible lactation problems, as well as the definition, classification and characterization of plants with lactogenic potential. Recent surveys showed that an estimated 16% of USA women, 20%-45% Chinese women, 59.9% Australian women and 97% of Italian women used at least one herbal product during the breastfeeding period (Zheng et al., 2019). The main aim of the present study is to summarize useful information about eight herbal galactogogues which are used as ingredients, in simple or mixed herbal teas, to stimulate lactation and are also the most commonly passed down recommendations from one generation to another.

A number of 175 papers were read, such as short communications, research articles and review papers, which were published between 2004 and 2020. Even so, further documentation is necessary and it is wisely to consult a specialist, a lactation consultant, before consuming these plants.

The importance of breastfeeding

Over the years, the role of breast milk has become increasingly recognized as beneficial in reducing morbidity among infants and especially among premature newborns. Breast milk is known to be the ideal form of nutrition for the baby in the first 6 months of life because it brings the intake of nutrients necessary for a healthy development (Özalkaya et al., 2018). Breastfeeding also confers a range of maternal benefits, which include reduced risk of breast, endometrial and ovarian cancer, together with faster return to pre-pregnancy weight and improvements in the psychological wellbeing of the nursing mother (Grzeskowiak et al, 2019).

Possible lactation disorders

Insufficient breast milk supply was frequently reported as the main reason for discontinuing breastfeeding. Numerous women, particularly those who delivered preterm babies, experienced difficulties in producing the required amount of human milk (Shawahna et al., 2018).

During the postpartum period, many women face acute and chronic health problems (cough, infections, back pain, migraine, depression, and many others) and need to take medication. This case is one of women's self-reported reasons for discontinuation of breastfeeding. In addition, many health professionals lack evidence-based knowledge on medication and may advise women to stop breastfeeding while taking them (Saha et al., 2015).

It has been claimed that at least 5% of women experience lactation failure (called agalactias) while approximately 15% of women experience inadequate supply of their breast milk (called hypogalactias) at 3 weeks postpartum and the numbers are constantly growing (Bekoe et al., 2019).

Definition

Natural products, especially herbal ones, are increasingly sought worldwide, in order to be used for pregnant and breastfeeding women, due to the low risk of complications they present (Aleandri et al., 2014).

Galactogogues are foods, pharmaceutical or herbal supplements that are used to support the initiation, continuation or augmentation of breast milk production (Hayati et al., 2019).

They also increase the secretion of prolactin and provide a psychological relief and a marginal contribution to the production of the breastmilk. Human milk production is a complex physiological process involving physical and emotional factors and the interaction of multiple hormones, the most important of which is believed to be prolactin (Brodribb et al., 2018).

Classification

As mentioned in the definition, galactogogues are:

* foods, such as banana flower, lemon basil, Thai basil, chicken, fish, pumpkin and others (Buntuchai et al., 2017);

* pharmaceuticals, such as metoclopramide, domperidone, chlorpromazine, and sulpiride;

* medicinal herbs.

There are numerous plants all over the world known as galactogogues. The most frequently used herbs in commercial preparations and formulations are fennel, anise, star anise, shatavari, torbangun, caraway, dill, fenugreek, cumin, lemon bam, milk thistle, thyme and many others (Khorshidian et al., 2019).

Characterization

The plants with lactogenic potential that will be detailed below belong mostly to the Apiaceae and Lamiaceae families. Although they originate mainly from the Mediterranean region, they are now found all over the world. What these plants have in common, in addition to their lactogenic properties, is the fact that they all possess antioxidant and antimicrobial properties and have been used since ancient times in various branches of alternative medicine.

Herbais with galactogogue potential

In Table 1 are presented eight of the most used herbal galactogogues across the world.

Fennel

Foeniculum vulgare L. is an important herb of Umbelliferae (Apiaceae) family, which is cultivated worldwide and can be used as spice, food or for herbal tea (Y aldiz and Camlica, 2019). It has many pharmacological properties like antioxidant and antibacterial, anti-inflammatory (Mokhtari and Ghoreishi, 2019), galactogogue (Shahat et al., 2011), antimutagenic, cardiovascular, chemomodulatory, antitumor and memory enhancing property (Yaldiz and Camlica, 2019). Its essential oils and plant extracts are also used to control stored food mites (Yaldiz and Camlica, 2019). The aqueous extract obtained from aerial parts of fennel can inhibit the growth of Agrobacterium radiobacter pv. tumefaciens, Erwinia carotovora, Pseudomonas fluorescens, and Pseudomonas glycinea (Sayed-Ahmad et al., 2017). Its extract mainly consists of some major chemical compounds such as trans-anethole, estragóle, fenchone and a-phellandrene (Mokhtari and Ghoreishi, 2019). As mentioned above, several fennel parts are edible (bulbs, leaves, stalks and fruits) meanwhile the mature fruit (the seeds) and essential oil of fennel are used as flavoring agents/spices in food products such as liqueurs, bread, cheese or as an ingredient in cosmetics and pharmaceutical products.

Badguj ar et al. (2014) mention a few regions where fennel is used as a milk stimulant for pregnant women, such as: in South Africa they use fennel leaves infusions, in Europe fruits are chewed or used as spice (in Rome, Italy) or they are turned in simple powder (in north-east of Mallorca) and in South America (in Alto, Bolivia) they make infusions from the aerial parts.

The galactogogue activity of fennel is supported by pharmacological investigations. A randomized clinical trial was performed on 78 babies, who were exclusively breastfed, by giving to their nursing mothers a herbal tea containing 3 g black tea with 7.5 g fennel seeds powder (intervention group) or only 3 g black tea (control group) three times a day for 4 weeks. The intervention group presented significantly increased lactation for nursing mothers, increased infant's weight, head circumference and increased number of breastfeeding times (Ghasemi et al., 2014). Prolactin is secreted by the anterior pituitary gland in response to nipple stimulation. It is under inhibitory control from the hypothalamus, which is mediated by dopamine. Dopamine, therefore, has inhibitory effects on prolactin secretion. Anethole, the main constituent of fennel, bears strong structural resemblance to dopamine. Therefore, anethole may influence milk secretion by competing with dopamine at the receptor sites, thereby inhibiting the antisecretory action of dopamine on prolactin (Javan et al., 2017).

Fenugreek

Fenugreek (Trigonella-foenum graecum) is known as one of the oldest traditional and medicinal herbs that belongs to the Fabaceae family. It is cultivated in the Indian subcontinent, parts of west Asia, Middle East, North Africa, United Kingdom, Russia, Mediterranean Europe, Australia and Canada (Ouzir et al., 2016).

Sim et al. (2014) reports that fenugreek was the most commonly used herbal galactogogue during breastfeeding among the respondents of a survey applied on 304 breastfeeding women.

The effect of fenugreek seeds on milk yield and fat percentage was studied for 9 weeks in 21 lactating dairy goats. The goats were divided into three groups (A, B and C) according to the level of fenugreek added in the feed (0%, 25% and 50% fenugreek). All diets were similar. Milk yield was recorded daily and the fat percentage was determined weekly. The Group B showed significantly higher (p>0.05) daily yield of milk and fat percentage than the other two groups, however group C showed a lower daily yield of milk and fat percentage than the control group (Group A). There were non-significant differences in plasma total protein, globulin, albumin, cholesterol, glucose and total lipids among the three groups (Wani and Kumar, 2016).

Despite being used worldwide for a long time, herbal galactogogues are lacking in scientific evaluation and confirmation of the clinical efficacy. There are numerous reports that suggest effectiveness of fenugreek in promoting lactation, including a survey of La Leche League (a breastfeeding organization) leaders and lactation consultants indicating positive effects in milk supply in approximately 75% of lactating women (Sim et al, 2015). The usual recommended dose to increase milk supply varies from 1 to 6 g daily; in dosages of about 25 g or more daily, fenugreek may lower cholesterol and blood sugar (Drugs and Lactation Database).

Anise

Anise (Pimpinella anisum) is the most widespread Pimpinella species of the Apiaceae family and has been cultivated since ancient times in different regions of the globe, mainly for its role in food (Rocha and Fernandes, 2016).

Extracts and essential oils, both, obtained from this plant are known to possess various properties such as: antioxidant, antimicrobial, carminative, expectorant, antiseptic, antispasmodic, estrogenic activity. In traditional medicine, the plant is also known to be able to alleviate menstrual pain and to be galactogogue and aphrodisiac (Anastasopoulou et al., 2020).

Due to its strong estrogenic activity, which it's caused by two main oil constituents: trans-anethole (93.9%) and estragole (2.4%), anise is used as galactogogue worldwide.

Hosseinzadeh et al. (2014) proves that Pimpinella anisum aqueous and ethanolic extracts increase milk production in rats and the research confirms the traditional use of P. anisum seeds as a lactogenic agent.

Star Anise

Star anise is a medicinal plant, which has been shown to possess numerous properties such as antibacterial, antioxidant, antifungal (Dwivedy et al., 2018), digestion stimulating, antiparasitic, and antipyretic properties. Its essential oil contains transanethole, which is a paramethoxyphenyl propene, as its main active ingredient (about 90%). Other compounds in the essential oil of star anise are estragole and anisaldehyde. Both, star anise and its essential oil, are generally recognized as safe and are widely used in food and health supplement industries (Ding et al, 2020). Cumin

Cumin (Cuminum cyminum L.) also belongs to the Apiaceae family and according to relevant reports it showed beneficial pharmacological properties such as antibacterial, antioxidant, anticancer and hypoglycemic actions mostly due to its essential oil and its main compounds, such as cuminaldehyde, cymene and terpenoids (Zhao et al., 2019).

Numerous studies were made in order to evaluate the lactogenic effect of cumin, but due to the short period of trial or to the absence of the placebo control group, results could not be attributed to the use of cumin (Drugs and Lactation Database).

Lemon balm

Lemon balm or balm (Melissa officinalis L.) represents one of the oldest medicinal plants, traditionally used for its sedative, carminative, antispasmodic, antibacterial, antiviral, anti-inflammatory, antioxidant and neuroprotective properties (Chizzola et al., 2018; Miraj et al., 2016).

It contains a low amount of lemon-scented essential oil that includes citronellal, neral, and geranial monoterpenoid aldehydes. It also consists of polyphenolic compounds (such as rosmarinic acid) and flavonoids (Chizzola et al., 2018).

A randomized trial assigned mothers of preterm infants to receive either an herbal galactogogue herbal tea twice a day, a fruit tea twice a day or nothing. Although the increase in volume of extracted milk was greater in the galactogogue tea group, there was no difference in maternal serum prolactin between the groups after 7 days of administration and no difference in infant weight gain was seen between groups, so the quality of the study was declared poor (Drugs and Lactation Database).

Milk thistle

Milk thistle (Silybum marianum L.) is an annual to biennial herb, native to the Mediterranean countries, member of Asteraceae family (Pereira et al., 2013).

Studies and clinical trials have proven its traditional use as hepatoprotective agent in the treatment of acute and chronic hepatitis, alcohol-related liver diseases and liver damage. In vitro anti-inflammatory, anti-arthritic, antioxidant and anticancer properties as well as clinical trials of silymarin testing in cancer therapy have also been documented (Pendry et al., 2017).

It is mainly used as a medicinal plant due to the presence of active phytochemical compounds. Milk thistle seeds are a major source of silymarin flavonoids. Silymarin is a mixture of four flavonolignans, including silybin (65%), silydianin (10%), silychristin (20%) (Sajadi et al., 2016) and isosilybin (5%). They are bioflavonoid phytoestrogens which stimulate lactation directly, but they could act on estrogen receptors by limiting the endogenous receptor antagonism of milk production (Zecca et al., 2016).

A study was made with a commercial dairy herd with lactating cows located in northern Italy. At approximately 30 days from the expected date of parturition, 30 pregnant cows were selected according to their health condition and previous milk production and were assigned randomly to either the control or treated group. From day 10, before the expected date of calving (assuming a gestation period of 280 days) today 15 after calving, 15 cows were treated with 10 g of silymarin (76% pure extract consisting in flavonolignans, taxifolin, and other trace compounds) per day. To guarantee the dose intake, the extract was mixed with water into a ready-to-use suspension and was immediately administered by an oral drench. Animals were monitored daily to evaluate general physical condition and health disorders by herd personnel or herd veterinarian. Although the biochemical mechanisms that led to the study's effects have not been established, the results showed a higher and earlier milk peak and no negative conditions attributable to the use of silymarin. There were not any adverse effects, indicated by blood and milk parameters, of feeding cows with this natural compound (Tedesco et al., 2004).

An in vivo study with gestational sows, which were fed with 4g silymarin twice a day for 20 days was made and the results showed a significant increase of circulating prolactin levels (Farmer et al., 2014).

Another study made on sows by Jiang et al. (2020), also indicate that silymarin supplementation during transition and lactation can increase circulating concentrations of prolactin transiently, reduce oxidative stress, increase feed intake and enhance protein metabolism, thereby significantly increase milk yield of sows and subsequently improve growth performance of their descendants.

Thyme

Thyme (Thymus serpyllum L.) or wild thyme, as it is also known, is a perennial subshrub of the Lamiaceae family, which grows in almost all the countries bordering the Mediterranean, in Asia and in parts of Central Europe (Jovanović et al., 2017). This medicinal plant possesses numerous properties, such as: antiseptic, diaphoretic, analgesic, carminative, expectorant, diuretic, emmenagogue, and stimulant properties (Nikolić et al., 2014).

The main component of the essential oil of T. serpyllum is carvacrol, while it also contains borneol, isobutyl acetate, caryophyllene, 1,8-cineole, citral, citronellal, citronellol, p-cymene, geraniol, linalool, a-pinene, y-terpinene, a-terpineol, terpinyl acetate, and thymol in relatively high concentrations. Carvacrol and thymol are isomers, belonging to the group of monoterpenic phenols with high antiseptic properties (Jarić et al., 2015).

In Table 2 are presented the administration dose of the herbal galactogogues.

Controversial galactogogues

Although they have many health benefits, herbs used without the supervision of a specialist can cause side effects. In Table 3 are presented the selected eight herbs with galactogogue potential and their possible harms.

Conclusions

Fennel, anise, cumin and the rest of the plants mentioned in the study are known for their ability to increase lactation, but in order to choose the appropriate herbal galactogogue is important to evaluate the potential benefits and side effects of each herb aside. Even if they are spread worldwide and they are promoted from generation to generation, it is wisely recommended to consult a specialist in breastfeeding/ lactation before use.

Further research

These herbal galactogogues should be deeper investigated in order to know their nutritional and phytochemical composition, their efficacy, safety and their mechanism of action because these herbs have the advantage of being cheaper and easily available for breastfeeding women.

Sidebar

Received on 6 November 2020

Revised on 19 May 2021

References

References

Aleandri, V. 2014. The use of herbal products during breastfeeding: A study from a public italian hospital. Journal of Food Processing & Technology, 05(08).

Anastasopoulou, E., Graikou, K., Ganos, C., Calapai, G., Chinou, I. 2019. Pimpinella anisum seeds essential oil from Lesvos Island: Effect of hydrodistillation time, comparison of its aromatic profile with other samples of the Greek market. Safe use. Food

Badgujar, S.B., Patel, V.V., Bandivdekar, A.H. 2014. FoeniculumvulgareMill: A Review of Its Botany, Phytochemistry, Pharmacology, Contemporary Application, and Toxicology. BioMedResearch International, 1-32.

Bekoe, E.O., Kitcher, C., Ama Mireku Gyima, N., Schwinger, G., Frempong, M. 2019. Medicinal plants used as galactagogues. In Pharmacognosy-Medicinal Plants. IntechOpen.

Brodribb, W. 2018. ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018. Breastfeeding Medicine, 13(5), 307-314.

Buntuchai, G., Pavadhgul, P., Kittipichai, W., Satheannoppakao, W. 2017. Traditional Galactagogue Foods and Their Connection to Human Milk Volume in Thai Breastfeeding Mothers. Journal of Human Lactation, 33(3), 552-559.

Chizzola, R., Lohwasser, U., Franz, C. 2018. Biodiversity within Melissa officinalis: Variability of Bioactive Compounds in a Cultivated Collection. Molecules, 23(2), 294.

Ding, X., Yang, C., Yang, Z., Ren, X., Wang, P. 2020. Effects of star anise (Illicium verum Hook.f) oil on the nuclear factor E2-related factor 2 signaling pathway of chickens during subclinical Escherichia coli challenge. Poultry Science, 99(6), 3092-3101.

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Cumin. [Updated 2018 Dec 3]. https://www.ncbi.nlm.nih.gov/ books accesed8.10.2020 12:00

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Fenugreek. [Updated 2020 Jul 20]. https://www.ncbi.nlm.nih.gov/ books accessed 8.10.2020 12:20

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Lemon Balm. [Updated 2018 Dec 3]. https://www.ncbi.nlm.nih.gov/books accessed 8.10.2020 12:35

Dwivedy, A.K., Singh, V.K., Prakash, B., Dubey, N.K. 2018. Nano-encapsulated Illicium verum Hook. f. essential oil as an effective novel plant-based preservative against aflatoxin B 1 production and free radical generation. Food and Chemical Toxicology, 111, 102-113.

Farmer, C., Lapointe, J., Palin, M.-F. 2014. Effects of the plant extract silymarin on prolactin concentrations, mammary gland development, and oxidative stress in gestating gilts. Journal of Animal Science, 92(7), 2922-2930.

Ghasemi, V., Kheirkhah, M., Samani, L.N., Vahedi, M., 2014. The Effect of Herbal Tea Containing Fennel Seed on Breast Milk Sufficiency Signs and Growth Parameters of Iranian Infants, Shiraz E-Med J, 15(4): e22262.

Grzeskowiak, L.E., Wlodek, M.E., Geddes, D.T. 2019. What Evidence Do We Have for Pharmaceutical Galactagogues in the Treatment of Lactation Insufficiency?-A Narrative Review, Nutrients, 11, 974.

Hayati, N.S., Apriyana, W., Rosyida, V.T., Indrianingsih, A.W., Nisa, K., Ratih, D., Indirayati, N. 2019. Pre-formulation and evaluation of Jamu Uyup - Uyup (an Indonesian herbal galactogogue). IOP Conference Series: Earth and Environmental Science, 251, 012022.

Hosseinzadeh, H., Tafaghodi, M., Abedzadeh, S., Taghiabadi, E. 2014. Effect of aqueous and ethanolic extracts of Pimpinella anisum L. seeds on milk production in rats. Journal of Acupuncture and Meridian Studies, 7(4), 211-216.

Jarić, S., Mitrović, M., Pavlović, P. 2015. Review of ethnobotanical, phytochemical, and pharmacological study of Thymus serpyllum L. Evidence-Based Complementary and Alternative Medicine, 1-10.

Javan, R., Javadi, B., & Feyzabadi, Z. (2017). Breastfeeding: A review of its physiology and galactogogue plants in view of traditional Persian medicine. Breastfeeding Medicine, 12(7). https://doi.org/10.1089/bfm.2017.0038

Jiang, X., Lin, S., Lin, Y., Fang, Z., Xu, S., Feng, B., ... Wu, D. 2020. Effects of silymarin supplementation during transition and lactation on reproductive performance, milk composition and haematological parameters in sows. Journal of Animal Physiology and Animal Nutrition, 00:1-8.

Jovanović, A.A., D strok signord strok signević, V.B., Zdunić, G.M., Pljevljakušić, D.S., Šavikin, K.P., God strok signevac, D.M., Bugarski, B.M. 2017. Optimization of the extraction process of polyphenols from Thymus serpyllum L. herb using maceration, heat and ultrasound assisted techniques.

Separation and Purification Technology, 179, 369-380. Kamdem, J. P., Adeniran, A., Boligon, A. A., Klimaczewski, C. V., Elekofehinti, O. O., Hassan, W., Ibrahim, M., Waczuk, E. P., Meinerz, D. F., & Athayde, M. L. (2013). Antioxidant activity, genotoxicity and cytotoxicity evaluation of lemon balm (Melissa officinalis L.) ethanolic extract: Its potential role in neuroprotection. Industrial

Crops and Products, 51, 26-34. https://doi.org/10.1016/jindcrop.2013.08.056 Khorshidian, N., Mahboubi, A., Kalantari, N., Hosseini, H., Yousefi, M., Arab, M., Gomez da Cruz, A., Mortazavian, A., Mahdavi, F. 2019. Chitosan-coated alginate microcapsules loaded with galactagogue herbs extract: formulation optimization and characterization, Iranian

Miraj, S., Rafieian-Kopaei, Kiani, S. 2016. Melissa officinalis L: A Review Study with an Antioxidant Prospective. Journal of Evidence-Based Complementary & Alternative Medicine, 22(3), 385-394.

Mokhtari, L., Ghoreishi, S.M. 2019. Supercritical carbon dioxide extraction of trans-anethole from Foeniculum vulgare (fennel) seeds: Optimization of operating conditions through response surface methodology and genetic algorithm. Journal of CO2 Utilization, 30, 1-10.

Nice, F.J. 2011. Common Herbs and Foods Used as Galactogogues. ICAN: Infant, Child, & Adolescent Nutrition, 3(3), 129-132.

Nikolić, M., Glamočlija, J., Ferreira, I.C.F.R., Calhelha, R.C., Fernandes, Â., Marković, T., Marković, D., Giweli, A., Soković, M. 2014. Chemical composition, antimicrobial, antioxidant and antitumor activity of Thymus serpyllum L., Thymus algeriensis Boiss and Reut and Thymus vulgaris L. essential oils. Industrial Crops and Products, 52, 183-190.

Ouzir, M., El Bairi, K., Amzazi, S. 2016. Toxicological properties of fenugreek (Trigonella foenum graecum). Food and Chemical Toxicology, 96, 145-154.

Özalkaya E, Aslandoǧdu Z, Özkoral A, Topcuoǧlu S, Karatekin G. 2018. Effect of a galactagogue herbal tea on breast milk production and prolactin secretion by mothers of preterm babies. Nigerian Journal of Clinical Practice, 21(1), 38-42.

Pendry, B.A., Kemp, V., Hughes, M.J., Freeman, J., Nuhu, H.K., Sanchez-Medina, A., Corcoran, O., Galante, E. 2017. Silymarin content in Silybum marianum extracts as a biomarker for the quality of commercial tinctures. Journal of Herbal Medicine, 10, 31-36.

Pereira, C., Calhelha, R.C., Barros, L., Ferreira, I.C.F.R. 2013. Antioxidant properties, anti-hepatocellular carcinoma activity and hepatotoxicity of artichoke, milk thistle and borututu. Industrial Crops and Products, 49, 61-65.

Rocha, L., Fernandes, C.P. 2016. Aniseed (Pimpinella anisum Apiaceae) Oils. In Preedy, V.R. (Ed.) Essential Oils in Food Preservation, Flavor and Safety. Academic Press, USA.

Saha, M.R., Ryan, K., Amir, L.H. 2015. Postpartum women's use of medicines and breastfeeding practices: a systematic review. International Breastfeeding Journal, 10:28.

Sajadi, S.M., Nasrollahzadeh, M., Maham, M. 2016. Aqueous extract from seeds of Silybum marianum L. as a green material for preparation of the Cu/Fe3O4 nanoparticles: A magnetically recoverable and reusable catalyst for the reduction of nitroarenes. Journal of Colloid and Interface Science, 469, 93-98.

Sayed-Ahmad, B., Talou, T., Saad, Z., Hijazi, A., Merah, O. 2017. The Apiaceae: Ethnomedicinal family as source for industrial uses. Industrial Crops and Products, 109, 661-671.

Sayed, N.Z., Deo, R., Mukundan, U. 2007. Herbal remedies used by Warlis of Dahanu to induce lactation in nursing mothers, Indian Journal of Traditional Knowledge, 6 (4), 602-605

Shahat, A., Ibrahim, A., Hendawy, S., Omer, E., Hammouda, F., Abdel-Rahman, F., Saleh, M. 2011. Chemical composition, antimicrobial and antioxidant activities of essential oils from organically cultivated fennel cultivars. Molecules, 16(2), 1366-1377.

Shawahna, R., Qiblawi, S., & Ghanayem, H. (2018). Which Benefits and Harms of Using Fenugreek as a Galactogogue Need to Be Discussed during Clinical Consultations? A Delphi Study among Breastfeeding Women, Gynecologists, Pediatricians, Family Physicians, Lactation Consultants, and Pharmacists. Evidence-Based Complementary and Alternative Medicine, 2018. https://doi.org/10.1155/2018/2418673

Sim, T.F., Hattingh, H.L., Sherriff, J., Tee, L.B. 2014. Perspectives and attitudes of breastfeeding women using herbal galactagogues during breastfeeding: a qualitative study. BMC complementary and alternative medicine, 14(1), 1-11.

Sim, T., Hattingh, H.L., Sherriff, J., Tee, L. 2015. The use, perceived effectiveness and safety of herbal galactagogues during breastfeeding: a qualitative study. International Journal of Environmental Research and Public Health, 12(9), 11050-11071.

Tedesco, D., Tava, A., Galletti, S., Tameni, M., Varisco, G., Costa, A., Steidler, S. 2004. Effects of Silymarin, a natural hepatoprotector, in periparturient dairy cows. Journal of Dairy Science, 87(7), 2239-2247.

Wani, S.A., Kumar, P. 2016. Fenugreek: A review on its nutraceutical properties and utilization in various food products. Journal of the Saudi Society of Agricultural Sciences, 17(2), 97-106.

Wang, G.-W., Hu, W.-T., Huang, B.-K., Qin, L.-P., 2011. Illicium verum: A review on its botany, traditional use, chemistry and pharmacology, Journal of Ethnopharmacology, 136, 10-20.

Yaldiz, G., Camlica, M. 2019. Variation in the fruit phytochemical and mineral composition, and phenolic content and antioxidant activity of the fruit extracts of different fennel (Foeniculum vulgare L.) genotypes. Industrial Crops and Products, 142, 111852.

Zecca, E., Zuppa, A.A., D'Antuono, A., Tiberi, E., Giordano, L., Pianini, T., Romagnoli, C. 2016. Efficacy of a galactogogue containing silymarin-phosphatidylserine and galega in mothers of preterm infants: a randomized controlled trial. European Journal of Clinical Nutrition, 70(10), 1151-1154.

Zhao, Y., Wang, P., Zheng, W., Yu, G., Li, Z., She, Y., Lee, M. 2019. Three-stage microwave extraction of cumin (Cuminum cyminum L.) Seed essential oil with natural deep eutectic solvents. Industrial Crops and Products, 140, 111660.

Zheng, T., Yao, D., Chen, W., Hu, H., Ung, C.O.L., Harnett, J.E. 2019. Healthcare providers' role regarding the safe and appropriate use of herbal products by breastfeeding mothers: A systematic literature review, Complementary Therapies in Clinical Practice, 35, 131-147.