Like an estimated two-thirds of new mothers, I had a tough time breastfeeding. My child was born a month early and refused to latch, so I spent the first few months of his life essentially milking myself for 20 hours a day, holding a pair of wheezing plastic cones over my nipples while my husband and I watched Oz on HBO Go.

My lactation consultant told me to keep going at the pump while simultaneously trying to get my son to latch. Once he did, she said, my milk supply would go up, as a baby is naturally much more efficient at drawing out milk from a breast than a pump is. But my son continued to refuse to nurse, and after every pumping session, I’d look at the few tiny drops of milk in the bottles and be quietly swept away by despair.

I was shattered by this, to say the least. Before giving birth, I had been taught — by doctors, mom blogs, relatives, and blissful celebrity mom Instagrams — that breast was best, and that giving my child formula was tantamount to force-feeding him cigarettes and McFlurries. But not only had I failed to breastfeed my son directly, I had also failed to produce enough milk for him. So I became obsessed with increasing my milk supply, to the point that I would literally fantasize about becoming a bountiful milk machine, my breasts spraying milk in slender arcs like an Austin Powers fembot assassinating her victims.

Gradually, the amount of milk I produced per pumping session became a litmus test of my self-worth, officially replacing my weight or my age or my cup size as a quantification of my value as a woman. I was constantly Googling “ways to increase your breast milk supply” and various permutations thereof. And this is how I stumbled on galactagogues, and the many, many ways they’re sold to new mothers.

The party line from lactation consultants, pediatricians, and other breastfeeding advocates is that most new mothers are naturally equipped to produce sufficient milk for babies, and that external factors, such as a baby’s poor latch or tongue tie or a mother failing to nurse often enough, are to blame for low milk supply. Yet there is a large industry of products intended to help you increase your supply — and that industry is only growing.

What are galactagogues, and how do they ostensibly work?

Galactagogues can be broadly defined as “foods, drinks, herbs, supplements, or medications that are said to increase milk supply,” explains Tipper Gallagher, a Minneapolis/St. Paul-based certified lactation consultant who also blogs at the breastfeeding support website the Boob Geek.

Galactagogues have a wide range of origins, some of which are reportedly ancient remedies mothers have used for centuries to increase milk supply. Blessed thistle, for instance, is a plant that was originally native to the Mediterranean and was used by monks in the Middle Ages to relieve digestion; its leaves are now sometimes recommended to nursing mothers in tea or capsule form. The leaves of moringa, an antioxidant-rich plant found in the tropics, also come in capsule or tea form to boost production. Fenugreek is perhaps the best-known production stimulator; the seed is often used in Indian cooking and to flavor maple syrup. (In fact, one of the most common myths associated with fenugreek is that you know it’s working if your pee smells like maple syrup.)

There are also certain foods and beverages that are rumored to have the unintended effect of boosting milk supply. Gatorade, for instance, is often cited as a lactation booster, though opinions on mom forums vary as to which flavor is more effective — some are in the blue camp, while others are squarely in the orange. (“While we’ve heard this theory before, there isn’t any scientific research to suggest drinking Gatorade helps new mothers increase their milk supply,” a spokesperson for Gatorade told Vox.) Dark beer and oatmeal are purported to boost supply; it’s also rumored that Pink Drink, a “secret menu” item at Starbucks that contains coconut milk and strawberry acai, makes you lactate like gangbusters.

Who’s buying galactagogues?

For new moms, it’s easy to see how galactagogues may be appealing. In light of increasing evidence that breastfeeding is correlated with a number of health benefits in babies, including reduced risk of obesity, asthma, allergies, and respiratory and ear infections, the World Health Organization (WHO) and other health organizations recommend that mothers exclusively breastfeed for a minimum of six months.

Although breastfeeding is still a highly fraught topic in parenting circles, in the United States, “breast is best” messaging has largely prevailed (at least, in middle- to upper-middle-class circles): 83.2 percent of mothers in the United States now breastfeed immediately after their children are born, according to 2018 data from the Centers for Disease Control and Prevention. Yet exclusive breastfeeding rates tend to drop off within the first six months of a baby’s life, due to the wide range of struggles a mom may encounter, from tongue ties to difficulty latching to, yes, low milk supply.

As a result, the breastfeeding accessory market has exploded. Though it still pales in comparison to the $70 billion formula industry, as of 2016, the nursing accessories market, which comprises everything from pumps to nipple balms to nursing pillows to supplements, was worth an estimated $1.4 billion. Brands like Milkmakers make lactation cookies intended to boost milk supply, which cost more than $20 per bag at Target.

One major player is Milky Mama, a lactation supplement and breastfeeding support company. Its founder Krystal Duhaney, a former registered nurse who also runs a brick-and-mortar shop in Rancho Cucamonga, California, was inspired to launch her business after struggling to nurse her first child. “You see pictures of moms breastfeeding and they’re smiling and laughing,” she told me. “To feel like I wasn’t able to do that, I felt like a failure.”

After she had her second child, Duhaney wanted to ensure that nursing wouldn’t be as difficult this time around. She started researching traditional galactagogues and came up with a recipe for lactation cookies, selling them to her local moms’ Facebook group. As a former registered nurse, “I saw what issues [postpartum women] were having” with nursing, she says. “Then I researched foods that have been used all over the world or in other cultures and used those time-tested remedies to help develop our products.”

In 2016, Duhaney opened her store, and later started selling lactation brownies ($12 for a dozen), lemonade ($32 for 7 days’ worth), lattes (also $32 for a week’s worth), and herbal supplements ($25 each). She says she is now on track to make $5.6 million in sales by the end of 2018.

While her products don’t come with any specific guarantees, there are a number of glowing customer reviews of the brownies, cookies, and supplements, all from formerly anxious mothers thrilled to see a supply boost. “I went from pumping an ounce and a half total after feeding to 6oz total,” one woman writes, adding, “I have my confidence back that I can continue breastfeeding when I start working again.” The implication is clear: By buying lactation supplements, you too can become the lactation goddess of your dreams — and, by extension, the ideal mother.

Are galactagogues effective?

The short answer: We don’t know.

Generally speaking, there is a paucity of research that herbal breastfeeding supplements actually work. Studies on galactagogues “have really small sample sizes, [and] they’re not well controlled,” says Gallagher. Breast milk volume is also tough to measure to begin with: While lactation consultants usually weigh a baby before and after a feeding to determine approximately how much milk they’re getting, unless a mother exclusively pumps (as opposed to directly breastfeeding their child), it’s hard to gauge exactly how much milk her breasts are producing.

“The main thing is there is not enough rigorous research” on galactagogues, says Alessandra Bazzano, an associate professor at Tulane University School of Public Health. In 2016, Bazzano published a review of 18 studies assessing the efficacy of five herbal galactagogues that are commonly searched on Google and recommended by lactation consultants, including fenugreek, garlic, and shatavari, which is commonly used in ayurvedic medicine. She found that the results on herbal galactagogues were mixed. “We have some evidence they could be effective for some women [in increasing milk production], but we need appropriately designed trials to know for sure,” she said.

Nonetheless, many lactation consultants (aside from Gallagher) will frequently promote herbal galactagogues in their own practices, recommending specific products to clients or even giving clients samples. In fact, according to Kimberly Schram, vice president of marketing and communications at Upspring, which sells capsules, cookies, and a berry drink mix to increase supply, the company partners with the International Lactation Consultant Association (ILCA), appearing at trade shows and supplying lactation consultants with samples.

In addition to herbal supplements, there are two pharmaceutical medications intended to increase milk supply: domperidone and metoclopramide, otherwise known as reglan, which Bazzano also assessed in her review. Both were developed to treat gastric issues but have the effect of boosting milk supply.

The debate over low milk supply

Although breastfeeding issues are far from uncommon, it’s not exactly clear how prevalent an issue low milk supply specifically is. Most lactation consultants and pediatricians will say that low milk supply is fairly uncommon: Though estimates vary, one study suggests that only about 15 percent of women have supply issues for a legitimate medical reason, such as a lack of sufficient glandular tissue. “In my practice, I might run across one person a month who has [these issues],” says Gallagher. She says it’s far more common for women to attribute breastfeeding issues to low milk supply, when in fact they may be struggling with mechanical issues like poor latch.

If a mom is concerned that she has low milk supply, most doctors and lactation consultants will tell her to breastfeed or pump more often. “The most effective way to increase milk supply is to make sure that milk is being extracted from the breast every two to three hours either by breastfeeding or pumping,” says Dr. Smita Malhotra, a Los Angeles-based pediatrician, explaining that milk production is based on “supply and demand.”

But there’s some debate over whether every mom can have sufficient milk supply, provided she empties her breasts often enough. Bazzano, for instance, suggests that low milk supply may be more common than lactation consultants and pediatricians often suggest. “There’s a lot of different things going on in terms of letdown and milk production,” she says, suggesting that maternal obesity, maternal stress, and delayed age of childbirth could contribute to mothers experiencing challenges with milk production.

Contrary to what most lactation consultants and pediatricians say, physiological barriers to breastfeeding may also be more common than we think, she says. “I work with lactation consultants, and I love them, but they have a vested interest in promoting counseling and support,” she says. “By and large, they are not physicians or herbal experts. ... I think their training is the idea that there are so few women who have a physiological barrier to breastfeeding. Most issues, they say, are mechanical. And that’s simply not true.”

The problem with current breastfeeding research

Of course, this debate (and myriad other debates over breastfeeding) could easily be solved if we better understood the mechanism behind increasing milk supply, not to mention lactation in general. But Bazzano says there’s not enough research on breastfeeding as a whole: “There’s a lot we don’t understand yet.”

Considering that mothers have been breastfeeding their babies for millennia, this may seem ridiculous. But the truth is that historically, breastfeeding — and maternal health in general — has not been considered a subject deemed worthy of study by the largely white male medical establishment, says Gallagher. “Women are not a real priority, especially in terms of maternal care and even more so in lactation,” she says. While we know that breastfeeding is beneficial to both mothers and babies, and we know what many of these specific benefits are, the research largely stops there.

“[There’s this] idea that there are so few women who have a physiological barrier to breastfeeding ... and that’s simply not true”

Schram, the manager of marketing and communications at Upspring, freely admits that there isn’t much peer-reviewed, substantive research to back up the effectiveness of galactagogues, though she says that Upspring has conducted internal clinical trials and is in talks with researchers to conduct official clinical trials. She says part of the reason there have been so few clinical external trials on galactagogues has to do with the fact that researchers need to establish “proper protocols” to control for various factors in a laboratory setting.

“There’s so many things that can cause a supply change and an increase or decrease with mom,” she says. “It can depend on how tired the baby is, the latch, the position of the baby. It’s hard to have women breastfeeding at the same time, [with] the same babies. ... It is such an individual experience that I think has a lot to do with [the lack of research on breastfeeding supplements]. Every baby and every mother is different.”

Do galactagogues have any negative side effects?

Most herbal galactagogues — like Upspring’s MilkFlow capsules and Milky Mama’s supplements — do not require approval from the Food and Drug Administration. “There’s no regulation. There’s no oversight,” Bazzano says. “But that goes for all vitamins and all supplements.”

Many of the ingredients associated with these supplements do not have well-documented, serious side effects. Gallagher says that for the most part, the breastfeeding supplements she’s seen on the market are harmless; at best, she says, a mother will see a marginal boost in her supply, and at worst, they “won’t do much of anything.”

That said, there have been reports of fenugreek producing side effects like lower blood sugar or gastrointestinal issues in mothers and babies. Further, some of these supplements do not disclose these potential side effects on their labels; the label for the blessed thistle and fenugreek supplement produced by the breastfeeding supplement company (and Khloe Kardashian-approved brand) Mommy Knows Best, for instance, includes no such warnings about fenugreek.

As for pharmaceutical medications, Bazzano found that while there was some evidence that domperidone could be effective at boosting milk supply, both domperidone and reglan have some pretty nasty side effects. Domperidone has been linked to long QT syndrome, a potentially fatal heart condition, which is why it is currently illegal in the United States; reglan has been linked to tardive dyskinesia (abnormal muscle movements) and even suicidal thoughts.

How galactagogues are marketed

Given the lack of research on galactagogues, it’s probably safe to view them with a slightly skeptical eye (and you certainly shouldn’t take herbal supplements of any kind without consulting a physician first). But to be fair, many of the people I spoke with for this article aren’t making any wildly exaggerated claims to the contrary, even if they are directly profiting from selling such supplements.

Duhaney, for instance, freely admits that supplements have their limits. As a trained lactation consultant, she believes that increasing supply ultimately comes down to good breastfeeding practice, i.e., regularly emptying the breasts every few hours and establishing a good latch with your baby. “There are tons of supplements that can help boost your supply, but nothing will help if mom isn’t emptying her breast properly,” she says.

“You think, ‘Breastfeeding is natural, every mammal does it, it won’t be a big deal’”

Nonetheless, imagery of overflowing Medela bottles and milk-splotched T-shirts dominates all the marketing surrounding lactation supplements, some of which is targeted specifically to mothers who are nursing or have just given birth. (For instance, Christa Knight, the digital marketing manager for Mommy Knows Best, says the company does targeted advertising for keywords and search terms like “lactation supplements” and“breastfeeding support.”)

When you’re a bleary-eyed new mom trying desperately to nourish a squalling little creature on demand, all this anecdotal evidence is pretty convincing. Peer-reviewed journals and scientific studies edited and authored by avuncular old white men are probably the last thing on your mind; you want to know what worked for other moms, and you want to do it fast.

And therein lies the seductive appeal of breastfeeding supplement brands: More than well-meaning relatives and friends and lactation consultants who can’t help but contribute to the disquieting sense that you’ve failed as a mother, the lactation supplement companies seem to be the only ones that know the truth about breastfeeding, at least as I experienced it. They know it’s not as easy as other people make it seem. They know about your omnipresent feelings of inadequacy, the one-sided, expletive-filled conversations you have with your pump at 2 am when you just can’t quite manage to eke out another drop. And they know that sometimes, you need a little push in the right direction.

“You’ve just delivered; your emotions are all over the place,” Schram said, summarizing new mothers’ nursing struggles. “You think, ‘Breastfeeding is natural, every mammal does it, it won’t be a big deal.’ It’s not until you actually have a baby that [it becomes clear] some moms do it easily and some moms don’t.”

On the advice of my lactation consultant, I did end up trying fenugreek and “mother’s milk tea,” a product that contains fenugreek and blessed thistle. I also tried eating oatmeal and drinking tons of Gatorade and Guinness, the latter of which was delicious but largely unhelpful. I did find that eating regularly and staying hydrated helped a little bit, as did alternating pumping with manual expression (a fancy term for “squeezing your boob and milking yourself like a cow”), but for the most part, my supply stayed relatively consistent. It wasn’t until I started desperately Googling around for a black-market domperidone supplier that I realized that nothing, not even exclusive breastfeeding, was worth risking my health to that degree. (The fact that I was basically netting two hours of sleep per night didn’t help matters.)

So I made peace with the fact that I would have to supplement with formula, cut down on my pumping sessions, and gave my son what little breast milk I could. Nearly two years later, I’m still haunted by the thought that maybe I should’ve tried harder; maybe I should’ve pumped more. Hell, maybe I should’ve tried Pink Drink (though honestly, strawberry acai sounds disgusting). But a different part of me also knows that there was no magic pill or herb or tea I could take that would solve the main problem: not feeling like I could never make enough for my son, but feeling like I could never be enough for him.

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Correction: A previous version of this post misspelled Bazzano’s name and misstated the year her article was published.