Is Fennel Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Fennel? Is Fennel safe for nursing mother and child? Does Fennel extracts into breast milk? Does Fennel has any long term or short term side effects on infants? Can Fennel influence milk supply or can Fennel decrease milk supply in lactating mothers?

Fennel (Foeniculum vulgare) seeds contain the volatile oil composed largely of anethole, which is a phytoestrogen, as well as fenchone, estragole, 1,8-cineole (eucalyptol), and other constituents. Fennel is a purported galactogogue and is included in some proprietary mixtures promoted to increase milk supply.[1][2][3][4][5][6][7][8][9][10][11] Two small studies found an increase in some parameters such as milk volume, fat content and infant weight gain with fennel galactogogue therapy. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[12] Immersing the breast in a warm infusion of fennel seeds and marshmallow root has been suggested as a treatment for breast inflammation,[13] but no scientific data are available that support this use. Anethole is excreted in breastmilk.[14] Fennel is generally well tolerated in adults, and fennel oil is "generally recognized as safe" (GRAS) for use in food by the U.S. Food and Drug Administration. It has been safely and effectively used alone and with other herbs in infants for the treatment of colic,[15][16][17] so the smaller amounts in breastmilk are likely not to be harmful with usual maternal doses. Some sources recommend limiting the duration of treatment to 2 weeks. Excessive maternal use of an herbal tea containing fennel, anise and other herbs appeared to cause toxicity in 2 breastfed newborns that was consistent with toxicity caused by anethole, which is found in fennel and anise. Fennel can cause allergic reactions after oral or topical use affecting the respiratory system or skin, including photosensitivity. Diarrhea and hepatomegaly occurred in a woman taking fennel, fenugreek, and goat's rue as galactagogues.[18] Elevated liver enzymes occurred in another woman taking Mother's Milk Tea, which contains fennel.[19] Avoid excessive sunlight or ultraviolet light exposure while using this herbal. Fennel should be avoided by mothers if they or their infants are allergic to carrots, celery, or other plants in the Apiaceae family because of possible cross-allergenicity. Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information #about dietary supplements# is available elsewhere on the LactMed Web site.

Two breastfed infants, aged 15 and 20 days, were admitted to the hospital for a reported lack of weight gain in the previous 7 to 10 days, caused by "difficult feeding". The parents reported restlessness and vomiting during the past day. One of the mothers also reported feeling drowsy and weak. On examination, the infants were afebrile but had hypotonia, lethargy, emesis, weak cry, poor sucking and weak responses to painful stimuli. Infant laboratory values, electrocardiograms and blood pressures were normal, and septic work-ups were negative. Both mothers had both been drinking more than 2 liters daily of an herbal tea mixture reportedly containing licorice, fennel, anise, and goat's rue to stimulate lactation. After the mothers discontinued breastfeeding and the herbal tea, the infants improved within 24 to 36 hours. Symptoms of the affected mother also resolved rapidly after discontinuing the herbal tea. After 2 days, breastfeeding was reinstituted with no further symptoms in the infants. Both infants were doing well at 6 months of age. The authors attributed the maternal and infant symptoms to anethole, which is found in both fennel and anise; however, the anethole levels were not measured in breastmilk, nor were the teas tested for their content.[24] Nursing mothers who were participating in an experiment on the excretion of 1,8-cineole (eucalyptol) in breastmilk took a 100 mg capsule of 1,8-cineole orally. Although instructed not to, 12 mothers breastfed their infants during the experiment. Mothers reported that none of their infants refused their milk or breastfed less than usual. Two mothers felt that their infants were more agitated a few hours after breastfeeding. A third mother reported that the infant stopped nursing from time to time and "looked puzzled", but resumed nursing. Upon repeating the experiment 6 weeks later, the infant did not react in an unusual way during breastfeeding.[20] A small manufacturer-sponsored, double-blind, randomized study compared Mother's Milk tea (Traditional Medicinals, Sebastopol, CA) to lemon verbena tea in exclusively breastfeeding mothers with milk insufficiency. Each Mother's Milk tea bag contained 560 mg of bitter fennel fruit as well as several other herbs. Mothers were instructed to drink 3 to 5 cups of tea daily. No differences were seen between groups in infant digestive, respiratory, dermatological, and other maternal-reported adverse events. No differences were seen in the growth parameters of the breastfed infants between the two groups.[25]

Possible Effects on Lactation: A group of 5 nursing mothers were given no herb for 5 days, 15 mL of a 5 % infusion of fennel seeds 3 times daily for 10 days, followed by another 5-day control period from days 15 to 20. Their diet and environment were kept constant during the study period. Milk volume was measured daily and milk fat percentage was measured on days 5, 10, 15 and 20. Milk volume and fat content increased somewhat during the 10-day treatment period and carried over for 3 to 5 days after discontinuation.[26] Because of the lack of randomization, blinding and controls, and small number of participants, no valid conclusion can be made from this study on the galactogogue effects of fennel. One hundred fifty-eight mothers in Iran of who reported difficulty in breastfeeding were given either a proprietary mixture of herbs (Shirafza Drop) or a chlorophyll solution as a placebo. The herbal mixture contained the purported galactogogues fennel, anise, cumin, black seed, and parsley. Infant ages ranged between 0 and 6 months and they were exclusively breastfed. Weight gain of the infants was measured over time. No difference in infant weight gain was seen between the two groups of infants.[27] Blinding and randomization in this study is unclear. Sixty-six postpartum mothers (22 in each of 3 groups) with no concurrent illnesses were randomly assigned to receive an herbal tea, placebo, or nothing after delivering healthy, fullterm infants. Mothers in the herbal tea group received at least 3 cups daily of 200 mL of Still Tea (Humana-Istanbul, Turkey; containing hibiscus 2.6 grams, fennel extract 200 mg, fennel oil 20 mg, rooibos 200 mg, verbena [vervain] 200 mg, raspberry leaves 200 mg, fenugreek 100 mg, goat's rue 100 mg, and, vitamin C 500 mg per 100 grams, per manufacturer's web site November 2011). A similar-looking apple tea was used as the placebo. All women were followed by the same nurse and pediatrician who were blinded to what treatment the mothers received. Mothers who received the Still Tea produced more breastmilk with an electric breast pump on the third day postpartum than mothers in the other groups. The infants in the Still Tea group had a lower maximum weight loss, and they regained their birth weights sooner than those in the placebo or no treatment arms. No long-term outcome data were collected. Because many of the ingredients in Still Tea are purported galactogogues, including fennel, no single ingredient can be considered solely responsible for the tea's effects, although the authors attributed the action to fengreek[28] An herbal tea containing fennel, fenugreek, hibiscus, rooibos, vervain, raspberry, goat's rue, and vitamin C (Humana Still-Tee, Humana GmbH, Herford, Germany) or water was randomly given to nursing mothers in a dosage of 3 cups daily beginning on the day of delivery. Several markers of antioxidant capacity were measured in breastmilk on day 1 and again after 7 to 10 days. No difference was found in the markers between mothers who received the tea and the water.[29] An uncontrolled, nonrandomized, nonblinded study in Iran enrolled 46 healthy nursing mothers between 18 and 35 years of age. At the start of the study, mothers were all nursing their infants and having no difficulty in doing so. The mothers' serum prolactin was measured in the morning before breakfast at least one hour after the previous nursing bout. Prolactin was measured before and after receiving powdered fennel in a dose of 3 grams daily by mouth for 15 days. The average baseline serum prolactin concentration was 64.6 mcg/L. The serum prolactin concentration after fennel therapy was 95.6 mcg/L. The difference was statistically significant. No measurements of milk production were made.[30] A double-blind study compared the effects of an herbal tea containing 7.5 grams fennel seed powder plus 3 grams of black tea to 3 grams of black tea alone taken three times a day in mothers exclusively nursing their 0- to 4-month old female infants. After 4 weeks, "breastmilk sufficiency" and infant's growth parameters were compared in the two groups. Infants whose mothers received the fennel had greater increases in the frequency of feedings, number of wet diapers, frequency of defecation, weight gain, and a slightly greater increase in head circumference than infants in the control group. No difference was seen in height gain.[31] In a survey of 188 nursing women from 27 states (52% from Louisana), 29 had used fennel as a galactogogue. Of those who used it, 59% were not sure that it increased their milk supply and 6 reported (unspecified) side effects.[32] A randomized trial assigned mothers of preterm infants to receive either a purported herbal galactogogue tea twice daily, a fruit tea twice daily or nothing. The galactogogue tea mixture (Natal, Hipp [Turkey]) contained 1% stinging nettle as well as melissa, caraway, anise, fennel, goat's rue, and lemon grass in unspecified amounts. All mothers received simil