Overload

Lactation failure

Category: Illness or disabilities

Type

Involuntary

Introduction and description

 

Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young.

The process can occur with almost all post-pregnancy female mammals, so it is as valid to look for any solutions to problems both inside and outside the human domain – and this we have done.

Lactation failure or deficiency, also known as agalactia or agalactorrhea, as well as hypogalactia or hypogalactorrhea, is a medical condition in which lactation is insufficient or fails completely due to an inadequacy of breast milk production and/or a failure of the milk let-down reflex in response to suckling following childbirth, resulting in an inability to properly breastfeed.

Background

 

Galactopoiesis is the term used to describe the maintenance of milk production.

This stage requires a number of naturally produced endogenous hormones.  These include prolactin, progesterone, oxytocin and estrogen. 

First we need to look at what can happen to inhibit lactation.  Once we know this we can determine the causes of these problems:

From the twenty-fourth week of pregnancy (the second and third trimesters), a woman's body produces hormones that stimulate the growth of the milk duct system in the breasts:

  • Progesterone influences the growth in size of alveoli and lobes; high levels of progesterone inhibit lactation before birth. Progesterone levels should drop after birth; triggering the onset of milk production.  If they don’t then no milk.  So one cause is Progesterone imbalance
  • Estrogen stimulates the milk duct system to grow and differentiate. Like progesterone, high levels of estrogen also inhibit lactation. Estrogen levels should also drop at delivery and remain low for the first several months of breastfeeding.  If they don’t then no milk.  So the second cause is estrogen imbalance
  • Prolactin contributes to the increased growth and differentiation of the alveoli, and also influences differentiation of ductal structures. It is prolactin that is raised to regulate and stimulate milk production.  So the third cause is prolactin imbalance

Furthermore anything that disrupts the cycle involving these three hormones,  changes to the Follicle stimulating hormone (FSH), luteinizing hormone (LH), and so on can also exert an effect.

 

After birth, oxytocin contracts the smooth muscle layer of band-like cells surrounding the alveoli to squeeze the newly produced milk into the duct system. Oxytocin is necessary for the milk ejection reflex, or let-down, in response to suckling, to occur.

So the actual intermediate causes are Prolactin imbalance, Estrogen imbalance, Progesterone imbalance and to a lesser extent Oxytocin imbalance.

 But, there will be an ultimate cause for these problems. 

Causes

All the same types of cause we see in all illnesses and disease can be implicated in lactation failure.  The actual pathogen may differ, but the types are constant - toxins, parasites, bacterial infection, radiation, fungal infection, viruses, heavy metals, nutritional deprivation, pharmaceuticals, surgery and psychological trauma.  

Toxins

 

The cause may be a toxin such as the endocrine disruptors found in food and household products.  Heavy metals can disrupt the endocrine system just as they can the other systems of the body.

Parasites

Parasites like the one we often get from cats [and dogs], such as tapeworms,can both enter the uterus and disrupt hormones and also cause disruption and failure to other organs

Viruses, or bacterial infection

A number of herpes viruses are implicated in disrupting the endocrine system, but bacterial infections can also cause problems.

Female sex hormones are known to regulate the adaptive and innate immune functions of the female reproductive tract. This review aims to update our current knowledge of the effects of the sex hormones estradiol and progesterone in the female reproductive tract on innate immunity, antigen presentation, specific immune responses, antibody secretion, and genital tract infections caused by Chlamydia trachomatis, .....PMID: 23860476

Nutritional deficiency

 

The deficency may relate to not enough minerals vitamins or amino acids. In some cases it can be too much - overdose.  It can be disruption from phytochemicals, where the person is not eating a sensible or balanced diet, but is relying on a fad diet full of soy milk, muesli and flax seeds!

It may be overdosing on Vitamins in the rather deluded belief that more is somehow better, when actually more is not better, more is poison and what we should be aiming for is balance through food.  The following comes from the eHealthme site.

On Sep, 06, 2017  57,632 people reported to have side effects when taking Vitamins.  Among them, 31 people (0.05%) have Suppressed lactation.

Pharmaceuticals

Another very prevalent cause is drugs and pharmaceuticals, legal and illegal.

If we use the eHealthme site, which collects the Adverse Drug Reports from doctors submitted to the FDA and SEDA, then the drugs that can cause Lactation disordersinclude a high proportion of anti-psychotics - Abilify, Zyprexa, Olanzapine and Paliperidone/Invega, for example.  Anti-depressants such as Seroquel have also been implicated.

Another antipsychotic implicated  is Amoxapine - brand names include: Asendin, Asendis, Defanyl, Demolox. It is a tetracyclic antidepressant, according to Wikipedia "Its use in breastfeeding mothers is not recommended as it is excreted in breast milk and the concentration found in breast milk is approximately a quarter that of the maternal serum level".  Unfortunately when someone is already on these medications, they very often cannot be taken off and amoxapine - apart from its effects on breast milk, can affect lactation.  The body here may simply be protecting the baby.

Rather inevitably contraceptives of various sorts are also implicated, as their sole purpose is to disrupt hormonal cycles.   At least one Intrauterine device (IUD) with progestogen has been implicated in lactation failure.  The eHealthme site has another entry [rather confusingly] for Suppressed lactation.  This list includes oral contraceptives, patches, as well as uterine devices.  For example the contraceptive patch Ortho Evra has this entry

"On Sep, 29, 2015: 26,824 people reported to have side effects when taking Ortho evra. Among them, 37 people (0.14%) have Suppressed Lactation."

Mirena, which is an IUD has this entry:  "On Sep, 23, 2015: 62,635 people reported to have side effects when taking Mirena. Among them, 113 people (0.18%) have Suppressed Lactation."

and Micronor, which is a Progesterone only pill has this entry:

"On Sep, 25, 2015: 686 people reported to have side effects when taking Micronor. Among them, 17 people (2.48%) have Suppressed Lactation."

All this points to the fact that the taking or using of contraceptives in women, runs the risk that the woman has not returned to a normal balance of hormones before pregnancy occurs and this imbalance carries on throughout pregnancy and into lactation.  This imbalance may of course affect the baby as well, as its hormones may also be put into imbalance by the mother's imbalance.  We feel this area has been poorly researched given the number and increase of congenital sexual problems in  children, for example

Congenital and acquired undescended testes are two distinct entities. Current management is surgery in the first 6-12 months of life for congenital undescended testes. ...Accurate diagnoses and expedient management are imperative in this condition to minimize the long-term sequelae of infertility and testicular cancer.  PMID: 18959703

For more details see Estrogen imbalance.  For more general information on Estrogen itself and its role in the reproductive system see Estrogen.

Extreme emotion

Last but by no means list in the list of causes for lactation failure is that of extreme negative emotion, fear, loneliness, stress, grief, rejection, all can have a negative impact.  Rather than give examples here, we have provided an observation by Dr Daniel Hack Tuke, listing a number of examples where lactation failure was induced by high negative emotion.

 Treatment

 

The treatment offered by doctors are the Lactation failure drugs called "galactogogues".  These are symptom based drugs.

But the answer is to try to find the cause and address the cause using the list above. 

As this is something of an urgent problem, because you do not know until you have lactation failure that it is there, then the kind way to help you and the baby is to eat foods that help raise prolactin.

It may also help to temporarily reduce the number of phytoestrogens that serve to raise estrogen levels - the so called estrogenics or raise progesterone levels. 

There appears to be a link between prolactin and the amino acid phenylalanine.  The research here is very sketchy, but it does exist:

Phenylalanine stimulates PRL secretion when given orally or iv to normal individuals. To differentiate between hypothalamic and pituitary sites of action, we examined the effects of concurrent infusion of valine on the PRL response to iv phenylalanine in eight normal men. Since large neutral amino acids share the same high affinity blood-brain barrier transport system, entry of phenylalanine into the brain will be diminished by the simultaneous presence of high serum concentrations of valine; the pituitary, lying outside the blood-brain barrier, is not subject to these competitive effects. Valine significantly blunted the PRL response to phenylalanine, supporting an effect of phenylalanine within the blood-brain barrier to stimulate PRL release. PMID: 2307734

Remember that the research here was on men not women and was unrelated to lactation. 

We have, however, included an observation that shows, according to Dr Duke's phytochemical database, which plants are a souce of phenylalanine.  We are not recommending you take phenylalanine in drug form, but it may help to redajust your diet to include more foods that contain this amino acid.  And here is a list derived from the USDA Nutrients database.

Description

Phenylalanine (g)
Value Per

 

Soy protein

4.59

 

Seeds, sesame

2.66

 

Seeds, safflower

1.77

 

Seeds, pumpkin and squash seed kernels, sunflower seeds

various

 

Cheese [all sorts of mostly hard cheese, but also mozzarella, camembert, cheddar, blue ]

various

 

Milk and buttermilk,

1.66

 

Nuts, butternuts, peanuts, almonds, mixed

various

 

Game meat

1.43

 

Fish roe

1.40

 

Beef

various

 

Pork

1.30

 

Veal

1.27

 

Lamb

various

 

Spices, mustard seed

1.17

 

Beans, black, pink, adzuki

various

 

Fish, yellowtail, mixed species, tuna, skipjack, salmon, trout, bluefish

various

 

Chicken

1.16

 

Turkey

1.13

Crustaceans, spiny lobster

1.11

Crustaceans, crab, queen

1.00

References and further reading

J Pharm Pharm Sci. 2010;13(2):162-74.  Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production.  Zuppa AA1, Sindico P, Orchi C, Carducci C, Cardiello V, Romagnoli C.  1Department of Pediatrics, Division of Neonatology, Catholic University of the Sacred Heart, Rome, Italy. zuppaaa@rm.unicatt.it

JAMA. 1979 Oct 26;242(17):1900-1.  Galactorrhea and hyperprolactinemia associated with amoxapine therapy. Report of a case.  Gelenberg AJ, Cooper DS, Doller JC, Maloof F.  PMID:  573343

J Clin Endocrinol Metab. 1990 Mar;70(3):814-6.  Evidence for an intracerebral action of phenylalanine in stimulation of prolactin secretion: interaction of large neutral amino acids.  Carlson HE1, Hyman DB, Blitzer MG.  1Northport Veterans Administration Medical Center, New York 11768.

Related observations