Complementary, Holistic, and Integrative Medicine: Advice for Clinicians on Herbs and Breastfeeding

Katarzyna Budzynska; Zoë E. Gardner; Tieraona Low Dog; Paula Gardiner

doi:10.1542/pir.34-8-343

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Katarzyna Budzynska, MD*,^†
Zoë E. Gardner, PhD^‡
Tieraona Low Dog, MD^§
Paula Gardiner, MD, MPH^†

^*Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.
^†Department of Family Medicine, Boston University School of Medicine, Boston, MA.
^‡Medicinal Plant Program, Department of Plant, Soil, and Insect Sciences, University of Massachusetts, Amherst, MA.
^§Arizona Center for Integrative Medicine, University of Arizona Health Sciences, Tucson, AZ.

Author Disclosure
Dr Budzynska has disclosed that she received financial support as the recipient of the Physician Training Award in Preventive Medicine, American Cancer Society, PTAPM 97-185-12. Dr Gardner has disclosed that she is employed by Traditional Medicinals, Sebastopol, CA. Dr Low Dog has disclosed that she is a consultant for Foodstate, Inc., Derry, NH, and Weil Lifestyle, LLC, Phoenix, AZ. Dr Gardiner has disclosed that she received financial support as the recipient of grant K07AT005463 from the National Center for Complementary and Alternative Medicine. This commentary does not contain discussion of unapproved/investigative use of a commercial product/device.

Abbreviations:

DSHEA:: Dietary Supplements Health and Education Act
GMP:: good manufacturing process
GRAS:: generally regarded as safe
SJW:: St John’s wort

Practice Gap

Pediatricians need to be aware that mothers commonly use herbal supplements while breastfeeding, despite the lack of regulatory guidelines and rigorous scientific evaluation. Several resources on the safety and efficacy of herbs during breastfeeding can help guide clinical recommendations.

Definition and Description

In the United States, herbal products are classified as dietary supplements, a regulatory category created with the introduction of the Dietary Supplements Health and Education Act (DSHEA). (1) Under this act, dietary supplements are defined as herbs or other botanicals, vitamins, minerals, enzymes, and certain other natural substances. Under DSHEA, herbal medicines are held to different regulatory standards than prescription medications in testing and marketing. Products sold as a dietary supplement, including herbal products, are not permitted to claim that they can treat, prevent, or cure any disease or condition. Currently in the United States, no existing regulatory guidelines set a standardized risk assessment to determine the safety and efficacy of herbs during breastfeeding. Despite the lack of rigorous scientific evaluation, many women use herbs during breastfeeding.

Breastfeeding

The benefits of breastfeeding are well known and include providing a special opportunity for maternal-infant bonding, provision of optimal nutrition, and transfer of immunologic properties. (2) Among the numerous health and medical organizations that endorse breastfeeding, …