I have received calls over 10 years from companies going out of business with these types of formulas in the US. They all agree they don't work. Please read a review of the science. I personally do not believe they work. Weight gain increases breast size.
CURRENT COMMENTARY
“Bust Enhancing” Herbal
Products
Adriane Fugh-Berman, MD
Department of Health Care Sciences, George Washington University School of
Medicine, Washington, DC
“Bust enhancing” herbal products are widely advertised.
No clinical trials have been published. These products
contain a variety of ingredients, including grains, hops, saw
palmetto, dong quai, chaste-tree berry, wild yam, kava,
fennel, black cohosh, and fenugreek. Several of these herbs
are hormonally active; for example, hops contain 8-prenylnaringenin,
a phytoestrogen that is more potent than other
dietary phytoestrogens. Many bust-enhancing dietary supplements
contain substrates for Fusarium, a fungus that
produces zearalenone, a potent estrogen that has been
associated with breast enlargement in humans and other
species. The use of bust-enhancing products should be
discouraged because of lack of evidence for efficacy and
long-term safety concerns. (Obstet Gynecol 2003;101:
1345–9. © 2003 by The American College of Obstetricians
and Gynecologists.)
“Bust enhancing” dietary supplements are widely marketed
to young women. A typical product costs $229 for
an 8-week supply. These products contain variable combinations
of herbs, the most popular being hops (Humulus
lupulus), saw palmetto (Serenoa repens), damiana (Turnera
diffusa), dong quai (Angelica sinensis), chaste-tree berry
(Vitex agnus-castus), blessed thistle (Cnicus benedictus), dandelion
(Taraxacum officinale), wild yam (Dioscorea villosa),
kava (Piper methysticum), fennel (Foeniculum vulgare), black
cohosh (Cimicifuga racemosa), and fenugreek (Trigonella
foenum-graecum). Some products also contain cereal
grains, including barley and oats. Here I review available
evidence on the efficacy and safety of purported bustenhancing
products. The databases MEDLINE (1966–
2002), TOXLINE (1972–2002), and REPROTOX
were searched broadly using the following key words:
“bust enhancers,” “breast enlargement,” “mammoplasia,”
“gynecomastia,” “Fusarium,” “zearalenone,”
“zearalenol,” “8-prenylnaringenin,” and the names of the
individual herbs and grains listed above. Information
from this search was supplemented from the author’s
extensive files.
HUMAN AND ANIMAL STUDIES
No clinical trials on the efficacy of bust-enhancing dietary
supplements have been published or presented to
the scientific community. The popularity of these products
stems from promotion on television, on the Internet,
and in magazines aimed at young women. Testimonials
are heavily used. An episode of the television show
20/20 on bust-enhancing products (aired June 21, 2002)
revealed that filmed testimonials were from paid actors,
and suggested that differences shown in “before and
after” pictures could be accounted for by lower-cut clothing
and pushup bras.
No animal studies have examined the effect of bustenhancing
products or their constituents on mammary
glands. Two estrogenicity assays of these products in
rodents were identified.1,2 One showed no estrogenic
effect on the uterus, whereas the other showed only
small and inconsistent effects. The first study tested
Erdic (Erdic International, London, United Kingdom)
(also sold as “Busting Out”), a product based on grains
and hops.1 The composition of this product has changed
over time. The current ingredients are “hops, buckwheat,
fennel, rye, malt, barley, and L-ornitine [sic]”3; the
package of a product purchased in 1999 states that it
contains “barley, hops (2 sorts), rye, wheat, malt, black
oats, maize.” It is not clear which formulation was tested.
Twenty female Sprague–Dawley rats from four dams
(litters were reduced to ten pups per dam) were randomly
distributed to three groups of six weanlings each.
Controls consumed a soy-free diet (AIN-93), positive
controls consumed the same diet with 160g of estradiol
3-benzoate, and the third group received a 20% powdered
Erdic, 80% AIN-93 diet for 3 days. There were no
differences in uterine weights among the Erdic and control
groups. Mean body weights were similar among
groups.
The second study, in mice, tested an herbal “bust
enhancement” product (not otherwise identified) containing
significant amounts of hops phytoestrogens.2
Fourteen day 18 mice were injected subcutaneously with
0.1 mL of an extract of the supplement or 17-ethinyl
estradiol dissolved in corn oil. Animals were killed on
day 4. Ovariectomized adult mice (seven per group)
received feed containing either 17-ethinyl estradiol or
Address reprint requests to: Adriane Fugh-Berman, MD, 1312
18th Street NW, Washington DC 20036; E-mail: fughberman@
aol.com.
The author acknowledges Ed Kennelly, PhD, and Fredi Kronenberg, PhD, for
high-pressure liquid chromatography analysis.
VOL. 101, NO. 6, JUNE 2003 0029-7844/03/$30.00 1345
© 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier. doi:10.1016/S0029-7844(03)00362-4
the herbal supplement in feed (1:1, 1:9, and 1:99 weight/
weight) for 5 days and were killed on day 6. In the
prepubertal mouse uterotrophic bioassay, the dietary
supplement significantly increased the uterus/body
weight fraction at two of five doses in a non–dose
dependent manner (0.24 and 0.84 g of 8-prenylnaringenin,
but not 0.024, 0.084, or 2.4 g of 8-prenylnaringenin).
In the ovariectomized mouse uterotrophic bioassay,
the dietary supplement significantly reduced the
uterine/body weight fraction in only the lowest of three
doses (at a ratio of 1:99, but not 1:9 or 1:1). Oral dosing
significantly decreased uterine weight in mice only at the
lowest dose tested (13.6 ng of 8-prenylnaringenin/g) and
not in a dose-dependent manner. 17-ethinyl estradiol
significantly increased the uterine/body weight fraction
relative to controls in both bioassays. The researchers
concluded that the supplement has only weak effects on
the uterus even with oral doses containing 542 ng/g of
8-prenylnaringenin, representing a dose 258-fold higher
than expected daily intake of the product.
ESTROGENICITY STUDIES IN INDIVIDUAL HERBS
Hops (Humulus lupulus)
Several herbs used in these formulas have been tested for
estrogenic effects. A common ingredient in bust-enhancing
formulas, hops (Humulus lupulus L.) contain the phytoestrogen
8-prenylnaringenin. Beer is flavored with
hops and may contain 8-prenylnaringenin, but beer has
not been specifically linked to breast enlargement.4 Anecdotally,
female hops pickers have developed menstrual
irregularities5 (8-prenylnaringenin apparently can be absorbed
via the skin). The scientist who isolated 8-prenylnaringenin
from hops credits his interest in the field to
his wife’s development of menstrual irregularities after
working with hops.6
A small, methodologically flawed study found a benefit
of 30 days of treatment with large doses of hops
extract (1600–2600 mg per day, titrating down to 1200–
1600 mg) on hot flashes in 25 women.7 The study was
not randomized, and the control group was apparently
composed of five women who had been accidentally
treated with a low dose of hops (300 mg), which because
it showed no benefit was considered a placebo. In 17 of
20 treated subjects, reduction of hot flash score (intensity
frequency) was significantly better than in controls;
neither statistical test nor significance level was stated.
Some subjects apparently received another herb, hawthorn
(Crataegus sp), as well as hops.
8-prenylnaringenin has 0.2–20% of the potency of
estradiol.3 Other hops phytoestrogens, including 6-prenylnaringenin,
6,8-diprenylnaringen, and 8-geranylnaringenin,
are also estrogenic, but have only 1% of the
potency of 8-prenylnaringenin.8 8-prenylnaringenin
binds equally to and estrogen receptors.9 A study of
8-prenylnaringenin, administered subcutaneously,
found that 30 g/g per day caused uterotrophic effects in
ovariectomized rats.9 8-prenylnaringenin was more potent
than coumestrol, genistein, or daidzein in several
assays, including stimulation of alkaline phosphatase in
Ishikawa Var I cells and competitive displacement from
rat uterine cytosol by [2,4,6,7-3H]17-estradiol).10 In
ovariectomized mice, 100 g of 8-prenylnaringenin/mL
(about 15 mg/kg per day) caused an estrogenic mitotic
response in vaginal but not endometrial epithelium.4
Black Cohosh (Cimicifuga racemosa)
It is unclear whether or not black cohosh, currently a
popular treatment for hot flashes, has an estrogenic
effect. Clinical studies are mixed, but some show a
benefit of black cohosh for treating hot flashes or improving
the vaginal maturation index; it does not appear to
affect prolactin, estradiol, sex hormone–binding globulin,
luteinizing hormone (LH), or follicle-stimulating hormone
(FSH) levels in humans.11 Even if black cohosh is
effective for treating hot flashes, this is not necessarily an
estrogenic effect.
Formerly thought to contain the phytoestrogen formononetin,
black cohosh has not been found to contain
formononetin in recent studies.12 It does contain small
amounts of a recently identified phytoestrogen, fukinolic
acid13 (2E-caffeoylfukiic acid), which has shown estrogenic
activity in a breast cancer cell line and increased
uterine weight in rats.13 It is difficult to extrapolate from
the activity of an isolated constituent to use of the whole
herb, especially when the constituent is present in tiny
quantities. In vivo and in vitro estrogenicity studies of
black cohosh are mixed. Increased uterine weight was
seen in two studies of mice given black cohosh14 (Eagon
CL, Elm MS, Teepe AG, Eagon PK. Medicinal botanicals.
Estrogenicity in rat uterus and liver [abstract]. Proc
Am Assoc Cancer Res 1997;38:293); two other studies
showed no estrogenic effects in mice given oral doses15,16
or rats given injected doses.16 A recent test of black
cohosh in several in vitro assays for estrogenicity
showed no estrogenic activity.17
Dong Quai (Angelica sinensis)
Dong quai, a Chinese herb used in many women’s
health formulas, has been tested for hot flashes in a
randomized, double-blind clinical trial; there was no
effect on hot flashes, vaginal mucosa, or endometrium.18
The herb is not considered estrogenic in traditional
Chinese medicine. There is one report of dong quai–
associated gynecomastia (breast enlargement in males)
in a man in Singapore.19 This appears to be an isolated
1346 Fugh-Berman “Bust Enhancing” Herbal Products OBSTETRICS & GYNECOLOGY
case, and the product was not analyzed; it may have been
adulterated with drugs.
Fennel (Foeniculum vulgare)
Little information is available on fennel seed, used as
both a culinary and a medicinal herb, but one animal
study found an estrogenic effect. In female rats, oral
administration of an acetone extract of fennel seed (dose
not available in abstract) for 10 days caused vaginal
cornification and estrus.20 Moderate doses increased the
weight of mammary glands; higher doses increased the
weight of the oviduct, endometrium, myometrium, cervix,
and vagina.
OTHER HORMONAL EFFECTS
Kava (Piper methysticum)
Kava appears to have dopamine antagonist effects.21
Dopamine antagonists increase prolactin secretion, and
increased prolactin may be associated with mammoplasia
(breast enlargement in women). Selective serotonin
reuptake inhibitors can increase prolactin levels, and an
observational study in 59 women treated with selective
serotonin reuptake inhibitors or venlafaxine for more
than 2 months found that 23 of them (39%) reported
some mammoplasia.22
Saw Palmetto (Serenoa repens)
Saw palmetto, used primarily to treat benign prostatic
hypertrophy, inhibits binding of dihydrotestosterone to
androgen receptors in prostate cells and inhibits binding
of [3H]dihydrotestosterone to its receptor in human
foreskin fibroblasts.23 Saw palmetto also inhibits prolactin24
and has potent 1-adrenoceptor effects in vitro.25
Studies are mixed on whether or not saw palmetto
inhibits 5-reductase.26–28 An antiestrogenic effect was
noted in men with benign prostatic hyperplasia who
received Serenoa repens (160 mg twice a day).29 These
effects would not be expected to enlarge breasts.
Chaste-Tree Berry (Vitex agnus-castus)
Vitex decreases FSH and increases LH, and inhibits
prolactin activity in vitro.30 None of these effects should
be associated with mammoplasia.
Fenugreek (Trigonella foenum-graecum) and Wild
Yam (Dioscorea villosa)
Although roasted fenugreek seeds were reputedly used
by harem women to enhance buxomness,31 there is no
evidence that fenugreek increases breast size. Both
fenugreek and wild yam contain diosgenin, which can be
converted to progesterone in a laboratory, but there is no
evidence that such conversion takes place endogenously.
An article distributed as evidence that diosgenin increases
mammary size does not support the claim. This
experiment, in which 20- or 40-mg/kg diosgenin was
given with or without estrogen to ovariectomized mice,
found no difference in wet or fat-free dry weight of
mammary glands in diosgenin-treated mice.32 Diosgenin
did significantly affect mammary maturation, increasing
terminal end bud differentiation (an effect that takes
place in late pregnancy or under estrogen treatment).
Although the words “growth stimulator” and “mammary
development” are used, in this case maturation is what
is meant.
ADVERSE EFFECTS OF BUST-ENHANCING HERBS
No adverse effects of the most common bust-enhancing
herbal products were apparent on the US Food and
Drug Administration Special Nutritionals Adverse
Event Reporting System (accessed August 2002). Kava
has been associated with numerous cases of hepatotoxicity
and should not be used33; acute dystonic reactions
have been reported as well. Dong quai has been associated
with increased risk of bleeding when combined with
anticoagulants.34 No serious adverse events have been
associated with black cohosh, saw palmetto, fennel,
damiana, blessed thistle (Cnicus benedictus), or dandelion
(Taraxacum officinale).
Most of the ingredients in these products have not
been associated with significant adverse effects. Estrogenic
stimulation of breast or endometrial tissue is of
concern with long-term ingestion of hormonally active
compounds; however, data to date do not support potent
hormonal effects of the labeled ingredients in bust-enhancing
products.
COULD THESE PRODUCTS BE EFFECTIVE?
No clinical trial of a bust-enhancing herbal product has
been published. It is unlikely that any of these products,
if they contain what their labels say that they contain,
would cause breast enlargement. Drugs associated with
gynecomastia or mammoplasia include estrogen, protease
inhibitors, penicillamine, neuroleptics, and antidepressants
(including tricyclics, monoamine oxidase inhibitors,
and serotonin reuptake inhibitors).35 No cases
of gynecomastia or mammoplasia have been reported
for herbs or grains except for a single unreliable case of
gynecomastia associated with dong quai (the product
was not analyzed to exclude steroid adulteration, which
is not uncommon in Asian herbal medicine products).
Some herbs contain estrogenic compounds, but the phenolic
phytoestrogens found in plants would not be expected
to be potent enough to cause mammoplasia. Kava
VOL. 101, NO. 6, JUNE 2003 Fugh-Berman “Bust Enhancing” Herbal Products 1347
has dopamine antagonist qualities and could raise prolactin
levels, but this effect has not been demonstrated
and would be unlikely to be strong.
The labeled ingredients in bust-enhancing products
are unlikely to enlarge breasts. However, some bustenhancing
products contain hops or grains that are excellent
substrates for Fusarium, a mold that commonly
infests cereal grains. Fusarium spp produce zearalenone,
an anabolic, potent resorcyclic acid lactone phytoestrogen.
Fusarium has been identified in corn, wheat, barley,
malt, rye, oats, and beer (which contains hops).36 Sprouting,
or “malting” barley (an excellent substrate for Fusarium)
increases the zearalenone concentration 50-fold.37
Zearalenone from moldy feed affects the reproductive
organs of animals. Male and female pigs given moldy
feed contaminated with Fusarium suffer mammary enlargement
and other symptoms.37 Humans may also be
affected. Fusarium-contaminated grain was linked to “endemic
breast enlargement disease” in China.38 It was
later determined that all samples of buckwheat grown in
the area were infected with mold; 34% were infected
with Fusarium.39 Zearalenone was extracted from the
affected buckwheat.
There is no evidence that bust-enhancing products are
contaminated with Fusarium. However, to my knowledge
only one product has been tested. A high-pressure liquid
chromatography analysis of an Erdic product purchased
in 1999 revealed no zearalenone or -zearalenol (unpublished
data, E. Kennelly, F. Kronenberg, A. Fugh-Berman).
It would be enlightening to analyze the plethora of
available products for the presence of zearalenone or
zearalenol.
CONCLUSION
There is no published evidence for efficacy of bustenhancing
herbal supplements. Products marketed for
“bust enhancement” contain herbs that may have pharmacological
effects. There are no long-term safety data
on any of these herbs, singly or in combination. Some
products contain substrates for Fusarium, a zearalenoneproducing
fungus associated with breast enlargement in
humans and pigs. Physicians should discourage the ingestion
of pharmacologically active substances with unknown
safety risks for the purpose of breast enlargement.
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Received November 26, 2002. Received in revised form December 16,
2002. Accepted January 23, 2003.
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