Summary of Use during Lactation

Alfalfa (Medicago sativa) leaves and sprouts contain saponins, estrogenic isoflavonoids (e.g., daidzein, genistein), vitamin K, and the amino acid L-canavanine. Alfalfa is a purported galactogogue and is included in some proprietary mixtures promoted to increase milk supply;[1-5] however, no scientifically valid clinical trials support this use. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[6,7] Daidzein and genistein are excreted into breastmilk in small amounts,[8-11] but have not been measured specifically after alfalfa intake. No data exist on the excretion of other components of alfalfa into breastmilk or on the safety and efficacy of alfalfa in nursing mothers or infants. Alfalfa is generally well tolerated and is "generally recognized as safe" (GRAS) as a food by the U.S. Food and Drug Administration. Worsening of systemic lupus erythematosus has been reported, possibly caused by immune system stimulation by L-canavanine. Because of its vitamin K content, alfalfa should be avoided in persons taking warfarin.

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 prove 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 not 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.

Drug Levels

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.

Eriksson R, Fransson GB, Kylberg E. Jordemodern. 1983;96:133–6. [Lucerne -- can it influence milk production?] [PubMed: 6552257]

2.

Kopec K. Herbal medications and breastfeeding. J Hum Lact. 1999;15:157–61. [PubMed: 10578793]

3.

Allaire AD, Moos MK, Wells SR. Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. Obstet Gynecol. 2000;95:19–23. [PubMed: 10636495]

4.

Scott CR, Jacobson H. A selection of international nutritional and herbal remedies for breastfeeding concerns. Midwifery Today Int Midwife. 2005;75:38–9. [PubMed: 16320878]

5.

Alachkar A, Jaddouh A, Elsheikh MS, et al. Traditional medicine in Syria: Folk medicine in Aleppo governorate. Nat Prod Commun. 2011;6:79–84. [PubMed: 21366051]

6.

Brodribb W. ABM Clinical Protocol #9. Use of galactogogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeed Med. 2018;13:307–14. [PubMed: 29902083]

7.

Breastfeeding challenges: ACOG Committee Opinion, Number 820. Obstet Gynecol. 2021;137:e42–e53. [PubMed: 33481531]

8.

Franke AA, Custer LJ, Tanaka Y. Isoflavones in human breast milk and other biological fluids. Am J Clin Nutr. 1998;68(6) Suppl:1466S–73S. [PubMed: 9848518]

9.

Franke AA, Custer LJ, Wang W, et al. HPLC analysis of isoflavonoids and other phenolic agents from foods and from human fluids. Proc Soc Exp Biol Med. 1998;217:263–73. [PubMed: 9492334]

10.

Choi MH, Kim KR, Hong JK, et al. Determination of non-steroidal estrogens in breast milk, plasma, urine and hair by gas chromatography/mass spectrometry. Rapid Commun Mass Spectrom. 2002;16:2221–8. [PubMed: 12478564]

11.

Min J, Wang Z, Liang C, et al. Detection of phytoestrogen metabolites in breastfed infants' urine and the corresponding breast milk by liquid chromatography-tandem mass spectrometry. J Agric Food Chem. 2020;68:3485–94. [PubMed: 32093471]

Substance Name

Alfalfa

Scientific Name

Medicago sativa

CAS Registry Number

8015-60-9

Drug Class

Breast Feeding

Lactation

Complementary Therapies

Food

Phytotherapy; Plants

Medicinal