Alfalfa (Medicago sativa L.)
 
Alfalfa (Medicago sativa L.)
Background
Alfalfa has a long history of dietary and medicinal use. A small number of animal and preliminary human studies report that alfalfa supplements may lower blood levels of cholesterol and glucose. However, most research has not been well designed. Therefore, there is not enough reliable evidence to form clear conclusions in these areas.
Alfalfa supplements taken by mouth appear to be generally well tolerated. However, ingestion of alfalfa tablets has been associated with reports of a lupus-like syndrome or lupus flares. These reactions may be due to the amino acid L-canavanine which appears to be present in alfalfa seeds and sprouts, but not in the leaves. There are also rare cases of pancytopenia (low blood counts), dermatitis (skin inflammation), and gastrointestinal upset.
Synonyms
Al-fac-facah, arc, buffalo herb, California clover, Chilean clover, Fabaceae , feuille de luzerne, isoflavone, jatt, kaba yonca, Leguminosae , lucerne, medicago, mielga, mu su, purple medic, phytoestrogen, purple medick, purple medicle, sai pi li ka, saranac, Spanish clover, team, weevelchek, yonja.
Evidence
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidenceGrade*High cholesterol
Reductions in blood levels of total cholesterol and low-density lipoprotein ("bad cholesterol") have been reported in animal studies and in a small number of human cases. High-density lipoprotein ("good cholesterol") has not been altered in these cases. Although this evidence is promising, better research is needed before a firm conclusion can be reached.
C
Atherosclerosis (cholesterol plaques in heart arteries)
Several studies in animals report reductions in cholesterol plaques of the arteries after use of alfalfa. Well-designed research in humans is necessary before a conclusion can be drawn.
C
Diabetes
A small number of rat studies report reductions in blood sugar levels following ingestion of alfalfa. Human data are limited, and it remains unclear if alfalfa can aid in the control of sugars in patients with diabetes or hyperglycemia.
C
* Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Allergies, appetite stimulant, asthma, bladder disorders, blood clotting disorders, boils, cough, convalescence, diuresis (increasing urination), estrogen replacement, gastrointestinal tract disorders, gum healing after dental procedures, hay fever, increasing breast milk, indigestion, inflammation, insect bites, jaundice, kidney disorders, menopausal symptoms, nutritional support, prostate disorders, rheumatoid arthritis, scurvy, skin damage from radiation, stomach ulcers, thrombocytopenic purpura, uterine stimulant, vitamin supplementation (vitamins A,C,E,K).
Dosing
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Standardization
There are no standard or well-studied doses of alfalfa, and many different doses are used traditionally. Safety of use beyond 8 weeks has not been proven in studies.
Adults (18 years and older)
Dried herb : 5 to 10 grams of dried herb taken by mouth three times daily has been used.
Tablets : Two tablets (one gram each) of Cholestaid® (esterin processed alfalfa) taken by mouth three times daily for up to two months, then one tablet three times daily, has been recommended by the manufacturer.
Liquid extract : 5 to 10 milliliters (one to two teaspoonfuls) of a 1:1 solution in 25% alcohol taken by mouth three times daily has been used.
Seeds : For treating high cholesterol, 40 grams of heated seeds prepared three times daily and taken by mouth with food has been used.
Children (younger than 18 years)
There is not enough scientific data to recommend alfalfa supplements for use in children, and it is not recommended due to potential side effects.
Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
Alfalfa should be avoided in people with allergies to members of the Fabaceae or Leguminous plant families. It remains unclear if alfalfa cross-reacts with grass, and caution is warranted in individuals with grass allergies.
Side Effects and Warnings
Alfalfa appears to be well tolerated by most individuals, although rare serious adverse effects have been reported.
Mild gastrointestinal symptoms may occur, such as stomach discomfort, diarrhea, gas, or larger/more frequent stools. Dermatitis (skin inflammation/redness) has been reported, and may be due to alfalfa allergy.
Blood sugar levels may be reduced, based on animal studies and a human case report. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.
Lupus-like effects have been associated with alfalfa use, including antinuclear antibodies in the blood, muscle pains, fatigue, abnormal immune system function, and kidney abnormalities. Therefore, people with a history of lupus (systemic lupus erythematosus), or family history of lupus should avoid alfalfa supplements.
Other rarely reported adverse effects include abnormal blood cell counts (pancytopenia) and lowered potassium levels (hypokalemia). In theory, thyroid hormone levels may be increased, gout flares may be stimulated, and estrogen-like effects may occur.
Contamination of alfalfa products with potentially dangerous bacteria (including Escherichia coli 0157:H7, Salmonella , and Listeria monocytogenes ) has been reported.
Many tinctures/liquid extracts contain high levels of alcohol, and should be avoided when driving or operating heavy machinery.
Pregnancy and Breastfeeding
Alfalfa supplements are not recommended during pregnancy and breastfeeding due to insufficient evidence and a theoretical risk of birth defects or spontaneous abortion. Amounts found in food are generally believed to be safe. Traditionally, alfalfa is believed to stimulate breast milk production, although this has not been well studied.
Tinctures/liquid extracts may contain high levels of alcohol, and should be avoided during pregnancy.
References
1. Alcocer-Varela J, Iglesias A, Llorente L, et al. Effects of L-canavanine on T cells may explain the induction of systemic lupus erythematosus by alfalfa. Arthritis Rheum 1985;28(1):52-57.
2. Anon. From the Centers for Disease Control and Prevention. Outbreaks of Escherichia coli O157:H7 infection associated with eating alfalfa sprouts-Michigan and Virginia, June-July 1997. JAMA 1997;278 (10) :809-810.
3. Backer HD, Mohle-Boetani JC, Werner SB, et al. High incidence of extra-intestinal infections in a Salmonella Havana outbreak associated with alfalfa sprouts. Public Health Rep 2000;115(4):339-345.
4. Bengtsson AA, Rylander L, Hagmar L, Nived O, Sturfelt G. Risk factors for developing systemic lupus erythematosus: a case-control study in southern Sweden.Rheumatology (Oxford). 2002 May;41(5):563-71.
5. Boue SM, Wiese TE, Nehls S, Burow ME, Elliott S, Carter-Wientjes CH, Shih BY, McLachlan JA, Cleveland TE. Evaluation of the estrogenic effects of legume extracts containing phytoestrogens. J Agric Food Chem. 2003 Apr 9;51(8):2193-9.
6. Dong Y, Iniguez AL, Ahmer BM, Triplett EW. Kinetics and strain specificity of rhizosphere and endophytic colonization by enteric bacteria on seedlings of Medicago sativa and Medicago truncatula. Appl Environ Microbiol. 2003 Mar;69(3):1783-90.
7. Elakovich SD, Hampton JM. Analysis of coumestrol, a phytoestrogen, in alfalfa tablets sold for human consumption. J Agric Food Chem 1984;32(1):173-175.
8. Farber JM, Carter AO, Varughese PV, et al. Listeriosis traced to the consumption of alfalfa tablets and soft cheese. N Engl J Med 1990;322(5):338.
9. Farnsworth NR. Alfalfa pills and autoimmune diseases. Am J Clin Nutr 1995;62(5):1026-1028.
10. Gill CJ, Keene WE, Mohle-Boetani JC, Farrar JA, Waller PL, Hahn CG, Cieslak PR. Alfalfa seed decontamination in a Salmonella outbreak. Emerg Infect Dis. 2003 Apr;9(4):474-9.
11. Howard MB, Hutcheson SW. Growth dynamics of Salmonella enterica strains on alfalfa sprouts and in waste seed irrigation water. Appl Environ Microbiol. 2003 Jan;69(1):548-53.
12. Hwang J, Hodis HN, Sevanian A. Soy and alfalfa phytoestrogen extracts become potent low-density lipoprotein antioxidants in the presence of acerola cherry extract. J Agric Food Chem 2001;49(1):308-314.
13. Jackson IM. Abundance of immunoreactive thyrotropin-releasing hormone-like material in the alfalfa plant. Endocrinology 1981;108(1):344-346.
14. Kaufman W. Alfalfa seed dermatitis. JAMA 1954;155(12):1058-1059.
15. Liao CH, Fett WF. Isolation of Salmonella from alfalfa seed and demonstration of impaired growth of heat-injured cells in seed homogenates. Int J Food Microbiol. 2003 May 15;82(3):245-53.
16. Mahon BE, Ponka A, Hall WN, et al. An international outbreak of Salmonella infections caused by alfalfa sprouts grown from contaminated seeds. J Infect Dis 1997;175(4):876-882.
17. Malinow MR, Bardana EJ, Jr., Goodnight SH, Jr. Pancytopenia during ingestion of alfalfa seeds. Lancet 1981;1(8220 Pt 1):615.
18. Malinow MR, Bardana EJ, Jr., Pirofsky B, et al. Systemic lupus erythematosus-like syndrome in monkeys fed alfalfa sprouts: role of a nonprotein amino acid. Science 1982;216(4544):415-417.
19. Malinow MR, McLaughlin P, Naito HK, et al. Effect of alfalfa meal on shrinkage (regression) of atherosclerotic plaques during cholesterol feeding in monkeys. Atherosclerosis 1978;30(1):27-43.
20. Malinow MR, McLaughlin P, Naito HK, et al. Regression of atherosclerosis during cholesterol feeding in . Am J Cardiol 1978;41:396.
21. Malinow MR, McLaughlin P, Stafford C. Alfalfa seeds: effects on cholesterol metabolism. Experientia 1980;36(5):562-564.
22. Mohle-Boetani J, Werner B, Polumbo M, et al. From the Centers for Disease Control and Prevention. Alfalfa sprouts-Arizona, California, Colorado, and New Mexico, February-April, 2001. JAMA 2002;287(5):581-582.
23. Molgaard J, von Schenck H, Olsson AG. Alfalfa seeds lower low density lipoprotein cholesterol and apolipoprotein B concentrations in patients with type II hyperlipoproteinemia. Atherosclerosis 1987;65(1-2):173-179.
24. Morimoto I, Shiozawa S, Tanaka Y, et al. L-canavanine acts on suppressor-inducer T cells to regulate antibody synthesis: lymphocytes of systemic lupus erythematosus patients are specifically unresponsive to L-canavanine. Clin Immunol Immunopathol 1990;55(1):97-108.
25. Ponka A, Andersson Y, Siitonen A, et al. Salmonella in alfalfa sprouts. Lancet 1995;345:462-463.
26. Prete PE. The mechanism of action of L-canavanine in inducing autoimmune phenomena. Arthritis Rheum 1985;28(10):1198-1200.
27. Roberts JL, Hayashi JA. Exacerbation of SLE associated with alfalfa ingestion. N Engl J Med 1983;308(22):1361.
28. Srinivasan SR, Patton D, Radhakrishnamurthy B, et al. Lipid changes in atherosclerotic aortas of Macaca fascicularis after various regression regimens. Atherosclerosis 1980;37(4):591-601.
29. Story JA, LePage SL, Petro MS, et al. Interactions of alfalfa plant and sprout saponins with cholesterol in vitro and in cholesterol-fed rats. Am J Clin Nutr 1984;39(6):917-929.
30. Swanston-Flatt SK, Day C, Bailey CJ, et al. Traditional plant treatments for diabetes. Studies in normal and streptozotocin diabetic mice. Diabetologia 1990;33(8):462-464.
31. Taormina PJ, Beuchat LR, Slutsker L. Infections associated with eating seed sprouts: an international concern. Emerg Infect Dis 1999;5(5):626-634.
32. Van Beneden CA, Keene WE, Strang RA, et al. Multinational outbreak of Salmonella enterica serotype Newport infections due to contaminated alfalfa sprouts. JAMA 1999;281(2):158-162.
33. Winthrop KL, Palumbo MS, Farrar JA, Mohle-Boetani JC, Abbott S, Beatty ME, Inami G, Werner SB. Alfalfa sprouts and Salmonella Kottbus infection: a multistate outbreak following inadequate seed disinfection with heat and chlorine. J Food Prot. 2003 Jan;66(1):13-7.
January 01, 2004 
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