In fairness, the published evidence that's available is scant - the most commonly cited source of effectiveness and safety is an unpublished study, funded by Go-Lacta, whose design makes it unethical to use out of the gate (even if the conclusions were useful, which I'm not sure they are). Go-Lacta also seems to have taken it down from their site (I wanted to link to it here).I've heard a lot of people talking about other studies, but they're not readily available in North America. (from the Philippine Family Medicine journal as well as two unpublished studies). The obscurity makes it hard for anyone to judge whether they personally are comfortable with that evidence (or to provide it to the primary health care providers or client who are really the ones making the final call).

This is a problem with many herbal preparations, but it is more of a problem with this one than say, fenugreek/blessed thistle. 

That it's a common food (and I can vouch from Filipino friends that it is) doesn't mean that it has no risks. We eat tumeric all the time, but it's still used medicinally (and with caution in that form). Frankly, if someone was drying up spinach and selling it for $20 a bottle, I'd have some big questions for them too. Not only about whether a food reformulated as a medicinal actually is as "safe" or effective, but whether it's ethical to recommend undertaking a course of treatment which costs $80+ a month (and up to 9 pills a day) when the soup might be just as effective.

It's simplified somewhat in Canada in that Go-Lacta is not approved for use by Health Canada and thus individuals have to import it themselves from the US - so really the applicability is limited unless clients are willing to import it themselves (knowing that Health Canada discourages the practice).

I do suspect that there's something to this because there are a number of people using it regularly whose opinions I respect - and I don't think they'd be using something that doesn't work in their clinical practice. But still, it's not something I am personally comfortable recommending in pregnancy at all or a first-line during breastfeeding. 

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