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'''Saw palmetto extract''' is an extract of the fruit of ''[[Serenoa repens]]''. It is rich in [[fatty acid]]s and [[phytosterol]]s. It has been used in [[Traditional medicine|traditional]], [[Eclectic medicine|eclectic]], and [[alternative medicine]] for a variety of indications, most notably [[benign prostatic hyperplasia]] (BPH). Its efficacy for this indication is in dispute.
'''Saw palmetto extract''' is an extract of the fruit of ''[[Serenoa repens]]''. It is rich in [[fatty acid]]s and [[phytosterol]]s. It has been used in [[Traditional medicine|traditional]], [[Eclectic medicine|eclectic]], and [[alternative medicine]] for a variety of indications, most notably [[benign prostatic hyperplasia]] (BPH). Review of clinical trials including those conducted by the [[National Center for Complementary and Alternative Medicine]] have found that the extract is no more effective than placebo for the treatment of BPH.<ref name=Cochrane>{{cite journal | pmid = 19370565 | year = 2009 | last1 = Tacklind | first1 = J | last2 = MacDonald | first2 = R | last3 = Rutks | first3 = I | last4 = Wilt | first4 = TJ | title = Serenoa repens for benign prostatic hyperplasia | issue = 2 | pages = CD001423 | doi = 10.1002/14651858.CD001423.pub2 | pmc = 3090655 | journal = Cochrane database of systematic reviews (Online) | editor1-last = Tacklind | editor1-first = James}}</ref>


== Traditional medicine ==
== Traditional medicine ==
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<blockquote>It is also an expectorant, and controls irritation of mucous tissues. It has proved useful in irritative cough, chronic bronchial coughs, whooping-cough, laryngitis, acute and chronic, acute [[catarrh]], asthma, tubercular laryngitis, and in the cough of [[Tuberculosis|phthisis pulmonalis]]. Upon the digestive organs it acts kindly, improving the appetite, digestion, and assimilation. However, its most pronounced effects appear to be those exerted upon the urino-genital tracts of both male and female, and upon all the organs concerned in reproduction. It is said to enlarge wasted organs, as the breasts, ovaries, and testicles, while the paradoxical claim is also made that it reduces hypertrophy of the prostate. Possibly this may be explained by claiming that it tends toward the production of a normal condition, reducing parts when unhealthily enlarged, and increasing them when atrophied.<ref>[http://www.henriettesherbal.com/eclectic/kings/serenoa.html King's American Dispensatory 1898]</ref></blockquote>
<blockquote>It is also an expectorant, and controls irritation of mucous tissues. It has proved useful in irritative cough, chronic bronchial coughs, whooping-cough, laryngitis, acute and chronic, acute [[catarrh]], asthma, tubercular laryngitis, and in the cough of [[Tuberculosis|phthisis pulmonalis]]. Upon the digestive organs it acts kindly, improving the appetite, digestion, and assimilation. However, its most pronounced effects appear to be those exerted upon the urino-genital tracts of both male and female, and upon all the organs concerned in reproduction. It is said to enlarge wasted organs, as the breasts, ovaries, and testicles, while the paradoxical claim is also made that it reduces hypertrophy of the prostate. Possibly this may be explained by claiming that it tends toward the production of a normal condition, reducing parts when unhealthily enlarged, and increasing them when atrophied.<ref>[http://www.henriettesherbal.com/eclectic/kings/serenoa.html King's American Dispensatory 1898]</ref></blockquote>


== Alternative medicine ==
== Benign Prostatic Hyperplasia ==
Saw palmetto extract is the a popular herbal preparation taken for [[benign prostatic hyperplasia]],<ref name="pmid14663456">{{cite journal |author=Markowitz JS, Donovan JL, Devane CL, ''et al.'' |title=Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers |journal=Clin. Pharmacol. Ther. |volume=74 |issue=6 |pages=536–42 |year=2003 |month=December |pmid=14663456 |doi=10.1016/j.clpt.2003.08.010 |url=}}</ref> a common condition in older men.
Saw palmetto extract is the most popular herbal preparation taken for [[benign prostatic hyperplasia]],<ref name="pmid14663456">{{cite journal |author=Markowitz JS, Donovan JL, Devane CL, ''et al.'' |title=Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers |journal=Clin. Pharmacol. Ther. |volume=74 |issue=6 |pages=536–42 |year=2003 |month=December |pmid=14663456 |doi=10.1016/j.clpt.2003.08.010 |url=}}</ref> a common condition in older men. Early research indicated that the extract is well-tolerated and suggested "mild to moderate improvement in urinary symptoms and flow measures".<ref name="pmid14663456"/><ref name="pmid12137626">{{cite journal |author=Wilt T, Ishani A, Mac Donald R |title=Serenoa repens for benign prostatic hyperplasia |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001423 |year=2002 |pmid=12137626 |doi=10.1002/14651858.CD001423 |url= |editor1-last=Tacklind |editor1-first=James}}</ref> Later trials of higher methodological quality indicated no difference from placebo.<ref name="pmid16467543">{{cite journal |author=Bent S, Kane C, Shinohara K, ''et al.'' |title=Saw palmetto for benign prostatic hyperplasia |journal=N. Engl. J. Med. |volume=354 |issue=6 |pages=557–66 |year=2006 |month=February |pmid=16467543 |doi=10.1056/NEJMoa053085 |url=}}</ref><ref name="pmid18423748">{{cite journal |author=Dedhia RC, McVary KT |title=Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia |journal=J. Urol. |volume=179 |issue=6 |pages=2119–25 |year=2008 |month=June |pmid=18423748 |doi=10.1016/j.juro.2008.01.094 |url=}}</ref> Questions of adequate [[Blinding (medicine)|blinding]] and delivery of any active ingredients remain.<ref name="NPR">{{cite audio | people = Allison Aubrey | date = 9 Feb 2006 | title = Morning Edition: Study Casts Doubt on Saw Palmetto as Prostate Remedy | url = http://www.npr.org/templates/story/story.php?storyId=5198053 | medium = Audio recording | publisher = National Public Radio }}</ref>


⚫
Inhibition of both forms of [[5-alpha-reductase]] with no reduction in cellular capacity to secrete prostate-specific antigen is indicated.<ref name=pmid17342743>{{cite journal |author=Wadsworth TL, Worstell TR, Greenberg NM, Roselli CE |title=Effects of dietary saw palmetto on the prostate of transgenic adenocarcinoma of the mouse prostate model (TRAMP) |journal=The Prostate |volume=67 |issue=6 |pages=661–73 |year=2007 |month=May |pmid=17342743 |doi=10.1002/pros.20552}}</ref><ref>{{cite journal |author=Scaglione F, Lucini V, Pannacci M, Caronno A, Leone C |title=Comparison of the potency of different brands of ''Serenoa repens'' extract on 5alpha-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells |journal=Pharmacology |volume=82 |issue=4 |pages=270–5 |year=2008 |pmid=18849646 |doi=10.1159/000161128}}</ref><ref>{{cite journal |author=Abe M, Ito Y, Oyunzul L, Oki-Fujino T, Yamada S |title=Pharmacologically relevant receptor binding characteristics and 5alpha-reductase inhibitory activity of free Fatty acids contained in saw palmetto extract |journal=Biological & Pharmaceutical Bulletin |volume=32 |issue=4 |pages=646–50 |year=2009 |month=April |pmid=19336899 |url=http://joi.jlc.jst.go.jp/JST.JSTAGE/bpb/32.646?from=PubMed |doi=10.1248/bpb.32.646 |format=}} {{dead link|date=July 2009}}</ref><ref>{{cite journal |author=Habib FK, Ross M, Ho CK, Lyons V, Chapman K |title=Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression |journal=International Journal of Cancer |volume=114 |issue=2 |pages=190–4 |year=2005 |month=March |pmid=15543614 |doi=10.1002/ijc.20701}}</ref>
Numerous clinical trials, some small but some involving over 1,000 men, initially indicated that the extract is well-tolerated and suggested "mild to moderate improvement in urinary symptoms and flow measures".<ref name="pmid14663456"/><ref name="pmid12137626">{{cite journal |author=Wilt T, Ishani A, Mac Donald R |title=Serenoa repens for benign prostatic hyperplasia |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001423 |year=2002 |pmid=12137626 |doi=10.1002/14651858.CD001423 |url= |editor1-last=Tacklind |editor1-first=James}}</ref> Later trials of higher methodological quality indicated no difference from placebo.<ref name="pmid16467543">{{cite journal |author=Bent S, Kane C, Shinohara K, ''et al.'' |title=Saw palmetto for benign prostatic hyperplasia |journal=N. Engl. J. Med. |volume=354 |issue=6 |pages=557–66 |year=2006 |month=February |pmid=16467543 |doi=10.1056/NEJMoa053085 |url=}}</ref><ref name="pmid18423748">{{cite journal |author=Dedhia RC, McVary KT |title=Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia |journal=J. Urol. |volume=179 |issue=6 |pages=2119–25 |year=2008 |month=June |pmid=18423748 |doi=10.1016/j.juro.2008.01.094 |url=}}</ref> Questions of adequate [[Blinding (medicine)|blinding]] and delivery of any active ingredients remain.<ref name="NPR">{{cite audio | people = Allison Aubrey | date = 9 Feb 2006 | title = Morning Edition: Study Casts Doubt on Saw Palmetto as Prostate Remedy | url = http://www.npr.org/templates/story/story.php?storyId=5198053 | medium = Audio recording | publisher = National Public Radio }}</ref> Saw palmetto extract was of comparable efficacy to the two most commonly-used drugs for BPH, [[tamsulosin]] and [[finasteride]], in this same meta-analysis, a confusing result that complicates analysis of the many trials on this extract.


⚫
Other proposals for mechanisms of action include interfering with [[dihydrotestosterone]] binding to the androgen receptor, relaxing smooth muscle tissue similarly to alpha antagonist drugs, and acting as a [[phytoestrogen]].<ref name="Prostate">{{cite journal |author=Di Silverio F, Monti S, Sciarra A, ''et al.'' |title=Effects of long-term treatment with Serenoa repens (Permixon) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia |journal=The Prostate |volume=37 |issue=2 |pages=77–83 |year=1998 |month=October |pmid=9759701 |doi=10.1002/(SICI)1097-0045(19981001)37:2<77::AID-PROS3>3.0.CO;2-I}}</ref><ref name="Drugs">{{cite journal |author=Plosker GL, Brogden RN |title=Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia |journal=Drugs & Aging |volume=9 |issue=5 |pages=379–95 |year=1996 |month=November |pmid=8922564 |doi=10.2165/00002512-199609050-00008}}</ref>
Longer-term (2 years; most controlled clinical trials have been 1 yr) uncontrolled studies suggest that saw palmetto reduces the risk of men with BPH ultimately needing to have surgery by as much as 50%.<ref>{{cite journal |author=Djavan B, Fong YK, Chaudry A, et al. |title=Progression delay in men with mild symptoms of bladder outlet obstruction: a comparative study of phytotherapy and watchful waiting |journal=World J Urol |year=2005 |volume=23 |pages=253-6 |pmid= 16175413 }}</ref> Longer-term controlled trials of saw palmetto comparing it to available drugs and placebo would be necessary to determine if these results are accurate.


⚫
Limited ''in vitro'' and animal model studies suggest possible anti-tumor activity and potential for use in the treatment of [[cancer]].<ref name=pmid17342743/><ref name="pmid19059205">{{cite journal |author=Scholtysek C, Krukiewicz AA, Alonso JL, Sharma KP, Sharma PC, Goldmann WH |title=Characterizing components of the Saw Palmetto Berry Extract (SPBE) on prostate cancer cell growth and traction |journal=Biochemical and Biophysical Research Communications |volume=379 |issue=3 |pages=795–8 |year=2009 |month=February |pmid=19059205 |doi=10.1016/j.bbrc.2008.11.114}}</ref><ref name="pmid16093232">{{cite journal |author=Anderson ML |title=A preliminary investigation of the enzymatic inhibition of 5alpha-reduction and growth of prostatic carcinoma cell line LNCap-FGC by natural astaxanthin and Saw Palmetto lipid extract in vitro |journal=Journal of Herbal Pharmacotherapy |volume=5 |issue=1 |pages=17–26 |year=2005 |pmid=16093232 |doi=10.1300/J157v05n01_03}}</ref> These results have not been substantiated with [[Clinical trial|human trials]].
== Alopecia ==
⚫
Saw palmetto extract has been suggested as a potential treatment for [[male pattern baldness]].<ref name=MedlinePlus>{{cite news | first= | last= | coauthors= |authorlink= | title=Saw Palmetto | date=2008-02-01 | publisher=[[National Library of Medicine]] | url =http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-sawpalmetto.html | work =[[MedlinePlus]] | pages = | accessdate = 2009-03-16 | language = }}</ref> At least one clinical trial confirmed it is effective for this purpose.<ref>{{cite journal |author=Prager N, Bickett K, French N,Marcovici G |title=A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-a-reductase in the treatment of androgenetic alopecia |journal=J Altern Complement Ther |year=2002 |volume=8 |pages=148-52 |pmid= 12006122 }}</ref>


⚫
Saw palmetto extract has been suggested as a potential treatment for [[male pattern baldness]].<ref name=MedlinePlus>{{cite news | first= | last= | coauthors= |authorlink= | title=Saw Palmetto | date=2008-02-01 | publisher=[[National Library of Medicine]] | url =http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-sawpalmetto.html | work =[[MedlinePlus]] | pages = | accessdate = 2009-03-16 | language = }}</ref>
== Molecular Mechanisms of Action ==
⚫
Saw palmetto inhibits both forms of [[5-alpha-reductase]] with no reduction in cellular capacity to secrete [[prostate-specific antigen]] (PSA).<ref name=pmid17342743>{{cite journal |author=Wadsworth TL, Worstell TR, Greenberg NM, Roselli CE |title=Effects of dietary saw palmetto on the prostate of transgenic adenocarcinoma of the mouse prostate model (TRAMP) |journal=The Prostate |volume=67 |issue=6 |pages=661–73 |year=2007 |month=May |pmid=17342743 |doi=10.1002/pros.20552}}</ref><ref>{{cite journal |author=Scaglione F, Lucini V, Pannacci M, Caronno A, Leone C |title=Comparison of the potency of different brands of ''Serenoa repens'' extract on 5alpha-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells |journal=Pharmacology |volume=82 |issue=4 |pages=270–5 |year=2008 |pmid=18849646 |doi=10.1159/000161128}}</ref><ref>{{cite journal |author=Abe M, Ito Y, Oyunzul L, Oki-Fujino T, Yamada S |title=Pharmacologically relevant receptor binding characteristics and 5alpha-reductase inhibitory activity of free Fatty acids contained in saw palmetto extract |journal=Biol Pharm Bulletin |volume=32 |issue=4 |pages=646–50 |year=2009 |month=April |pmid=19336899}}</ref><ref>{{cite journal |author=Habib FK, Ross M, Ho CK, Lyons V, Chapman K |title=Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression |journal=International Journal of Cancer |volume=114 |issue=2 |pages=190–4 |year=2005 |month=March |pmid=15543614 |doi=10.1002/ijc.20701}}</ref> Clinical trials have repeatedly shown that men who take saw palmetto extract for BPH do not have artificially lowered levels of total PSA.<ref>{{cite journal |author=Carraro JC, Raynaud JP, Koch G, et al. |title=Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostatic hyperplasia: A randomized international study of 1,098 patients |journal=Prostate |year=1996 |volume=20 |pages=231-40 |pmid= 8876706 }}</ref><ref>{{cite journal |author=Gerber GS, Fitzpatrick JM |title=The role of a lipido-sterolic extract of Serenoa repens in the management of lower urinary tract symptoms associated with benign prostatic hyperplasia |journal=BJU Int |year=2004 |volume=94 |pages=338-44 |pmid= 15291864 }}</ref><ref>{{cite journal |author=Willetts KE, Clements MS, Champion S, Ehsman S |title=Serenoa repens extract for benign prostatic hyperplasia: A randomized controlled trial |journal=BJU Int |year=2003 |volume=92 |pages=267-70 |pmid= 12887481 }}</ref>


The latest Cochrane Database review (2009) concludes that "Serenoa repens was not more effective than placebo for treatment of urinary symptoms consistent with BPH".<ref name=Cochrane/>
⚫
Other proposals for mechanisms of action include interfering with [[dihydrotestosterone]] binding to the androgen receptor, relaxing prostatic, urinary bladder, and urethral smooth muscle tissue by blocking alpha-1 adrenergic receptors, and acting as a [[phytoestrogen]].<ref name="Prostate">{{cite journal |author=Di Silverio F, Monti S, Sciarra A, ''et al.'' |title=Effects of long-term treatment with Serenoa repens (Permixon) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia |journal=The Prostate |volume=37 |issue=2 |pages=77–83 |year=1998 |month=October |pmid=9759701 |doi=10.1002/(SICI)1097-0045(19981001)37:2<77::AID-PROS3>3.0.CO;2-I}}</ref><ref name="Drugs">{{cite journal |author=Plosker GL, Brogden RN |title=Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia |journal=Drugs & Aging |volume=9 |issue=5 |pages=379–95 |year=1996 |month=November |pmid=8922564 |doi=10.2165/00002512-199609050-00008}}</ref>

⚫
Limited ''in vitro'' and animal model studies suggest possible anti-tumor activity and potential for use in the treatment of [[cancer]].<ref name=pmid17342743/><ref name="pmid19059205">{{cite journal |author=Scholtysek C, Krukiewicz AA, Alonso JL, Sharma KP, Sharma PC, Goldmann WH |title=Characterizing components of the Saw Palmetto Berry Extract (SPBE) on prostate cancer cell growth and traction |journal=Biochemical and Biophysical Research Communications |volume=379 |issue=3 |pages=795–8 |year=2009 |month=February |pmid=19059205 |doi=10.1016/j.bbrc.2008.11.114}}</ref><ref name="pmid16093232">{{cite journal |author=Anderson ML |title=A preliminary investigation of the enzymatic inhibition of 5alpha-reduction and growth of prostatic carcinoma cell line LNCap-FGC by natural astaxanthin and Saw Palmetto lipid extract in vitro |journal=Journal of Herbal Pharmacotherapy |volume=5 |issue=1 |pages=17–26 |year=2005 |pmid=16093232 |doi=10.1300/J157v05n01_03}}</ref> These results have not been substantiated with [[Clinical trial|human trials]].


A 2001 study published in JAMA (The [[Journal of the American Medical Association]]) found that saw palmetto fruit extract failed to reduce urinary tract symptoms more than placebo. The double-blind study was conducted at eleven North American clinics and included 369 men.<ref name="JAMA">{{cite web|url= http://jama.ama-assn.org/content/306/12/1344.abstract?sid=a4fc4f87-b392-4bb6-99eb-9e36b49e371d | title= Effect of Increasing Doses of Saw Palmetto Extract on Lower Urinary Tract Symptoms| publisher=[[Journal of the American Medical Association]]| accessdate=2011-10-08}}</ref> Men in the experimental group experienced a 2.20 point drop in their American Urological Assn. Symptom Index (AUASI) score. However, men in the placebo group saw a 2.99 point drop. The [[Los Angeles Times]] reports, “42.6% of the men in the extract group saw their AUASI scores fall by at least three points; 44.2% of the men in the placebo group saw the same degree of benefit.” The study was funded by several offices within the [[NIH]], including the [[National Center for Complementary and Alternative Medicine]].”<ref name="Los Angeles Times">{{cite web|url=http://articles.latimes.com/2011/sep/27/news/la-heb-enlarged-prostate-saw-palmetto-20110927| title= Saw palmetto extract likely won't relieve enlarged prostate symptoms| publisher=[[Los Angeles Times]]|date=27 September 2011| accessdate=2011-10-08}}</ref>
A 2001 study published in JAMA (The [[Journal of the American Medical Association]]) found that saw palmetto fruit extract failed to reduce urinary tract symptoms more than placebo. The double-blind study was conducted at eleven North American clinics and included 369 men.<ref name="JAMA">{{cite web|url= http://jama.ama-assn.org/content/306/12/1344.abstract?sid=a4fc4f87-b392-4bb6-99eb-9e36b49e371d | title= Effect of Increasing Doses of Saw Palmetto Extract on Lower Urinary Tract Symptoms| publisher=[[Journal of the American Medical Association]]| accessdate=2011-10-08}}</ref> Men in the experimental group experienced a 2.20 point drop in their American Urological Assn. Symptom Index (AUASI) score. However, men in the placebo group saw a 2.99 point drop. The [[Los Angeles Times]] reports, “42.6% of the men in the extract group saw their AUASI scores fall by at least three points; 44.2% of the men in the placebo group saw the same degree of benefit.” The study was funded by several offices within the [[NIH]], including the [[National Center for Complementary and Alternative Medicine]].”<ref name="Los Angeles Times">{{cite web|url=http://articles.latimes.com/2011/sep/27/news/la-heb-enlarged-prostate-saw-palmetto-20110927| title= Saw palmetto extract likely won't relieve enlarged prostate symptoms| publisher=[[Los Angeles Times]]|date=27 September 2011| accessdate=2011-10-08}}</ref>


== Contraindications and Adverse Effects ==
== Contraindications and side effects ==
Few side effects or allergic reactions are associated with saw palmetto extract use. The most common side effects are gastrointestinal, some of which may be reduced by taking the extract with food. Use may increase the risk of bleeding or affect sex hormones, and concurrent use of other drugs with similar action should be avoided.<ref name=MedlinePlus /> In clinical trials, these problems have not been reported to occur more often than in people taking placebo.<ref>{{cite journal |author=Avins AL, Bent S, Staccone S, et al. |title=A detailed safety assessment of a saw palmetto extract |journal=Complement Ther Med |year=2008 |volume=16 |pages=147-54 |pmid= 18534327 }}</ref>
Few side effects or allergic reactions are associated with saw palmetto extract use. The most common side effects are gastrointestinal, some of which may be reduced by taking the extract with food. Use may increase the risk of bleeding or affect sex hormones, and concurrent use of other drugs with similar action should be avoided.<ref name=MedlinePlus />

Saw palmetto extract did not affect [[cytochrome P450]] enzymes in healthy humans, indicating there is a low risk of pharmacokinetic interactions between it and drugs.<ref name="pmid14663456">{{cite journal |author=Markowitz JS, Donovan JL, Devane CL, ''et al.'' |title=Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers |journal=Clin. Pharmacol. Ther. |volume=74 |issue=6 |pages=536–42 |year=2003 |month=December |pmid=14663456 |doi=10.1016/j.clpt.2003.08.010 |url=}}</ref>


Beta-[[sitosterol]], one chemical present in saw palmetto extract, is chemically similar to cholesterol. High levels of sitosterol concentrations in blood have been correlated with increased severity of heart disease in men who have previously suffered from heart attacks.<ref name="Nutr">{{cite journal |author=Assmann G, Cullen P, Erbey J, Ramey DR, Kannenberg F, Schulte H |title=Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study |journal=Nutrition, Metabolism, and Cardiovascular Diseases : NMCD |volume=16 |issue=1 |pages=13–21 |year=2006 |month=January |pmid=16399487 |doi=10.1016/j.numecd.2005.04.001}}</ref> Saw palmetto extract itself has never been shown to increase heart disease severity.
Beta-[[sitosterol]], one chemical present in saw palmetto extract, is chemically similar to cholesterol. High levels of sitosterol concentrations in blood have been correlated with increased severity of heart disease in men who have previously suffered from heart attacks.<ref name="Nutr">{{cite journal |author=Assmann G, Cullen P, Erbey J, Ramey DR, Kannenberg F, Schulte H |title=Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study |journal=Nutrition, Metabolism, and Cardiovascular Diseases : NMCD |volume=16 |issue=1 |pages=13–21 |year=2006 |month=January |pmid=16399487 |doi=10.1016/j.numecd.2005.04.001}}</ref>


As with other herbal preparations, precise chemical constituents may vary by manufacturer and batch.
As with other herbal preparations, precise chemical constituents may vary by manufacturer and batch.


Contraindications include pregnancy and lactation due to lack of information.
Contraindications include pregnancy, lactation due to antiandrogenic and estrogenic activity.


==References==
==References==
Line 47: Line 41:


==External links==
==External links==
*[http://http://nccam.nih.gov/health/palmetto/]-National Center for Complementary and Alternative Medicine
*[http://www.berkeleywellness.com/html/ds/dsSawPalmetto.php Guide to Supplements-Saw Palmetto]-Berkeley Wellness Letter
*[http://www.berkeleywellness.com/html/ds/dsSawPalmetto.php Guide to Supplements-Saw Palmetto]-Berkeley Wellness Letter
*[http://www.aafp.org/afp/20030315/1281.html Saw Palmetto for Prostate Disorders]-American Academy of Family Physicians
*[http://www.aafp.org/afp/20030315/1281.html Saw Palmetto for Prostate Disorders]-American Academy of Family Physicians

Revision as of 23:34, 3 February 2012

Saw palmetto extract is an extract of the fruit of Serenoa repens. It is rich in fatty acids and phytosterols. It has been used in traditional, eclectic, and alternative medicine for a variety of indications, most notably benign prostatic hyperplasia (BPH). Review of clinical trials including those conducted by the National Center for Complementary and Alternative Medicine have found that the extract is no more effective than placebo for the treatment of BPH.[1]

Traditional medicine

Saw palmetto is used in several forms of traditional medicine. Native Americans used the fruit for food and in the treatment of a variety of urinary and reproductive system problems.[2] The Mayans drank it as a tonic, and the Seminoles used the berries as an expectorant and antiseptic.[2]

A book by Susan Hales (1898) describes the saw palmetto fruit as a staple food item for the Seminole Indians. The aboriginal American medicine man also kept a medicine bag of saw palmetto around to treat illness and to nourish the body.[citation needed] Other historical uses have included the treatment of infertility in women, treatment of underdeveloped breasts, increased lactation, painful menstruation cycles, reduce prostate, appetite stimulant, and as a tonic.[citation needed]

Eclectic medicine

The crude extract was used for at least 200 years for various conditions including asthenia (weakness), recovery from major illness, and urogenital problems. For instance, the eclectic medicine practitioner H. W. Felter wrote of it, "Saw palmetto is a nerve sedative, expectorant, and a nutritive tonic, acting kindly upon the digestive tract...Its most direct action appears to be upon the reproductive organs when undergoing waste of tissue..."[3]

King's American Dispensatory (1898) describes the extract as:

It is also an expectorant, and controls irritation of mucous tissues. It has proved useful in irritative cough, chronic bronchial coughs, whooping-cough, laryngitis, acute and chronic, acute catarrh, asthma, tubercular laryngitis, and in the cough of phthisis pulmonalis. Upon the digestive organs it acts kindly, improving the appetite, digestion, and assimilation. However, its most pronounced effects appear to be those exerted upon the urino-genital tracts of both male and female, and upon all the organs concerned in reproduction. It is said to enlarge wasted organs, as the breasts, ovaries, and testicles, while the paradoxical claim is also made that it reduces hypertrophy of the prostate. Possibly this may be explained by claiming that it tends toward the production of a normal condition, reducing parts when unhealthily enlarged, and increasing them when atrophied.[4]

Alternative medicine

Saw palmetto extract is the most popular herbal preparation taken for benign prostatic hyperplasia,[5] a common condition in older men. Early research indicated that the extract is well-tolerated and suggested "mild to moderate improvement in urinary symptoms and flow measures".[5][6] Later trials of higher methodological quality indicated no difference from placebo.[7][8] Questions of adequate blinding and delivery of any active ingredients remain.[9]

Inhibition of both forms of 5-alpha-reductase with no reduction in cellular capacity to secrete prostate-specific antigen is indicated.[10][11][12][13]

Other proposals for mechanisms of action include interfering with dihydrotestosterone binding to the androgen receptor, relaxing smooth muscle tissue similarly to alpha antagonist drugs, and acting as a phytoestrogen.[14][15]

Limited in vitro and animal model studies suggest possible anti-tumor activity and potential for use in the treatment of cancer.[10][16][17] These results have not been substantiated with human trials.

Saw palmetto extract has been suggested as a potential treatment for male pattern baldness.[18]

The latest Cochrane Database review (2009) concludes that "Serenoa repens was not more effective than placebo for treatment of urinary symptoms consistent with BPH".[1]

A 2001 study published in JAMA (The Journal of the American Medical Association) found that saw palmetto fruit extract failed to reduce urinary tract symptoms more than placebo. The double-blind study was conducted at eleven North American clinics and included 369 men.[19] Men in the experimental group experienced a 2.20 point drop in their American Urological Assn. Symptom Index (AUASI) score. However, men in the placebo group saw a 2.99 point drop. The Los Angeles Times reports, “42.6% of the men in the extract group saw their AUASI scores fall by at least three points; 44.2% of the men in the placebo group saw the same degree of benefit.” The study was funded by several offices within the NIH, including the National Center for Complementary and Alternative Medicine.”[20]

Contraindications and side effects

Few side effects or allergic reactions are associated with saw palmetto extract use. The most common side effects are gastrointestinal, some of which may be reduced by taking the extract with food. Use may increase the risk of bleeding or affect sex hormones, and concurrent use of other drugs with similar action should be avoided.[18]

Beta-sitosterol, one chemical present in saw palmetto extract, is chemically similar to cholesterol. High levels of sitosterol concentrations in blood have been correlated with increased severity of heart disease in men who have previously suffered from heart attacks.[21]

As with other herbal preparations, precise chemical constituents may vary by manufacturer and batch.

Contraindications include pregnancy, lactation due to antiandrogenic and estrogenic activity.

References

  1. ^ a b Tacklind, J; MacDonald, R; Rutks, I; Wilt, TJ (2009). Tacklind, James (ed.). "Serenoa repens for benign prostatic hyperplasia". Cochrane database of systematic reviews (Online) (2): CD001423. doi:10.1002/14651858.CD001423.pub2. PMC 3090655. PMID 19370565.
  2. ^ a b "Saw palmetto (Serenoa repens [Bartram] Small)]". Mayo Clinic. Retrieved 2011-12-15.
  3. ^ Felter's complete text
  4. ^ King's American Dispensatory 1898
  5. ^ a b Markowitz JS, Donovan JL, Devane CL; et al. (2003). "Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers". Clin. Pharmacol. Ther. 74 (6): 536–42. doi:10.1016/j.clpt.2003.08.010. PMID 14663456. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  6. ^ Wilt T, Ishani A, Mac Donald R (2002). Tacklind, James (ed.). "Serenoa repens for benign prostatic hyperplasia". Cochrane Database Syst Rev (3): CD001423. doi:10.1002/14651858.CD001423. PMID 12137626.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ^ Bent S, Kane C, Shinohara K; et al. (2006). "Saw palmetto for benign prostatic hyperplasia". N. Engl. J. Med. 354 (6): 557–66. doi:10.1056/NEJMoa053085. PMID 16467543. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  8. ^ Dedhia RC, McVary KT (2008). "Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia". J. Urol. 179 (6): 2119–25. doi:10.1016/j.juro.2008.01.094. PMID 18423748. {{cite journal}}: Unknown parameter |month= ignored (help)
  9. ^ Allison Aubrey (9 Feb 2006). Morning Edition: Study Casts Doubt on Saw Palmetto as Prostate Remedy (Audio recording). National Public Radio.
  10. ^ a b Wadsworth TL, Worstell TR, Greenberg NM, Roselli CE (2007). "Effects of dietary saw palmetto on the prostate of transgenic adenocarcinoma of the mouse prostate model (TRAMP)". The Prostate. 67 (6): 661–73. doi:10.1002/pros.20552. PMID 17342743. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. ^ Scaglione F, Lucini V, Pannacci M, Caronno A, Leone C (2008). "Comparison of the potency of different brands of Serenoa repens extract on 5alpha-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells". Pharmacology. 82 (4): 270–5. doi:10.1159/000161128. PMID 18849646.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ Abe M, Ito Y, Oyunzul L, Oki-Fujino T, Yamada S (2009). "Pharmacologically relevant receptor binding characteristics and 5alpha-reductase inhibitory activity of free Fatty acids contained in saw palmetto extract". Biological & Pharmaceutical Bulletin. 32 (4): 646–50. doi:10.1248/bpb.32.646. PMID 19336899. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) [dead link]
  13. ^ Habib FK, Ross M, Ho CK, Lyons V, Chapman K (2005). "Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression". International Journal of Cancer. 114 (2): 190–4. doi:10.1002/ijc.20701. PMID 15543614. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  14. ^ Di Silverio F, Monti S, Sciarra A; et al. (1998). "Effects of long-term treatment with Serenoa repens (Permixon) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia". The Prostate. 37 (2): 77–83. doi:10.1002/(SICI)1097-0045(19981001)37:2<77::AID-PROS3>3.0.CO;2-I. PMID 9759701. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  15. ^ Plosker GL, Brogden RN (1996). "Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia". Drugs & Aging. 9 (5): 379–95. doi:10.2165/00002512-199609050-00008. PMID 8922564. {{cite journal}}: Unknown parameter |month= ignored (help)
  16. ^ Scholtysek C, Krukiewicz AA, Alonso JL, Sharma KP, Sharma PC, Goldmann WH (2009). "Characterizing components of the Saw Palmetto Berry Extract (SPBE) on prostate cancer cell growth and traction". Biochemical and Biophysical Research Communications. 379 (3): 795–8. doi:10.1016/j.bbrc.2008.11.114. PMID 19059205. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  17. ^ Anderson ML (2005). "A preliminary investigation of the enzymatic inhibition of 5alpha-reduction and growth of prostatic carcinoma cell line LNCap-FGC by natural astaxanthin and Saw Palmetto lipid extract in vitro". Journal of Herbal Pharmacotherapy. 5 (1): 17–26. doi:10.1300/J157v05n01_03. PMID 16093232.
  18. ^ a b "Saw Palmetto". MedlinePlus. National Library of Medicine. 2008-02-01. Retrieved 2009-03-16. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
  19. ^ "Effect of Increasing Doses of Saw Palmetto Extract on Lower Urinary Tract Symptoms". Journal of the American Medical Association. Retrieved 2011-10-08.
  20. ^ "Saw palmetto extract likely won't relieve enlarged prostate symptoms". Los Angeles Times. 27 September 2011. Retrieved 2011-10-08.
  21. ^ Assmann G, Cullen P, Erbey J, Ramey DR, Kannenberg F, Schulte H (2006). "Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study". Nutrition, Metabolism, and Cardiovascular Diseases : NMCD. 16 (1): 13–21. doi:10.1016/j.numecd.2005.04.001. PMID 16399487. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
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