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Limited ''in vitro'' and animal model studies have investigated potential for use in the treatment of [[cancer]].<ref name="pmid19059205">{{cite journal |vauthors=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 |date=February 2009 |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> However, according to the [[American Cancer Society]], "available scientific studies do not support claims that saw palmetto can prevent or treat prostate cancer in humans".<ref>{{cite web|url=http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/saw-palmetto|title=Saw Palmetto|date=28 November 2008|publisher=[[American Cancer Society]]|accessdate=13 September 2013}}</ref>
Limited ''in vitro'' and animal model studies have investigated potential for use in the treatment of [[cancer]].<ref name="pmid19059205">{{cite journal |vauthors=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 |date=February 2009 |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> However, according to the [[American Cancer Society]], "available scientific studies do not support claims that saw palmetto can prevent or treat prostate cancer in humans".<ref>{{cite web|url=http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/saw-palmetto|title=Saw Palmetto|date=28 November 2008|publisher=[[American Cancer Society]]|accessdate=13 September 2013}}</ref>

A study in 2002 used 5-alpha reductase inhibitors such as liposterolic and beta-sitosterol extracted from saw palmetto to see whether they work in the treatment of androgenetic alopecia. 60% of the patients showed improvements. The authors believe that the beta-sitosterols and the liposterolic extract from the saw palmetto may work in the treatment of androgenetic alopecia by inhibiting the enzyme 5-alpha reductase.<ref>{{Cite news|url=http://www.nicehair.org/topical-saw-palmetto-hair-loss-read-trying/|title=Topical Saw Palmetto for Hair Loss: Read This Before Trying|last=|first=|date=2017-01-23|access-date=2017-05-11|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>


==Adverse effects==
==Adverse effects==

Revision as of 18:53, 11 May 2017

Saw palmetto extract is an extract of the fruit of the saw palmetto. It is rich in fatty acids and phytosterols.[specify] It has been used in traditional, eclectic, and alternative medicine to treat a variety of conditions, in particular benign prostatic hyperplasia (BPH). Reviews of clinical trials, including those conducted by the National Center for Complementary and Alternative Medicine, found the extract to be no more effective than placebo for BPH.[1]

Medical

Historical and folk medicine

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

Crude saw palmetto extract was used by European/American medical practitioners for at least 200 years for various conditions, including asthenia (weakness), recovery from major illness, and urogenital problems. 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) says of the extract:

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]

Research

Saw palmetto extract has been claimed to be a herbal treatment for benign prostatic hyperplasia,[5] a common condition in older men. Early research indicated that the extract brought about a "mild to moderate improvement in urinary symptoms and flow measures."[5][6] However, newer and more thorough research concluded saw palmetto is ineffective as a treatment for BPH.[1][7][8]

Limited in vitro and animal model studies have investigated potential for use in the treatment of cancer.[9][10] However, according to the American Cancer Society, "available scientific studies do not support claims that saw palmetto can prevent or treat prostate cancer in humans".[11]

A study in 2002 used 5-alpha reductase inhibitors such as liposterolic and beta-sitosterol extracted from saw palmetto to see whether they work in the treatment of androgenetic alopecia. 60% of the patients showed improvements. The authors believe that the beta-sitosterols and the liposterolic extract from the saw palmetto may work in the treatment of androgenetic alopecia by inhibiting the enzyme 5-alpha reductase.[12]

Adverse effects

Few adverse effects or allergic reactions are associated with saw palmetto extract use. The most common 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.[citation needed]

Beta-sitosterol, a chemical present in saw palmetto extract, is chemically similar to cholesterol. In one trial, high levels of serum sitosterol correlated with increased risk of heart attack.[13] However, a meta-analysis of 17 trials saw no connection between serum sitosterol status and cardiovascular disease.[14]

Precautions and contraindications

Children

The use of saw palmetto extract is not recommended in children under 12 years old because it may affect the metabolism of androgen and estrogen hormones.[15]

Pregnancy and lactation

Saw palmetto extract should not be used during pregnancy.[15] The effects of saw palmetto extract on androgen and estrogen metabolism can potentially impair fetal genital development.[16] Saw palmetto extract should also be avoided during breastfeeding due to a lack of available information.[16]

Surgery and bleeding risk

In a case report, a patient taking saw palmetto extract had increased bleeding time during surgery. Bleeding time returned to normal after stopping taking the herb.[17] One clinical trial pre-treated prostate surgery patients with saw palmetto for five weeks prior to the surgery, because there was evidence from earlier literature that such pre-treatment reduced operative bleeding. The trial reported no improvement compared to placebo.[18] As a general rule surgeons should ask patients to discontinue dietary supplements prior to scheduled surgery.[19]

Interactions

Saw palmetto extract may decrease the effectiveness of estrogen products by reducing estrogen levels in the body via its antiestrogenic effects.[16] It can interfere with the use of birth control pills that contain estrogen as an active ingredient. As a result, it is recommended that an additional form of birth control, such as a condom, be used to prevent pregnancy in patients taking birth control pills with saw palmetto extract. In addition, saw palmetto extract can also interfere with hormone replacement therapy by reducing the effectiveness of estrogen pills. The combination of saw palmetto extract with estrogen products should be used with caution.[16]

When used in combination with an anticoagulant or antiplatelet drug, saw palmetto extract can increase the risk of bleeding by enhancing the anticoagulation or antiplatelet effects. Some examples of anticoagulant and antiplatelet drugs include aspirin, clopidogrel, nonsteroidal anti-inflammatory drugs (NSAIDs) and warfarin. Therefore, the combination of saw palmetto extract with anticoagulant or antiplatelet drugs should be used with caution.[16]

See also

References

  1. ^ a b Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ (2012). "Serenoa repens for benign prostatic hyperplasia". Cochrane Database Syst Rev. 12: CD001423. doi:10.1002/14651858.CD001423.pub3. PMID 23235581.
  2. ^ "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. (December 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.
  6. ^ Wilt T, Ishani A, Mac Donald R (2002). Tacklind J (ed.). "Serenoa repens for benign prostatic hyperplasia". Cochrane Database Syst Rev (3): CD001423. doi:10.1002/14651858.CD001423. PMID 12137626.
  7. ^ Bent S, Kane C, Shinohara K, et al. (February 2006). "Saw palmetto for benign prostatic hyperplasia". N. Engl. J. Med. 354 (6): 557–66. doi:10.1056/NEJMoa053085. PMID 16467543.
  8. ^ Dedhia RC, McVary KT (June 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.
  9. ^ Scholtysek C, Krukiewicz AA, Alonso JL, Sharma KP, Sharma PC, Goldmann WH (February 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.
  10. ^ 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.
  11. ^ "Saw Palmetto". American Cancer Society. 28 November 2008. Retrieved 13 September 2013.
  12. ^ "Topical Saw Palmetto for Hair Loss: Read This Before Trying". 2017-01-23. Retrieved 2017-05-11. {{cite news}}: Cite has empty unknown parameter: |dead-url= (help)
  13. ^ Assmann G, Cullen P, Erbey J, Ramey DR, Kannenberg F, Schulte H (January 2006). "Plasma sitosterol elevations are associated with 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.
  14. ^ Genser B, Silbernagel G, De Backer G, Bruckert E, Carmena R, Chapman MJ, Deanfield J, Descamps OS, Rietzschel ER, Dias KC, März W (2012). "Plant sterols and cardiovascular disease: a systematic review and meta-analysis". Eur. Heart J. 33 (4): 444–51. doi:10.1093/eurheartj/ehr441. PMC 3279314. PMID 22334625.
  15. ^ a b "Fructus Serenoae Repentis". WHO Monographs on Selected Medicinal Plants. World Health Organization. Retrieved 29 October 2014.
  16. ^ a b c d e "Saw Palmetto". Natural Standard: The Authority on Integrative Medicine. Natural Standard. Retrieved 29 October 2014.
  17. ^ Cheema, P; El-Mefty, O; Jazieh, AR (Aug 2001). "Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature". J Intern Med. 250 (2): 167–9. doi:10.1046/j.1365-2796.2001.00851.x. PMID 11489067.
  18. ^ Tuncel A, Ener K, Han O, Nalcacioglu V, Aydin O, Seckin S, Atan A (2009). "Effects of short-term dutasteride and Serenoa repens on perioperative bleeding and microvessel density in patients undergoing transurethral resection of the prostate". Scand. J. Urol. Nephrol. 43 (5): 377–82. doi:10.3109/00365590903164498. PMID 19921983.
  19. ^ Wang CZ, Moss J, Yuan CS (2015). "Commonly Used Dietary Supplements on Coagulation Function during Surgery". Medicines (Basel). 2 (3): 157–185. doi:10.3390/medicines2030157. PMC 4777343. PMID 26949700.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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