Saw palmetto extract
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 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.
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.
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..."
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.
Saw palmetto extract has been claimed to be a herbal treatment for benign prostatic hyperplasia, 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." However, newer and more thorough research concluded saw palmetto is ineffective as a treatment for BPH.
Limited in vitro and animal model studies have investigated potential for use in the treatment of cancer. 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".
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.
Beta-sitosterol, a chemical present in saw palmetto extract, is chemically similar to cholesterol. High levels of sitosterol concentrations in blood have correlated with increased severity of heart disease in men who previously suffered heart attacks.  There is limited evidence that increased consumption of plant sterols will increase the risk of cardiovascular disease. More research is needed of the long term effects of increased consumption of plant sterols. 
Precautions and contraindications
Pregnancy and lactation
Saw palmetto extract should not be used during pregnancy. The effects of saw palmetto extract on androgen and estrogen metabolism can potentially impair fetal genital development. Saw palmetto extract should also be avoided during breastfeeding due to a lack of available information.
Saw palmetto extract can significantly slow down blood clotting, leading to increased bleeding time before and after surgery. In a case report, a patient taking saw palmetto had increased bleeding time during surgery. The bleeding time returned to normal after he stopped taking the herb. It is recommended that the use of saw palmetto extract be stopped at least two weeks before a scheduled surgery.
Saw palmetto extract may decrease the effectiveness of estrogen products by reducing estrogen levels in the body via its antiestrogenic effects. 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. Therefore, the combination of saw palmetto extract with estrogen products should be used with caution.
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.
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- Felter's complete text
- King's American Dispensatory 1898
- 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.
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