Talk:Saw palmetto extract
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- Apparently beta-sitosterol (found in several natural remedies for benign prostate hypertrophy) blocks the conversion of testosterone to dihydrotestosterone. This ought to make it effective against male-pattern baldness, too. See beta-sitosterol. Unfree (talk) 06:04, 18 May 2008 (UTC)
I wonder whether the word "eclectic" is used in this article in its ordinary sense, rather than as the name of a particular group of physicians, which appears to be implied by the capitalization of its initial letter and by the presence of a link to a non-existing article, "Eclectic." Unfree (talk) 06:04, 18 May 2008 (UTC)
a contradiction? Though men taking saw palmetto may develop..reduced libido.. the rate of such problems is clinically and statistically far less .... (statistically small) It has not been proven that Saw palmetto causes a reduction of libido ... (statistically zero) —Preceding unsigned comment added by 18.104.22.168 (talk) 21:29, 11 October 2008 (UTC)
From what I have read,and experienced, neither saw palmetto nor Proscar will significantly reverse the effects of BPH and improve urine flow. They may slow the rate at which it occurs by inhibiting 5-alpha-reductase, interfering with dihydrotestosterone binding to the androgen receptor.
Studies at one time indicated that saw palmetto was effective. Later studies, comparing saw palmetto with Proscar, show that saw palmetto is no more effective than the placebo. Studies comparing saw palmetto with Proscar were likely funded by the drug company. You may draw your own conclusions.
All studies focused on improving urine flow over a relatively short term (a few years). None focused on the real benefit of slowing the progress of BPH.
Anecdotal evidence: I tried Proscar for six months. I noticed no improvement in urine flow, but I did notice a problem with libido and ED. I have switched to saw palmetto and do not notice the unfortunate side effects. I did not tell my urologist about the switch and he has not reported any difference (single blind study). Urine flow can be significantly improved with Flomax. I have to take it on faith that saw palmetto will slow the progress of BPH. None of the studies I have found are definitive.
The article states:
"The latest Cochrane Database review. (2009) concludes that "The evidence suggests that Serenoa repens provides mild to moderate improvement in urinary symptoms and flow measures. Serenoa repens produced similar improvement in urinary symptoms and flow compared to finasteride and is associated with fewer adverse treatment events. "
This is not true, this is the conclusion of the review in 2002, as correctly refered to in reference 
However, the update of this study in 2009 states:
"Serenoa repens was not more effective than placebo for treatment of urinary symptoms consistent with BPH."
- Ref #1 is now the most recent Cochrane review (2012). Conclusion still negative: "Serenoa repens... did not improve urinary flow measures or prostate size in men with lower urinary tract symptoms consistent with BPH." David notMD (talk) 10:05, 20 April 2017 (UTC)
At what dosages?
Serenoa, in contrast to this article, seemed equivocal (at first reading) on the matter of efficacity against BPH; a check of the references was necessary to realize that the positive results were all from earlier years. But there has been intense and growing political pressure to find treatments ineffective, as a means of reducing governments' entitlement liabilities, and it seems plausible that this could influence the design of government-funded medical research. Studies are less likely to find differences from placebo if they use lower dosages and/or shorter durations of treatment.
This seems like a particularly good idea when reporting what appears to have been a complete reversal over the past decade (from "safe and effective" to "no different from placebo") in the evaluation of efficacity, occurring simultaneously with a financial crisis and a strong push from government to popularize the strategy of leaving BPH untreated.
DOSES: I have access to the PDFs of the clinical trials. The commercially available products and most clinical trials use 320 mg/day. Bent (2006) used 320 mg/day for 12 months. Barry (2011) started with 320 mg/day, then stepped up to 640 mg/d and finally 960 mg/d over 72 weeks. Neither trial reported any positive outcome for saw palmetto, including symptoms and PSA levels. Older trials and the Boyle (2000) meta-analysis reported a significant benefit. Most of the trials used 320 mg/day. As noted, the Tacklind (2009) meta-analysis concluded there was no benefit. Again, most trials used 320 mg/day. The more recent studies and reviews did not use lower doses or shorter durations.David notMD (talk) 04:06, 28 January 2016 (UTC)
Works for me. If I quit taking it for a few days I have to get up four or five times a night. I have to wonder what they measure when they say it doesn't do anything. ;Bear (talk) 18:20, 12 October 2015 (UTC)
- What you describe is entirely consistent with a placebo effect. Deli nk (talk) 18:24, 12 October 2015 (UTC)
What these trials use is validated scoring systems such as the Amer Urological Assoc Symptom Index (AUASI) or Intl Prostate Symptom Score (IPSS), plus number of times urinating per night, peak flow, prostate size, PSA levels, sexual dysfuntion... The problem with clinical trials (and individual testimonies) is that there is a strong placebo effect for any type of subjective scoring of symptoms. Same applies to osteoarthritis pain relief. Here is a short list of saw palmetto published uncontrolled trials with positive results when a comparison was made from start to end of the trial: Sinescu L 2011, Suter A 2012, Bertaccini 2012 and Giulianelli R 2012.David notMD (talk) 04:17, 28 January 2016 (UTC)
Surgery and bleeding risk
The article identifies saw palmetto extract as potentially increasing surgical bleeding risk. I have rewritten this. Leading with the existing ref of a case study with reported this problem. Removing the Medscape ref, which was cited as evidence for bleeding risk, as that link is broken. Current NIH content on saw palmetto makes no mention of bleeding risk. Adding primary research: Tuncel (2009) treated subjects with saw palmetto for five weeks (only 160 mg/day) before prostate surgery. This study was conducted because of claims that pre-treatment reduced operative bleeding. Tuncel reported no benefit compared to control. The trial reported in JAMA in 2011 (Barry et al) included doses as high as 960 mg/day and did not report bleeding problems, but that trial had excluded people on anti-coagulation meds. There are no available secondary sources to cite. David notMD (talk) 10:48, 20 April 2017 (UTC)