Saw palmetto extract

Saw palmetto extract is an extract of the fruit of the saw palmetto. It is marketed as a treatment for benign prostatic hyperplasia (BPH), but reviews of clinical trials, including those conducted by the National Center for Complementary and Alternative Medicine, found it ineffective for this purpose.[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]

Research

Although saw palmetto extract has been claimed to be a herbal remedy for benign prostatic hyperplasia (BPH), it is an ineffective treatment.[1][3][4][5] However, the Cochrane studies used different extracts. This suggests that the lack of an effect found in the most recent Cochrane review was due to the differences in the saw palmetto extracts used. Permixon was used in a 2016 study.[6] Limited in vitro and animal model studies have investigated potential for use in the treatment of cancer.[7][8] 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".[9]

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.[10] However, a meta-analysis of 17 trials saw no connection between serum sitosterol status and cardiovascular disease.[11]

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.[12]

Pregnancy and lactation

Saw palmetto extract should not be used during pregnancy.[12] The effects of saw palmetto extract on androgen and estrogen metabolism can potentially impair fetal genital development.[13] Saw palmetto extract should also be avoided during breastfeeding due to a lack of available information.[13]

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.[14] 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.[15] As a general rule surgeons should ask patients to discontinue dietary supplements prior to scheduled surgery.[16]

Interactions

Saw palmetto extract may decrease the effectiveness of estrogen products by reducing estrogen levels in the body via its antiestrogenic effects.[13] 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.[13]

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.[13]

References
  1. 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. Bent S, Kane C, Shinohara K, et al. (February 2006). "Saw palmetto for benign prostatic hyperplasia" (PDF). N. Engl. J. Med. 354 (6): 557–66. doi:10.1056/NEJMoa053085. PMID 16467543.
  4. 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.
  5. 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. Novara G, Giannarini G, Alcaraz A, Cózar-Olmo JM, Descazeaud A, Montorsi F, Ficarra V (2016). "Efficacy and Safety of Hexanic Lipidosterolic Extract of Serenoa repens (Permixon) in the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: Systematic Review and Meta-analysis of Randomized Controlled Trials". Eur Urol Focus. 2: 553–561. doi:10.1016/j.euf.2016.04.002. PMID 28723522.CS1 maint: multiple names: authors list (link)
  7. 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.
  8. 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.
  9. "Saw Palmetto". American Cancer Society. 28 November 2008. Retrieved 13 September 2013.
  10. 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.
  11. 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.
  12. "Fructus Serenoae Repentis". WHO Monographs on Selected Medicinal Plants. World Health Organization. Retrieved 29 October 2014.
  13. "Saw Palmetto". Natural Standard: The Authority on Integrative Medicine. Natural Standard. Retrieved 29 October 2014.
  14. 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.
  15. 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.
  16. 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.
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