Saw Palmetto and Liver Toxicity. How Over-The-Counter Herbal Supplements Can Kill You.

Saw palmetto comes from a palm-like plant that grows in the southeast United States. The berries of this plant are used to make the capsule form of saw palmetto.

Saw palmetto has been used to treat symptoms of enlarged prostate (benign prostatic hypertrophy or BPH). Saw palmetto is also popular as an herbal remedy for a type of hair loss and baldness called androgenic alopecia, or male- and female-pattern baldness. This type of hair loss is typically the greatest at the top of the head or around the temples. Although it is still not know exactly how it works, its believed that it may block an enzyme (5-alpha-reductase) from allowing the hormone testosterone from being converted to another hormone, dihydrotestosterone. Dihydrotestosterone is considered a key contributing factor to the onset and progression of androgenic alopecia and benign prostatic hyperplasia. Saw palmetto has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of saw palmetto may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. The case below is an example of what a liver with saw palmetto toxicity would look like. Before the liver is sliced, you can appreciate how abnormal it looks. Grossly it is just gnarly. Its enlarged, green-orange/brown and extremely nodular. Compare that to

the normal liver photo seen directly below it

The outer surface of the liver is so nodular it almost looked cirrhotic, until it was sliced.

The orange/brown areas of the liver are grossly consistent with confluent to almost submassive hepatic necrosis. Microscopically these areas would show dead hepatocytes (liver cells). These findings can be seen in fulminant hepatic necrosis with autoimmune hepatitis, hepatitis B virus and drug toxicity. The liver grossly looks nodular because the areas of necrosis (orange/brown)areas are dead and collapsed, so the live (green) areas are raised giving a nodular appearance. It is not cirrhotic. Laboratory tests could rule out autoimmune hepatitis and viral hepatitis. The final diagnosis: Confluent to almost sub-massive hepatic necrosis due to acute drug (saw palmetto) toxicity.

According to the National Institutes of Health, several cases of liver problems have been reported from saw palmetto use. A report of possible acute liver toxicity from saw palmetto was published in British Journal of Clinical Pharmacology in 2010. After the patient discontinued saw palmetto, all symptoms disappeared within a few weeks. Unfortunately, in some cases, the liver can be damaged beyond repair and this diagnosis is made at autopsy.