St. John's wort (SJW), or Hypericum perforatum, is a perennial herb that is used to treat depression in several countries. Based on the available evidence, it can be hypothesized that SJW would also have beneficial prophylactic and therapeutic effects in patients with metabolic syndrome. In this review, we summarize and discuss the best designed studies that have investigated the effects of SJW extract on adipocyte differentiation, the inflammatory process, and glucose metabolism, all of which are relevant to the development of metabolic syndrome. Despite some lack of clarity in reporting of research and discrepancies in interpretation, we consider that SJW is able to enhance differentiation of adipocytes via activation of peroxisome proliferator-activated receptor gamma and increase expression of adiponectin, exert anti-inflammatory effects by inhibiting expression of proinflammatory adipokines, and maintain normal glucose metabolism by protecting pancreatic beta cells and peripheral target tissues against changes in insulin secretion and insulin sensitivity. Although further research is necessary, there is encouraging evidence that SJW may help to attenuate the pathologic process associated with metabolic syndrome.