Saw palmetto

Definition

Saw palmetto is an extract derived from the deep purple berries of the saw palmetto fan palm (Serenoa repens), a plant indigenous to the coastal regions of the southern United States and southern California. There is an estimated one million acres of wild saw palmetto palms in Florida, where the bulk of commercial saw palmetto is grown.

Description

Saw palmetto is used by natural health practitioners to treat a variety of ailments in men and

women, such as testicular inflammation, urinary tract inflammation, coughs, and respiratory congestion. It is also used to strengthen the thyroid gland, balance the metabolism, stimulate appetite, and aid digestion. Most of the evidence supporting these uses is anecdotal and has not been proven by controlled clinical trials. However, there is much scientific documentation outlining the effectiveness of the herb in treating irritable bladder and urinary problems in men with benign prostate hyperplasia (BPH), an enlargement of the prostate gland. BPH results in a swelling of the prostate gland that obstructs the urethra. This causes painful urination, reduced urine flow, difficulty starting or stopping the flow, dribbling after urination, and more frequent nighttime urination. Saw palmetto does not reduce prostate enlargement . Instead, it is thought to work in a variety of ways. First, it inhibits the conversion of testosterone into dihydrotestosterone (DHT). BPH is thought to be caused by an increase in testosterone to DHT. Second, saw palmetto is believed to interfere with the production of estrogen and progesterone, hormones associated with DHT production.

In addition to causing pain and embarrassment, BPH can lead to serious kidney problems if undiagnosed and left untreated. It is a common problem in men over the age of 40. Estimates are that 50 to 60% of all men develop BPH in their lifetimes. The Agency for Health Care Policy and Research estimates there are six million men between the ages of 50 and 79 who have BPH serious enough to require some type of therapy. Yet only half of them seek treatment from physicians. Health practitioners in both the allopathic and natural medicine communities recommend annual prostate exams for men over the age of 50 and an annual blood test that measures prostate specific antigen, a marker for prostate cancer .

In 2006, researchers in San Francisco reported that a year-long study of saw palmetto to treat BPH showed it was no more effective than a placebo in controlling symptoms. The study of 225 men taking 160 mg of saw palmetto twice a day concluded that there clearly was no benefit of using saw palmetto to treat BPH. The researchers said that previous studies that showed saw palmetto effective in treating BPH involved a small number of participants and had a short duration. However, researchers said their study was not conclusive and urged further research. They also noted that other health practitioners believe a higher dose of saw palmetto is needed for it to be effective.

Saw palmetto berries have been used in American folk medicine for several hundred years as an aphrodisiac and for treating prostate problems. Native Americans in the southeast United States have used saw palmetto since the 1700s to treat male urinary problems. In the 1800s, medical botanist John Lloyd (1854–1945) noted that animals that ate saw palmetto appeared healthier and fatter than other livestock. Early American settlers noticed the same effects and used the juice from saw palmetto berries to gain weight, to improve general disposition, as a sedative, and to promote reproductive health. A pungent tea made from saw palmetto berries was commonly used in the early 1900s to treat prostate enlargement and urinary tract infections. It was also used in men to increase sperm production and sex drive, although these uses are discounted in the late 2000s. One of the first published medical recommendations that saw palmetto was effective in treating prostate problems appeared in the 1926 edition of United States Dispensatory. In the late 1920s, the use of medicinal plants, including saw palmetto, began to decline in the United States, while at the same time, it was on the rise in Europe.

Uses in women

There is very little documentation or scientific research into saw palmetto use in women. However, several studies in the 1990s show that the BPH drug Proscar can be effective in stopping unwanted facial and body hair growth and in treating thinning hair in women. It works by blocking the action of an enzyme called 5-alpha reductase. Anecdotal reports suggest that saw palmetto may be as effective as Proscar in treating unwanted hair growth and thinning hair and in preventing some types of acne. It has also been used to treat urinary tract inflammation and help relieve the symptoms of menstruation. There are claims it can be used to enlarge breasts, but these claims have not been scientifically tested.

QUESTIONS TO ASK YOUR PHARMACIST

• Have you recommended saw palmetto for prostate enlargement in other patients?
• If so, what were the results?
• Will saw palmetto interact with any current medications I'm taking?
• Do you recommend a particular brand and/or dosage. If so, why?

Recommended dosage

People taking saw palmetto should use only standardized extracts that contain 85 to 95% fatty acids and sterols. Dosages vary depending on the type of saw palmetto used. A typical dose is 320 mg per day of standardized extract or 1 to 2 g per day of ground, dried, whole berries. It may take up to four weeks of use before beneficial effects are seen.

Precautions

There are no special precautions associated with taking saw palmetto, even in high doses. However, BPH can become a serious problem if left untreated. Men who are experiencing symptoms should be examined by a physician, since the symptoms of BPH are similar to those of prostate cancer . Men over the age of 50 should have a yearly prostate exam. Saw palmetto should only be used under a doctor's supervision by people with prostate cancer, breast cancer , or any sex hormone related diseases. Women taking estrogen replacement products should consult a physician before taking saw palmetto. Persons taking testosterone or other anabolic steroids should not take saw palmetto without first consulting their doctor.

In rare cases, allergic reactions to saw palmetto have been reported. Symptoms include difficulty breathing, constricting of the throat, hives, and swelling of the lips, tongue, or face. Persons experiencing any of these symptoms should stop taking saw palmetto and seek immediate medical attention.

KEY TERMS

Anabolic steroids —A group of mostly synthetic hormones sometimes taken by athletes to temporarily increase muscle size.

Aphrodisiac —Any substance that excites sexual desire.

Benign prostate hyperplasia (BPH) —Enlargement of the prostate gland.

Estrogen —A hormone that stimulates development of female secondary sex characteristics.

Placebo —An inert or innocuous substance used in controlled experiments testing the efficacy of another substance.

Progesterone —A steroid hormone that is a biological precursor to corticoid (another steroid hormone) and androgen (a male sex hormone).

Testosterone —A male hormone produced in the testes or made synthetically that is responsible for male secondary sex characteristics.

Urethra —The tube that carries urine from the bladder out of the body and in males also carries semen.

Side effects

The only reported minor side effects are rare and include cramps, nausea, diarrhea , and headache.

Interactions

Saw palmetto may interfere with hormone-related drugs such as testosterone and estrogen replacements, including Premarin, Cenestin, Vivelle, Fempatch, and Climara. Individuals on these types of medications should consult with their doctor before taking saw palmetto. There are no known restrictions on food, beverages, or physical activity while taking saw palmetto. Some factors that can impair the effectiveness of saw palmetto include beer, cigarette smoke, and some chemical pesticides used on fruit and vegetables. Some physicians recommend using saw palmetto in addition to a prescription medicine for BPH, such as Proscar, Hytrin, or Cardura.

Caregiver concerns

Since saw palmetto is generally considered safe, there is no reason for caregivers to be concerned about its use. They should be aware that saw palmetto can interfere with certain hormone-related drugs, such as testosterone and estrogen replacements.

Resources

periodicals

Altshul, Sara. “Soothe His Prostate Problems.” Prevention (January 2006): 80.

Bent, S., et al. “Saw Palmetto for Benign Prostatic Hyperplasia.” New England Journal of Medicine (February 9, 2006): 557–566.

Cooperman, Ted. “Saw Palmetto for Benign Prostatic Hyperplasia.” Townsend Letter: The Examiner of Alternative Medicine (June 2006): 94.

Ebell, Mark. “SawPalmetto Ineffective for Prostate Patients.” American Family Physician (June 1, 2006): 2023.

Helmer, Jodi. “Saw Palmetto: Find Out How This Dwarf Plant May Help Stop Prostate Enlargement.” Better Nutrition (June 2006): 12.

Sego, Sherril. “Saw Palmetto.” Clinical Advisor (May 2006):113.

organizations

American Association of Clinical Urologists, 1100 E. Woodfield Rd., Suite 520, Schaumburg, IL, 60173, (847) 517-1050, (847) 517-7229, [email protected], http://www.aacuweb.org.

American Prostate Society, PO Box 870, Hanover, MD, 21076, (410) 859-3735, (410) 850-0818, [email protected], http://www.americanprostatesociety.com.

American Urological Association, 1000 Corporate Blvd., Suite 410, Linthicum, MD, 21090, (410) 689-3700, (866) 746-4282, (410) 689-3800, [email protected], http://www.auanet.org.

Canadian Urological Association, 1155 University, Suite 1155, Montreal, QC, Canada, H3B 3A7, (514) 395-0376, (514) 875-0205, [email protected], http://www.cua.org.

National Kidney and Urologic Diseases Information Clearinghouse, 3 Information Way, Bethesda, MD, 20892-3580, (800) 891-5390, (703) 738-4929, [email protected], http://www.kidney.niddk.nih.gov.

Urological Society of Australia and New Zealand, 180 Ocean St., Suite 512 Eastpoint, Edgecliff, NSW, Australia, 2027, (61) 2 9362-8644, (61) 2 9362-1433, [email protected], http://www.usanz.org.au.

Ken R. Wells