Saw Palmetto
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.
Purpose
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. According to the American Dietetic Association, saw palmetto is one of the most commonly used dietary supplements among Americans between the ages of 50 and 76.
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. Secondly, 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 50-60% of all men will develop BPH in their lifetimes. It is estimated that there are six million men between the ages of 50-79 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 examinations for men over the age of 50, and an annual blood test that measures prostate specific antigen, a marker for prostate cancer.
Recently, a number of clinical trials have confirmed the effectiveness of saw palmetto in treating BPH. Many of these trials have shown saw palmetto works better than the most commonly used prescription drug, Proscar. Saw palmetto is effective in nearly 90% of patients after six weeks of use, while Proscar is effective in less than 50% of patients. In addition, Proscar may take up to six months to achieve its full effect. Since Proscar blocks the production of testosterone, it can cause impotence and breast enlargement. Also, saw palmetto is significantly less expensive than Proscar. A one-month supply of saw palmetto costs $12-25, while a one month supply of Proscar costs $65-75. Other prescription drugs used to treat BPH are Cardura (doxazosin), Hytrin (terazosin), and Flomax (tamsulosin hydrochloride). Originally prescribed to treat hypertension, Cardura and Hytrin can drop blood pressure, causing lightheadedness and fainting. Presently, saw palmetto is being evaluated by the U.S. Food and Drug Administration (FDA) for treatment of BPH. If approved, it would become the first herbal product to be licensed by the agency as a treatment for a specific condition. Saw palmetto is also used as a treatment for prostate complaints and irritable bladder.
Since the 1960s, extensive clinical studies of saw palmetto have been done in Europe. A 1998 review of 24 European trials involved nearly 3,000 men, some taking saw palmetto, others taking Proscar, and a third group taking a placebo. The men taking saw palmetto had a 28% improvement in urinary tract symptoms, a 24% improvement in peak urine flow, and 43% improvement in overall urine flow. The results were nearly comparable to the group taking Proscar and superior to the men taking a placebo.
On the other hand, saw palmetto does not appear to be useful in treating prostatitis or chronic pelvic pain syndrome (CPPS) in men. A group of researchers at Columbia University reported in early 2004 that men given saw palmetto for CP/CPPS showed no appreciable improvement at the end of a year-long trial.
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.
History
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 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.
In the United States, the medicinal uses of saw palmetto were first documented in 1879 by Dr. J. B. Read, a physician in Savannah, Georgia, who published a paper on the medicinal benefits of the herb in the April 1879 issue of American Journal of Pharmacy. He found the herb useful in treating a wide range of conditions. "By its peculiar soothing power on the mucous membrane it induces sleep, relieves the most troublesome coughs, promotes expectoration, improves digestion, and increases fat, flesh and strength. Its sedative and diuretic properties are remarkable," Read wrote. "Considering the great and diversified power of the saw palmetto as a therapeutic agent, it seems strange that it should have so long escaped the notice of the medical profession."
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 today. 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.
Preparations
The National Institute on Aging recommends that people taking saw palmetto should obtain it only from reputable sources. In addition, people should use only standardized extracts that contain 85-95% 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 (1-2 g) per day of ground dried whole berries. It may take up to four weeks of use before beneficial effects are seen. In late 1999, the web-based independent consumer organization ConsumerLab.com tested 27 leading brands of saw palmetto for fatty acid and sterol content. Ten of the brands contained less than the minimum recommended level of 85% fatty acids and sterols.
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. Although the effects of saw palmetto on a fetus is unknown, pregnant women are advised not to take saw palmetto. Saw palmetto can alter hormonal activity that could have an adverse effect on the fetus. Women taking birth control pills or 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.
Side effects
The only reported minor side effects are rare and include cramps, nausea, diarrhea, and headache.
Interactions
Saw palmetto may interfere with such hormone-related drugs as testosterone and estrogen replacements, including Premarin, Cenestin, Vivelle, Fempatch, and Climara. It may also interact with such birth control pills as Triphasil, Ovral, Lo-Ovral, Nordette, Alesse, Demulen, and Ortho-Novum. Anyone on these types of medications should consult their doctor before taking saw palmetto. There are no known restrictions on food, beverages, or physical activity while taking saw palmetto.
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.
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 canal that carries urine from the bladder.
Several herbs and minerals have been used in conjunction with saw palmetto in treating BPH. A 1996 European study showed positive results in treating patients with a daily dose of 320 mg of saw palmetto extract and 240 mg of nettle root extract. Many alternative health practitioners also recommend saw palmetto be used in combination with the herb pygeum africanum, pumpkin seeds, zinc, flaxseed oil, certain amino acids, antioxidants, and diets high in protein and soy products. 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, such as Proscar, Hytrin, or Cardura.
Resources
BOOKS
Foster, Steven W. Guide to Herbal Dosages. Loveland, CO: Interweave Press, 2000.
PERIODICALS
D'Epiro, Nancy Walsh. "Saw Palmetto and the Prostate." Patient Care April 15, 1999: 29.
Gong, E. M., and G. S. Gerber. "Saw Palmetto and Benign Prostatic Hyperplasia." American Journal of Chinese Medicine 32 (March 2004): 331-338.
Gunther, S., R. E. Patterson, A. R. Kristal, et al. "Demographic and Health-Related Correlates of Herbal and Specialty Supplement Use." Journal of the American Dietetic Association 104 (January 2004): 27-34.
Kaplan, S. A., M. A. Volpe, and A. E. Te. "A Prospective, 1-Year Trial Using Saw Palmetto Versus Finasteride in the Treatment of Category III Prostatitis/Chronic Pelvic Pain Syndrome." Journal of Urology 171 (January 2004): 284-288.
Peng, C. C., P. A. Glassman, L. E. Trilli, et al. "Incidence and Severity of Potential Drug-Dietary Supplement Interactions in Primary Care Patients: An Exploratory Study of 2 Outpatient Practices." Archives of Internal Medicine 164 (March 22, 2004): 630-636.
ORGANIZATIONS
National Institute on Aging (NIA) Information Center. P. O. Box 8057, Gaithersburg, MD 20892-8057. (800) 222-2225. 〈http://www.nih.gov/nia〉.
Saw Palmetto
Saw palmetto
Description
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.
General use
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 prostatic gland. BPH produces 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 the ratio of testosterone to DHT. Secondly, 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 50-60% of all men will develop BPH in their lifetimes. The Agency for Health Care Policy and Research estimates there are six million men between the ages of 50-79 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 for men over the age of 50, and an annual blood test that measures prostate-specific antigen (PSA), a marker for prostate cancer .
Recently, a number of clinical trials have confirmed the effectiveness of saw palmetto in treating BPH. Many of these trials have shown saw palmetto works better than the most commonly used prescription drug, finasteride, sold unter the trade name Proscar. Saw palmetto is effective in nearly 90% of patients after six weeks of use, while Proscar is effective in less than 50% of patients. In addition, Proscar may take up to six months to achieve its full effect. Since Proscar blocks the production of testosterone, it can cause impotence and breast enlargement. Also, saw palmetto is significantly less expensive than Proscar. A one-month supply of saw palmetto costs $12-25, while a one_month supply of Proscar costs $65-75. Other prescription drugs used to treat BPH are Cardura (doxazosin), Hytrin (terazosin), and Flomax (tamsulosin hydrochloride). Originally prescribed to treat hypertension , Cardura and Hytrin can cause a drop in blood pressure, causing light-headedness and fainting. Presently, saw palmetto is being evaluated by the U.S. Food and Drug Administration (FDA) for treatment of BPH. If approved, it would become the first herbal product to be licensed by the agency as a treatment for a specific condition. Saw palmetto is listed in the Physicians Desk Reference for Herbal Medicine (1998 edition) as a treatment for prostate complaints and irritable bladder.
Since the 1960s, extensive clinical studies of saw palmetto have been done in Europe. A review of 24 European trials appeared in the November 1998 issue of the Journal of the American Medical Association. The trials involved nearly 3,000 men, some taking saw palmetto, others taking Proscar, and a third group taking a placebo. The men taking saw palmetto had a 28% improvement in urinary tract symptoms, a 24% improvement in peak urine flow, and 43% improvement in overall urine flow. The results were nearly comparable to the results from the group taking Proscar and superior to the results from men taking the placebo. As of 2002, however, many American physicians still regard the effectiveness of saw palmetto as requiring further proof.
Uses in women
There is very little documentation or scientific research regarding 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 that it can be used to enlarge breasts, but these claims have not been scientifically tested.
History
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, the medical botanist John Lloyd 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.
In the United States, the medicinal uses of saw palmetto were first documented in 1879 by Dr. J.B. Read, a physician in Savannah, Georgia, who published a paper on the medicinal benefits of the herb in the April 1879 issue of the American Journal of Pharmacy. He found the herb useful in treating a wide range of conditions. "By its peculiar soothing power on the mucous membrane it induces sleep, relieves the most troublesome coughs, promotes expectoration, improves digestion, and increases fat, flesh and strength. Its sedative and diuretic properties are remarkable," Read wrote. "Considering the great and diversified power of the saw palmetto as a therapeutic agent, it seems strange that it should have so long escaped the notice of the medical profession."
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 today. One of the first published medical recommendations that saw palmetto was effective in treating prostate problems appeared in the 1926 edition of the 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.
Preparations
People taking saw palmetto should use only standardized extracts that contain 85–95% 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 1–2 g per day of whole berries that have been dried and ground. It may take up to four weeks of use before beneficial effects are seen. In late 1999, the web-based independent consumer organization ConsumerLab.com tested 27 leading brands of saw palmetto for fatty acid and sterol content. Ten of the brands contained less than the minimum recommended level of 85% fatty acids and sterols. The 17 brands that passed the test are listed on the organization's web site at http://www.consumerlab.com/results/sawpalmetto.html.
Precautions
There are no special precautions associated with taking saw palmetto, even in high doses. BPH can become a serious problem, however, 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 examination. Saw palmetto should be used only under a doctor's supervision by people with prostate cancer, breast cancer , or any sex hormone related diseases. Although the effects of saw palmetto on a fetus is unknown, pregnant women are advised not to take saw palmetto. Saw palmetto can alter hormonal activity that could have an adverse effect on the fetus. Women taking birth control pills or 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.
Physicians who accept saw palmetto as an effective remedy for prostate problems nevertheless point out that it is not completely free of side effects. 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.
Side effects
Other reported minor side effects are rare. They include cramps, nausea, diarrhea , and headache .
Interactions
Saw palmetto may interfere with such hormone-related drugs as testosterone and estrogen replacements, including Premarin, Cenestin, Vivelle, Fempatch, and Climara. It may also interact with birth control pills, such as Triphasil, Ovral, Lo-Ovral, Nordette, Alesse, Demulen, and Ortho-Novum. Anyone 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.
Several herbs and minerals have been used in conjunction with saw palmetto in treating BPH. A 1996 European study showed positive results in treating patients with a daily dose of 320 mg of saw palmetto extract and 240 mg of nettle root extract. Many alternative health practitioners also recommend saw palmetto be used in combination with the herb pygeum africanung, pumpkin seeds, zinc, flaxseed oil, certain amino acids, antioxidants , and diets high in protein and soy products. 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, such as Proscar, Hytrin, or Cardura.
Resources
BOOKS
Fleming, Thomas, editor. PDR for Herbal Medicine. Montvale, NJ: Medical Economics Co., 1998.
Foster, Steven W. 101 Medicinal Herbs. Loveland, CO: Interweave Press, 1998.
Foster, Steven W. Guide to Herbal Dosages. Loveland, CO: Interweave Press, 2000.
Sahelian, Ray. Saw Palmetto, Nature's Prostate Healer. New York: Kensington Publishing Corp., 1998.
Winston, David. Saw Palmetto for Men & Women: Herbal Healing for the Prostate, Urinary Tract, Immune System, and More. North Adams, MA: Storey Books, 1999.
PERIODICALS
PERIODICALS
D'Epiro, Nancy Walsh. "Saw Palmetto and the Prostate." Patient Care (April 15, 1999): 29.
Ernst, E. "The Risk-Benefit Profile of Commonly Used Herbal Therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava." Annals of Internal Medicine 136 (January 1, 2002): 42-53.
Lowe, F. C., and E. Fagelman. "Phytotherapy in the Treatment of Benign Prostatic Hyperplasia." Current Opinion in Urology 12 (January 2002): 15-18.
Overmyer, Mac. "Saw Palmetto Shown to Shrink Prostatic Epithelium." Urology Times (June 1999): 1, 42.
Wilt, Timothy J., et al. "Saw Palmetto for Benign Prostatic Hyperplasia." Nutritional Research Newsletter (March 1999): 1.
Ken R. Wells
Rebecca J. Frey, PhD
Saw Palmetto
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
Saw Palmetto
Saw palmetto
Definition
Saw palmetto is a natural plant remedy used to treat men who are experiencing difficulty when urinating.
Purpose
Saw palmetto is not used to treat cancer. It is used to treat non-malignant enlargement of the prostate gland, also called benign prostatic hyperplasia (BPH).
Description
The prostate gland is found only in men. It is located where the bladder drains into the urethra. The urethra is the tube that takes urine out of the body. The prostate gland contributes to the fluid in which sperm are ejaculated (semen).
It is common for the prostate to enlarge in men over age 50. This enlargement often is not malignant. It is thought to occur because of the action of testosterone , a male hormone, on the cells of the prostate. As the prostate grows, it can press on the urethra and narrow it. This causes men to have problems with urination that include the frequent urge to urinate (especially at night) and a week, dribbling, interrupted urine stream.
Saw palmetto is the bushy palm, Serenoa repens that grows to a height of about 18 feet (6 m) along the coast of the United States from South Carolina to Florida, and in Southern California. It is also found in Europe along the Mediterranean. Other names for this plant are American dwarf palm, cabbage palm, serenoa, or sable. The medicinal part of the saw palmetto is an extract from the dark, olive-sized berries.
Saw palmetto has a long history of use by Native Americans in treating bladder inflammation, urinary difficulties, sexual difficulties, and respiratory tract infections. Of these uses, the only scientifically substantiated claim is that saw palmetto eases urinary difficulties and increases urine output. Although the exact mechanism of action of saw palmetto has not been determined, it is believed to interfere with the action of testosterone on the prostate gland. Finasteride (Proscar, also known as Permixon) is a prescription drug used to treat BPH that works in the same way. It is important to remember that BPH is not cancer, and saw palmetto is not a treatment for cancer.
Recommended dosage
Extract of saw palmetto is available in health food stores in capsules, liquid concentrate, tablets, and as dried, ground berries. An average daily dose of the drug is 1-2 grams of which 320 mg are the active ingredients. Dosage may vary from manufacturer to manufacturer.
Saw palmetto is classified as a dietary supplement. The United States Food and Drug Administration does not test or certify it. Unlike traditional pharmaceuticals, its manufacture is largely unregulated. Dietary supplements such as saw palmetto are not required to meet standards of purity or effectiveness in controlled clinical trials . Men interested in using saw palmetto should look for a reputable manufacturer of supplements who provides adequate testing and label information. The cost of dietary supplements is not covered by insurance.
Precautions
Men who are having trouble urinating should see a doctor before taking any remedies on their own. Prostate cancer is a serious, sometimes life-threatening disease, and its symptoms can be similar to BPH. A blood test and physical examination are used to diagnose prostate cancer. It is believed that saw palmetto may interfere with this blood test (called a prostate specific antigen or PSA test). Men should have this blood test done before they begin taking saw palmetto to make sure they get correct results.
Side effects
Saw palmetto has few side effects, and is generally regarded as safe. Medical authorities in Germany, France, and Italy all officially recognize it as a safe and generally effective treatment for symptoms of BPH. Side effects that have been reported are uncommon but include headache, upset stomach, and diarrhea .
Interactions
Since saw palmetto is a natural remedy, few controlled studies have been done on how it interacts with other herbal remedies or traditional pharmaceuticals. Patients taking any supplements such as vitamins or herbs should tell their doctor.
Tish Davidson, A.M.
KEY TERMS
Malignant
—Cancerous. Cells tend to reproduce without normal controls on growth and form tumors or invade other tissues.
Testosterone
—The main male hormone. It is produced in the testes and is responsible for the development of primary and secondary male sexual traits.