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Supplements

saw palmetto

What Is It?
Health Benefits
Forms
Dosage Information
Guidelines for Use
General Interaction
Possible Side Effects
Cautions
Evidence Based Rating Scale
References


What Is It?

From the olive-sized berries of the saw palmetto tree comes a remedy for benign enlargement of the prostate gland. While harmless, this common condition (BPH, or benign prostatic hyperplasia) can interfere with the urine's exit from the bladder, causing frequent urination, nighttime awakenings, and other uncomfortable urinary symptoms. It's not clear what causes BPH. But as the millions of men who suffer from it can attest--more than half of men over 60 are affected--relief is welcome indeed.

The popularity of saw palmetto--so-named in recognition of the saw-toothed stems that lie at the base of each palm leaf--has waxed and waned over time. Until 1950, it was officially recognized in the United States as a drug for urinary and genital problems. But conventional American doctors eventually became disenchanted with the remedy; they could find little solid evidence to prove its effectiveness for any condition. Europeans, on the other hand, have been steadfast in their enthusiasm for the prostate-healing gifts of this scrubby, native American palm tree (also known as Serenoa repensor S. serrulata). Herbalists worldwide have also recommended saw palmetto as a general tonic and remedy for persistent cough and digestive problems. 

Health Benefits

Numerous test tube, animal, and human studies indicate that an oily compound in saw palmetto berries reduces the discomforts of a mild to moderately enlarged prostate (1). While the Herb doesn't actually shrink this gland, it does appear to prevent it from getting any larger. How it accomplishes this remains a matter of debate. Research points to an anti-inflammatory action and an ability to inhibit the hormones (possibly including a form of testosterone) that cause prostate cells to multiply. Antiandrogenic (anti-male sex Hormone) actions have also been implicated. Because men tend to get hormonal imbalances and prostate swelling as they age, saw palmetto is found in certain multivitamen and "longevity" programs that nutritional practitioners offer to help mature men maintain youthful vitality. This usage has not been well researched.

One of the great appeals of saw palmetto is its price: It typically costs about one-third to one-half that of the conventional BPH medications. And based on recent findings it also works faster and causes fewer cases of impotence and reduced libido than the conventional prostate drugs, Finasteride and Tamulosin (2). By affecting levels of cancer-promoting hormones it may even play a role in protecting against prostate cancer, although this requires further research. Finally, test tube studies indicate that the herb boosts the immune system's ability to kill bacteria, suggesting a potential treatment for prostate or urinary tract infections.

Specifically, saw palmetto may help to:

• Reduce the symptoms of BPH. Saw palmetto relieves the major symptoms of BPH. Numerous studies have shown that it reduces the number of times a sufferer feels the urge to urinate (including at night, thus reducing the number of nighttime awakenings), increases maximum urine flow, and minimizes the sensation that the bladder has not emptied (3, 4) . Painful urination may lessen as well. A recent meta-analysis of multiple trials including 4280 men, concluded that a saw palmetto Extract (Permixon) significantly improved measures of peak flow, and reduced nocturia (night-time urination) (5). Other randomized controlled trials have shown that Permixon is superior to Tamulosin (6, 7). However, all trials of saw palmetto have not shown it to be effective in the treatment of BPH. A very well publicized trial recently published in the New England Journal of Medicine found no benefit to saw palmetto supplementation for moderate to severe cases of BPH, when compared with Placebo (8). Other randomized controlled trials have supported this finding (9). Currently, since there is evidence pointing to benefit and conversely no benefit, it is recommended that if you have a confirmed diagnosis of BPH, it may still be beneficial to supplement with saw palmetto. The current level of evidence slightly favors in support of saw palmetto supplementation. Of course, this may change with time and additional studies conducted on saw palmetto supplementation for BPH. Currently, since it is well tolerated with little side effects it should still be considered a viable treatment for BPH.

• Treat male and female pattern baldness. By blocking the same enzymes implicated in the causation of BPH (5-alpha-reductase), saw palmetto may help reduce hair loss associated with androgenic alopecia (male or female pattern baldness). Limited trial evidence exists, but some small randomized controlled trials have shown benefit (10). More research is necessary before saw palmetto can be prescribed as a viable treatment for this condition.

Forms

    • Tincture
    • tablet
    • softgel
    • dried herb/tea
    • berries (fresh or dried)  
    • capsule

Dosage Information

Special Tips:

--Look for supplements made from extracts standardized to contain 85% to 95% fatty acids and sterols—the medicinal, Fat-soluble ingredients in the berries (11).

--Because the potency of commercial preparations may vary, follow manufacturer's instructions.

• For prostate problems: Take 160 mg twice a day.

• For hair loss: Take 160 mg twice a day.

Guidelines for Use

• To minimize the risk of stomach upset, take saw palmetto with breakfast and dinner.

• Don't use a tea made from the dried herb; the plant's medicinal oils don't dissolve in water.

• To increase its effectiveness for prostate problems, try combining saw palmetto with other prostate-healthy herbs such as pygeum africanum, nettle, or pumpkin seed. Beware of so-called Men's Formula combinations that actually contain very little saw palmetto.

• Be patient when treating prostate problems. Although it may work faster than many prescription drugs for BPH, you will probably have to take saw palmetto for six to eight weeks before noticing any improvement in symptoms. 

General Interaction

• Because of its mechanism of action, saw palmetto may increase the risk of bleeding. Ask your doctor if saw palmetto is right for you if you are currently taking aspirin, Plavix, Non-Streoidal Anti-inflammatory Drugs (NSAID), ibuprofen, naproxen, warafrin or other drugs commonly prescribed for Inflammation or heart disease.

• Saw palmetto may also interact with oral contraceptives or hormone therapy. Ask your doctor if saw palmetto can safely be combined with any conventional therapies you are currently taking. 

Possible Side Effects

• Side effects of saw palmetto are relatively uncommon, although mild abdominal pain, nausea, dizziness, and headache have been documented. Lower the dose or stop taking the herb if side effects occur.

• Problems with reduced libido and impotence can develop. These reactions are still less likely than with prescription drugs for BPH, however.

• Rarely, male breasts become enlarged. 

Cautions

• Don't try to self-diagnose BPH. Although often benign, prostate problems should always be examined by a doctor to rule out other, more serious conditions, including prostate cancer.

• Consult a doctor if you develop any new symptoms of prostate problems (trouble urinating despite the urge, more frequent need to urinate, urinary leaking) or if you detect blood in your urine.

• Don't stop taking a prescription medication and start taking saw palmetto for prostate problems without discussing the change with your doctor.

• Despite some claims to the contrary, saw palmetto won't increase sexual vigor or increase your sperm count.

• Avoid taking more than 320 mg daily; little is known about how high doses might affect your health.

• Because the herb appears to affect hormone levels, men with prostate cancer or breast cancer, or anyone with a hormone-dependent illness, should first discuss the idea of taking saw palmetto with a doctor.

• Be sure to let your doctor know that you are taking saw palmetto before taking the test used to rule out prostate cancer. To be safe, before beginning saw palmetto supplementation ask you physician to perform a baseline PSA assessment. This will allow you to adequately track your PSA levels throughout your treatment regimen.

• If you are pregnant or breast-feeding do not use saw palmetto. The herb’s safety has not been established for these groups.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.

Condition

Rating

Explanation

 

   

 

Prostate problems

 

   

 

 

               

 

 

Multiple studies support efficacy for use in Benign Prostatic Hyperplasia, not other prostate problems

.

 

 

   

 

 

Hair problems

 

 

 

 

 

                 

 


Limited inconsistent evidence for androgenic alopecia (male or female pattern baldness). No evidence for other hair problems.  

 

References

1.      Talpur N, Echard B, Bagchi D, Bagchi M, Preuss HG. Comparison of Saw Palmetto (extract and whole berry) and Cernitin on prostate growth in rats. ol Cell Biochem. 2003 Aug;250(1-2):21-6.

2.      Zlotta AR, Teillac P, Raynaud JP, Schulman CC. Evaluation of male sexual function in patients with Lower Urinary Tract Symptoms (LUTS) associated with Benign Prostatic Hyperplasia (BPH) treated with aphytotherapeutic agent (Permixon), Tamsulosin or Finasteride. Eur Urol. 2005 Aug;48(2):269-76. Epub 2005 Apr 18.

3.      Giannakopoulos X, Baltogiannis D, Giannakis D, Tasos A, Sofikitis N, Charalabopoulos K, Evangelou A. The lipidosterolic extract of Serenoa repens in the treatment of benignprostatic hyperplasia: a comparison of two dosage regimens. Adv Ther. 2002 Nov-Dec;19(6):285-96.

4.      Date Published: 01/14/2007

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