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SAW PALMETTO

There are about 40 published studies on saw palmetto berries, which reduce levels of substances that our bodies use to make hormones such as testosterone and estrogen. While we associate testosterone with men and estrogen with women, both men and women have testosterone and estrogen in their bodies, just in different levels.

For men, too much of a substance called dihydrotestosterone (DHT) has been blamed for a disorder called benign prostatic hyperplasia (BPH). Estrogen may also have something to do with it. In BPH, cells in the prostate gland (a tiny gland that lies behind the urethra) grow too quickly. The gland swells and presses on the urethra, so that it feels as if you constantly need to urinate. A common prescription drug for BPH, Proscar, reduces DHT in order to slow or stop BPH.

Recently, researchers concluded that saw palmetto can be as effective as Proscar in relieving certain symptoms of BPH such as urine flow, which is reduced in BPH, and the constant feeling that you have to urinate. One difference between the two therapies, however, is that Proscar can shrink the size of the prostate, and saw palmetto can't. For this reason, if you have chosen to try saw palmetto for your BPH symptoms, it is very important to do so under the guidance of a health care provider, and to keep regular appointments with him or her so that your progress can be monitored.

Saw palmetto berries were not always used for BPH; Native Americans ate them as part of their diet, and they were also used to increase libido.

Plant Description

Saw palmetto is a fan palm that can reach heights of 10 feet in warm climates. In the United States, it grows in the warm climates of the southeast, from South Carolina to Mississippi and throughout Florida. Lush, green leaves fan out from thorny stems. The plant bears white flowers, which develop yellow olive-like berries. The berries, when ripe, turn bluish-black and are dried for medicinal use.

What's It Made Of?

Saw palmetto's active ingredients are fatty acids and plant sterols. However, most likely the fatty acids and sterols are not the only part of the berries that affect hormone production, and it will take more scientific study before we know exactly how saw palmetto works.

The berries also contain high-molecular-weight polysaccharides, which are usually associated with either anti-inflammatory or immune-stimulant effects.

Available Forms

You can buy saw palmetto as crude dried berries, tea, powdered capsules, tablets, liquid tinctures, and liposterolic extracts. Look for products that say on the labels that they are standardized and contain 85 to 95 percent fatty acids and sterols.

How to Take It

Saw palmetto relieves symptoms of Stage I and II BPH. Common symptoms include frequent need to urinate, a delay before you are able to urinate, dripping after urinating, and having to get up numerous times throughout the night to urinate. The majority of men over 60 are considered to have urinary symptoms attributable to BPH, which can disturb sleep, affect self-confidence, cause constant low-grade anxiety or even pain, and may progress to infections in the bladder or kidneys. If you think you have BPH and your health care provider has suggested that you try saw palmetto, try to keep track of how it affects you. It shouldn't take long for you to notice whether it's helping you.

The recommended dosages for Stages I and II BPH is 160 mg, two times a day, of a fat-soluble saw palmetto extract, which has been standardized to contain 85 to 95 percent fatty acids and sterols.

Precautions

Saw palmetto is a very mild herb. Side effects are very rare and mild stomach complaints are the only recorded reactions. The American Herbal Products Association gives saw palmetto a class 1 safety rating, which means that it is safe when used as directed.

You should not try to self-diagnose, or self-medicate, BPH. Saw palmetto only relieves the symptoms of BPH, despite the fact that it alters DHT production and testosterone levels. It will not shrink the prostate. Your health care provider should monitor the course of BPH.

Saw palmetto should not be used during pregnancy or breast-feeding.

Possible Interactions

No harmful drug interactions have been reported.

Supporting Research

Blumenthal M, ed. The Complete German Commission E Monographs:Therapeutic Guide to Herbal Medicine. Boston, Mass: Integrative Medicine Communications; 1998.

Braeckman J. The extract of Serenoa repens in the treatment of benign prostatic hyperplasia: A multicenter open study. Curr Therapeut Res 1994;55:776–785.

Carilla E, Briley M, Fauran F, et al. Binding of Permixon, a new treatment for prostatic benign hyperplasia, to the cytosolic androgen receptor in the rat prostate. J Steroid Biochem 1984;20:521-523.

Carraro JC, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. The Prostate. 1996;29(4):231-240.

Champault G, Patel JC, Bonnard AM. A double-blind trial of an extract of the plant Serenoa repens in benign prostatic hyperplasia. Br J Clin Pharmacol. 1984;18:461-462.

Di Silverio F, D'Eramo G, Lubrano C, et al. Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Uro.1992;21:309-314.

Goepel M, Hecker U, Krege S. Saw palmetto extracts potently and noncompetitively inhibit human a1-adrenoceptors in vitro. Prostate. 1998;38(3):208–215.

Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200–2211.

el-Sheikh M, Dakkak MR, Saddique A. The effect of permixon on androgen receptors. Acta Obstet Gynecol Scand. 1988;67:397–399.

Hutchens AR. Indian Herbalogy of North America. Boston, Mass: Shambhala Publications; 1973:243–244.

Leung A, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons; 1996:467–468.

McGuffin M, Hobbs C, Upton R, Goldberg A. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, Fla: CRC Press; 1996.

Murray MT. The Healing Power of Herbs: Tthe Enlightened Person's Guide to the Wonders of Medicinal Plants. Rocklin, Calif: Prima Publishing; 1995.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London, England: The Pharmaceutical Press; 1996,

Schulz V, Hänsel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. Berlin, Germany: Springer-Verlag; 1998.

Sökeland J, Albrecht J. A combination of Sabal and Urtica extracts vs. finasteride in BHP (stage I to II acc. to Alken): A comparison of therapeutic efficacy in a one-year double-blind study. Urologe A. 1997;36:327–333.

Mandressi A, et al. Treatment of uncomplicated benign prostatic hypertrophy BPH by an extract of Serenoa Repens clinical results. J Endocrinol Invest. 1987;10(suppl 2):49.

Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA. 1998;280:1604–1609.

Wood HC, Osol A. United States Dispensatory. 23rd ed. Philadelphia, Pa: J.B. Lippincott; 1943;971–972.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.