saw palmetto

More about Saw Palmetto: Purpose Preparations Precautions Side effects Interactions Resources

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.

— Ken R. Wells

---

n.
A small creeping palm (Serenoa repens) of the southeast United States, having palmately divided leaves with one-ribbed segments and black, one-seeded fruit.

For more information on saw palmetto, visit Britannica.com.

Key Terms: Malignant.

Definition

Saw palmetto is a natural plant remedy used to treat men who are experiencing difficulty when urinating. 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.

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).

Although saw palmetto has also been used to treat prostatitis and chronic pelvic pain syndrome (CPPS) in men, it does not appear to be useful for these conditions. 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.

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. In general, however, persons taking birth control pills, estrogen replacement therapy, or testosterone replacement therapy should consult their doctor before taking saw palmetto. Patients taking any supplements such as vitamins or herbs should tell their doctor.

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. .

—Tish Davidson, AM; Rebecca J. Frey, PhD

North American palm (Serenoa repens, S. serrulata); the berries were eaten by native Americans, and there is some evidence that the oil may have beneficial effects in treatment of benign prostate enlargement. It also contains sterols.

Brand names: Centrum® Herbals Saw Palmetto , One-A-Day® Prostate Health, Quanterra™ Prostate

Español:
• Tabletas y cápsulas de palma enana americana, Serenoa repens

Saw Palmetto, Serenoa repens tablets and capsules

What is saw palmetto?

Saw palmetto (Centrum® Herbals Saw Palmetto, One-A-Day® Prostate Health, Quanterra(TM) Prostate, and many others) is a dietary supplement (herbal remedy) that is being promoted for its ability to improve symptoms associated with swelling of the prostate gland in men. Enlargement of the prostate gland, sometimes called benign prostatic hypertrophy or BPH, is not a self-limiting condition and should not be self-diagnosed. The decision to self-treat symptoms of prostate enlargement with saw palmetto may prevent proper medical treatment. For example, self-treatment could delay the detection of prostate carcinoma or other urinary tract problem. You are advised to see your health care professional for evaluation prior to the use of saw palmetto.

What should I tell my health care provider before I take this medicine?

It is important for you to tell your prescriber or health care professional or other health care provider that you are using saw palmetto. Some herbs exert potent effects and may interact with other drugs you are taking.

You should discuss saw palmetto with your health care professional BEFORE taking it if you have any of these conditions:
• liver disease
• prostate cancer
• an unusual or allergic reaction to plants or herbs, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

This herb should be taken orally (i.e., swallowed). It is recommended that you take this herb with food to minimize stomach upset. The effects of saw palmetto take several weeks to appear so it should be taken daily for several weeks for best results.

What if I miss a dose?

Missing a dose is probably not harmful. If you miss a dose, simply resume taking it on your previous schedule. Do not take double doses to catch up, however.

What drug(s) may interact with saw palmetto?

• finasteride
• hormones

For many herbs, interactions with other medications are unknown. That is why you should always be careful when mixing herbal remedies with traditional medications. If you take any other medications, consult with your health care professional prior to taking saw palmetto.

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking saw palmetto?

Since saw palmetto is derived from a plant, allergic reactions are possible. Stop using this herb if you develop a rash. You may want to see your health care professional, or inform them that this occurred.

Do not use saw palmetto if you are currently being treated for prostate problems except on the advice of your health care professional. Saw palmetto may interfere with your treatments. Also do not stop your prescribed treatments without talking to your prescriber or health care professional.

Different brands of saw palmetto might contain different amounts of active ingredient so be careful to use the same brand. It is recommended that you use a brand from a reliable manufacturer and one that has been standardized. A standardized product is more likely to contain the same amount of herb from dose to dose. Your health care professional or pharmacist can assist you in finding a standardized product.

If you are scheduled to have surgery, let your surgeon know you are taking saw palmetto.

What side effects may I notice from using saw palmetto?

Serious side effects with saw palmetto are rare. Side effects that you should report to your prescriber or health care professional as soon as possible:
• abdominal pain
• dark yellow or brown urine
• fever or chills
• lower back or side pain
• severe nausea and vomiting
• pain or increased difficulty in passing urine
• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• breast tenderness or enlargement
• headache
• heartburn
• nausea or upset stomach

Where can I keep my medicine?

Keep out of the reach of children.
Store at room temperature between 8 and 25 degrees C (46 and 77 degrees F); do not freeze. Throw away any unused medicine after the expiration date.

GENERAL INFORMATION REGARDING DIETARY SUPPLEMENTS:
Dietary supplements include amino acids, vitamins, minerals, herbs, botanicals, and other plant-derived substances, and extracts of these substances. These products are easy to identify as they must state "Dietary Supplement" on the label. A "Supplement Facts" panel is provided on the label for most products. Supplements are not drugs and are not regulated like drugs. You should note that rigid quality control standards are not required for dietary supplements. Big differences in potency and purity of these products can occur. Scientific data to support the use of a dietary supplement for a certain disease or ailment may not be available. This product is not intended to diagnose, treat, cure or prevent any disease.

The Food and Drug Administration suggests the following to help consumers protect themselves:
• Always read product labels and follow directions.
• "Natural" doesn't mean a product is safe for humans to take.
• Look for products containing ingredients with the "USP" notation. This indicates the manufacturer followed the standards of the US Pharmacopoeia.
• Supplements produced or distributed by a nationally known food or drug company are more likely to be made under tight controls as these companies have standards in place for their other products. You can write to the company for more information about how the product was made.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

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.

[Article by: Ken R. Wells; Rebecca J. Frey, PhD]

saw palmetto	Buy Nature's Bounty Saw Palmetto
Saw Palmetto 350 Soft Gels