Articles

Saw Palmetto

Plant Part Used

Berry

Active Constituents

Steroidal saponins (beta-sitosterol), fatty acids, polysaccharides, zinc, volatile oils, caprylic acid.(1),(23)

[span class=alert]This section is a list of chemical entities identified in this dietary supplement to possess pharmacological activity. This list does not imply that other, yet unidentified, constituents do not influence the pharmacological activity of this dietary supplement nor does it imply that any one constituent possesses greater influence on the overall pharmacological effect of this dietary supplement.[/span]

Introduction

Saw palmetto is an evergreen palm that grows along the Southeastern and Gulf coast of the United States of America. Saw palmetto has been used as a food source by Native Americans for centuries, and also used as a medicinal agent in urinary complications. Saw palmetto is mainly used in men suffering from benign prostatic hyperplasia (BPH).(2),(3),(4) There have been several studies reporting the effects of saw palmetto in BPH, some as being at least as good as the common pharmaceutical drugs used to treat BPH.(5),(6) Saw palmetto has also been used in nocturnal enuresis and other urinary tract disorders.(7)

Interactions and Depletions

Interactions

Dosage Info

Dosage Range

80-320mg (standardized extract), 2 times a day.

Most Common Dosage

160mg (standardized extract), 2 times a day.

Standardization

[span class=doc]Standardization represents the complete body of information and controls that serve to enhance the batch to batch consistency of a botanical product, including but not limited to the presence of a marker compound at a defined level or within a defined range.[/span]

The most current available medical and scientific literature indicates that this dietary supplement should be standardized to 80-90% free fatty acids per dose.

Uses

Frequently Reported Uses

  • Benign Prostate Hyperplasia (BPH)

Other Reported Uses

  • Prostate cancer
  • Urinary Tract Disorders
  • Impotence
  • Immune Enhancement

Toxicities & Precautions

General

This dietary supplement is considered safe when used in accordance with proper dosing guidelines.(8),(24)

Concern has been raised regarding the effect that saw palmetto use can have on serum prostate specific antigen (PSA). Research shows that saw palmetto use apparently has no effect on the PSA level.(9),(10),(11) Proprietary herbal blends that contain saw palmetto as well as other products have been formulated to improve symptoms associated with the prostate. Studies and case reports show that these blends can alter the PSA level.(12),(13)

Pregnancy/ Breast Feeding

If pregnant or nursing, consult a physician before use.

Age Limitations

Do not use in children under 2 years of age unless recommended by a physician.

Pharmacology

Men’s Health

Benign prostatic hyperplasia (BPH) is thought to be caused by an increase in the conversion of testosterone to 5-a dihydrotestosterone (DHT) in the prostate.(14) DHT stimulates the production of prostate cells. Excessive formation of DHT leads to overproduction and enlargement of the prostate (hyperplasia). Another factor is the presence of estrogen which inhibits the elimination of DHT. There are several reported mechanisms of action of saw palmetto for use in treating BPH. They include inhibition of DHT production, inhibition of the binding of DHT to its receptors and promoting its breakdown.(15),(16),(17) Pretreatment of saw palmetto to patients with benign prostatic hyperplasia undergoing a transurethral resection of prostate operation seemed to have improved efficacy of the procedure itself and experienced a reduced risk of complications.(18)

Also, saw palmetto is reported to exert an antiestrogenic effect, as well as an antiandrogenic effect.(3) Some investigators believe that its antiestrogenic effect may be more important than any of its other actions. Saw palmetto inhibits 5-a reductase, an enzyme that catalyzes the conversion of testosterone into DHT, having alpha-1 and alpha-2 adrenergic blocking capabilities.(19),(20) Various clinical studies have reported the positive benefits of using standardized saw palmetto extracts in the prevention of BPH.(21) Saw palmetto has compared favorably with drug treatments for BPH including finasteride and tamsulosin.(25)

A 2009 Cochrane Database System Review looked at studies in 5222 men with BPH. The authors concluded that saw palmetto was not more effective than placebo for treatment of urinary symptoms consistent with BPH.(26) However, a combination of saw palmetto and nettle (Urtica dioica) in 219 people reported significant benefits in LUTS (International Prostate Symptom Score).(27) Similar results using saw palmetto and urtica extract in combination have been reported in other human trials.(28),(29) A 12 month Korean study found a combination of saw palmetto and pumpkin seed oil in 47 men with BPH was found to improve the quality of life in these patients.(30) Saw palmetto in combination with curcumin (Curcuma longa) and the bioflavonoid quercitin improved the efficacy of in conjunction with the antiboitic prulifloxacin in treating bacterial prostatitis.(31)

Other Uses

Laboratory studies have reported saw palmetto extracts are effective against various cancer cells lines, inducing growth arrest and apoptosis.(32),(33),(34),(35) Beta-sitosterol and stigmasterol are reported to have antitumor activity in laboratory studies.(36)

Of interest is immune stimulating activity of polysaccharides found in the fruit of saw palmetto.(22) In vitro, a 4:1w/v water extract of the fruit produced an increase in phagocytic activity by 36 percent. Also, in laboratory mice, the polysaccharide fraction of saw palmetto berry (10mg/kg) produced a much higher carbon clearance value than echinacea (Echinacea purpurea) or Siberian ginseng (Eleutherococcus senticosus) and showed a higher value than any of nine other plant extracts.(22) However, the standardized and alcohol extracted preparations of saw palmetto are not extracted with water, so would not contain these immune stimulating polysaccharides – use encapsulated raw berries.

References

  1. View Abstract: Di Silverio F, et al. Plant Extracts in BPH. Minerva Urol Nefrol. 1993;45(4):143-49.
  2. Briley M, et al. Permixon, a New Treatment for Prostatic Benign Hyperplasia, Acts Directly at the Cytosolic Androgen Receptor in Rat Prostate. J Steroid Biochem. 1979;10:483-86.
  3. View Abstract: Di Silverio F, et al. Evidence that Serenoa repens Extract Displays an Antiestrogenic Activity in Prostatic Tissue of Benign Prostatic Hypertrophy Patients. European Urologv. 1992;21(4):309-14.
  4. View Abstract: Plosker GL, et al. Serenoa repens (Permixon). A Review of Its Pharmacology and Therapeutic Efficacy in Benign Prostatic Hyperplasia. Drugs Aging. 1996;9(5):379-95.
  5. View Abstract: Strauch G, et al. Comparison of Finasteride (Proscar) and Serenoa repens (Permixon) in the Inhibition of 5-alpha Reductase in Healthy Male Volunteers. European Urology. 1994;26:247-52.
  6. View Abstract: Iehle C, et al. Human Prostatic Steriod 5-alpha-Reductase Isoforms--A Comparative Study of Selective Inhibitors. J Steroid Biochem & Molecular Biol. 1995;54(5-6):273-79.
  7. View Abstract: Bracher F. Phytotherapy of Benign Prostatic Hyperplasia. Urologe A. Jan1997;36(1):10-17.
  8. Sabal fructus (Saw Palmetto fruit). German Commission E Monograph. Mar1989:Bundesanzeiger, no. 43.
  9. View Abstract: Marks LS, Partin AW, Epstein JI, Tyler VE, Simon I, Macairan ML, et al. Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol. May2000;163(5):1451-6.
  10. View Abstract: Gerber GS. Saw palmetto for the treatment of men with lower urinary tract symptoms. J Urol. May2000;163(5):1408-12.
  11. View Abstract: Gerber GS, Zagaja GP, Bales GT, Chodak GW, Contreras BA. Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Urology. Jun1998;51(6):1003-7.
  12. View Abstract: Porterfield H. UsToo PC-SPES surveys: review of studies and update of previous survey results. Mol Urol. Sep2000;4(3):289-91.
  13. View Abstract: de la Taille A, Hayek OR, Burchardt M, Burchardt T, Katz AE. Role of herbal compounds (PC-SPES) in hormone-refractory prostate cancer: two case reports. J Altern Complement Med. Oct2000;6(5):449-51.
  14. Braeckman J. The Extract of Serenoa repens in the Treatment of Benign Prostatic Hyperplasia: A Multicenter Open Study. Curr Ther Res. 1994;55(7):76-84.
  15. View Abstract: Ravenna L, et al. Effects of the Lipidosterolic Extract of Serenoa repens (Permixon) on Human Prostatic Cell Lines. Prostate. 1996;29(4):219-30.
  16. View Abstract: Delos S, et al. Testosterone Metabolism in Primary Cultures of Human Prostate Epithelial Cells and Fibroblasts. J Steroid Biochem & Molecular Biol. 1994;48(4):347-52.
  17. View Abstract: Paubert-Braquet M, et al. Effect of Serenoa repens Extract (Permixon) on Stradiol/Testosterone-induced Experimental Prostate Enlargement in the Rat. Pharmacol Res. 1996;34(3-4):171-79.
  18. View Abstract: Pecoraro S, Annecchiarico A, Gambardella MC, Sepe G. Efficacy of pretreatment with Serenoa repens on bleeding associated with transurethral resection of prostate. Minerva Urol Nefrol. Mar2004;56(1):73-8.
  19. View Abstract: Sultan C, et al. Inhibition of Androgen Metabolism and Binding by a Liposterolic Extract of "Serenoa repens B" in Human Foreskin Fibroblasts. J Steroid Biochem. 1984;23:515.
  20. View Abstract: Goepel M, et al. Saw Palmetto Extracts Potently and Non-competitively Inhibit Human Alpha1-Adrenoceptors In Vitro. Prostate. Feb1999;38(3):208-15.
  21. View Abstract: Wilt TJ, et al. Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review. JAMA. Nov1998;280(18):1604-9.
  22. View Abstract: Wagner H, et al. Immunostimulating Action of Polysaccharides (Heteroglycans) From Higher Plants. Arzneimittelforschung. 1985;35(7):1069-75.
  23. Abe M, Ito Y, Suzuki A, Onoue S, Noguchi H, Yamada S. Isolation and pharmacological characterization of fatty acids from saw palmetto extract. Anal Sci. Apr 2009;25(4):553-557.
  24. Agbabiaka TB, Pittler MH, Wider B, Ernst E. Serenoa repens (saw palmetto): a systematic review of adverse events. Drug Saf. 2009;32(8):637-647. doi: 10.2165/00002018-200932080-00003. Review.
  25. Hizli F, Uygur MC. A prospective study of the efficacy of Serenoa repens, tamsulosin, and Serenoa repens plus tamsulosin treatment for patients with benign prostate hyperplasia. Int Urol Nephrol. 2007;39(3):879-886. Epub 2007 Jan 4.
  26. Tacklind J, MacDonald R, Rutks I, Wilt TJ. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 15 Apr 2009;(2):CD001423. Review.
  27. Lopatkin N, Sivkov A, Schläfke S, Funk P, Medvedev A, Engelmann U. Efficacy and safety of a combination of Sabal and Urtica extract in lower urinary tract symptoms--long-term follow-up of a placebo-controlled, double-blind, multicenter trial. Int Urol Nephrol. 2007;39(4):1137-1146. Epub 2007 Feb 15.
  28. Lopatkin NA, Sivkov AV, Medvedev AA, et al. [Combined extract of Sabal palm and nettle in the treatment of patients with lower urinary tract symptoms in double blind, placebo-controlled trial]. Urologiia. Mar-Apr 2006;(2):12,14-19. Russian.
  29. Engelmann U, Walther C, Bondarenko B, Funk P, Schläfke S. Efficacy and safety of a combination of sabal and urtica extract in lower urinary tract symptoms. A randomized, double-blind study versus tamsulosin. Arzneimittelforschung. 2006;56(3):222-229.
  30. Hong H, Kim CS, Maeng S. Effects of pumpkin seed oil and saw palmetto oil in Korean men with symptomatic benign prostatic hyperplasia. Nutr Res Pract. Winter2009;3(4):323-327. Epub 2009 Dec 31.
  31. Cai T, Mazzoli S, Bechi A, Addonisio P, Mondaini N, Pagliai RC, Bartoletti R. Serenoa repens associated with Urtica dioica (ProstaMEV) and curcumin and quercitin (FlogMEV) extracts are able to improve the efficacy of prulifloxacin in bacterial prostatitis patients: results from a prospective randomised study. Int J Antimicrob Agents. Jun2009;33(6):549-553. Epub 2009 Jan 31.
  32. Che Y, Hou S, Kang Z, Lin Q. Serenoa repens induces growth arrest and apoptosis of human multiple myeloma cells via inactivation of STAT 3 signaling. Oncol Rep. Aug2009;22(2):377-383.
  33. Petrangeli E, Lenti L, Buchetti B, et al. Lipido-sterolic extract of Serenoa repens (LSESr, Permixon) treatment affects human prostate cancer cell membrane organization. J Cell Physiol. Apr 2009;219(1):69-76.
  34. Yang Y, Ikezoe T, Zheng Z, Taguchi H, Koeffler HP, Zhu WG. Saw Palmetto induces growth arrest and apoptosis of androgen-dependent prostate cancer LNCaP cells via inactivation of STAT 3 and androgen receptor signaling. Int J Oncol. Sep 2007;31(3):593-600.
  35. Baron A, Mancini M, Caldwell E, et al. Serenoa repens extract targets mitochondria and activates the intrinsic apoptotic pathway in human prostate cancer cells. BJU Int. May 2009;103(9):1275-1283. Epub 2009 Jan 14.
  36. Scholtysek C, Krukiewicz AA, Alonso JL, Sharma KP, Sharma PC, Goldmann WH. Characterizing components of the Saw Palmetto Berry Extract (SPBE) on prostate cancer cell growth and traction. Biochem Biophys Res Commun. 13 Feb 2009;379(3):795-798. Epub 2008 Dec 6.