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Saw palmetto

Also listed as: Sabal serrulata; Serenoa repens

• Overview
• Plant Description
• What's It Made Of?
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Saw palmetto ( Serenoa repens/Sabal serrulata ) is a palm-like plant that is native to the southeastern United States. The berries of the American saw palmetto plant can increase urine flow, reduce inflammation, and relieve muscle spasms.

Saw palmetto berries were a staple food among native Americans of the southeastern United States. They also used them to treat digestive problems and intestinal disease, and even to boost libido. Early in the 20th century, saw palmetto was listed in the US Pharmacopoeia as an effective remedy for bladder and urinary tract inflammation, breast disorders, bronchitis, laryngitis, and benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland.

Benign Prostatic Hyperplasia (BPH)

Saw palmetto has been used by millions of men to ease BPH symptoms and is often recommended as an alternative to the medication finasteride (Proscar). However, a well-conducted study published in the February 9, 2006 edition of the New England Journal of Medicine found that the popular herb was no better than a dummy pill in relieving the signs and symptoms of BPH. Further studies are needed. If you use saw palmetto and think it works, ask your health care provider if you should still take it.

Other Uses for Saw Palmetto

Saw palmetto may also be useful in treating the following conditions:

• Hirsutism -- an excessive growth of dark, coarse body and facial hair in women
• Polycystic ovarian disease  -- multiple ovarian cysts that lead to menstruation problems and possible infertility

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 has white flowers, which produce yellow berries. The berries turn bluish-black when ripe, and are dried for medicinal use.

What's It Made Of?

Saw palmetto's active ingredients include fatty acids, plant sterols, and flavonoids. The berries also contain high molecular weight polysaccharides, which are usually associated with either anti-inflammatory or immune-stimulant effects.

Available Forms

Saw palmetto can be purchased as dried berries, tea, powdered capsules, tablets, liquid tinctures, and liposterolic extracts. The product label should indicate that contents are standardized and contain 85 - 95% fatty acids and sterols. In a ConsumerLab.com evaluation, more than a third of the leading brands of saw palmetto did not contain the standard amount. Read labels carefully and buy only from reputable companies.

How to Take It

Children

Saw palmetto is not currently recommended for children.

Adult

The recommended dosages for early stages of BPH is 160 mg, twice a day. The supplement should be a fat-soluble saw palmetto extract that contains 85 - 95% fatty acids and sterols.

Precautions

Because of the potential for side effects and interactions with medications, herbs should be taken only under the supervision of a knowledgeable healthcare provider.

Saw palmetto is a very mild herb. The American Herbal Products Association gives saw palmetto a class 1 safety rating, which means that it is safe when used as directed. Side effects are very rare, although mild stomach complaints and minor headaches may occur. One case of significant bleeding during surgery has been attributed to saw palmetto use prior to the operation.

Saw palmetto has not been studied or used in women who are pregnant or nursing.

Saw palmetto may interfere also with the absorption of iron.

Possible Interactions

Finasteride (Proscar)

Because saw palmetto may work similarly to finasteride (Proscar), you should not use this herb in combination with finasteride or other medications used to treat BPH.

Supporting Research

Bent S, Kane C, Shinohara K, et. al. Saw Palmetto for Benign Prostatic Hyperplasia. NEJM . 2006; 354:557-566.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs . Newton, MA: Integrative Medicine Communications; 2000:335-340.

Bone K, Mill S, eds. Principles and Practices of Phytotherapy, Modern Herbal Medicine . London: Churchill Livingstone; 2000:523-532.

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.

Darzynkiewicz Z, Traganos F, Wu JM, Chen S. Chinese herbal mixture PC-SPES in treatment of prostate cancer (Review). Int J Oncol . 2000;17:729-736.

De La Taille A, Buttyan R, Hayek O, et al. Herbal therapy PC-SPES: In vitro effects and evaluation of its efficacy in 69 patients with prostate cancer. J Urol . 2000;164:1229-1234.

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.

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

Ernst E. Herbal medications for common ailments in the elderly. Drugs Aging . 1999;15(6):423-428.

Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Intern Med . 2002;136(1):42-53.

Gerber GS. Saw palmetto for the treatment of men with lower urinary tract symptoms. J Urol. 2000;163(5):1408-1412.

Gerber GS, Kuznetsov D, Johnson BC, Burstein JD. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology . 2001;58(6):960-965.

Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs . 2001;61(15):2163-2175.

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

Koch E. Extracts from fruits of saw palmetto ( Sabal serrulata ) and roots of stinging nettle ( Urtica dioica ): viable alternatives in the medical treatment of benign prostatic hyperplasia and associated lower urinary tracts symptoms. Planta Med . 2001;67(6):489-500.

Marks LS, Partin AW, Epstein JI, et al. Effects of saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol. 2000;163(5):1451-1456.

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

O'Hara M, Kiefer D, Farrell K, Kemper K. A review of 12 commonly used medicinal herbs. Arch Fam Med. 1998;7(6):523-536.

Pittler MH. Complementary therapies for treating benign prostatic hyperplasia. FACT . 2000;5(4):255-257.

Pizzorno JE, Murray MT. Textbook of Natural Medicine . New York, NY: Churchill Livingstone; 1999:943-946,1147-1152.

Quality of prostate supplements get mixed review in consumerlab.com study. January 31, 2000; Accessed on April 29, 2002 at http://www.consumerlab.com/news/news_13100.asp

Robbers JE, Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals . New York: NY: The Haworth Herbal Press; 1999:103-105.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine . Philadelphia, Penn: Hanley & Belfus, Inc.; 2002:327-331.

Small EJ, Frohlich MW, Bok R, et al. A prospective trial of the herbal supplement PC-SPES in patients with progressive prostate cancer. J Clin Oncol . 2000;18(21):3595-3603.

Sultan C, Terraza A, Devillier 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;20(1):515-519.

Wilt TJ, Ishani A, Rutks I, MacDonald R. Phytotherapy for benign prostatic hyperplasia.

Public Health Nutr . 2000;3(4A):459-472.

Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systemic review. JAMA. 1998;280(18):1604-1609.

• Review Date: 2/9/2006
• Reviewed By: A.D.A.M. Editorial. Previously reviewed by: Robert A. Anderson, MD (April 1999), President, American Board of Holistic Medicine, East Wenatchee, WA; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Newton, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick, MA; Steven Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's Administrative Hospital, Londonderry, NH; R. Lynn Shumake, PD, Director, Alternative Medicine Apothecary, Blue Mountain Apothecary & Healing Arts, University of Maryland Medical Center, Glenwood, MD; David Winston, Herbalist (April 1999), Herbalist and Alchemist, Inc., Washington, NJ; Tom Wolfe, P.AHG (April 1999), Smile Herb Shop, College Park, MD. All interaction sections have also been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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