Saw Palmetto

Saw palmetto is a native plant of North America, and although Europeans are its principal consumers, it is still primarily grown in the United States. The saw palmetto tree grows only about 2 to 4 feet high, with fan-shaped serrated leaves and abundant berries. Native Americans used these berries for the treatment of various urinary problems in men, as well as for women with breast disorders. European and American physicians took up saw palmetto as a treatment for benign prostatic hyperplasia (BPH), but in the United States the herb ultimately fell out of favor, along with all other herbs. European interest endured, and in the 1960s, French researchers discovered that by concentrating the oils of saw palmetto berry they could maximize the herbs effectiveness. Saw palmetto contains many biologically active chemicals. Unfortunately, we dont know which ones are the most important. We also dont really know how saw palmetto works, although it appears to interact with various sex hormones.

Saw palmetto oil is an accepted medical treatment for benign prostatic hyperplasia (BPH) in New Zealand, France, Germany, Austria, Italy, Spain, and other European countries. In some countries it is regarded as the gold standard against which new prostate drugs must prove themselves! Typical symptoms of BPH include difficulty starting urination, weak urinary stream, frequent urination, dribbling after urination, and waking up several times at night to urinate. Research suggests that saw palmetto can markedly improve all these symptoms. Benefits require approximately 4 to 6 weeks of treatment to develop. It appears that about two thirds of men respond reasonably well. Furthermore, while the prostate tends to continue to grow when left untreated, saw palmetto causes a small but definite shrinkage. In other words, it isn't just relieving symptoms, but may actually be retarding prostate enlargement. The drug Proscar does this too (and to even a greater extent than saw palmetto) but other standard medications for BPH have no effect on prostate size. Research tells us that saw palmetto is equally effective to Proscar, but it has one great advantage: It leaves PSA (prostate-specific antigen) levels unchanged. Cancer raises PSA levels, and lab tests that measure PSA are used to screen for prostate cancer. Because Proscar lowers PSA measurements, its use may have the unintended effect of masking prostate cancer. Saw palmetto wont do this. On the other hand, Proscar has been shown to reduce the need for surgery, unlike saw palmetto or any of the other drugs used for BPH. Saw palmetto also appears to be equally effective as another class of standard drugs known as alpha blockers, but may cause fewer side effects. Note: Before self-treating with saw palmetto, be sure to get a proper medical evaluation to rule out prostate cancer. Saw palmetto is also widely used to treat chronic prostatitis, but it may not be effective. An open trial that compared saw palmetto to the drug Proscar for the treatment of chronic nonbacterial prostatitis found that while the drug proved effective, the herb did not. In addition, saw palmetto is sometimes recommended as a treatment for hair loss, but there is no evidence as yet that it is effective for this purpose.

BPH The science for the effectiveness of saw palmetto in treating prostate enlargement is quite strong, although it could stand to improve. At least seven double-blind studies involving a total of about 500 people have compared the benefits of saw palmetto against placebo over a period of 1 to 3 months. In these studies, the herb significantly improved urinary flow rate and most other measures of prostate disease. Only one study failed to find any benefit. This is fairly impressive, but it would be nice to have a long-term (6 months to 1 year) study of saw palmetto versus placebo. A double-blind study followed 1,098 men who received either saw palmetto or the drug Proscar over a period of 6 months (unfortunately, there was no placebo group). The treatments were equally effective, but while Proscar lowered PSA levels and caused a slight worsening of sexual function on average, saw palmetto caused no significant side effects. Both treatments caused the prostate to shrink, but Proscar had a greater effect. A 52-week double-blind study of 811 men compared saw palmetto to a standard drug in another class: the alpha-blocker tamsulosin. Once again, both treatments proved equally effective. However, saw palmetto caused fewer side effects than the drug. In addition, the herb caused some prostate shrinkage, while the drug caused a slight prostate enlargement. A study involving 435 men found that the benefits of saw palmetto endure for at least 3 years. However, there was no control group in this study, making the results unreliable. A 48-week double-blind trial of 543 men with early BPH compared combined saw palmetto and nettle root against Proscar and found equal benefits. Finally, a 6-month double-blind placebo-controlled trial of 44 men given a saw palmetto herbal blend (containing, in addition, nettle root and pumpkin seed oil) found shrinkage in prostate tissue. No significant improvement in symptoms was seen, but the authors pointed out that the study size was too small to statistically detect such improvements if they did occur. Non-Specific Lower Urinary Tract Symptoms Some men experience annoying symptoms similar to those caused by an enlarged prostate, but not necessarily related to BPH. A recent study found that saw palmetto might help. This 6-month double-blind placebo-controlled study of 81 men with moderate to severe lower urinary tract symptoms (LUTS) found that use of saw palmetto led to a statistically significant improvement in symptoms as compared with placebo.

The standard dosage of saw palmetto for the treatment of BPH is 160 mg twice a day of an extract standardized to contain 85 to 95% fatty acids and sterols. A single daily dose of 320 mg may be just as effective for this condition. However, taking more than this amount does not seem to produce better results.

Saw palmetto is generally thought to be essentially nontoxic. It is also nearly side-effect free. In a 3-year study only 34 of the 435 participants complained of side effects—primarily the usual mild gastrointestinal distress. However, there is one unexpected case report of saw palmetto apparently causing excessive bleeding during surgery. The significance of this isolated event isnt clear, but it definitely raises concerns. It is probably prudent to avoid saw palmetto prior to and just after surgery, and during the period surrounding labor and delivery. Individuals with bleeding problems (such as hemophillia) should also avoid saw palmetto, as should those taking any drug that thins the blood, such as warfarin (Coumadin), heparin, aspirin, clopidogrel (Plavix), ticlopidine (Ticlid), and pentoxifylline (Trental). Saw palmetto has no known drug interactions. Safety for pregnant or nursing women, or those with severe kidney or liver disease has not been established.