||Saw Palmetto Berry (English)|
repens/Sabal serrulata (Botanical)
Sabal fructus (Pharmacopeial)
Saw palmetto is a leading treatment for benign prostatic hyperplasia (BPH) in
Germany and Austria, and is among the top five dietary supplements sold in the
United States. It relieves bladder and urinary disturbances associated with
stage I and II BPH. Stage I symptoms include frequent urination, nocturia,
delayed urination, low urinary force, and post-void dribbling; stage II symptoms
herald bladder function debility and include urgency and incomplete emptying of
the bladder. Sexual dysfunction has also been reported. The majority of men over
60 are considered to have urinary symptoms attributable to BPH. The condition
may progress to prostate cancer, bladder infections, and damaged kidneys if left
First used in the treatment of BPH late in the nineteenth century, saw
palmetto has been the subject of at least 20 laboratory studies and 18 clinical
studies. These experiments demonstrated saw palmetto's antiestrogenic and
antiandrogenic effects and confirmed that the berry extract reduces
5-alpha-reductase. These are considered significant interventions in the
treatment of BPH.
Most recently, researchers assessed the results of 18 controlled trials and
concluded that saw palmetto can be as effective as finasteride in improving
BPH-affected urine flow and urgency. Compared to placebo, saw palmetto relieved
nocturia by 25%, urinary tract symptoms by 28%, increased peak urine flow by
28%, and decreased residual volume by 43%. Finasteride does shrink the prostate,
however, and saw palmetto does not.
Saw palmetto berries provided food and medicine for Native Americans for
centuries. Aside from their nutritional value, the berries were considered
expectorant, sedative, and diuretic by traditional folk healers. It was used to
reduce inflammation in genitourinary catarrh and to treat breast disorders in
women. Some herbalists claim that saw palmetto can increase breast size, and
that it is an aphrodisiac. These claims are unsubstantiated, however.
From 1906 to 1916, saw palmetto berries were listed in the U.S. Pharmacopoeia
and were described as effective remedies for chronic and subacute cystitis,
chronic bronchitis, laryngitis, catarrh that accompanies asthma, and enlarged
prostate glands. It was also in the National Formulary from 1926 to 1950.
The saw palmetto shrub is a fan palm that grows from 6 to 10 feet in warm
climates, from South Carolina to Mississippi and throughout Florida. Lush
palmate leaves have lance-shaped leaflets and are supported by spiny stems.
Flowers are white and develop yellow olive-like berries, which become
bluish-black when ripe and have an oily sheen attributable to their fatty acid
Saturated and unsaturated, mostly free fatty acids (capric, caprylic,
caproic, lauric, palmitic, and oleic acids); free and conjugated sterols; fruits
also contain high-molecular weight polysaccharides and flavonoids. Fat-soluble
extracts are standardized to contain 85% to 95% fatty acids and sterols.
Crude dried berries, tea, powdered encapsulations, tablets, tinctures, and
liposterolic extracts standardized to contain 85% to 95% fatty acids and
Saw palmetto was historically used as an expectorant and to treat general
debility, respiratory catarrh, and muscle wasting due to age or menopause.
Traditional herbal actions: Tonic for both female and male reproductive
systems and urinary tracts, nourishing tonic, anti-inflammatory, urinary
antiseptic, relaxant, diuretic.
Clinical applications: Used for the relief of symptoms of stage I and II BPH.
Future research may lead to the treatment of female androgen excess disorders,
such as hirsutism and polycystic ovary disease. Increases milk flow in nursing
mothers, used to treat infections of the genitourinary system, such as cystitis,
urethritis, and salpingitis.
Liposterolic extracts act at the cytosolic, androgenic receptor of prostate
tissue in vitro to inhibit 5-alpha-reductase, block adrenergic receptors, and
inhibit DHT-producing enzymes. Inhibition of dihydrotestosterone (DHT) and
5-alpha-reductase may have a positive effect in the treatment of BPH.
Finasteride inhibits 5-alpha-reductase, which in turn blocks testosterone from
transforming into DHT, and DHT may be responsible for the hyperproliferation of
prostate cells involved in the etiology of BPH.
Despite evidence of estrogenic activity, liposterolic extracts also
significantly stimulate antiestrogenic effects; it blocked nuclear estrogen
receptors in prostatic tissue samples of patients with BPH. After a 90-day
treatment period, researchers analyzed the function of androgen, estrogen, and
progesterone receptor tissues in 35 study participants. The group given saw
palmetto extract had lower cellular and nuclear estrogen and progesterone
receptor values than the placebo group. Cellular androgen levels remained the
same, but nuclear androgen levels declined. Estrogen may promote BPH due to
inhibition of hydroxylation and elimination of DHT. Some investigators feel that
estrogen's role in BPH is more significant than that of DHT.
|Dosage Ranges and Duration of
To reduce symptoms associated with stages I and II BPH: 160 mg liposterolic
extract, standardized to contain 85% to 95% fatty acids and sterols, or
- Tincture (1:4): 2 to 4 ml tid
- Fluid extract of dried berry pulp (1:1): 1 to 2 ml tid
- Capsules: 1,000 mg tid
- Tea: 2 tsp. dried berry with 24 oz. water, simmer slowly until liquid
is reduced by half, take 4 oz. tid. The tea tastes vile but is
Adverse effects are very rare and include mild stomach upset. The American
Herbal Products Association gives saw palmetto a class 1 safety rating,
indicating that it is safe with appropriate use.
Before self-medicating with saw palmetto, patients should get a firm
diagnosis of BPH. Although saw palmetto relieves symptoms, it does not shrink
the prostate; therefore, the condition should be closely monitored by a health
Saw palmetto has hormonal effects and should not be used during pregnancy or
lactation until specific studies prove otherwise.
No clinically significant interactions between saw palmetto and conventional
medications are known to have been reported in the literature to date, including
the German Commission E monograph (Blumenthal 1998). Because the mechanism of
action for saw palmetto is similar to that for finasteride, it has been
recommended that this herb not be used in combination with finasteride or other
antiandrogenic drugs (Chavez and Chavez 1998).
|Regulatory and Compendial
Dietary supplement in the U.S., saw palmetto is approved for use in the
treatment of stage I and II BPH by Germany's Commission E, and is on the General
Sales List (GSL) in England.
Blumenthal M, ed. The Complete German Commission E Monographs Therapeutic
Guide to Herbal Medicines. Boston: Integrative Medicine Communications;
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prostatic hyperplasia: a multicenter open study. Curr Therapeut Res.
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
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extract displays an antiestrogenic activity in prostatic tissue of benign
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Leung A, Foster S. Encyclopedia of Common Natural Ingredients Used in
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Sökeland J, Albrecht J. A combination of Sabal and Urtica
extracts vs. finasteride in BHP (stage I to II acc. to Alken): a comparison
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benign prostatic hyperplasia: a systematic review. JAMA.
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Copyright © 2000 Integrative Medicine
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