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Saw Palmeto

(Sabal; Serenoa repens; Sabal serrulata)

Introduction

A member of the palm family, saw palmetto is found in coastal regions of Texas and Florida. The fruit and seeds of the saw palmetto plant have been claimed to be helpful in treating a wide variety of medical conditions. Current medical interest is focused on beneficial effects for men with enlarged prostates.

What other claims have been made for Saw Palmeto?

Claims have been made that Saw Palmeto can:

  • strengthening the thyroid gland
  • correcting hormonal imbalances
  • strengthening male and female reproductive systems
  • relieving testicular inflammation and breast tenderness
  • treat cough and congestion brought on by asthma, bronchitis and colds
  • balance the metabolism, aid digestion and stimulate the appetite to increase weight gain.

Any truth to these claims?

No scientific evidence to support nonprostate uses.

What does the prostate do and what are symptoms of prostate problems?

The prostate is a gland, located between the bladder and the penis, that produces various components of semen that mixes with sperm produced in the testes during ejaculation. The prostatic fluids are necessary for sperm to fertilize an egg.

The prostate gland continually enlarges in men as they age. This is known as "Benign Prostatic Hypertrophy" or BPH. Although the incidence of prostate cancer increases dramatically as men get older, BPH is not though to be a risk factor in and of itself for prostate cancer.

The urethra, a small tube carrying urine, passes through the prostate on its way from the bladder to the penis. BPH can cause narrowing of the urethra as it passes through the prostate. This can make it difficult to fully empty the bladder as the bladder stretches and loses some of its muscular tone over time.

Symptoms of BPH include:

  • urinating small amounts very frequently
  • weak urine stream
  • sudden urge to urinate with loss of bladder control if not able to reach a toilet quickly.
  • regularly waking up more than once a night to urinate
  • full aching sensation in the lower abdomen

Does Saw Palmeto help men with symptomatic BPH?

Studies in both Europe and the United States have shown Saw Palmeto to have a mild to modest beneficial effect on BPH symptoms. 2 There are several prescription medications available (Proscar™- finasteride; Hytrin™- terazosin) that produce similar results. The mechanism of action is unknown. Recent studies using MRI imaging do not show a decrease in overall prostate size; however, a small amount of tissue near the urethra does appear to shrink in size possibly resulting in improved urine flow.

  • In over 50% of patients medical therapy is not effective.

  • Those whom it is effective may require at least six to twelve months of daily use to see a benefit.

  • Saw Palmeto appears about as effective as Hytrin™ and Proscar™in decreasing BPH symptoms. 1, 3

  • Saw Palmeto does not appear to effect PSA (Prostate Specific Antigen) levels and thus does not interfere with PSA screening for prostate cancer.
For many men a surgical procedure known as a "TURP" or transurethral resection of prostate is the most (only) effective option. In this procedure an instrument is passed through the urethra to the prostate with prostate tissue being removed from within the prostate thus widening the prostatic urethra. In layman's terms this is known as a Rotorooter ream job.

 

Any side effects or drug interactions?

None reported thus far.

Dose

Saw Palmetto Concentrate contains 160 mg per capsule. Typical doses are 1 or 2 capsules two times or four times daily.

Bottom Line

Saw Palmeto, Hytrin and Proscar all are reasonable choices for men with mild to moderate symptoms of BPH who want to avoid surgery and can wait 6-12 months if they are not helped by medication treatment. Optimal dosing is not known.

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Resources

1. Carraro JC, Raynaud JP, Koch G, Chisholm GD, DiSilverio F, Teillac P, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostatic hyperplasia: a randomized international study of 1,098 patients. Prostate 1996;29:231-40.

2. Marks LS, Partin AW, Epstein JI, Tyler VE, Simon I, Macairan ML, Chan TL, Dorey FJ, Garris JB, Veltri RW, Santos PB, Stonebrook KA, deKERNION JB. Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol 2000 May;163(5):1451-63.

3. Roehrborn CG, Oesterling JE, Auerbach S, Kaplan SA, Lloyd LK, Milam DE, Padley RJ. Hytrin Community Assessment Trial study: a one-year study of terazosin versus placebo in the treatment of men with symptomatic benign prostatic hyperplasia. Urology 1996 Feb;47(2):159-68

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