SAW PALMETTO

Occurrence

Saw palmetto is a palm found in the United States.

Uses

Saw palmetto is primarily used to treat mild to moderate benign prostatic hypertrophy (BPH), stages I, II. It is also used to treat chronic and subacute cystitis; to increase breast size, sperm count, sexual potency; and as a mild diuretic.

Indications

Saw palmetto (Serenoa repens) is a dwarf American palm native to the extreme southeastern United States. A lipidosterolic extract of its berries contains fatty acids (especially lauric acid), phytosterols, monocylglycerides, and polysaccharides. Fatty acids constitute more than 80% of the extract and are thought to be the most clinically effective component. It is widely used to treat benign prostatic hypertrophy (BPH). The berries themselves are less well absorbed than the extract and are therefore believed to be less effective.

Mechanism of action

Saw palmetto extract can inhibit the enzyme 5-α-reductase in vitro. This enzyme converts testosterone into dihydrotestosterone (DHT), which in turn contributes to prostatic enlargement. Saw palmetto also appears to have an antiinflammatory effect and can reduce DHT binding to prostatic androgen receptors (antiandrogenic effect). Despite its proposed 5-α-reductase mechanism, saw palmetto has not consistently lowered serum testosterone, DHT, or prostate-specific antigen (PSA) levels, so it is likely that other mechanisms exist.While several earlier studies did indicate lowered PSA levels, more recent research has not supported these findings. It appears that saw palmetto does not shrink the total prostate either, although it may reduce the size of the transition zone or inner prostatic epithelium.

Clinical Use

Numerous (but not all) trials have indicated improvement in BPH symptom scores compared to placebo with 1 to 3 months of therapy. Saw palmetto extract appears to be equally effective as finasteride (see Chapter 63) but is less effective than 1-adrenoceptor antagonists. No information appears to be available on the use of saw palmetto in the prevention of hair loss.

Anticancer Research

This plant’s ripe fruit is used to make medicine. This plant is rich in fatty acids andphytosterols (Lust 2014). It has been used in traditional medicine to treat benignprostatic hyperplasia and to decrease the symptoms of an enlarged prostate (Tacklindet al. 2012). This herb has repeatedly been shown, in multiple studies, to reduceprostate cancer inflammation and enlargement. It appears to be completely safe touse, with no side effects. It also works for over 90% patients after 4–6 weeks(Champault et al. 1984). Traditional medicine suggests a dose of 320 mg of sawpalmetto, daily for 2 months before prostate surgery to minimise the risk of surgeryand blood loss (Lust 2014).

Side effects

Headache and GI symptoms are the most frequently reported side effects. It is possible to reduce GI side effects, such as nausea, abdominal discomfort, and diarrhea, by taking the extract with food. Theoretically, decreased libido or erectile dysfunction could also occur. Because of saw palmetto’s possible hormonal effects (and lack of indications for use), pregnant and nursing women should avoid it. It is important to rule out prostate cancer in those taking saw palmetto for BPH, since the symptoms are similar. The effect of saw palmetto on prostatic cancer would likely be beneficial but not curative. No drug interactions have been reported.