Historical overview
(1)Saw Palmetto has many names: sabal serulata, Saw Palmetto, serenoa repens. The first inhabitants of America, the Mayas, already used its fruit (or berry). Traditionally, Saw Palmetto berries were used as a male reproductive system tonic: Saw Palmetto had a reputation for stimulating male hormone production (see pharmacology). Moreover, Saw Palmetto berries were used for every urinary problem and were considered to have breast-enhancing properties in women and to improve fertility.
The first European settlers considered its fruits as an emergency food because they keep very well when dried (however, they were not meant to please our taste buds).
Benign prostate hyperplasia (BPH) is a problem affecting men from the age of forty. At 50, 50% of men are affected and at 80, 95% of men have BPH symptoms and the other 5% have a latent form without symptoms. The main BPH symptoms are a reduction of urinary flow, a frequent sense of urgency to urinate, nocturia (frequent nighttime urination), an inability to completely empty the bladder and a residual urine volume of the bladder. BPH may cause an important decrease in the quality of life and may lead to serious complications like kidney infections and illnesses.
Contrary to popular belief, BPH is not a swelling (hypertrophy) but an increase in the number of cells (hyperplasia) in the prostate. Aside from surgery, no treatments can reduce the number of cells. However, the symptoms can be effectively treated and BPH progression can be reduced and even stopped.
The clinical picture of BPH contains many elements including tissue inflammation, an increase of the estrogen/testosterone ratio and spasms of the urinary sphincters. BPH is due in part to a transformation of testosterone into dihydrotestosterone (DHT), a hormone that is 10 times more potent, by the 5-alpha reductase enzyme. DHT is so potent that is stimulates prostate cell division.
Actions and pharmacology
Saw Palmetto is by far the most studied and most effective medicinal herb to treat benign prostate hyperplasia symptoms. It contains many active components: some hydrosoluble, like flavonoids, tannins and sugars, and some liposoluble, like carotene, sterols, fatty acids and fatty alcohols. These liposoluble molecules are demonstrated to be the most active in BPH treatment. The extracts in the studies were standardized to 80 to 95% liposoluble components.
Saw Palmetto extract works in many different ways. It inhibits the 5-alpha reductase enzyme, therefore reducing DHT production. This effect seems to be specific to the prostate.(2) Saw Palmetto also has an antagonist effect on DHT at the receptor level, reducing the impact of the cellular DHT. It also has an anti-inflammatory effect via cyclo-oxygenase and lipo-oxygenase inhibition (these two enzymes are responsible for the synthesis of inflammation factors like prostaglandins and leucotrienes).(3) Moreover, Saw Palmetto has an antispasmodic effect that could improve urinary symptoms.(4) However, it does not modify the circulating hormone levels, which confirms that it is effective only at the cellular level.(5)
Recently, a few studies have looked into Saw Palmettos reported anti-cancer effect. Although this data comes from in vitro studies, Saw Palmetto seems to effectively stop the proliferation of cancerous prostate cells. A special fatty acid, myristoleic acid, would have cytotoxic properties on these cells.(6)
The German Commission E acknowledges its benefits in cases of: urination problems in benign prostatic hyperplasia.
Scientific studies
The first clinical studies on Saw Palmetto were conducted more than 30 years ago (1969). Many clinical studies on benign prostate hyperplasia demonstrate without a doubt the efficacy of 320 mg daily of a Saw Palmetto extract standardized to 85% fatty acids. A meta-analysis was published in December 2000 on the phytotherapeutic treatments of BPH. Specifically on Saw Palmetto, the authors found 18 controlled studies conducted in 1996 and 1997 and involving 2939 men. They noticed that Saw Palmetto is the treatment yielding the best results: objective improvement of symptoms (for example: reduction of nocturia evaluated by the number of nighttime urinations and subjective appreciation of effectiveness and side effects by the patients.(7)
Many studies compared Saw Palmetto to prescription medications. For example, a study published in 1996 has demonstrated that Saw Palmetto was as effective as finasteride (Proscar) but much better tolerated.(8)
Composition
Each capsule contains:
Organic Saw Palmetto berry extract (Sabal serrulata; Serenoa repens) (certified by BIO Suisse) 3200 mg
Other ingredients (capsule): Gelatin; glycerin; purified water; sorbitol (from natural plant source); red, black and yellow iron oxides
Dosage
Adults: take 1 capsule daily with a small amount of water after a meal.
Precautions, contraindications and interactions
Contraindication: known allergy to one of the ingredients.
Saw Palmetto is very well tolerated. A few side effects have been reported but the authors noted that they are similar to those reported with a placebo: gastric discomfort, nausea, diarrhea and/or constipation.
Saw Palmetto is not recommended during pregnancy and nursing.
BPH, prostatitis (prostate infection or inflammation) and prostate cancer should not be confused. A medical follow up is necessary for all men aged 40 and over.
References
1-Dionne JY, Gazella KA. Protecting your prostate. Impakt communications 2000. Green Bay Wi USA.
2-Bayne CW, Ross M, Donnelly F, Habib FK. The selectivity and specificity of the actions of the lipido-sterolic extract of Serenoa repens (Permixon) on the prostate. J Urol 2000 Sep;164(3 Pt 1):876-81
3-Breu W, Hagenlocher M, Redl K, et al. Anti-inflammatory activity of sabal fruit extracts prepared with supercritical carbon dioxide. In vitro antagonists of cyclooxygenase and 5-lipoxygenase metabolism. Arzneimittelforschung 1992 Apr;42(4):547-51
4-Gutierrez M, Hidalgo A, Cantabrana B. Spasmolytic activity of a lipidic extract from Sabal serrulata fruits: further study of the mechanisms underlying this activity. Planta Med 1996 Dec;62(6):507-11
5-Casarosa C, Cosci di Coscio M, Fratta M. Lack of effects of a lyposterolic extract of Serenoa repens on plasma levels of testosterone, follicle-stimulating hormone, and luteinizing hormone. Clin Ther 1988;10(5):585-8
6-Iguchi K, Okumura N, Usui S et al. Myristoleic acid, a cytotoxic component in the extract from Serenoa repens, induces apoptosis and necrosis in human prostatic LNCaP cells. Prostate 2001 Apr;47(1):59-65
7-Wilt TJ, Ishani A, Rutks I, MacDonald R. Phytotherapy for benign prostatic hyperplasia. Public Health Nutr 2000 Dec;3(4A):459-72
8-Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate 1996;29:231-40.
9-Etude Bioforce
10-The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines. Blumenthal M et al 1998. American Botanical Council, 6200 Manor Rd, Austin, Texas
11-Natural Medicines Comprehensive DataBase 2001. Pharmacist`s Letter 3120 W. March Lane, PO Box 8190, Stockton, CA 95208
Information is taken from the A.Vogel website.
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