Saw palmetto extract

Saw palmetto extract is an extract of the fruit of "Serenoa repens". It is rich in fatty acids and phytosterols, and has shown promise in treating benign prostatic hyperplasiacite journal | author=Wilt TJ "et al" | title=Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review | journal=JAMA | year=1998 | volume=280 | pages= 1604–1609 | url=http://jama.ama-assn.org/cgi/content/full/280/18/1604 | doi=10.1001/jama.280.18.1604 ] .

Native Americans used the fruit for food, but also in the treatment of a variety of urinary and reproductive system problems. The Mayans drank it as a tonic, and the Seminoles used the berries as an expectorant and antiseptic.cite web |url=http://www.mayoclinic.com/health/saw-palmetto/NS_patient-sawpalmetto |title=Saw palmetto |accessdate=2008-04-17 |work=Mayo Clinic ] The European colonists learned of the use of saw palmetto. It was used as a crude extract for at least 200 years for various conditions including asthenia (weakness), recovery from major illness, and urogenital problems. For instance, the Eclectic physician H. W. Felter wrote of it, "Saw palmetto is a nerve sedative, expectorant, and a nutritive tonic, acting kindly upon the digestive tract...Its most direct action appears to be upon the reproductive organs when undergoing waste of tissue..." [http://www.henriettesherbal.com/eclectic/felter/serenoa.html Felter's complete text] ]

The Eclectics knew saw palmetto as more than a prostate herb. King's American Dispensatory, in 1898 claims:

It is also an expectorant, and controls irritation of mucous tissues. It has proved useful in irritative cough, chronic bronchial coughs, whooping-cough, laryngitis, acute and chronic, acute catarrh, asthma, tubercular laryngitis, and in the cough of phthisis pulmonalis. Upon the digestive organs it acts kindly, improving the appetite, digestion, and assimilation. However, its most pronounced effects appear to be those exerted upon the urino-genital tracts of both male and female, and upon all the organs concerned in reproduction. It is said to enlarge wasted organs, as the breasts, ovaries, and testicles, while the paradoxical claim is also made that it reduces hypertrophy of the prostate. Possibly this may be explained by claiming that it tends toward the production of a normal condition, reducing parts when unhealthily enlarged, and increasing them when atrophied. [ [http://www.henriettesherbal.com/eclectic/kings/serenoa.html King's American Dispensatory 1898] ]

In modern times, much research has been done on extract made from the fruits, which are highly enriched with fatty acids and phytosterols. This research has been the subject of a thorough meta-analysis published in the Journal of the American Medical Association and has been shown to be effective for the treatment of men with symptomatic benign prostatic hyperplasia (enlargement of the prostate) compared to placebo and the two major categories of drugs used for men with this condition. There are also small, positive clinical trials published on the use of saw palmetto extracts topically and internally for male-pattern baldnessFact|date=April 2008.

In 2005, a long-term, placebo-controlled trial showed that a combination of saw palmetto fruit and nettle root extracts were effective in treating urinary tract symptoms in older men.cite journal | author= Lopatkin N "et al" | title= Long-term efficacy and safety of a combination of sabal and urtica extract for lower urinary tract symptoms—a placebo-controlled, double-blind, multicenter trial | journal= World Journal of Urology | year= 2005 | volume= 23 | issue= 2 | pages= 139–146 | url= http://www.springerlink.com/index/N021278U68653773.pdf | doi= 10.1007/s00345-005-0501-9 ] However, in February 2006, a large, blinded placebo-controlled study published in the "New England Journal of Medicine" showed no reduction of symptoms from enlarged prostate by taking saw palmetto, as compared to placebo.cite journal | author=Bent S "et al" | title=Saw Palmetto for Benign Prostatic Hyperplasia | journal=NEJM | year=2006 | volume=354 | pages= 557–566 | url=http://content.nejm.org/cgi/content/abstract/354/6/557 | doi=10.1056/NEJMoa053085 ] Designers of the latest study questioned whether the differently-flavored placebos in previous studies were adequately blinded. Critics of the latest study questioned whether a sufficient dosage of active ingredients was given.cite audio | people = Allison Aubrey | date = 9 Feb 2006 | title = Morning Edition: Study Casts Doubt on Saw Palmetto as Prostate Remedy | url = http://www.npr.org/templates/story/story.php?storyId=5198053 | medium = Audio recording | publisher = National Public Radio ] The authors of the 2006 study stated in their report: "The level of active ingredient in the extract may not have been sufficient to produce a measurable effect. We cannot completely address this possibility, because the active ingredient in saw palmetto, if one exists, is not known. However, prior in vitro studies suggest that the active ingredient is contained within the fatty-acid fraction."

An earlier single case study on saw palmetto concluded that searching for information on a herbal medicine using MEDLINE alone was insufficient, and expanded their search to "alternative" databases, including AGRICOLA, EMBASE, IBIS, and Cochrane, plus a manual search of unindexed herbal journals.cite journal | author= McPartland JM, Pruitt PL. | title=Benign prostatic hyperplasia treated with saw palmetto: a literature search and an experimental case study | journal=JAOA | year=2000 | volume=100 | issue= 2 | pages= 89–96 | url=http://www.jaoa.org/cgi/reprint/100/2/89 ]

Other research has shown that the herb works by multiple mechanisms, including inhibiting 5-alpha-reductase, interfering with dihydrotestosterone binding to the androgen receptor, by relaxing smooth muscle tissue similarly to alpha antagonist drugs, and possibly by acting as a phytoestrogen.cite journal | author= Di Silverio F "et. al" | title= Effects of long-term treatment with Serenoa repens (Permixon) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia | journal=Prostate | year=1998 | volume=37 | issue= 2 | pages= 77&ndash;83 | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=9759701 | doi= 10.1002/(SICI)1097-0045(19981001)37:2<77::AID-PROS3>3.0.CO;2-I | doilabel= 10.1002/(SICI)1097-0045(19981001)37:277::AID-PROS33.0.CO;2-I] cite journal | author= Plosker GL, Brogden RN | title= Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia | journal=Drugs Aging | year=1996 | volume=9 | issue= 5 | pages= 379&ndash;95 | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=8922564]

Because the fruit is the part used and because a prolific quantity is produced by an adult saw palmetto plant, this herbal medicine is considered ecologically sustainable.

Though in vitro studies suggest saw palmetto has properties that might make it useful against prostate cancer cells or to reduce prostatitis, clinical trials are lacking.

David Winston RH (AHG) describes a variety of conditions where saw palmetto extract is useful for men and women, using both research and ethnobotanical uses. [cite book | author = David Winston | title =Saw Palmetto for Men & Women: Herbal Healing for the Prostate, Urinary Tract, Immune System and More (Medicinal Herb Guide) | publisher =Storey Publishing, LLC | date =1999 | id = ISBN 978-1580172066 ]

Contraindications and side effects

Though men taking saw palmetto may develop mild nausea, reduced libido, or erectile dysfunction, the rate of such problems is clinically and statistically far less common than in men taking drugs to treat BPH symptoms, based on the JAMA meta-analysis cited above. There are no known drug interactions. It should generally be avoided in pregnancy and lactation and in small children due to lack of experience and knowledge in these populations and because of the purely theoretical risk of hormonal interference.

It has not been proven that Saw palmetto causes a reduction of libido or erectile dysfunction. In fact saw Palmetto is used also as a light aphrodisiac; Saw palmetto reduces the DHT in the blood in a different way than Finasteride which could cause reduced libido. It is common to find in herbal drugs as a cure for sexual problems, such as reduced libido or erectile disfunction, a small dose of saw palmetto extract associated with ginseng or other plants that contain L-arginine (Emanuel Gargiulo)

While saw palmetto is generally considered safe, one of its primary active ingredients, beta-sitosterol, is chemically similar to cholesterol. High levels of sitosterol concentrations in blood have been correlated with increased severity of heart disease in men who have previously suffered from heart attacks.cite journal | author= Assmann G, "et. al" | title= Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Munster (PROCAM) study | journal=Nutr Metab Cardiovasc Dis | year=2006 | volume=16 | issue= 1 | pages= 13&ndash;21 | url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=16399487 | doi= 10.1016/j.numecd.2005.04.001]

As with other nutrients and herbs, various people may have different responses based on their chemical and biological make up.

References

External links

* [http://www.berkeleywellness.com/html/ds/dsSawPalmetto.php Guide to Supplements-Saw Palmetto] -Berkeley Wellness Letter
* [http://www.aafp.org/afp/20030315/1281.html Saw Palmetto for Prostate Disorders] -American Academy of Family Physicians
* [http://cancer.ucsd.edu/Outreach/PublicEducation/CAMs/sawpalmeto.asp Complementary and Alternative Therapies For Cancer Patients Saw Palmetto] -University of California at San Diego Medical Center