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Can Saw Palmetto Help an Enlarged Prostate?

Saw palmetto is one of the most common herbal remedies used in the treatment of benign prostate hyperplasia and for improving prostate health in general. It has also been well-studied for this use. Is saw palmetto effective for improving prostate health? How does it work and how should it be taken? Is it safe? Can it be combined with other natural remedies to improve prostate health? This article answers those questions and even more.
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What is Saw Palmetto?

Saw palmetto (Serenoa repens) is also sometimes referred to as Sabal serrulatum especially in alternative medicine. As its name suggests, saw palmetto is a small palm of about 20 leaflets armed with sharp spines. This palm grows as high as 6 feet and it is commonly found in dense undergrowth of pine woods in sandy areas along the coasts.

This plant is common in the US especially in the coastal lands of the southeastern region.

Saw palmetto fruit has been extensively used by Native Americans for centuries mainly as a food source but also for its medicinal benefits.

Extracts from the fruits are now used in alternative medicine to treat some health problems especially benign prostatic hyperplasia (BPH). In fact, saw palmetto fruit extract has become the most popular herb for treating this prostate problem which is common in older men.

Benign prostatic hyperplasia is a medical disorder that is characterized by an increase in prostatic cells thereby leading to the formation of large nodules around the urethral in the prostate. The nodules are sometimes large enough to partially or completely block the urethral canal, making the flow of urine very difficult.

Among the various groups of phytochemicals present in saw palmetto, fatty acids and phytosterols are the main groups of bioactive chemicals responsible for the therapeutic effects of the herb. Therefore, herbal formulations of saw palmetto are standardized by these two active liposterolic components.

The fruit of the plant also contains some polysaccharide sugars which are believed to have anti-inflammatory and immunomodulatory effects.

Depending on the solvents used in preparing the extracts, the liposterolic content of saw palmetto supplements may vary from extract to extract. However, a standardized extract of saw palmetto must contain at least 80% to 95% sterols and fatty acids to be effective.

How Does Saw Palmetto Work?

Many clinical studies have investigated the efficacy of saw palmetto extract in improving prostate health but these studies have produced mixed results. However, saw palmetto remains the most popular herb used for the treatment of prostate enlargement and its use for this indication is growing.

In addition, anecdotal evidences and clinical treatment data indicate that the herb is effective in respect to treating prostate problems.

Although the mechanisms by which the active components of saw palmetto fruit extract work are not completely understood, many theories have been proposed as to how they function.

The most popular of these proposed theories is the inhibition of testosterone action on the prostate.

Testosterone is an androgenic steroid hormone secreted by the testicles and ovaries in men and women respectively. One of the functions of this steroid hormone is the development of the prostate.

In men, a small amount of this hormone is reduced to the more potent dihydrotestosterone (DHT). This conversion can occur in the prostate as well as other parts of the body. DHT in turn is responsible for the growth and enlargement of the prostate and it is a major causative factor for BPH.

This reduction process which produces DHT from testosterone however requires the action of either one of the two enzymes, 5-alpha reductase type 1 and type 2. By blocking the actions of these enzymes, the phytochemicals in saw palmetto can halt the production of DHT and, by extension, relieve and even treat BPH.

Furthermore, it has been proposed that saw palmetto hinders the binding of DHT to the androgenic receptor but detailed explanation of this mechanism is lacking. However, the result of this antagonism is the reduced activity of DHT on the prostate.

Since DHT can only act by binding to androgenic receptors, blocking this binding will dramatically reduce its effect. It is very possible that some of the bioactive phytochemicals in saw palmetto bind to these receptors without activating them. By occupying these receptors, saw palmetto prevents DHT from binding to them.

Yet another possible mechanism of action suggested involves the contraction of smooth muscles.

In a way similar to the actions of alpha antagonist drugs, the active ingredients in saw palmetto contract the smooth muscles of the urethral sphincter in the prostate. This action consequently reduces the pressure in the urethral and thus, relieves the symptoms of BPH.

The dual inhibition of DHT by saw palmetto is also responsible for the use of the herb in the treatment of hair loss. By preventing the conversion of testosterone to DHT, saw palmetto stops the progression of androgenetic alopecia, the most common type of hair loss.

In addition, androgenic receptors are also present in hair follicles, and the phytochemicals in saw palmetto can also block DHT from binding to them.

Directions for Use

Saw palmetto extracts are obtained from its fruits and they are usually sold as supplements in the form of tablets, capsules, tinctures and herbal tea.

During the preparation of the herbal tea, the bioactive volatile oils are lost. In addition, the fatty acid contents of saw palmetto extract do not dissolve in water. As a result, saw palmetto herbal tea may not be effective in treating BPH.

Saw palmetto is also sold as crushed berries but this form is not often properly standardized. Hence, crushed berries may not deliver sufficient amount of active liposterolic contents to effectively treat BPH.

The recommended daily dose of standardized saw palmetto fruit extract is 320 mg. The daily intake can be broken down into two servings of 160 mg each or it can be taken once. A six-month study showed that a daily dose of 480 mg was no more effective than the suggested 320 mg even though the herb was still well tolerated at this higher dose.

As with most herbs, the bioactive contents of saw palmetto extracts may vary from one brand to another. Therefore, it is important to ensure that the amount of the liposterolic contents fall within the standard range in the saw palmetto extract you intend to buy.

Side Effects and Contraindications

Most of the studies done on saw palmetto extracts showed that the herb was well tolerated though moderate side effects were reported in some cases.

Gastrointestinal problems were the most common complaints while mild cases of dizziness, headache, nausea, and vomiting have also been documented but less frequently. By taking saw palmetto extract with food, it is possible to reduce the occurrence of gastrointestinal side effects.

Due to the chemical similarity between the beta-sitosterol found in saw palmetto and cholesterol, the extract may worsen or increase the risk of heart disease in men who have formerly suffered heart attacks.

Furthermore, saw palmetto extract is believed to be unsafe for children, pregnant and lactating women because it acts like a hormone. In fact, one of its hormone-like actions is to reduce the population of estrogen and androgen receptors and this action may interfere with oral contraceptives by making them less effective.

Lastly, there are concerns that saw palmetto can cause or worsen internal bleeding by reducing the activities of blood platelets. Users should therefore avoid taking the extract along with other blood thinners such as aspirin and ibuprofen.

Clinical Studies on Saw Palmetto

A 2012 study published in the journal, Phytotherapy Research, investigated the efficacy of saw palmetto extract in reducing BPH symptoms. For this study, 82 patients suffering from BPH were recruited and evaluated based on scores from the International Prostate Symptom Scale (I-PSS).

The participants were given 320 mg saw palmetto extract daily for a period of 8 weeks.

The result of the study showed that participants’ scores on the International Prostate Symptom Scale were reduced in all the patients following the saw palmetto therapy. This indicated an improvement in the symptoms of BPH.

Another 2000 study published in The Journal of Urology examined the effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia (BPH).

In this double-blind, randomized, placebo-controlled study, 44 male patients suffering from symptomatic BPH and between the ages of 45 and 80 were recruited. They were randomly given either 160 mg saw palmetto herbal blend or placebo three times daily for a period of 6 months.

The patients were assessed based on the International Prostate Symptom Score and other clinical parameters.

After the six month duration of the study, improvements were observed in patients who were given the saw palmetto herbal blend compared to those given placebo. The herbal blend was also found to be well tolerated and no side effects were recorded.

The effectiveness of the combination of saw palmetto extract and some other natural products (cernitin and vitamin E) was also examined in another randomized, placebo-controlled, double-blind study.

Cernitin is a natural product derived from the pollens of a number of plants. It contains a rich blend of vitamins, minerals, amino acids, nucleic acids, enzymes, plant hormones, plant alcohols, plant hormones, unsaturated fatty acids and precursors of prostaglandins.

Vitamin E is an antioxidant vitamin. Both of these natural remedies are used to treat BPH in alternative medicine.

The researchers in this 2001 study published in the International Urology and Nephrology Journal recruited 127 patients diagnosed with BPH. The patients were divided into two groups: test group (70 patients) and placebo group (57).

The patients in the test group were given 2 pills of the combined natural products (378 mg cernitin, 286 mg of standardized saw palmetto extract, and 100 IU vitamin E) while the placebo group also received 2 pills of placebo daily.

The patients were evaluated based on the American Urological Association (AUA) Symptom Index Score and their urinary flow rates were also monitored.

After the 3-month duration of the study, the results showed significant improvement in the patients of the test group compared to those in the placebo group.

The effectiveness of a combination of saw palmetto extract and nettle root extract was also investigated and compared to that of finasteride in a study published in the British Journal of Urology International.

For this double-blind study, 431 patients at the early stages of BPH were recruited. The participants were either given a fixed combination of 160 mg saw palmetto fruit extracts and 120 mg nettle root or finasteride for a duration of 24 weeks.

Prostate volumes of the patients were determined at the start and during the period of the study.

The result of the study showed improvements in all the patients. This indicated that both the herbal combination and finasteride were effective for treating BPH.

However, the combination of saw palmetto extract and nettle root extract was found to be better tolerated with fewer side effects when compared to those who received finasteride.

Sources


http://www.nlm.nih.gov/medlineplus/druginfo/natural/971.html

http://www.aafp.org/afp/2003/0315/p1281.html

http://www.umm.edu/altmed/articles/saw-palmetto-000272.htm

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