The berries of the saw palmetto (Serenoa repens/Sabal serrulata), a
fan palm native to the southeastern United States, act to increase urine flow,
to diminish inflammation, and to reduce muscle spasms. In Europe, saw palmetto
is widely used to treat benign prostatic hyperplasia, or BPH, which is an
enlargement of the prostate gland (see details below). In the United States, it
ranks among the top ten dietary supplements in terms of sales.
Saw palmetto berries were a staple food among native Americans of the
southeastern United States, who also used them to treat digestive problems,
genitourinary inflammation, dysentary, and lack of libido. Early in the 20th
century, saw palmetto was listed in the US Pharmacopoeia as an effective remedy
for enlargement of the prostate gland (called benign prostatic hyperplasia or
BPH), urinary tract inflammation, cystitis (bladder inflammation), breast
disorders, bronchitis, and laryngitis.
Benign Prostatic Hyperplasia (BPH) In BPH, cells in the
prostate gland (a tiny gland that lies behind the urethra) grow too quickly. The
gland swells and presses on the urethra, creating the constant sensation of a
need to urinate. The majority of men over 60 have urinary symptoms attributable
to BPH, which can disturb sleep, affect self-confidence, cause constant
low-grade anxiety or even pain, and may progress to infections in the bladder or
Saw palmetto is comparable to finasteride (a common prescription drug that
slows or stops the progression of BPH) in relieving symptoms of BPH during its
early stages. Such symptoms include frequent need to urinate, a delay before
being able to urinate, dripping after urinating, and having to get up numerous
times throughout the night to urinate. While saw palmetto appears to produce
symptom relief in a much shorter time than finasteride, one important difference
between the two is that finasteride shrinks the size of the prostate, and saw
palmetto only relieves the symptoms of BPH without changing the size of the
prostate. Also, studies to date of saw palmetto have not evaluated the safety of
the herb for long periods of time.
Prostate Cancer Saw palmetto is also one of the eight herbal
ingredients that make up PC-SPES, a Chinese herbal treatment for prostate cancer
that is gaining popularity in the West as a possible alternative to conventional
therapy for this condition. Research on PC-SPES is ongoing and may prove to be
of particular interest for men who do not respond to surgery, radiation, or
medication. (It is important to note, however, that the U.S. Food and Drug
Administration [FDA] recently issued a warning to consumers that PC SPES may
contain undeclared prescription drug ingredients that could cause dangerous side
Other Because it effects both male and female sex hormones,
saw palmetto may also be useful in treating such conditions as hirsutism
(excessive growth of dark, coarse body and facial hair in women) and polycystic
ovarian disease (multiple cysts in the ovaries that leads to irregular or absent
menses and, possibly, infertility) in women.
Saw palmetto is a fan palm that can reach heights of 10 feet in warm
climates. In the United States, it grows in the warm climates of the southeast,
from South Carolina to Mississippi and throughout Florida. Lush, green leaves
fan out from thorny stems. The plant bears white flowers, which develop yellow
olive-like berries. The berries, when ripe, turn bluish-black and are dried for
What's It Made Of?
Saw palmetto's active ingredients include fatty acids, plant sterols, and
flavonoids. However, most likely these are not the only substances within the
berries that affect hormone production, and it will take more scientific study
to determine exactly how saw palmetto works.
The berries also contain high-molecular-weight polysaccharides, which are
usually associated with either anti-inflammatory or immune-stimulant effects.
Saw palmetto can be purchased as dried berries, tea, powdered capsules,
tablets, liquid tinctures, and liposterolic extracts. The product label should
indicate that contents are standardized and contain 85% to 95% fatty acids and
sterols. In a ConsumerLab.com evaluation, approximately 63% of the leading
brands of saw palmetto were standardized to this amount appropriately; this
means that as many as 37% were not. Again, read labels carefully to make sure
that they are labeled as containing 85% to 95% fatty acids and sterols and buy
from reputable companies.
How to Take It
There are no known scientific reports on the pediatric use of saw palmetto.
Therefore, it is not currently recommended for children.
The recommended dosages for early stages of BPH is 160 mg, two times per day,
of a fat-soluble saw palmetto extract, which has been standardized to contain
85% to 95% fatty acids and sterols.
Because of the potential for side effects and interactions with medications,
herbs should be taken only under the supervision of a knowledgeable healthcare
provider. That said, saw palmetto is a very mild herb and The American Herbal
Products Association gives saw palmetto a class 1 safety rating, which means
that it is safe when used as directed. Side effects are very rare, although mild
stomach complaints and minor headaches may occur; also, one case of significant
bleeding during surgery, attributed to saw palmetto use prior to the operation,
has been reported.
It is important that those with BPH be under the supervision of a healthcare
provider who can determine the best treatment and monitor its effects.
Saw palmetto has not been studied or used in women who are pregnant or
nursing; therefore, it should not be used during pregnancy or while
breast-feeding. In addition, saw palmetto may, in theory, interfere with the
absorption of iron -- another reason not to use this herb if pregnant or
nursing, since iron is necessary for the mother, fetus, and baby.
Finasteride There are no reports in the scientific literature
to suggest that saw palmetto interacts with any conventional medications.
However, because saw palmetto may work similarly to finasteride, it has been
recommended that this herb not be used in combination with finasteride or other
medications used to treat BPH.
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Review Date: April 2002
Reviewed By: Participants in the review process include: Robert A. Anderson, MD (April
1999), President, American Board of Holistic Medicine, East Wenatchee, WA;
Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley
Hospital, Harvard University and Senior Medical Editor Integrative Medicine,
Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson
Drugs, Natick, MA; Steven Ottariono, RPh (Pediatric Dosing section February
2001), Veteran's Administrative Hospital, Londonderry, NH; R. Lynn Shumake, PD,
Director, Alternative Medicine Apothecary, Blue Mountain Apothecary &
Healing Arts, University of Maryland Medical Center, Glenwood, MD; David
Winston, Herbalist (April 1999), Herbalist and Alchemist, Inc., Washington, NJ;
Tom Wolfe, P.AHG (April 1999), Smile Herb Shop, College Park, MD. All
interaction sections have also been reviewed by a team of experts including
Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria,
VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T
Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor,
University of Maryland School of Pharmacy; President, Your Prescription for
Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and
Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu,
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