Saw Palmetto Saw palmetto is an American dwarf palm tree indigenous to the Eastern United States coastal region. The ripe fruit, or berry, is used medicinally.
Uses and Benefits: Saw palmetto is commonly marketed and used to treat symptoms of benign prostatic hyperplasia (BPH). Standardized products are considered first-line therapy for BPH by doctors and patients in many European countries. Traditionally, the plant has also been used for a variety of urogenital and other conditions in both men and women, such as impotence and infertility, irritable bladder symptoms, and acute or chronic prostatitis.
Pharmacology: Standardized saw palmetto products consist of an oily liposterolic extract of the saw palmetto berry, extracted with hexane, 90% ethanol, or liquid CO, The extract contains a omplex mixture of free fatty acids and their esters, with smaller quantities of aliphatic alcohols, sterols (such as beta-sitosterol), other compounds.
Clinical Trials: Saw palmetto has been evaluated for effects on symptoms of BPH in many European randomized controlled trials (RCTs), and these trials have been extensively reviewed. Although most studies were of short duration (1 to 3 months) and included small numbers of patients (20-80), both subjective symptoms and objective parameters (nocturia, post-void residual, and peak urine flows) generally improved relative to placebo. Benefits were reported within 1 month of starting treatment. 6 Studies are of varying quality; many trial results have been criticized due to smaller than usual effects seen in the placebo groups, lack of validated urologic symptom scales, and inadequate study methods or reporting of data.
Adverse Effects: There are no significant side effects. Mild gastrointestinal complaints comparable to placebo are generally reported in less than 2-4% of patients. Unlike finasteride, saw palmetto does not cause erectile dysfunction.
Side Effects and Interactions: There are no recognized drug interactions, and PSA levels are not affected.
Cautions: There are no contraindications or other cautions with saw palmetto, although self-treatment of patients with unsuspected prostate cancer may delay medical therapy. Saw palmetto has not been studied in children and pregnant or nursing women, but is not marketed for these populations.
Preparations & Doses:The oral dose of standard liposterolic extracts found beneficial in clinical studies is 160 mg b.i.d. Equivalent effects have been demonstrated when given as a single daily dose of 320 mg. Although the most widely studied product (Permixon) is not currently marketed in the U.S. another European product found to be effective, Prostagutt (by Schwabe), is marketed under the brand name ProstActive (by Nature's Way). Commercial liposterolic extracts, similar to those marketed in European countries, are also available in the U.S. and are usually standardized to 85-95% combined fatty acids and sterols. Crushed berry products or whole extracts, equivalent to about 2-4 g/day of dried berries, should be equivalent to the standard liposterolic extract, but have not been adequately studied.
Summary Evaluation Saw palmetto extracts have been extensively studied in European countries, and found to be safe and effective in most RCTs. A single U.S. controlled trial that did not find clinical benefits may have been too small to detect a clinical effect. However, its results imply that benefits may be minimal, or that other products are more reliable. Nevertheless, based on the evidence to date, saw palmetto can be recommended as a safe herbal alternative or as an adjunct to standard medical therapy for patients with BPH. It has a shorter onset and is as effective as finasteride, but may not be as effective as alpha-blockers
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