The Health Benefits of Saw Palmetto

Dosage: Saw Palmetto (Serenoa repens)

What It Does: Relieves symptoms of benign prostatic hyperplasia (BPH), especially the urge to urinate during the night. Preliminary research shows that it may also help women suffering from ovarian and uterine irritations.

How We Know: For BPH–clinical trials. For ovarian and uterine irritations– preliminary research.

Dosage: For BPH, up to three 585-mg capsules daily or 20 to 30 drops of tincture four times daily; products standardized to 85 to 95 percent fatty acids and sterols are taken one or two times a day for a total daily dose of 320 mg. Dosages for treatment of ovarian and uterine problems haven’t been established.

Cautions: Reports of discomfort linked to taking saw palmetto are rare. One source suggests that because of saw palmetto’s possible impact on estrogen, it may affect hormonal treatments, including birth control pills and hormone replacement therapy. Additionally, the safety of saw palmetto for women who are pregnant or nursing hasn’t been established, so using it during these times should be avoided.

As I write this, the saw palmetto harvest is under way in Florida, where workers will handpick about seven million pounds of berries this season, according to University of Florida field observers. Most of the crop will be sent to­ ­Europe, but a large portion will return to the United States in the form of standardized extracts.

Saw palmetto is primarily used to treat benign prostatic hyperplasia (BPH), an enlargement of the prostate gland that affects about half of all men older than fifty. The herb has become a popular BPH treatment in the United States, where it’s the fifth top-selling phytomedicine on the market, according to a 1998 survey by Whole Foods magazine.

Still, standard U.S. medical treatment of BPH generally consists of prescribing synthetic drugs or surgery to remove some prostate tissue. The drugs can help offset frequent urination and pain, but they can also have side effects, including hypertension, dizziness, and decreased sex drive.

In Europe, medical doctors for years have prescribed saw palmetto and other herbs to treat mild to moderate cases of BPH. Today in Germany alone, the sale of BPH products totals about $400 million, and 90 percent of those sales are herbal preparations, including saw palmetto, pumpkin seed, and stinging nettle root. Each of these herbs is believed to regulate hormone metabolism, mediate the immune system, fight congestion, and affect bladder muscles.

Given this history, then, it’s no surprise that most scientific research on saw palmetto as a BPH treatment comes from Europe. Last August, just as the saw palmetto harvest was in full swing in Florida, European and U.S. doctors, pharmacists, and researchers gathered in that state to bring each other up to date on the latest research.

A Little Background, Some Recent Research

BPH is a noncancerous growth of the prostate gland. The prostate sits under the bladder and, if the prostate grows in mature men, it pinches the urethra, or urine tube, and problems begin, including painful urination and frequent nighttime trips to the bathroom. Researchers estimate that BPH affects about ten million men in the United States–some in their forties, half of all men older than fifty, and four out of every five men older than eighty.

Research conducted in Europe since the beginning of the 1980s shows that saw palmetto is an effective treatment for BPH. A 1984 clinical trial in France, for example, showed that saw palmetto reduced by nearly 50 percent the number of times BPH sufferers had to get up to go to the bathroom during the night and ­significantly reduced painful or difficult urination. More recently, researchers compared a saw palmetto extract with finasteride, the conventional BPH drug. The study involved 1,098 men diagnosed with BPH, and researchers concluded that both treatments relieved BPH symptoms in about two-thirds of the men. But while finasteride significantly reduced prostate size, it also decreased sex drive and potency. Saw palmetto didn’t reduce prostate size, but the men taking the herb complained less about decreased sex drive and impotence.

At the Florida conference, German researchers said that a three-year study involving 315 men with BPH showed that nearly three-fourths of the men using saw palmetto found relief from frequent nighttime urination, and more than half found relief from frequent urination during the day. Further, more than a fourth of them experienced a reduction in prostate size, and nearly all of those using saw palmetto–98 percent–experienced no side ­effects.

To date, researchers believe that saw palmetto’s fatty acids and sterols contain the active ingredients that relieve BPH symptoms. These active compounds, some researchers say, prevent the conversion of testosterone to DHT, the agent thought to be responsible for prostate enlargement.

Don’t Bypass Cancer Screening

While much of the news about saw palmetto is good, some medical practitioners say they are concerned that its use could be risky: The symptoms of BPH and prostate cancer are similar, so using saw palmetto–which is sold over the counter–may simultaneously relieve symptoms and mask signs of a more serious problem.

However, saw palmetto doesn’t impact a man’s PSA count, a measurement doctors use to test for prostate cancer. Therefore, say medical practitioners, stay in touch with your health-care provider, and don’t bypass screening for prostate cancer. 8

Not Just For Men Anymore?

Last August, when doctors, pharmacists, and other professionals gathered at the International Saw Palmetto Symposium in Florida, much of their discussion focused on saw palmetto as a treatment for men. However, they also turned their attention to preliminary research showing that it may help women who suffer from painful menstruation and other uterine discomforts.

Dr. D. Paul Barney, a medical doctor from Utah, says he has prescribed saw palmetto preparations for women who are seeking relief from premenstrual ­syndrome. Common PMS symptoms ­include menstrual cramps, bloating, heaviness or pressure in the pelvic area, and headaches.

“Sixty to seventy percent of my patients who use it say that it worked very well for them . . . that it’s better for PMS symptoms than the standard anti-inflammatory medicine,” Barney says.

Barney bases his belief that saw palmetto can offer effective medicine for women as well as men on multiple layers of research, including historic use. Written records show that herbalists of the 1800s credited the herb with having a tonic effect, lauding its powers to stimulate the bladder, prostate, and testicles–as well as the ovaries and uterus.

But historic use provides only a clue. Barney also studies the scientific research, most of which focuses on saw palmetto as a treatment for prostate problems. Yet this evidence encourages him to believe that the herb may work for conditions beyond those linked to the male reproductive system.

“From the existing research [on men], we know a lot about its safety in terms of its impact on overall body systems,” Barney says. “It doesn’t affect the liver or kidneys, important considerations, but it does alter the function of hormones–testosterone, progesterone [also present in women]–and has a buffering effect.”

Additionally, Barney points to a recent Argentine study indicating that a preparation made from saw palmetto (Serenoa repens) and pygeum (Pygeum africanum), derived from an African evergreen tree, provides relief from pelvic congestive syndrome, a condition of the female reproductive system. Sixty women between the ages of eighteen and forty-five took part in the study; each suffered from moderate to severe pelvic pain, with symptoms such as painful menstruation, urinary disorders, bloating, and/or painful intercourse.

The researchers divided the women into three groups. Twenty women were treated with the saw palmetto/pygeum combination, twenty with anti-inflammatory drugs, and twenty with a placebo. The researchers followed the participants’ progress through two menstrual cycles, then reported that nineteen of the women who took the herbal treatment experienced relief from or an end to their symptoms, which included nausea, vomiting, and headaches. Ten of those taking anti-inflammatory drugs experienced relief, and four of those on the placebo felt better, according to the study.

The researchers–the chief of the gynecology division at the Dr. J. M. Ramos Mejia General Hospital in Buenos Aires and another medical doctor working in that division–attributed the results of the study to saw palmetto’s ability to ­increase blood mobility, which relieves bloating and pain, and the ability of pygeum to block substances that stimulate smooth-muscle contractions.

Barney acknowledges that large-scale clinical trials may be necessary for many in the medical profession to recognize saw palmetto as an effective treatment for conditions related to the female reproductive system. But he says that his first concern is the safest route to good health, and often herbal medications can provide that.

“I have the ability to follow people along closely [in my practice] and see how [patients] respond,” he adds. “I may not require as many studies as some, but I am willing to read all I can about something and consider whether it is better than the alternatives.”

The safety of saw palmetto for women has yet to be established, how­ever, especially for pregnant or nursing mothers. To be on the safe side, women of childbearing age should use it only under the supervision of a medical doctor. In Herbal Medicines: A Guide for Health-Care Professionals (The Pharmaceutical Press, 1996), the authors suggest that because of saw palmetto’s reported estrogenic activity, it may affect hormonal treatments, including birth control pills and hormone replacement therapy.

Additional Reading

• Carraro, J., 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, 29:231-240.
• Champault, G., et al. “Medical treatment of the prostatic adenoma: a controlled test of PA 109 (Permixon: Serenoa repens extract) vs. placebo in 110 patients.” Annual Journal of Urology 1984, 18(6): 407-410.
• Hobbs, Christopher, and Stephen Brown. Saw Palmetto (Interweave Press, 1997).

Steven Foster is the author of nine books on herbal health, including 101 Medicinal Herbs (Interweave Press, 1998), and a member of the Herbs for Health Editorial Advisory Board. His articles and photographs appear frequently in Herbs for Health, The Herb Companion, and other publications.

Additional information for this article was provided by the American Herbal Products Association, an industry group based in Silver Spring, Maryland, and sponsor of the 1998 International Saw Palmetto Symposium in Naples, Florida.