What Is It?
From the olive-sized berries of the saw palmetto tree comes a remedy for benign enlargement of the prostate gland. While harmless, this common condition (BPH, or benign prostatic hyperplasia) can interfere with the urine’s exit from the bladder, causing frequent urination, nighttime awakenings, and other uncomfortable urinary symptoms. It’s not clear what causes BPH. But as the millions of men who suffer from it can attest–more than half of men over 60 are affected–relief is welcome indeed.
The popularity of saw palmetto–so-named in recognition of the saw-toothed stems that lie at the base of each palm leaf–has waxed and waned over time. Until 1950, it was officially recognized in the United States as a drug for urinary and genital problems. But conventional American doctors eventually became disenchanted with the remedy; they could find little solid evidence to prove its effectiveness for any condition. Europeans, on the other hand, have been steadfast in their enthusiasm for the prostate-healing gifts of this scrubby, native American palm tree (also known as Serenoa repensor S. serrulata). Herbalists worldwide have also recommended saw palmetto as a general tonic and remedy for persistent cough and digestive problems.
Numerous test tube, animal, and human studies indicate that an oily compound in saw palmetto berries reduces the discomforts of a mild to moderately enlarged prostate. While the herb doesn’t actually shrink this gland, it does appear to prevent it from getting any larger. How it accomplishes this remains a matter of debate. Research points to an anti-inflammatory action and an ability to inhibit the hormones (possibly including a form of testosterone) that cause prostate cells to multiply. Antiandrogenic (anti-male sex hormone) actions have also been implicated.
One of the great appeals of saw palmetto is its price: It typically costs about one-third to one-half that of the conventional BPH medications. And based on recent findings it also works faster and causes fewer cases of impotence and reduced libido than the conventional prostate drug, finasteride (Proscar). By affecting levels of cancer-promoting hormones it may even play a role in protecting against prostate cancer, although this requires further research. Finally, test tube studies indicate that the herb boosts the immune system’s ability to kill bacteria, suggesting a potential treatment for prostate or urinary tract infections.
Specifically, saw palmetto may help to:
• Ease prostate problems. Saw palmetto relieves the major symptoms of BPH. Numerous studies have shown that it reduces the number of times a sufferer feels the urge to urinate (including at night, thus reducing the number of nighttime awakenings), increases maximum urine flow, and minimizes the sensation that the bladder has not emptied. Painful urination may lessen as well. A recent analysis of several small clinical trials of saw palmetto published in The Journal of the American Medical Association(JAMA) found that men given saw palmetto were twice as likely to report a lessening of symptoms than those given a placebo. Compared with a placebo, the herb improved urinary tract symptoms by about 25%.
–Look for supplements made from extracts standardized to contain 85% to 95% fatty acids and sterols—the medicinal, fat-soluble ingredients in the berries.
–Because the potency of commercial preparations may vary, follow manufacturer’s instructions.
• For prostate problems: Take 160 mg twice a day.
Guidelines for Use
• To minimize the risk of stomach upset, take saw palmetto with breakfast and dinner.
• Don’t use a tea made from the dried herb; the plant’s medicinal oils don’t dissolve in water.
• To increase its effectiveness for prostate problems, try combining saw palmetto with other prostate-healthy herbs such as pygeum africanum, nettle, or pumpkin seed. Beware of so-called Men’s Formula combinations that actually contain very little saw palmetto.
• Be patient when treating prostate problems. Although it may work faster than many prescription drugs for BPH, you will probably have to take saw palmetto for six to eight weeks before noticing any improvement in symptoms.
• Although no specific interactions have been reported, it’s wise to consult your doctor before combining saw palmetto and prescription drugs for prostate problems.
• There are no known drug or nutrient interactions associated with saw palmetto.
Possible Side Effects
• Side effects of saw palmetto are relatively uncommon, although mild abdominal pain, nausea, dizziness, and headache have been documented. Lower the dose or stop taking the herb if side effects occur.
• Problems with reduced libido and impotence can develop. These reactions are still less likely than with prescription drugs for BPH, however.
• Rarely, male breasts become enlarged.
• Don’t try to self-diagnose BPH. Although often benign, prostate problems should always be examined by a doctor to rule out other, more serious conditions, including prostate cancer.
• Consult a doctor if you develop any new symptoms of prostate problems (trouble urinating despite the urge, more frequent need to urinate, urinary leaking) or if you detect blood in your urine.
• Don’t stop taking a prescription medication and start taking saw palmetto for prostate problems without discussing the change with your doctor.
• Despite some claims to the contrary, saw palmetto won’t increase sexual vigor or increase your sperm count.
• Avoid taking more than 320 mg daily; little is known about how high doses might affect your health.
• Because the herb appears to affect hormone levels, men with prostate cancer or breast cancer, or anyone with a hormone-dependent illness, should first discuss the idea of taking saw palmetto with a doctor.
• Be sure to let your doctor know that you are taking saw palmetto before taking the test used to rule out prostate cancer.
Aging 160 mg twice a day
Impotence 160 mg standardized extract twice a day or 1/2 tsp. liquid extract twice a day or 600 mg. freeze-dried herb twice a day
Prostate Problems 320 mg once a day or 160 mg twice a day of standardized extract or 1/2 tsp. liquid extract twice a day
David Edelberg, M.D.
All men with a doctor’s diagnosis of prostate enlargement, take heed: The next time you get up to urinate at night–maybe for the fifth or sixth time!–think of the thousands of men in your position who have successfully used a low-cost alternative to pricey prescription prostate medications: saw palmetto. This remedy, made from the olive-sized berries of the shrubby saw palmetto, won’t increase your sexual vigor or up your sperm count, as some overly enthusiastic sources claim, but in clinical trials it has worked as effectively and even faster than standard prostate drugs. And thankfully with fewer side effects—less risk of impotence or libido lag, for example. Along with lessening the constant urge to urinate and the repeated nighttime awakenings, saw palmetto often provides a greater flow stream and a welcome relief from the sensation that your bladder just won’t empty completely. If you have any pain while urinating, it may reduce that as well.
HOW IT HELPS PROSTATE PROBLEMS
While you can’t count on saw palmetto to actually shrink your prostate, it may well keep the gland from getting any bigger and worsening your discomfort. Exactly how it accomplishes this is still something of a mystery. Experts suspect the herb exerts an anti-inflammatory effect and blocks a conversion of the male hormone testosterone that can cause your prostate cells to multiply. This effect on testosterone, however, in no way inhibits libido, sexual vigor, or erectile function but just affects prostate gland enlargement.
WHAT TO LOOK FOR
One of the great appeals of saw palmetto is its price–it typically costs about one-third to one-half as much as conventional prostate medications do. But like the standard drugs, you’ll need to take saw palmetto indefinitely.
There are several forms of saw palmetto available. The key is to pick an extract that is based in alcohol or hexane, both of which are fat-soluble and can therefore release the therapeutic oil in the plant’s berries. Liquid extracts of the berry is the form that many of the men in the clinical trials were given. Take your daily doses in a little water or juice with breakfast and dinner to lessen the chance of stomach upset. However, carrying around a bottle of liquid extract can be inconvenient. Softgel capsules of the liquid extract are available and seem to be a very good choice. Teas of saw palmetto berry may not be worth bothering with because they are water-soluble rather than fat-soluble, and won’t release all of the herb’s healing compounds.
Like many men with prostate problems, you may do well with products that combine saw palmetto with other prostate-healthy herbs such as Pygeum africanum, nettle, or zinc. But read labels carefully and steer clear of so-called ‘Men’s Formula’ vitamin combinations that actually contain very little of the king of them all—saw palmetto. For mild cases of BPH, you may get by with 160 mg a day. However, most of the studies used 320 mg a day.
Always look for supplements made from extracts standardized to contain 85% to 95% fatty acids and sterols—the medicinal, fat-soluble ingredients in the berries—which has demonstrated the maximum effectiveness.
Although saw palmetto may work faster than many prescription drugs, it still demands patience. Look for some improvements after six to eight weeks of treatment; it may take a full three months or more for maximum relief.
Saw palmetto is a very promising remedy for prostate problems, but you should always get examined by a doctor for a diagnosis before self-treating your discomfort. Keep in mind that it’s important to: Discuss your interest in saw palmetto with your doctor. Continue taking any prescription prostate medications unless your doctor specifically advises otherwise. Then, maybe you’ll be able to sleep through the night and get on with your life!
David Edelberg, MD