Saw Palmetto supplement extract dosage prostate enlargement side effects, hair loss, 320 mg, influence on enlarged prostate gland, DHT, testosterone and hair growth, proper dosage and extract potency by Ray Sahelian, M.D., author of Saw Palmetto: Nature's Prostate Healer
March 22, 2014

Saw palmetto is an herb that has been shown in clinical studies to have a role in maintaining a healthy prostate although not all studies have shown consistent benefits. Serenoa repens, sometimes referred to as sabal in Europe, grows naturally in the southeast United States, including Georgia, Mississippi, and particularly Florida. It is not the only herb that has an influence on the prostate gland. Several other herbs and plant compounds that are potentially useful including pygeum, stinging nettle, isoflavones such as genistein and daidzein, rye pollen, phytosterols such as beta sitosterol, and carotenoids such as lycopene.
   It appears that urinary symptoms resulting from mild-to-moderate prostate enlargement respond more readily to saw palmetto than symptoms due to severe enlargement. It often takes several weeks or months for the effects of saw palmetto and other herbs to be fully appreciated. These plants and extracts have fewer side effects than drugs used for prostate enlargement but, based on our current knowledge, they do not appear to be as potent or effective.

Prostate Power Rx for a healthier gland carefully formulated with high dose saw palmetto extract and important herbs and nutrients to provide optimal prostate health.
Saw Palmetto extract supplement
guaranteed to supply 45% fatty acids and beneficial plant sterols, which are the herb's key active ingredients. Note: In order for a saw palmetto product to be effective, it should either supply a daily dose of 320 mg of 85 to 95% fatty acids, or 640 mg of a 45% fatty acid extract. Some products that do not have these high potency fatty acid extracts may not be as effective.


 

 

 


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Supplement Facts
Saw Palmetto extract (standardized to contain 45% fatty acids - serenoa repens fruit)
Stinging Nettle 4:1 extract (urtica diocia root)
Quercetin (one study shows the combination of quercetin and finasteride works very well)
Rosemary 4:1 extract
Beta Sitosterol
Pygeum 4:1 bark extract (Pygeum Africanum)
Genistein (standardized to contain 40% isoflavones)
Daidzein (standardized to contain 40% isoflavones)
  
(treatment with the isoflavones daidzein and genistein, the estrogen-like compounds found in soy, block prostate growth in rats)
Lycopene

Q. A few months ago I started using a saw palmetto supplement from a company. After one week on their supplement I was getting up every two hours to use the restroom. I finally reordered the product you formulated. Within a week I was again sleeping right through the night. Can there be such variances in products, or, as I suspect, could I have been receiving a "placebo"? I just want also, to let your readers know how good your products are.
    A. It is possible that the product you purchased may have been pure powder instead of an extract. There can be vast differences between companies regarding the same herb or product since many steps are involved in growing and processing herbal products.

Curr Med Chem. 2013. Serenoa Repens, lycopene and selenium: a triple therapeutic approach to manage benign prostatic hyperplasia. BPH is thought to involve in disruption of dihydrotestosterone (DHT)-supported homeostasis between cell proliferation and cell death, and, as a result, proliferative processes predominate and apoptotic processes are inhibited. Phytotherapeutic supplements, mainly based on Saw Palmetto-derived Serenoa Repens (SeR), are numerous and used frequently. Serenoa Repens reduces inflammation and decreases in vivo the androgenic support to prostatic cell growth. Furthermore, SeR stimulates the apoptotic machinery; however, data supporting efficacy is limited, making treatment recommendations difficult. Besides SeR, selenium (Se), an essential trace element mainly functioning through selenoproteins and able to promote an optimal antioxidant/oxidant balance, and lycopene (Ly), a dietary carotenoid synthesized by plants, fruits, and microorganisms with a strong antioxidant activity, has been shown to exert beneficial effects in prostate disease. SeR is frequently associated with Ly and Se, in order to increase its therapeutic activity in benign prostatic hyperplasia (BPH). It has been shown that the Ly-Se-SeR association has a greater and enhanced antiinflammatory activity that might be of particular interest in the treatment of BPH. The Ly-Se-SeR association is also more effective than SeR alone in reducing prostate weight and hyperplasia, in augmenting the pro-apoptotic Bax and caspase-9 and blunting the anti-apoptotic Bcl-2 mRNA. In addition, Ly-Se-SeR more efficiently suppresses the EGF and Vascular Endothelial Growth Factor (VEGF) expressions in hyperplastic prostates. Therefore, saw palmetto particularly when combined with selenium and lycopene may have a greater potential for the management of benign prostate hyperplasia.

Saw palmetto side effects, risk, safety
No significant saw palmetto side effects have been reported in medical studies thus far. It does not seem that the herb influences levels of PSA (prostate specific antigen) to any significant degree. The following study evaluated potential side effects in a one year study.

A detailed safety assessment of a saw palmetto extract.
Complement Ther Med. 2008.
The Saw palmetto for Treatment of Enlarged Prostates (STEP) study was a randomized clinical trial performed among 225 men with moderate-to-severe symptoms of benign prostatic hyperplasia, comparing a standardized extract of the saw palmetto berry (160mg twice daily) with a placebo over a 1-year period. Despite careful assessment, no evidence for serious toxicity of saw palmetto was observed in this clinical trial.

For what conditions is it of benefit?

5alpha reductase inhibition? Influence on PSA testing
The steroid 5alpha-reductase 2 catalyzes the metabolism of testosterone into the more potent androgen dihydrotestosterone in the prostate gland. Finasteride is a competitive and specific inhibitor of Type II 5 alpha-reductase, an intracellular enzyme that converts the androgen testosterone into dihydrotestosterone (DHT). Two distinct isozymes of 5 alpha-reductase are found in mice, rats, monkeys, and humans: Type I and II. Each of these isozymes is differentially expressed in tissues and developmental stages. In humans, Type I 5 alpha-reductase is predominant in the sebaceous glands of most regions of skin, including scalp and liver. Type I 5 alpha-reductase is responsible for approximately one-third of circulating DHT. The Type II 5 alpha-reductase isozyme is primarily found in prostate, seminal vesicles, epididymides and hair follicles as well as liver, and is responsible for two-thirds of circulating DHT.

Over the years I have been asked whether it has an influence on PSA test results. PSA is the blood test that is often recommended to monitor prostate tumor growth. Medical science has questioned the reliability of PSA testing as a screening tool for cancer detection. Although there is a lot of controversy and varied opinions, it appears PSA testing is not as accurate a tool as was previously thought.

Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression.
Int J Cancer. 2004;
The phytotherapeutic agent saw palmetto is an effective dual inhibitor of 5alpha-reductase isoenzyme activity in the prostate. Unlike other 5alpha-reductase inhibitors, saw palmetto induces its effects without interfering with the cellular capacity to secrete PSA. Unlike other 5alpha-reductase inhibitors, SP does not inhibit binding between activated AR and the steroid receptor-binding consensus in the promoter region of the PSA gene. Our results demonstrate that despite saw palmetto effective inhibition of 5alpha-reductase activity in the prostate, it did not suppress PSA secretion. Therefore, we confirm the therapeutic advantage of saw palmetto over other 5alpha-reductase inhibitors as treatment with the phytotherapeutic agent will permit the continuous use of PSA measurements as a useful biomarker for prostate cancer screening and for evaluating tumour progression.

Acne
I have read somewhere that saw palmetto might be used to treat adult acne.
    It is unlikely that saw palmetto helps acne. You may try eating more cold water fish such as halibut and salmon, and more vegetables, while cutting back on nuts, dairy and refined carbohydrates. Omega-3 oils in fish are likely to benefit your skin.

Hair loss or regrowth
I am often asked whether saw palmetto is useful for hair loss.
One of the causes of prostate enlargement is testosterone being converted into DHT (dihydrotestosterone). Excess DHT in prostate tissue is thought to lead to prostate growth, and excess DHT in hair tissue leads to hair thinning in men and women. Saw palmetto may inhibit the enzyme 5-alpha-reductase in prostate tissue. This enzyme converts testosterone to DHT. There are two major forms of this enzyme, called types I and II. In humans, Type I 5 alpha-reductase is predominant in the sebaceous glands of most regions of skin, including scalp. The Type II 5 alpha-reductase isozyme is primarily found in prostate tissue, seminal vesicles, epididymides and less so in hair follicles. I have not come across research as to whether saw palmetto blocks the conversion of testosterone to DHT in hair tissue to a degree adequate enough to prevent or restore hair loss. My personal opinion is that I suspect, even if saw palmetto has a mild effect, it is not nearly as potent as the drug finasteride - an alpha reductase blocker - used for prostate enlargement (as Proscar) and hair regrowth (as Propecia). I do not know if there is an additive effect to finasteride if saw palmetto is taken along with it. There was a small study a few years ago that showed a potential benefit for hair growth in male pattern baldness when saw palmetto was combined with beta sitosterol.

Int J Immunopathol Pharmacol. 2012. Comparitive effectiveness of finasteride vs Serenoa repens in male androgenetic alopecia: a two-year study. The objective of this open label study is to determine the effectiveness of Serenoa repens in treating male androgenetic alopecia (AGA), by comparing its results with finasteride. For this purpose, we enrolled 100 male patients with clinically diagnosed mild to moderate AGA. One group received saw palmetto 320 mg every day for 24 months, while the other received finasteride 1 mg every day for the same period. In order to assess the efficacy of the treatments, a score index based on the comparison of the global photos taken at the beginning (T0) and at the end (T24) of the treatment, was used. The results showed that only 38 of patients treated with Serenoa repens had an increase in hair growth, while 68 of those treated with finasteride noted an improvement. Moreover finasteride was more effective for more than half of the patients with level II and III alopecia. We can summarize our results by observing that SP could lead to an improvement of androgenetic alopecia, while finasteride confirmed its efficacy. We also clinically observed, that finasteride acts in both the front area and the vertex, while SP prevalently in the vertex. Obviously other studies will be necessary to clarify the mechanisms that cause the different responses of these two treatments.

A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia.
J Altern Complement Med. 2002.
We report the first example of a placebo-controlled, double-blind study undertaken in order to examine the benefit of these botanical substances in the treatment of androgenetic alopecia. Included in this study were males between the ages of 23 and 64 years of age, in good health, with mild to moderate AGA. The blinded investigative staff assessment report showed that 60% of (6/10) study subjects dosed with the active study formulation were rated as improved at the final visit.

What is your opinion on combining finasteride with serenoa repens? I take Propecia to combat male pattern hair loss and was wondering whether it would be just as effective to take the herbal medicine instead.
   I don't see any obvious harm adding the herb, but I honestly don't know whether there would be a synergistic effect.

I purchased a Saw Palmetto product and began a regimen of a couple pills in the morning and couple in the evening. The product had Zinc 15 mg - 100%, Selenium 55 mcg - 79%, Saw Palmetto extract 320 mg standardized to 85% fatty acids. No help. I went for six pills morning and six evening. In three days, my hair stopped falling out. Nothing in the comb. Nothing in the shower. If I wait a week to shampoo, THEN I might get 25 to 50 hairs tops. I went from 125 hairs per day, to 125 hairs lost, per month. I didn't grow any new hair, but since 20% of your hair is "at rest" at any one time, that hair began to surface over the next 18 months and the remaining hair, avoiding dormancy, stuck around for company. 18 months is not a quick process. But it made a startling demonstrative difference. I wish I'd have started those pills twenty years ago.
    This is interesting, I wonder if very high dosages of saw palmetto are required to stop hair loss. However, the long term side effects of high dose use are not clearly understood.

Is it possible to take He Shou Wu, Propecia, and Saw Palmetto together? And how should you space them out?
   This combination has not been tested, so it is difficult to predict the long term effects.

PCOS
In your research, have you come across any studies that shows the benefits and effects of saw palmetto in women suffering with Polycystic ovarian syndrome PCOS? Are there any benefits with those suffering from incontinence, such as my mother who's 81?
   We have not come across any research indicating that saw palmetto would be beneficial in the 2 conditions you mention.

Libido and sex, effect on impotence
The aphrodisiac properties of saw palmetto have not been evaluated thoroughly. Anecdotal reports indicate that it may help with erectile function, but I cannot make this claim with a great deal of certainty. If you have low libido or have difficulty maintaining a healthy erection, there are several herbs that are quite potent and these herbs are combined in an excellent formula.

Q. I have significant erectile dysfunction, have been taking saw palmetto to counteract prostate enlargement, does this herb influence testosterone levels?
   A. My latest understanding in regards to its influence on testosterone is that it may slightly inhibit its conversion into DHT in prostate tissue.

Q. Have you, by perusing research, or through clinical experience found anything to suggest that saw palmetto influences erectile efficiency ?
   A. I have not come across any research regarding the influence of saw palmetto on erectile dysfunction. However, people report that the use of Prostate Power Rx enhances their sexuality.

Prostate enlargement, BPH
The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens.
Adv Ther. 2002.
This 6-month double-blind, randomized, parallel-group study compared two dose regimens of Libeprosta, the lipidosterolic extract of saw palmetto herb in 100 male outpatients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The patients received two 80-mg tablets twice daily or two 80-mg tablets three times daily. Significant improvements from baseline occurred in quality-of-life scores, maximum and mean urinary flow rates, and residual urine volume. The decrease in residual urine with both regimens was highly significant. No significant differences in efficacy were noted between the two dose groups, and no treatment-related complications or clinical adverse events occurred.

Long-term clinical and biologic effects of the lipidosterolic extract of Saw palmetto in patients with symptomatic benign prostatic hyperplasia.
Adv Ther. 2002.
This open study assessed the efficacy and tolerability of saw palmetto160 mg twice daily administered for 2 years. One hundred fifty-five men with clinically diagnosed BPH and complaints of prostatic symptoms were enrolled in the study. International Prostate Symptom Score and quality of life for those on saw palmetto improved significantly from baseline at each evaluation time point.  Prostate size decreased. Sexual function remained stable during the first year of saw palmetto treatment and significantly improved during the second year. Prostate-specific antigen was not affected, and no changes in plasma hormone levels were observed. Nine patients reported 10 adverse events, none related to treatment with saw palmetto. Improvements in efficacy parameters began at 6 months and were maintained up to 24 months.

PSA level
J Urol. 2013. The effect of increasing doses of saw palmetto fruit extract on serum prostate specific antigen: analysis of the CAMUS randomized trial. No affect was seen on serum prostate specific antigen more than placebo, even at relatively high doses.

What's in the herb?
There are a variety of compounds within the
saw palmetto berry. As a rule they are divided into four major categories:

Free fatty acids. Quite a number of fatty acids are present in
saw palmetto. The ones in highest concentration include oleic acid, lauric acid, myristic acid and palmitic acid.
Phytosterols (plant sterols). These plant sterols (phyto means plant) have a chemical structure similar to cholesterol. The most commonly found phytosterols in
saw palmetto are beta-sitosterol, campesterol, stigmasterol and cycloartenol.
Free fatty alcohols. These are usually made up of fatty acids joined to an alcohol molecule.
Monoglycerides, which are single fatty acids attached to a three-carbon glycerol molecule.

Is there nothing else in saw palmetto except for free fatty acids, free fatty alcohols, phytosterols, and monoglycerines?
    Every herb has dozens or hundreds of substances and the four categories you mention form the bulk of this herb. There may be minor substances also but I have not studied these in detail.

How does it work? Mechanism of action
Natural medicines have had far less research money devoted to them than they deserve. Saw palmetto is no exception. Consequently, we don't know all the answers to the exact mechanisms of how the different compounds within saw palmetto work. However, there have been enough studies to give us some clues. Some of the most likely mechanisms include the reduction in the amount of dihydrotestosterone (DHT) in prostate tissue, inhibition of the binding of DHT to androgen receptors in prostate cells, and the anti-estrogenic action in prostate tissue. Another possibility is the ability of compounds within saw palmetto to reduce the action of IGF-1 on prostate tissue.
Insulin-like growth factor (IGF) action is important for prostate growth and development, and changes in the IGF system have been documented in BPH tissues.

   Unlike Proscar finasteride, which has one active ingredient, saw palmetto has a number of different compounds within it. Thus, you can see why it would be complicated to evaluate all the possible interactions that these compounds have on a variety of tissues within our bodies. Furthermore, it is possible that a single compound within saw palmetto may not have much of an influence on its own although its combination with the other compounds would have a synergistic effect.
   The more I learn about the human body, the more I realize how complicated it is. Early in my medical career I unquestioningly accepted the results of studies done in a laboratory or on animals and was quick to use this information to generalize to humans. I now know otherwise. In order to understand truly how a medicine works, it has to be studied directly on humans. Although laboratory and animal studies can give us important information, they are never a replacement for thorough human evaluations.            
   Another complicating factor is that modern medicine does not advance solely on the basis of seeking the most efficient therapy for human diseases. There are significant economic factors that influence the funding of studies, the subsequent interpretation of the results, and especially the dissemination of this information. Many of the studies done with saw palmetto were financed either by companies who market this extract, such as Pierre Fabre Medicament, or by pharmaceutical companies, such as Merck, who have developed competing drugs that treat prostate enlargement. Merck has the drug Proscar. Not surprisingly, the results of studies obtained by Merck scientists on saw palmetto are often in disagreement with the results obtained by scientists working under the auspices of saw palmetto-selling companies.

Berry or extract?
When you purchase
saw palmetto, you will find some bottles that provide crushed berries, not the extracts. Until we learn more about the effects of using the full contents of the berries, I recommend that you buy the extracts which will contain the actual substances that are effective in a much higher concentration. The berries will provide you with smaller amounts of the needed active ingredients. Whether the crushed berries have compounds that provide other benefits is not fully known at this time. If you want to take saw palmetto berries, you may need to ingest at least one or two grams a day. The ratio of the dried berry to the lipophilic extracts is usually about 10 to 1. Some users prefer to take both the saw palmetto extracts and the berries, thinking that there are substances within the full berries that could be beneficial. We certainly need more research in order to have a fuller understanding.

What about combining saw palmetto with other herbs?
Research shows when taken for 3 months, a combination of natural products (rye pollen extract, saw palmetto, Beta sitosterol, and vitamin E) compared to placebo can significantly lessen nocturia and frequency and diminish overall symptoms of prostate enlargement.

Is saw palmetto for a Woman, too? - Does it lead to female breast enhancement?
I have not come across any research to indicate whether it is useful for a woman or whether it is helpful in PCOS. I have not seen any research as to whether saw palmetto use leads to breast enhancement. One test tube study that showed saw palmetto may slow the growth of breast cancer cells. We have had one report of a male who noticed breast enlargement after several months of taking saw palmetto.

Q. I found an inquiry on your web site about possible male breast enlargement from the use of saw palmetto interesting due to my personal experience. About six months into its use  I developed painful gynecomastia (breast pain) on one side. After extensive diagnostic efforts including a mammogram and a full endocrine blood work-up (both negative except that testosterone was on the low side of the normal range), surgical removal was suggested by one surgeon. A second surgeon asked about saw palmetto use and suggested discontinuing it. I did so and the problem resolved in about 30 days. The endocrinologist asked about supplements and specifically ruled out saw palmetto as a cause of breast enhancement in response to my question. Since I am not biologically trained, and this happened about six years ago, I cannot recall the exact explanation, but the endocrinologist explained his understanding of saw palmetto’s biological mechanisms. When I researched the described mechanisms, it became clear to me that there was a serious academic controversy about the mechanisms.
   A. Your personal experience with saw palmetto leading to male breast enlargement is interesting. We will keep an eye out for any research on this topic.

Dosage and dose
The common dosage of saw palmetto is 320 mg of a 80-90% of liposterolic extract a day, or 640 mg of a 40-50% extract. The dose can be split and taken twice daily.

Interactions with prescription medications
Limited research suggests that saw palmetto does not influence the ability of the liver to metabolize other drugs, for instance it does not alter the activity of cytochrome P450.

Is there info available re taking saw palmetto along with prescription meds such as high blood pressure meds?
    As far as we know, the use of the herb does not interfere to any clinical degree with other medications but time will tell.

I'm a 52 yrs old very healthy male. I wake up at nite about 3-4 times, my PSA level has not changed since last year which is 5 , then I was examined by my urologist, no lump was found during my rectal examination, he prescribed a drug. Does saw palmetto interfere with sicj medication?
   There are no indications at this time that saw palmetto interferes with drugs used for prostate enlargement.


My overall opinion, review
Over the past several decades, dozens of studies have indicated that saw palmetto herb is helpful in mild to moderate symptoms of BPH but many others have not shown it to be effective. For the time being I am still confident that saw palmetto herb has a role to play in prostate health. Maybe saw palmetto does not work well in severe cases of prostate enlargement. But, we have to look at the totality of experiments and not rely on the results of the latest study, otherwise we would feel like ping pong balls shifting from one side to the other based solely on the latest results. Also, it is quite possible that a blend of several herbs that have an influence on prostate health would potentially work significantly better than saw palmetto alone.
    Prescription drugs that treat BPH have many side effects, for instance finasteride causes sexual problems and terazosin causes dizziness.

Prostate cancer
Study and research trial results regarding its role in cancer prevention or treatment have not shown consistent results. Researchers at Children's Hospital in Boston, Massachusetts exposed prostate cancer cells and a generic cancer cell line to various concentrations of saw palmetto berry extract. About one-fifth the amount of berry extract was needed to decrease the cell growth of the prostate cancer cells compared to the amount needed to slow down the growth of the generic cancer cells.

Effect of Permixon on human prostate cell growth: Lack of apoptotic action.
Division of Urology, University of Maryland School of Medicine, Baltimore, Maryland. Prostate. 2004.

Emails
Q. If DHT is the business end of testosterone, then will supplements that diminish DHT or (5 alpha reductase) also decrease masculine strength and stamina and also is it true that DHT keeps estrogen in check and therefore reducing DHT will increase estrogen in a man? Though your saw palmetto product is targeted toward prostate health, wouldn't it also be effective for androgenic alopecia caused by sensitivity to DHT at the follicle site?
   A. Research with saw palmetto and other herbs is so limited that it is difficult to be exact in our answers. Perhaps, but it is possible that certain compounds may act locally in prostate tissue but have a different effect in other tissues. The enzymes that convert testosterone to DHT in hair tissue are different that in prostate tissue, and perhaps different in muscle tissue. The extent of estrogen rise in men from saw palmetto, if any, would theoretically seem to be minimal. As mentioned above, hair tissue acts differently than prostate tissue, but it is possible that saw palmetto may have some effect in hair although we have not seen much research on this topic.

My husband is 45, in good health and is taking no medications. He has been taking a saw palmetto complex (2 capsules a day for the past year and a half consisting of Vitamin B6 5mg, zinc 15mg, Saw Palmetto Extract 160 mg for one capsule, pumpkin seed oil extract 40 mg, pygeum extract10 mg, and uva-ursi extract 5 mg. His father had prostate cancer about 13 years ago but survived it and is alive today at 80 yrs. old. My husband's uncle also had prostate cancer and died from it within a year after he was diagnosed. His brother died from brain cancer at 52 yrs. of age. My husband is taking the saw palmetto complex to help prevent getting prostate cancer not because of any physical problems that he has such as an enlarged prostate. My question is do you think it is beneficial for him to continue taking this supplement (preventive maintenance) and if so, does it need to be taken everyday or ever other day or how often? He takes a multivitamin everyday and COq10 30 mg. every other day. Also, can the ingredients in the saw palmetto complex he takes cause him to have impotence or a lower sex drive?
   We can't provide individual advice as to whether a person should or should not take saw palmetto or any other herb or supplement. In my opinion, saw palmetto may actually be beneficial for sexual function, although I am still waiting for more research on this topic.

If I am taking warfarin, can I take saw palmetto herbal extract?
   This herb is not known to cause bleeding problems, but it is difficult to predict interactions with medications.

This plant is sometimes misspelled as palmeto or pametto or palmetta