Saw Palmetto berry supplement, extract benefit, side effects, influence on 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
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 they are not as potent.
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Prostate Power Rx 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 (Rosemarinus officinales leaf)
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
Saw Palmetto Extract
Supports Healthy Prostate Function
Guaranteed to
supply 45% fatty acids and beneficial plant sterols, which are the
herb's key active ingredients. Extraction is done using carbon dioxide,
the finished product is free of solvent residues.
Supplement Facts
Saw palmetto extract (Berry) - 320 mg
Fatty Acids - 45% fatty acids
Suggested Use: As an herbal supplement, take 1 or 2 saw palmetto capsules per day.
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.
A few months ago I started using a saw palmetto
supplement from a company whose two word name both begin with P. 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.
It is possible that the product you purchases 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.
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?
Serenoa repens ( Permixon ) inhibits the 5alpha-reductase activity of human
prostate cancer cell lines without interfering with PSA expression.
Int J Cancer. 2005.
Saw palmetto is an effective dual 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,
it does not inhibit binding
between activated AR and the steroid receptor-binding consensus in the promoter
region of the PSA gene.
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
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.
Clinical Research and Development Network, Aurora, CO, USA.
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 saw palmetto 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.
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
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.
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This herbal sexual formula
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Dr. Sahelian and his research staff have tested various doses and extracts of
exotic herbs from a number of raw material suppliers to determine
the ideal dose and combination for optimal libido enhancement with fewest side
effects. After years of research and trial and error, a proprietary
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The potent herbal extracts in Passion Rx include Ashwagandha, Catuaba, Cnidium, Herba Cistanches, Horny goat weed, Maca, Muira puama,
Passion flower,
Tongkat-Ali (Eurygold and LJ100),
Tribulus and Yohimbe. A version of Passion Rx without yohimbe is also
available. Passion Rx does not contain hormones such as testosterone, androstenedione, or DHEA,
nor does it have pharmaceutical impotence treating drugs.
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.
Permixon, the lipidosterolic extract of Serenoa repens is widely used for the
treatment of symptoms associated with benign prostatic hyperplasia BPH. 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.
Saw Palmetto, PSA
Over the years I have been asked whether saw palmetto, the herb
used for prostate enlargement, 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.
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.
You mention four groups of ingredients in saw
palmetto are free fatty acids, phytosterols, free fatty alcohols, and
monoglycerines. From what I've read, the two active ingredients are free fatty
acids and phytosterols. If these four groups of ingredients are the only ones in
saw palmetto herb, and they are obviously found in most plants and grains albeit
in different combinations, it shouldn't have any side effects right? In other
words, there are no other groups of ingredients that could be causing some to
claim there are side effects from saw palmetto similar to Propecia, finasteride?
Propecia, also known as finasteride, has a completely different
chemistry as the substances found in saw palmetto. There have been long term
studies with saw palmetto that have not shown any major side effects, but, to be
cautious, it is a good idea to take breaks from use.
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
Unfortunately, many herbal and 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. The
extracts 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. (See below for the full study.)
Is saw palmetto for a Woman, too? - Does it lead
to female breast enhancement?
I have not come across any research to indicate whether
saw palmetto 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.
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.
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. A comprehensive analysis of 21 trials
involving over 3,000 men found saw palmetto provided "mild to moderate improvement" in symptoms with fewer adverse
events than finasteride (Proscar). The multistudy analysis was performed by the
Cochrane Collaboration, a nonprofit group that specializes in reviewing
medical literature.
(By the way, did the researchers purposely choose
men with moderate and severe symptoms in order for the saw palmetto
results to fail?)
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.
Saw Palmetto studies and review of research trials
Prostate cancer is a significant cause of death in Western countries and is
under the strong influence of androgens. 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.
Men who are bothered by symptoms of an enlarged
prostate may find some relief in certain herbal remedies and simple
lifestyle changes. Men who are bothered by such symptoms have several options for
combating them, including the herbal product saw palmetto, according to
Dr. Harvey B. Simon, an associate professor of medicine at Harvard Medical
School in Boston and editor of the Harvard Men's Health Watch. In the
November 2004 issue, Simon details
some of the research that suggests saw palmetto may ease BPH symptoms. For
instance, a review of 18 studies found that overall, saw palmetto cut
nighttime urination and other BPH symptoms by about one-quarter. The
studies, conducted mostly in Europe, included nearly 3,000 men between the
ages of 40 and 88. Exactly why saw palmetto may aid in BPH is not fully clear. Simon
points out that animal and lab research suggests that the herb affects
hormone receptors on prostate cells. And like certain prescription drugs
for BPH -- finasteride (Proscar) and dutasteride (Avodart) -- saw palmetto
appears to inhibit an enzyme that converts testosterone to the hormone
dihydrotestosterone, which is believed to be involved in prostate
enlargement. There are other herbs purported to ease BPH symptoms, such as Pygeum
africanum -- extracted from the bark of the African plum tree -- and
extracts from Urtica dioica, the stinging nettle. But the evidence for
these herbs is weaker than that for saw palmetto, according to Simon.
Saw palmetto and benign prostatic hyperplasia.
Am J Chin Med. 2004.
Benign prostatic hyperplasia (BPH) is a common health issue that affects 8% of
all men at the age of 40, 60% of men in their 70s, and 90% of those greater than
80 years of age. One-fourth of these men will develop moderate to severe lower
urinary tract symptoms that greatly affect their quality of life. Recent
evidence suggests that the use of saw palmetto leads to improvements in urinary
function for those suffering from BPH. The favorable comparison of saw palmetto
with tamsulosin, a well-known first line agent in the treatment of urinary tract
symptoms, demonstrates promise towards a beneficial effect of this herbal agent,
with very few, if any, adverse effects. However, what degree of this beneficial
activity is due to placebo effects is yet to be determined. In addition, the
precise mechanism of action of saw palmetto in men with BPH remains unclear.
Serenoa repens ( Permixon) inhibits the
5alpha-reductase activity of human prostate cancer cell lines without
interfering with PSA expression.
Int J Cancer. 2004 Nov 12;
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. Here, we focussed on the
possible pathways that might differentiate the action of saw palmetto from that of
synthetic 5alpha-reductase inhibitors. We demonstrate that saw palmetto,
unlike other 5alpha-reductase inhibitors, does not inhibit binding between
activated AR and the steroid receptor-binding consensus in the promoter region
of the PSA gene. This was shown by a combination of techniques: assessment of
the effect of saw palmetto on androgen action in the LNCaP prostate cancer cell line
revealed no suppression of AR and maintenance of PSA protein expression at
control levels. This was consistent with reporter gene experiments showing that
saw palmetto failed to interfere with AR-mediated transcriptional activation of PSA
and that both testosterone and DHT were equally effective at maintaining this
activity. 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.
Effect of permixon (saw palmetto extract) on human prostate cell growth:
Lack of apoptotic action.
Hill B, Kyprianou N. Division of Urology, University of Maryland School of
Medicine, Baltimore, Maryland.
Prostate. 2004.
Permixon, a phytotherapeutic agent derived from the serenoa repens plant, is
a lipid/sterol extract that is believed to interfere with 5alpha-reductase
activity, thus inhibiting prostate growth. In this study, we investigated the
magnitude and specificity of the effect of saw palmetto extract on cell
proliferation and apoptosis in human prostate cancer cells.Our
findings indicate that saw palmetto extract is weak inhibitor of
5alpha-reductase compared to finasteride. This study challenges previous
evidence on the anti-growth effect of saw palmetto extract in the prostate and
its ability to inhibit 5alpha-reductase activity, while questioning apoptosis as
a mechanism of action of this phytotherapeutic against prostate growth, a
concept that may have therapeutic significance.
Efficacy of pretreatment with Serenoa
repens on bleeding associated with transurethral resection of
prostate
Minerva Urol Nefrol. 2004 Mar;56(1):73-8.
We enrolled 108 patients, randomised either in the saw palmetto group or
in the control one. Patients in the saw palmetto group received a pretreatment
with saw palmetto (320 mg/die of Permixon ) for at least 8 weeks before the
TURP procedure. In the control group patients did not receive any medical
treatment before the intervention. In the saw palmetto group the perioperative bleeding
was significantly lower than in the control one (respectively 124 vs 287 ml) and
the need of transfusion decreased remarkably. Moreover, in the saw palmetto group,
the duration of postoperative catheterization (respectively 3 vs 5 days) and the
evaluated hematological parameters (red cells 4.5 vs 4 million, hemoglobin 13 vs 11.9 g, hematocrit 40% vs 35%) were significantly lower than in the control
group. The pretreatment with saw palmetto, before TURP procedure,
improves the efficacy of the procedure itself and reduces the risk of
complications, in particular perioperative bleeding and duration of
postoperative catheterization.
Prostate Cancer
Extract from the Saw Palmetto berry may also have anti-cancer properties, researchers
at Children's Hospital in Boston, Massachusetts announced at a meeting of The
American Society for Cell Biology. The research 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.
Emails
Q. I have significant erectile dysfunction, have been taking saw palmetto
to counteract prostate enlargement, and I am wondering if the saw palmetto works
(in part?) by "suppressing the effects of testosterone" or by actually possibly
suppressing the levels of testosterone in the body?
A. My latest understanding with saw palmetto in regards to testosterone is that
it may inhibit its conversion into DHT in prostate tissue. Whether it
influences levels of testosterone in the body or is a factor in causing
erectile dysfunction
is not clear to me at this time.
Q.
Hello doctor, I had taken saw palmetto
to try to inhibit hair loss about 5 months. Most studies show that it is
useful in treating BPH but also inhibits DHT in the prostate.
A. First, it is difficult to say what kind of effect saw palmetto has on
hair follicles and hair growth. My suspicion is that it has little influence (as
opposed to finasteride, Proscar, Propecia) although we just don't know for
certain since the role of saw palmetto and hair growth has not been studied to
any great extent.
Q. Have you, by perusing research, or through clinical experience
found anything to suggest that saw palmetto may reduce 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. This product has saw palmetto and
several other other herbs for prostate health.
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 the use of saw palmetto 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. Without fully understanding
the debate, I understood enough at the time to understand that depending on who
was right, saw palmetto could effect male breast enlargement. In the course of
my research I found a re-print of a non-technical publication by an herbalist in
the 1950’s who noted that saw palmetto could be used for female breast
enlargement and generally for female hormonal imbalances.
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.
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 5.1 , then
I
was examined by my urologist, no lump was found during my rectal examination, he
prescribed a drug. I want to take this saw palmetto you described.
My question is will this saw interfere with my medication or i can take it any
time?, will this extract help to reduce my PSA level ? will this extract work in very
short time and stop or do I have to take it for life?
Saw palmetto should not interfere with drugs used for
prostate enlargement. I doubt if it will reduce PSA levels. Saw palmetto should be taken
for many years as long as there is prostate enlargement.
Herb vs Drug --The Match of the Decade
Could extracts from a common, dwarf palm tree berry compete with the
so-called "gold standard" of traditional BPH therapy? Merck and Company, one of
the largest pharmaceutical corporations in the world, had invested hundreds of
millions of dollars in the past decade in creating, studying, and marketing
finasteride (Proscar). This medicine has become one of the most frequently used
drugs in the therapy of BPH. But, could there be a cheaper, as effective, and
more natural alternative, such as saw palmetto?
The largest study ever done comparing Proscar with saw palmetto was a six month double-blind, randomized trial and included 1,098 men (Carraro, 1996). (Double blind means that neither the researchers, nor the patients, know whether they are taking the real medicine or a dummy pill until the code is broken at the end of the study.) It was done in 87 urology centers in nine European countries. All the men had BPH, were over the age of 50 years, and had symptoms associated with bladder flow obstruction.
Saw palmetto extract, in the form of the trademarked version Permixon, was administered at a dose of 160 mg twice a day, in the morning and evening, for a period of 26 weeks. This was compared to Proscar at a 5 mg dosage in the morning. It was a close tie with both medicines showing advantages and disadvantages. There was improvement noted in both groups within 6 weeks, and the improvement continued as the study went on. Both medicines reduced the size of the prostate gland, however, Proscar was more effective. Sexual function -- only one patient in each treatment group withdrew from the study because of sexual problems. However, patients on Proscar reported a deterioration in sexual function compared to those on saw palmetto. They had a higher incidence of decreased libido, impotence, and ejaculatory disorders. Urinary flow -- the ability to urinate rapidly improved in both groups with a slightly higher improvement on Proscar.
A Long term study
The results showed nocturia to be improved in 73 percent of the patients. At the start of the study, only 13 patients did not have nocturia, whereas, at the conclusion of the 3-year trial, 114 patients were symptom-free. Daytime frequency improved in 54 percent of the patients. Residual volume diminished by 50 percent. With respect to digital rectal examination, after three years of therapy with saw palmetto, no changes in the size of the prostate could be determined.
Overall, 80 percent of the patients and doctors felt the improvements on saw palmetto were either good or very good. The researchers conclude, "If one compares the results of the present three-year study of IDS 89 (saw palmetto extract) with published data on the long-term treatment of BPH using synthetic active ingredients--i.e. a three-year finasteride study (Stone, 1994), and an 18-months study on the selective alpha-1-blocker, terazosin (Wilde, 1993)--one can, despite methodological reservations, conclude somewhat unexpectedly that better clinical efficacy [effectiveness] has been documented in respect to the saw palmetto preparation. Withdrawal from therapy because of adverse events was 1.8 percent with saw palmetto , as opposed to 11 percent with finasteride and 10 percent with terazosin."
This study is very important because it has been known that patients with BPH have a significant response to placebo that can go on for many months, and even up to two years. This finding was reported by Dr. J. Curtis Nickel, professor or urology at Queen's University Faculty of Medicine in Kingston, Ontario, at the 1997 annual meeting of the American Urological Association (Family Practice News, 1997). Therefore, the 3-year study reported above lends additional credence to the effectiveness of saw palmetto. Unfortunately, this 3-year study was not placebo-controlled. Hence, more long-term, placebo-controlled studies are required to satisfy the skepticism of critics.
Review
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.
Q. Thanks to Dr. Ray Sahelian, M.D. For about nine months I had mixed results using another product that contained Beta-Sitosterol, 600 mg plus a number of minerals such as, Zinc, Copper, Manganese, etc. etc.. I replaced the aforementioned supplement with Prostate Power Rx and within two to three weeks I experienced a truly significant improvement in my condition. Now after about six weeks of use I am a very happy camper. I now only get up during the night ,one or two times as opposed to three, four and sometimes five times. Also, during the day I have very much more control over my need to find a men's room. I highly recommend Prostate Power RX. JB, Hollister, California
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.
Does saw palmetto decrease libido or erection? Since it
prevents testosterone to be converted to DHT, which is an important hormone for
maintaining good libido and erection, it would make sense that saw palmetto
could cause decrease libido or erection.
Actually we have not seen any studies regarding its
influence on libido. Our limited clinical anecdotal experience
indicates that saw palmetto may, in some people, help with erectile function.
I found the number of inquiries on Dr. Sahelian’s web site about possible male breast enlargement from the use of saw palmetto interesting due to my personal experience. About six months into the use of saw palmetto I developed painful gynecomastia 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 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 (albeit with one view in a distinct minority) about the mechanisms. Without fully understanding the debate, I understood enough at the time to understand that depending on who was right, saw palmetto could effect male breast enlargement. In the course of my research I found a re-print of a non-technical publication by an herbalist in the 1950’s who noted that saw palmetto could be used for female breast enlargement and generally for female hormonal imbalances. In light of the number of inquiries, my personal experience, the academic dispute, and the older herbalist publication indicating some folk wisdom on the subject, a warning about possible side effects should be considered.
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.
I used saw palmetto extract 320 mg 80 to 90% standardized for about 5 months. During month 3 and 4 I noticed soft erection and decreased ejaculation volume also little bit gynecomastia. I did not pay attention up until Jan, 2009 when my skin turned yellow and my stomach stayed constantly upset. I stopped the herb cold turkey. I got well quickly, appetite became good but only for 3 weeks when suddenly symptoms came back very severely and I became impotent, with no erection and sever joint pain. Blood test showed low total and free testosterone. After 2 months another blood test showed values below normal. My LH got smooth decline in 5 months. Now I am still very week, impotent low in energy at time of writing this on Nov, 2009 (8 months after quitting). I googled and found many men struggling with the same problem after using this herb as I am in now. I am very depressed. My understanding is that long term suppression of DHT lets estrogen increase (during which gynecomastia develops). this increase in estrogen lowers LH through negative feed back on hypothalamus. Now our body is more estrogenic and has been locked at this state. I don't know how and when body will come out of this state.
I have used saw palmetto and pygeum for about 25 years.
Standardized extract, 320 mg per day. I knew it provided relief for the
discomfort of BPH. I just recently was made aware that I was
retaining 1900 cc of urine! I am told I was fortunate that my kidneys were just
BEGINNING to be affected and I had not damaged them. It makes me wonder if the
saw palmetto was masking the root of the problem and delaying addressing the
issue of a restricted urethra. Apparently, in me, it did NOT help reduce the
size of the prostate. I am currently doing self catheterization and planning for
surgery to open up my urethra. After 25 years of extolling the virtue of saw
palmetto I wanted to make a knowledgeable person like you aware of this surprise
revelation.
I don't have enough feedback from long term users to know the
effects of this herb on long term prostate gland size. There are many possible
explanations. It is possible the herb slowed the enlargement of your prostate
gland and if you had not been taking it the urine retention may have come
sooner. It is possible that it had little or no effect at all. Perhaps the
quality of the latest batches were not good. Perhaps if you had taken a
prescription medication such as Proscar or Avodart the same thing could have
happened. It is possible that if you had taken Proscar or Avodart urine
retention may not have occurred, but then again these drugs have many other side
effects. It is difficult to know based on the results of one person.
This plant is sometimes misspelled as palmeto or pametto or palmetta