SAW PALMETTO

BACKGROUND

Ingredient Type: Botanical, Extract

Also Known As: American Dwarf Palm Tree, Baies du Chou Palmiste, Baies du Palmier Scie, Cabbage Palm, Chou Palmiste, Ju-Zhong, Palma Enana Americana, Palmier de Floride, Palmier Nain, Palmier Nain Américain, Palmier Scie, Sabal, Sabal Fructus, Sabal serrulata, Saw Palmetto Berry, Serenoa repens, Serenoa serrulata.

The shrublike palm of Saw Palmetto is considered native to the southeastern region of the United States; having been found as far north as North Carolina and as far south as Texas. The plant is known to tolerate a wide range of conditions as well as being salt-tolerant, making it rather ideal for coastal climates. Saw Palmetto is also considered an asset to wildlife as the berries are an important food source for a lot of mammals and birds (23). As far as humans are concerned, the plant has been consumed in various forms for thousands of years. For instance, the aborigines of the Florida peninsula had a diet that consisted of fruits, potatoes, seeds, frog legs and shellfish. While the Saw Palmetto fruit was reported to be rather repugnant, it was considered a staple food item during those times. For instance, the Mayans utilized a liquid form of Saw Palmetto as a tonic (25).

Being that consumption of Saw Palmetto was considered somewhat less than palatable, it was often mixed with other herbs, grains and/or seeds, such as nettle root and pumpkin seeds. Saw Palmetto was introduced into the Western medical practice in the late 1800’s by the less conventional practitioners for urological conditions, especially revolving aroud the prostate. Shortly thereafter, due to the observed positive effects on livestock, further interest was found in how Saw Palmetto could be used to treat such genitourinary conditions as enlarged prostate, cystitis, gonorrhea, and irritation/inflammation of the mucous membranes. Although the Saw Palmetto berries were introduced into the US Pharmacopeia in 1906/1916 and the National Formulary in 1926, its presence and use in the United States waned following the World War II era (23).

TRADITIONAL USES

According to historical records, the Native American’s kept Saw Palmetto around to utilize as an antiseptic and a tonic for impotence, inflammation, and infertility.  In women specifically, it was found to treat infertility, underdeveloped breasts, increase lactation and mitigate painful menstruation cycles. In men, Saw Palmetto helped to reduce the size of enlarged prostate (23). Additionally, for over 200 years, it was found that crude extracts of Saw Palmetto were also used for various conditions such as general weakness and recovery from major illnesses.

WHAT DOES SCIENCE TELL US?

Decrease Male Pattern Baldness

According to research, it is the extract form of Saw palmetto that works to stop androgenic alopecia, which is recognized as one of the causes of hair loss in both males and females, potentially resulting in a form of pattern baldness. From the observations in related research, it is believed that Saw Palmetto can slow or even stop the resulting pattern baldness. It’s been suggested that the Saw palmetto extract from works by blocking 5-alpha-reductase, working similarly to other synthetic ingredients, which are commonly found in medical treatments utilized for hair loss (16).

Recent research has revealed that Saw Palmetto may help to reduce hair loss. Although the information is limited, the research results are still promising. The pathway of function occurs when the extracts of saw palmetto resist an enzyme (5-alpha-reductase), which is known to convert testosterone into (dihydrotestosterone) DHT. In excess, the molecules of DHT are believed to be the cause of pattern baldness. The effects of DHT shorten hairs, resulting in both thinner and weaker hair strands; more easily resulting in hair damage and/or loss. A study was conducted on 50 patients who presented with hair loss. These patients were subsequently treated with the Saw Palmetto berry extract. Upon a 4-month follow-up, a 11.9 % increase in hair growth was reported in 50% of the patients (25).

A similar, but smaller study was conducted on men between 23-64 years of age with mild to moderate (Androgenic Alopecia) AGA, aka. hair baldness. Each of the treatment group participants received 200 mg of the standard dose of Saw Palmetto, along with another plant extract, beta-sitosterol, which is well known in its ability to promote hair growth. As a result of this experiment, 60% of the participating men had noticeably reduced hair growth. Counter to other studies, the results of this study revealed the efficiency of the 5AR inhibitor, yielding to the continued deleterious effects of AGA, as it pertained to hair growth (17).

It has been investigated that Saw Palmetto may also help to reduce inflammation on the scalp, further supporting circulation, nourishment, and integrity of the hair follicles; thus, resulting in a decrease of lost hair while concurrently supporting the growth and maintenance of new hair (Duggan & Grundy, 2021). The recommended forms to consume Saw Palmetto for its effects related to hair health are as a capsule, liquid, or tea. Although not typically consumed on its own, it is often combined with other supplements that support hair growth such as pumpkin seed and primrose oil (7).

Anti-Inflammatory Properties

In this review article, the role of inflammation in lower urinary tract symptoms due to benign prostatic hyperplasia is evaluated as well as the specifically identified treatments that are utilized to treat prostatic inflammation, such as, hexanic lipidosterolic extract of Serenoa repens, nonsteroidal anti-inflammatory drugs and vitamin D receptor agonists. Although rather limited, studies have found that the hexanic extract of S. repens is responsible for a decrease in prostaglandin and leukotriene production, leading to a decrease in inflammatory factors and gene expression (9). Specifically, as it relates to human prostate carcinoma cells, the observed inhibitor effect on cell growth was attributed to the downregulation of inflammatory-related genes as well as the activation of the nuclear factor-kappa B pathway (19).

Another systematic review, where possible, meta-analysis, was conducted on existing evidence regarding both the safety and efficacy of the Saw Palmetto extract, Serenoa rapens in men with symptomatic benign prostatic hyperplasia (BPH). In this randomized trial, participants who had BPH either received a preparation of S. repens alone, in combination with other phytotherpeutics, a placebo or other pharmacological therapies for BPH over a treatment period of at least 30 days. While it was noted that there is rather limited literature on S. repens for the treatment of BPH in short study durations, evidence suggested that S. repens was noted to improve urologic symptoms and flow measures. Similarly, when compared to finasteride, S. repens, yielded similar urinary tract symptoms and flow improvement. It was indicated, however due to the short duration of this study/review that further research is necessary to determine the long-term effectiveness of and ability to prevent BPH complications (26).

Benign Prostatic Hyperplasia (BPH) has been commonly observed to present with pervasive inflammatory infiltrates which are mainly composed of the common inflammatory markers such as activated T- cells, monocytes, and macrophages. The researchers in this study wanted to further assess the anti-inflammatory activity of Permixon®, a hexanic lipodosterolic extract of Serenoa repens which is normally used to treat urinary symptoms associated with benign prostatic hyperplasia. Through the study, it was found that the active ingredient in Permixon® was able to reduce the inflammatory response in a concentration-dependent manner. More specifically, the Hexanic LSESr impeded key steps of inflammatory modulator attraction and adherence by inhibiting expression by prostate and vascular cells in an inflammatory environment (13).

A similar, multicenter study was conducted to assess the effects of Profluss® on chronic inflammation associated with benign prostatic hyperplasia. The active ingredients in Profluss® included Serenoa repens, selenium and lycopene. Of 168 subjects affected by (lower urinary tract symptoms) LUTS due to bladder outlet obstruction, two groups were identified in order to ascertain the efficacy of Profluss® on those with PCI associated with BPH or those with histologically diagnosed BPH. Core biopsies were obtained at the start as well as at the 3-month interval to assess changes in inflammatory parameters. It was observed amongst both study groups that there was a significant reduction in inflammatory marker presence as it related to both the treatment of PCI in BPH and/or PIN/ASAP patients (15).

Promotion of Urination

In a study of about 50 men who presented with lower urinary tract (LUT) problems along with a minimum International Prostate Symptom Score (IPSS) of 10 or greater; they were subsequently treated with a daily dose of 160 mg of Saw Palmetto twice a day for a trial period of 6 months. The initial assessment included baseline measurements for peak urinary flow rate, postvoid residual urine volume, a pressure-flow study, as well as a serum prostate-specific antigen (PSA) level. Upon assessment of the 46 men who completed the treatment for 2-months, a significant improvement of symptoms (50% or better) was observed in the patients for 2, 4, and 6 months (21%, 30% and 46%) respectively. While Saw Palmetto was relatively well tolerated and did provide benefit as it pertained to lower urinary tract symptoms, the study was unable to demonstrate a significant improvement in the area of bladder outlet obstruction; specifically, “there were no significant changes in peak urinary flow rate, postvoid residual urine volume or detrusor pressure at peak flow” among the studied patients. Further studies are needed to better evaluate Saw Palmetto and its general effectiveness related to LUT symptoms (11).

Another study was conducted to assess the effects of Saw Palmetto on urinary symptoms, sexual function, as well as urinary flow of men who presented with general lower urinary tract symptoms. The participating men in this study were at least 45 years of age or older who came to the study with an International Prostate Symptom Score of at least 8 or greater. A total of 85 men were randomized to receive either a placebo or the Saw Palmetto treatment for a duration of 6 months. During the study, the following parameters were measured to determine the efficacy of Saw Palmetto: IPSS, a sexual function questionnaire, as well as a urinary flow rate measurement. Upon review of the results, while the quality-of-life score greatly improved in the Saw Palmetto group, it was not considered statistically significant. In the department of sexual function, there was not change observed. Lastly, pertaining to the peak flow rate, an increase of 1.0 mL/s and 1.4 mL/s was observed in the Saw Palmetto and placebo groups, respectively. While the exact mechanism of Saw Palmetto is still unknown, Saw Palmetto was observed to yield statistically significant improvements in the symptoms associated with lower urinary tract disorders when compared to the placebo. There however was no measurable effect from this study on urinary flow rates (10).

A systematic review, where possible, meta-analysis, was conducted on existing evidence regarding both the safety and efficacy of the Saw Palmetto extract, Serenoa rapens in men with symptomatic benign prostatic hyperplasia (BPH). In this randomized trial, participants who had BPH either received a preparation of S. repens alone, in combination with other phytotherpeutics, a placebo or other pharmacological therapies for BPH over a treatment period of at least 30 days. While it was noted that there is rather limited literature on S. repens for the treatment of BPH in short study durations, evidence suggested that S. repens was noted to improve urologic symptoms and flow measures (26).

Reduction of Benign Prostatic Hypertrophy (BPH)

This Chinese double blind, placebo-controlled study was conducted to determine the efficacy of the effects of Serenoa repens amongst male patients presenting with benign prostatic hyperplasia, as well as other similarly related lower urinary tract symptoms. Of 19 institutions that participated in this study, a total of 354 participants were randomly assigned to either the treatment group or the placebo group for a duration of 24-weeks. The efficacy parameters measured throughout the study included: the IPPS marker, peak urinary flow, storage/voiding symptom scores, prostate volume, urinary frequency, as well as total PSA levels. Some other values were ascertained as well such as a quality-of-life score, a 4-item male sexual function questionnaire score and an International Index of Erectile Function score. Upon further investigation at the conclusion of the study, statistically significant improvements were noted in the Serenoa repens extract group, when compared with the placebo group using a wide range of the aforementioned study parameters. For instance, the positively observed results were noted with peak urinary flow, IPSS scores, the scores related to storage and voiding symptoms, amongst others. It was also noted in this study that the Serenoa repens extract was not only seen as effective but save and well tolerated (30).

Another study was conducted in order to evaluate the tolerance and efficaciousness of a Saw Palmetto oil concentrate containing 3% β-sisterol in the specific treatment of benign prostatic hyperplasia and androgen deficiency. The 99 participants in this study were between the ages of 40 – 65 yeas old who were known to be symptomatic with BPH. There was a 12-week duration to this double-blind treatment. Participants were either placed in the group who received 500mg dose of   β-sisterol-enriched Saw Palmetto oil, conventional Saw Palmetto oil or a placebo group in the form of an oral capsule. The measured parameters used in this study to determine effectivity were: IPSS, uroflowmetry, a serum measurement of one’s PSA, along with a testosterone and 5α-reductase level.  Upon review of the results, there was a significantly noted decrease in the IPSS and postvoiding residual volume. Additionally, there was also a significantly noted increment in the maximum and average urine flow rate in the subjects treated with the enriched Saw Palmetto oil when compared to the placebo group (21).

A systematic review, where possible, meta-analysis, was conducted on existing evidence regarding both the safety and efficacy of the Saw Palmetto extract, Serenoa rapens in men with symptomatic benign prostatic hyperplasia (BPH). In this randomized trial, participants who had BPH either received a preparation of S. repens alone, in combination with other phytotherpeutics, a placebo or other pharmacological therapies for BPH over a treatment period of at least 30 days. While it was noted that there is rather limited literature on S. repens for the treatment of BPH in short study durations, evidence suggested that S. repens was noted to improve urologic symptoms and flow measures. Similarly, when compared to finasteride, S. repens, yielded similar urinary tract symptoms and flow improvement. It was indicated, however due to the short duration of this study/review that further research is necessary to determine the long-term effectiveness of and ability to prevent BPH complications (26).

Effects on Erectile Dysfunction

Saw palmetto has been found to improve erectile response by enhancing vasodilation while simultaneously reducing vasoconstriction through the improvement of turgor and the provision of a ‘faster response’. In studies, it has been found to increase levels of available nitric oxide, thereby helping to regulate blood circulation in erectile tissue. In 2013, a study on 82 men with clinically diagnosed erectile dysfunction was established. Each of the participants were treated with 320 mg of Saw Palmetto extract once a day for a duration of 8 weeks. Upon review of the results, it was found that International Index of Erectile Function (IIEF-5) marker significantly improved by 51% along with an improvement of erectile dysfunction and sexual functions by 40%. Additionally, with regard to the International Prostate Symptom Scores (IPSS), it was found that improved bladder emptying, and urination were observed (22).

In 2004, in the Journal of Urology, 30 in-vivo and in-vitro studies were analyzed to assess Saw Palmetto’s use for the following male-specific disorders: erectile dysfunction, low libido and BPH. Review of the studies revealed that Saw Palmetto had a somewhat wide-spectrum activity, working via numerous mechanisms. The verified activity included the suppression of excess testosterone and DHT, its anti-inflammatory response, as well as its effectiveness for erectile function (5).

It has also been observed, in various clinical trials, that the action of Saw Palmetto boosts the nitric oxide levels in the penile blood vessels which is known as one of the major factors for the support of healthy erectile function. With further research to determine efficacy and the exact pathway that supports increased nitric oxide levels, it would explain the significant reports of improved pelvic circulation and sexual function in men who have received Saw Palmetto as part of their research trials (28). For instance, one specific clinical trial what was published in the New England Journal of Medicine found that following the second year of consuming Saw Palmetto, significant improvements were observed as it pertained to sexual function, along with a decrease in prostate related symptoms over time (4).

Lastly, in a local clinic, a select group of patients participated in a trial who consumed a minimum of 144mg of Saw Palmetto sterols daily (160mg at 90% or 320mg at 45%). It was reported that the male constituent was able to attain erections faster, keeping them longer and supported more satisfactory intimate encounters. Through further research, it was also recognized that significantly better results would be attained if Pygeum (Prunus Africana) and Stinging Nettle were added. This combination seemed to magnify the beneficial activity seen in Saw Palmetto alone (12).

SAFETY

As noted in many of the noted studies, Saw Palmetto appears to be well-tolerated by most of its consumers and can be considered safe when taken in recommended dosages. For those who may experience side-effects associated with the intake of Saw Palmetto, the most notable are mild G.I. discomfort, nausea, constipation, as well as dizziness and headache (3).

When consuming Saw Palmetto, it is recommended to take with food. While a majority of the studies are conducted on male subjects, it is recommended to talk with your doctor before starting this supplement in women or children.

Side-Effects:

While the most common side effects associated with the supplementation of Saw Palmetto include nausea, diarrhea constipation and similar G.I. disturbances, it has also been recognized to have been associated with decreased libido, fatigue, headache and rhinitis (1).

If you are taking or consider taking Saw Palmetto, it is recommended to speak with your health provider prior to supplementation. Concurrently supplementing Saw Palmetto with some of the following herb or pharmaceutical medications may result in adverse effects related to the efficacy or side-effects of the partnered herb or pharmaceutical medication.

For those currently taking, or who will be taking, a form of anticoagulants, antiplatelets or NSAIDS, due to the active components of Saw Palmetto, it may further promote additional anticoagulative effects of the concurrent medication. It is advised to consult with a healthcare professional for advice before supplementing with Saw Palmetto alongside your anticoagulant/antiplatelet medications. This is also the case for those taking any Nonsteroidal anti-inflammatory drugs (NSAIDs) (6), (24), (18).

Similarly, for those taking either UGT (Uridine 5’-diphoshpho-glucuronosyltransferase) substrates or CYP 450 substrates, Saw Palmetto has been found to inhibit/ interfere with the drug actions metabolized by these specific enzymes. Although clinical relevance is said to not be known, it is still recommended to consult with a healthcare professional for advice before supplementing with Saw Palmetto alongside your medications (14), (27).

REFERENCES

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