Palmetto, saw

Saw palmetto is a palm that grows in the southern United States, and extracts from the fruit of this palm are used primarily to treat benign prostatic hypertrophy (BPH).27 Evidence suggests that saw palmetto extracts can reduce urinary restriction and increase 

Historically, saw palmetto has also been used to increase sperm production, breast size, and sexual vigor. Today, saw palmetto is promoted as improving prostate health and urinary flow, and as enhancing reproductive and sexual functioning. 

Saw palmetto is known to have diuretic, urinary antiseptic, endocrinological, and anabolic properties. Traditionally, it is used for chronic or subacute cystitis, catarrh of the genitourinary tract, testicular atrophy, sex hormone disorders, and specifically for prostatic enlargement. 

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Saw palmetto (cabbage palm, fan palm, scrub palm) Serenoa repens %mptoms of benign prostatic hyperplasia Generally well-tolerated occasional gastrointestinal effects May interact with hormones such as oral contraceptive drugs and hormone replacement therapy. 

Dietary supplements are available in a variety of delivery forms such as capsules, tablets, teas, tinctures, extracts, and bulk herbs. Sixty-eight percent of the herbal products available are in the form of a capsule or tablet. Approximately half of the herbal preparations contain a single herb [3]. An example of a softgel is Saw Palmetto Complex by PhytoPharmica. 

Unfortunately, not all products that are used in clinical trials are available in the United States. In a randomized, double-blind, multicenter European study, 1069 men with moderate benign prostatic hyperplasia were randomized to receive saw palmetto (Permixon" )1 160 mg twice daily (90% free and 7% esterified fatty acids) or finasteride 5 mg once daily for 6 months [32]. As determined by patients and physicians, Permixon offered similar improvement in symptoms related to benign prostatic hyperplasia compared to finasteride. Since Permixon is not available in the United States, it should be recommended to patients to use a product that is similar to Permixon that contains a standardized extract of saw palmetto containing 85-95% sterols and fatty acids [18]. 

ConsumerLab.com is an independent testing company that evaluates whether certain dietary supplements have met their standardization claims. Dietary supplements that have been tested include herbs (ginkgo, saw palmetto, ginseng), vitamins (vitamin C), and others (glucosamine, chondroitin, SAMe). Products that meet the German testing standards are published at the ConsumerLab.com website [33]. 

Side effects may be as mild and rare as headache, nausea, and stomach upset for saw palmetto [23,24], However, some supplements may have serious side effects. Hypertension, euphoria, restlessness, nervousness, insomnia, skin eruptions, edema, and diarrhea were reported in 22 patients following long-term ginseng use at an average dose of 3 g of ginseng root daily [38]. Side effects reported with valerian use include headaches, hangover, excitability, insomnia, uneasiness, and cardiac disturbances. Valerian toxicity including ataxia, decreased sensibility, hypothermia, hallucinations, and increased muscle relaxation have been reported [39]. 

Blumenthal M. ConsumerLab.com tests ginkgo and saw palmetto products. HerbalGram 48 66, 2000. 

Although widely used in Europe for BPH, phytotherapy with products such as saw palmetto berry (Serenoa repens), stinging nettle (Urtica dioica),... 

The results of clinical trials of saw palmetto in prostatism are provided in S. Bent,... 

Saw palmetto (Serenoa repens) Prevents prostate disease... 

Numberless phytotherapeutic preparations for the treatment of BPH are on the market. However, the active ingredients and the mode of action remain unknown for most of them. Serenoa repens (also known as saw palmetto from the American dwarf palm) has been investigated in a number of scientific experiments and in chnical trials. It has been proposed that it inhibits the 5aR-2. Since Serenoa repens has no effect on serum prostate-specific antigen (PSA) levels, the mode of action might certainly differ from the mode of action of finasteride or dutasteride [129]. 

Saw palmetto Serenoa repens) is a dwarf American palm native to the extreme southeastern United States. A lipidosterolic extract of its berries contains fatty acids (especially lauric acid), phytosterols, monocylglycerides, and polysaccharides. Fatty acids constitute more than 80% of the extract and are thought to be the most clinically effective component. It is widely used to treat benign prostatic hypertrophy (BPH). Tlie berries themselves are less well absorbed than the extract and are therefore believed to be less effective. 

Saw palmetto extract can inhibit the enzyme 5-a-reductase in vitro. This enzyme converts testosterone into dihydrotestosterone (DHT), which in turn contributes to prostatic enlargement. Saw palmetto also appears to have an antiinflammatory effect and can reduce DHT binding to prostatic androgen receptors (antiandrogenic effect). Despite its proposed 5-a-reductase mechanism. 

Numerous (but not all) trials have indicated improvement in BPH symptom scores compared to placebo with 1 to 3 months of therapy. Saw palmetto extract appears to be equally effective as finasteride (see Chapter 63) but is less effective than aj-adrenoceptor antagonists. No information appears to be available on the use of saw palmetto in the prevention of hair loss. 

Headache and GI symptoms are the most frequently reported side effects. It is possible to reduce GI side effects, such as nausea, abdominal discomfort, and diarrhea, by taking the extract with food. Theoretically, decreased libido or erectile dysfunction could also occur. Because of saw palmetto s possible hormonal effects (and lack of indications for use), pregnant and nursing women should avoid it. It is important to rule out prostate cancer in those taking saw palmetto for BPH, since the symptoms are similar. The effect of saw palmetto on prostatic cancer would likely be beneficial but not curative. No drug interactions have been reported. 

Saw palmetto extract is a fairly well tolerated, safe alternative to finasteride for long-term treatment of BPH, although tti-adrenoceptor blocking agents undoubtedly afford more rapid symptom relief. 

E. Saw palmetto reduces the symptoms of prostatic obstruction with long-term use and appears to be as effective as finasteride. Green tea is recommended as an antioxidant and for its reputed cardiovascular benefits. Bilberry is used for improving night vision, while cayenne pepper is appUed topically as a coun-... 

D. Kava is often recommended for anxiety, and it appears significantly more effective than placebo for this condition. Garlic is used for cardiovascular benefits, saw palmetto for prostatic hypertrophy, and ginkgo as a cerebral vasodilator. Echinacea is considered an immunomodulating herb with potential benefit in viral illnesses. 

Palma nana Italy Saw palmetto United Kingdom... 

Palma sabal Spain Saw palmetto United States... 

Category III prostatitis/chronic pelvic pain syndrome. Extract, administered to men 24 to 58 years old (mean age 43.2), diagnosed with category III prostatitis (CP)/ chronic pelvic pain syndrome (CPPS), at a dose of 325 mg daily for 1 year, produced no appreciable long-term improvement. There was a decrease of mean total National Institutes of Health Chronic Prostatitis Symptom Index score from from 24.7 to 24.6 in the saw palmetto arm (p = 0.41). There were three cases of headache in the saw palmetto group. At the end of the trial, 13 of 32... 

Cytochrome P450 2D6 and 3A4 activities. Saw palmetto extract, administered to healthy volunteers (six men and six women) for 14 days at generally recommended doses, did not alter the disposition of coadministered dextromethorphan and alprazolam primarily dependent on the CYP2D6 or CYP3A4 pathways for elimination b Cytotoxic activity. Extract from saw palmetto, in LNCaP cell culture, produced cell... 

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