Saw Palmetto: A Natural Remedy for Hot Flashes and Prostate Health?
With age comes wisdom and experience. But it also comes with some less desirable traits, like achy joints, a sudden need for reading glasses, hot flashes for women, and prostate issues for men.
Not surprisingly, in all four cases, the first thing many physicians reach for is their prescription pad. And while reading glasses aren’t really worth worrying about, the hormone therapies for menopause and prostate health can come with a whole host of negative side effects, such as decreased libido and increased risk of stroke and even cancer.
But what if you didn’t need a prescription? What if you could ease symptoms of prostate problems or even prevent them from occurring in the first place with something as common as a tree found in Florida?
Men, pay attention. Women, listen up as well. Your husband’s prostate health is about to take a turn for the better, thanks to saw palmetto.
A Man’s Favorite Tree…
Saw palmetto is an extract of the fruit of Serenoa repens. It has been known by a number of synonyms, including Sabal serrulatum, under which name it still often appears in alternative medicine.
It is native to the West Indies and the Atlantic coast of the U.S., most notably in Florida. Parts of the plant have been employed in various economic ways, such as the thatching of huts, making of mattresses, straw hats, and paper. However, it is the saw palmetto berry that has garnered the most attention. For several hundred years, they have been used in American folk medicine as an aphrodisiac and for treating prostate problems.
Specifically, Native Americans in the southeast United States have used saw palmetto since the 1700s to treat male urinary problems. The aboriginal American medicine man kept a medicine bag of saw palmetto to treat infertility in women, underdeveloped breasts, increase lactation, ease painful menstruation cycles, reduce prostate, stimulate appetite, and to treat general illness and nourish the body.
In the 1800s, medical botanist John Lloyd noted that animals that ate saw palmetto appeared healthier and fatter than other livestock. Early American settlers noticed the same effects and used the juice from saw palmetto berries as a sedative, to gain weight, to improve general disposition, and to promote reproductive health.
Aside from these traditional uses, Dr. J. B. Read, a physician in Savannah, Georgia, documented the medicinal uses of saw palmetto in the April 1879 issue of American Journal of Pharmacy.1 He found the herb useful in treating a wide range of conditions, including insomnia, coughs, digestion, and anxiety.
More than 20 years later, in 1898, Edwin M, Hale, MD, wrote a book entitled Saw Palmetto, which describes the medicinal value of saw palmetto as tinctures of the berries (fruits) and crushed seeds.
In that same year, King’s American Dispensatory described saw palmetto extract as an expectorant that controls irritation of mucous tissues.2 It also noted that it has proved useful in treating a wide variety of coughs, laryngitis, and asthma. However, it goes on to state that saw palmetto’s most pronounced effects appear to be those exerted upon the urino-genital tracts of both males and females, and upon all the organs concerned in reproduction.2
In the 1926 edition of the United States Dispensatory, saw palmetto was noted as being effective in treating prostate problems. It was also listed in the National Formulary (NF) from 1926 to 1950, and again in the United States Pharmacopeia (USP) in 1994.3
Today, the bulk of the research on saw palmetto centers on its use for prostate health.
Saw Palmetto and the Prostate…
The fruit of the saw palmetto are highly enriched with fatty acids and phytosterols, namely beta-sitosterol, which works much the same way as the prescription drug Proscar.4 In both instances, the compounds prevent the conversion of testosterone to dihydrotesterone (DHT), an active form of testosterone.
For this reason, saw palmetto appears to be most effective in easing the symptoms associated with benign prostatic hyperplasia (BPH), or enlargement of the prostate. While BPH is often associated with elevated prostate specific antigen (PSA) levels, it does NOT, in and of itself, lead to or increase your risk of prostate cancer.
Rather, the elevation in PSA levels is more likely due to increased prostate volume and inflammation. This is also what triggers the more common symptoms associated with BPH, namely difficulty urinating or a sudden urge to urinate, decreased urinary flow rate or incomplete voiding, a frequent need to urinate, painful urination, increased nighttime urination, and increased risk of urinary tract infections.
It is in the treatment of BPH that saw palmetto really shines. According to a meta-analysis of 18 randomized controlled trials involving 2,939 men (16 of which were double-blinded) that lasted four to 48 weeks, men treated with saw palmetto (as Serenoa repens) had decreased urinary tract symptom scores and nocturia (nighttime urination), improvement in self-rating of urinary tract symptoms, and improved peak urine flow.5
These findings were confirmed in a 2008 randomized, double-blind, placebo-controlled trial performed over 12 months on 47 benign prostatic hyperplasia patients with average age of 53.3 years and international prostate symptom score (IPSS) over 8.6
Subjects that received 320 mg of saw palmetto oil per day saw a reduction in IPSS scores as well as improvement in quality of life scores within three months. Maximum urinary flow rates were gradually improved, with statistical significance reached after 12 months of treatment.
Yet another study supports the use of saw palmetto for BPH. In a double blind, placebo-controlled study of 92 Chinese men between the ages of 49 and 75, researchers divided participants into two groups.7 The first received two saw palmetto soft gels per day for 12 weeks, while the second group was given a placebo.
After 12 weeks, those men receiving the saw palmetto enjoyed a significantly higher maximum urinary flow rate as compared to the control group. Additionally, relative urinary resistance was significantly lower in the saw palmetto group than in the control group.
Nearly 40 percent of the saw palmetto group also showed a significant improvement in IPSS scores (noted as a decrease of three or greater), while just two percent of the control group saw similar improvements.
This all bodes very well for saw palmetto, but how does Nature’s treatment stack up against man’s?
Saw Palmetto Versus Prescription Treatments…
Clearly there is strong evidence showing that saw palmetto is an effective treatment for men suffering from BPH symptoms. But how does it stack up against common medications for the same condition?
Currently, the prescription, finasteride, is considered to be best used in men with larger prostate volumes and, consequently, in disease that may be considered more severe. As such, most of the research comparing saw palmetto to prescription therapies are done with finasteride.
In one large, double-blind, randomized study, researchers compared the effects of 320 mg of saw palmetto with 5 mg of finasteride (taken daily for six months) in 1,098 men with moderate BPH.8 They found that both saw palmetto and the drug decreased IPSS scores (37 percent and 39 percent, respectively), improved quality of life (38 percent compared to 41 percent), and increased peak urinary flow rate (25 percent versus 30 percent), with no statistical difference between the two treatments.
While finasteride did have a more significant effect on lowering prostate volume and PSA levels than saw palmetto, the herb fared significantly better when it came to sexual function, namely giving rise to fewer complaints of decreased libido and impotence.
The second study of 543 men treated for 48 weeks had similar results.9 Researchers divided the men into two groups, one receiving saw palmetto and the other receiving finasteride daily.
Researchers noted a comparable increase of urinary flow rate in both treatment groups, as well as a similar reduction in IPSS scores, specifically from 11.3 to 8.2 in the saw palmetto group compared to a drop from 11.8 to 8.0 in the prescription group. Additionally, both groups enjoyed near-identical improvement in quality of life scores.
Interestingly, those men taking the saw palmetto noted fewer instances of erectile dysfunction and headache than those taking the finasteride.
Lastly, a meta-analysis of 18 randomized, placebo-controlled studies confirmed these findings.5 Researchers noted that, compared with men receiving finasteride, men treated with saw palmetto had similar improvements in urinary tract symptom scores and peak urine flow.
And, once again, erectile dysfunction was more frequent with finasteride than with saw palmetto. Additionally, adverse effects related to the herb were mild and infrequent.
So, let’s recap. Not only is saw palmetto highly effective at easing symptoms associated with BPH, it works as well as the most commonly prescribed drug, and has fewer side effects, most notably those associated with sexual function.
How can that be bad?
But, before we get too carried away, there is one area where saw palmetto seems to fall short: prostate cancer.
While there is not enough scientific evidence to recommend saw palmetto to treat prostate cancer or even reduce your risk for the disease, the upside is that the herb does not increase your risk either.
Given this, saw palmetto appears to be smart medicine when it comes to treating BPH.
Give Saw Palmetto a Try…
According to the research, saw palmetto is most effective when taken to treat early to moderate BPH versus advanced conditions. Additionally, you will need to be a bit patient, as improvements aren’t typically noted for two to three months.
Start with 320 mg of saw palmetto per day, standardized to 85 percent to 95 percent of liposterolics (fatty acids). While side effects are usually mild, some people have reported dizziness, headache, nausea, vomiting, constipation, and diarrhea. Additionally, saw palmetto is thought to potentially thin the blood, and has been linked to excessive bleeding in a person who took it before surgery.
There is also concern that saw palmetto might cause liver or pancreas problems in some people. There have been two reports of liver damage and one report of pancreas damage in people who took saw palmetto, but there is not enough information to know if saw palmetto was the actual cause of these effects.10 Also, because saw palmetto works similarly to finasteride (brand name Proscar), you’ll want to avoid combining these two treatments.
As positive as all this research is, it is important to keep an open mind to new ideas, ALWAYS do your own homework…and combine that with common sense to figure out what’s best for YOU.
4Rhodes, L et al. Comparison of finasteride (Proscar), a 5-reductase inhibitor, and various commercial plant extracts in vitro and in vivo 5-reductase inhibition. Prostate. 1993;22(1):43-51.
5Wilt, TJ et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia. A systematic review. JAMA. 1998;280:1604–9.
6Hong, H et al. Nutr Res Pract. 2009 Winter;3(4):323-7.
7Shi, R et al. Effect of saw palmetto soft gel capsule on lower urinary tract symptoms associated with benign prostatic hyperplasia: a randomized trial in Shanghai, China. J Urol. 2008 Feb;179(2):610-5.
8Carraro, JC et al. Prostate. 1996 Oct;29(4):231-40.
9Sokeland, J and Albrecht, J. Urologe A. 1997 Jul;36(4):327-33.
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