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Saw Palmetto and Enlarged Prostate and More

Saw Palmetto

The connection between saw palmetto and prostate health is not new. With time, however, more studies are conducted on it; thus more people know about it. In fact the plant is now one of the most common food supplements recommended for prostatic problems, mostly BPH. But saw palmetto benefits vary from patients to patients and depending on the preparation. Some producers seem to provide better extracts than others.  

 

Some documents reveal that the berries of the plant were used as food by the Seminole Native Americans who inhabited Florida. They also used it to treat various disorders of the urinary system in men and breast problems in women. The papers talk about the plant under different names: Serenoa repens, American Dwarf Palm Tree, Cabbage Palm, Sabal serrulata, and others 

 

The Europeans, who found that saw palmetto berries have an unpleasant soapy taste, have used them only for medicinal purposes. Some doctors at the Eclectic School of Medicine used it mostly to treat the symptoms associated with benign prostatic hyperplasia, commonly known as BPH. After many studies, Serenoa repens was first included in the list of official drugs in the United States in 1950. But the remedy quickly fell into oblivion in America due to unfavorable prejudices medical doctors had against traditional remedies, as it is the case today.

However, the plant has remained popular in Europe, which led some French doctors to develop, in the 1960s, a type of lipophilic extract (extract with oils). Today,
 lipophilic extract from saw palmetto is still used to help men with prostate problem.  In Germany, Austria and Italy in particular, saw palmetto for enlarged prostate is widely used as first-line treatment. Permixon® is one of the drugs made of the extract of the plant.

During the 1990s, the plant has re-entered America, sold as a food supplement on the internet and many food stores.
 Serenoa repens is often combined with other herbs to combat benign prostatic hyperplasia, including nettle, African plum and pumpkin seeds. In addition, it has been proposed, with no clinical evidence, for other therapeutic uses such as treatment of male hair loss, and women breast augmentation. But no practical evidence has shown saw palmetto for hair loss really works.  


Modern Research on Saw Palmetto and BPH 

 

Several meta-analysis and syntheses concluded that saw palmetto BPH treatment was more effective than placebo in reducing BHP symptoms. One of these meta-analyses, published in 2004, focused on Permixon®, a saw palmetto extract sold in Europe, which has undergone the majority of the studies. However, at least another extract yielded conclusive results during a recent trial conducted in China. Prostataplex® was the supplement that was considered in the Chinese trial.


Saw Palmetto VS Finasteride (Proscar) and
 Tamsulosin (Flomax) 

The researchers also compared the effect of Permixon® with synthetic prescription drugs - finasteride (Proscar) and tamsulosin (Flomax®) - in 2 trials involving over 1,900 subjects in total; the plant was as effective as these drugs while having fewer side effects on sexual function. In terms of efficiency, Permixon is equally effective to these medications, according to a study conducted in Spain. 

 

However, in 2006, a double-blind study of high methodological quality caused some doubt on the effectiveness of saw palmetto extract and BPH; the results were inconclusive, said the researchers. The study was conducted on 225 men with moderate to severe benign enlarged prostate for a year. Following this test, some authors concluded that saw palmetto benefits had not been proven.   

 

But doubts have been raised on several points of this study: active ingredients contained in the supplement used; classification system of the symptoms and stage of the disease, which might be too advanced for the subjects to benefit from 320 mg daily used in the study.

What about When Saw Palmetto and Nettle (stinging nettle) Combined?  

 

Combination of saw palmetto and nettle is often used in many supplements a treatment for enlarged prostate, as nettle is also beneficial in fighting urinary problems. In 1995, a study conducted among 2,080 men treated with an extract of these 2 plants, gave conclusive results. The results of two double-blind studies of 24 weeks, as well as those monitored without placebo for 48 weeks have confirmed the efficacy of the combination of these two plants as an effective natural treatment for BPH. During the study, the researchers used standardized extracts providing 320 mg of saw palmetto and 240 mg nettle per day. 


The researchers also compared Prostagutt Forte®, a supplement which contained 320 mg of saw palmetto and 240 mg nettle, with conventional drugs finasteride and tamulosine during 2 comparative trials that lasted 1 year. The results show the two plants are as effective as the drugs but with no side effects. 

 

Based on these many positive studies, the plants are increasing accepted as a treatment of benign prostatic hyperplasia by the medical community, especially in Europe. For instance, The German Commission E and the World Health Organization now recognize the use of serenoa repens for treating urinary disorders caused by mild to moderate benign prostate problems.   

 

Saw Palmetto and Prostatitis 

 

Prostatitis is a chronic prostate inflammation of the prostate which has symptoms similar to benign prostatic hyperplasia. It has been therefore tested whether saw palmetto might be helpful for treating the condition, but so far results are contradictory and controversial.

Saw Palmetto and Prostate Cancer 

 

An epidemiological study published in 2006 did not establish a link between taking saw palmetto supplements and a reduced risk of prostate cancer. However, some researchers continue to examine the potential protective effects of the plant against this cancer. The data are preliminary at this time; no conclusive results can be deducted yet.

 

But, given so many health benefits the plant shown to have on the prostate gland, some scientists believe it will somehow help prevent development or combat proliferation of cancer cells in the gland. One point also considered is the fact taking saw palmetto extract helps reduce urinary problems, such as urgent and constant need to urinate, which are typical symptoms of prostate cancer. 


How Saw Palmetto Works? 

 

Although it is not well known how palmetto works, it is generally believed that, like the conventional drugs, the plant would prevent or reduce the conversion of testosterone to dihydrotestosterone, a substance that intervene in the development of benign prostatic hyperplasia. It would also have an anti-inflammatory effect and beneficially influence the estrogen / testosterone ratio. 

 


Precautions 

Saw palmetto BPH treatment” is a common claim found on the internet from almost all sellers of the supplement. But although the effectiveness of the supplement is established for the treatment of non malignant enlarged symptoms, it is advised not to stick to self-diagnosis and overdose the extract of plant. It is important to consult a doctor before self-medication.

Cons-indications
While
 American dwarf palm tree is not used by women, note that because of the theoretical possibility that the extract has estrogenic or anti-androgenic activity, it is not recommended to pregnant women.

Possible Side Effects

At the recommended doses usually, the plant is safe. Very rare cases of mild gastrointestinal disorders have been reported. It is suggested to take saw palmetto extracts with food to avoid these possible side effects. 


Interactions with Drugs

It is recommended to people taking anticoagulants and antiplatelet drugs to use
 Serenoa repens with caution.  

 

References

1.      Wilt TJ, Ishani A, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review.JAMA 1998 Nov 11;280(18):1604-9.

2.      Boyle P, Robertson C, et al. Meta-analysis of clinical trials of permixon in the treatment of symptomatic benign prostatic hyperplasia.Urology 2000 Apr;55(4):533-9.

3.      Gordon AE, Shaughnessy AF. Saw palmetto for prostate disorders. Am Fam Physician. 2003 Mar 15;67(6):1281-3. Review. Texte intégral : http://www.aafp.org

4.      Boyle P, Robertson C, et al. Updated meta-analysis of clinical trials of Serenoa repens extract in the treatment of symptomatic benign prostatic hyperplasia. BJU Int. 2004 Apr;93(6):751-6.

5.      erber GS, Fitzpatrick JM. The role of a lipido-sterolic extract of Serenoa repens in the management of lower urinary tract symptoms associated with benign prostatic hyperplasia. BJU Int. 2004 Aug;94(3):338-44. Review.

6.      Buck AC. Is there a scientific basis for the therapeutic effects of serenoa repens in benign prostatic hyperplasia? Mechanisms of action. J Urol. 2004 Nov;172(5 Pt 1):1792-9. Review.
Fong YK, Milani S, Djavan B.
 Role of phytotherapy in men with lower urinary tract symptoms. Curr Opin Urol. 2005 Jan;15(1):45-8. Review.

7.      The efficacy of drugs for the treatment of LUTS/BPH, a study in 6 European countries. Hutchison A, Farmer R, et al. Eur Urol. 2007 Jan;51(1):207-15; discussion 215-6.  

8.      [Economic evaluation of medical treatment of benign prostatic hyperplasia (BPH) in the specialised care setting in Spain. Application to the cost-effectiveness of two drugs frequently used in its treatment]. Carballido J, Ruiz-Cerdá JL, et al. Actas Urol Esp. 2008 Oct;32(9):916-25. Spanish. 

9.      Bent S, Kane C, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med. 2006 Feb 9;354(6):557-66.

10.  Evaluation of male sexual function in patients with Lower Urinary Tract Symptoms (LUTS) associated with Benign Prostatic Hyperplasia (BPH) treated with a phytotherapeutic agent (Permixon), Tamsulosin or Finasteride. Zlotta AR, Teillac P, et al. Eur Urol. 2005 Aug;48(2):269-76.

11.  Cheema P, El-Mefty O, Jazieh AR. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature.J Intern Med 2001 Aug;250(2):167-9.

12.  Stepanov VN, Siniakova LA, et al. Efficacy and tolerability of the lipidosterolic extract of Serenoa repens (Permixon) in benign prostatic hyperplasia: a double-blind comparison of two dosage regimens. Adv Ther 1999;16(5):231-241

13.  Sinclair RD, Mallari RS, Tate B. Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia. Australas J Dermatol. 2002 Nov;43(4):311-2.

14.  Habib FK, Wyllie MG. Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis. 2004;7(3):195-200. Review.

15.   ConsumerLab.com. Product Review: saw palmetto. États-Unis, 2006, 2008. [Consulté le 25 août 2009]. www.consumerlab.com