The berries of the saw palmetto (Serenoa repens/Sabal serrulata), a fan palm native to the southeastern United States, act to increase urine flow, to diminish inflammation, and to reduce muscle spasms. In Europe, saw palmetto is widely used to treat benign prostatic hyperplasia, or BPH, which is an enlargement of the prostate gland (see details below). In the United States, it ranks among the top ten dietary supplements in terms of sales.

Saw palmetto berries were a staple food among native Americans of the southeastern United States, who also used them to treat digestive problems, genitourinary inflammation, dysentary, and lack of libido. Early in the 20th century, saw palmetto was listed in the US Pharmacopoeia as an effective remedy for enlargement of the prostate gland (called benign prostatic hyperplasia or BPH), urinary tract inflammation, cystitis (bladder inflammation), breast disorders, bronchitis, and laryngitis.

Benign Prostatic Hyperplasia (BPH)
In BPH, cells in the prostate gland (a tiny gland that lies behind the urethra) grow too quickly. The gland swells and presses on the urethra, creating the constant sensation of a need to urinate. The majority of men over 60 have urinary symptoms attributable to BPH, which can disturb sleep, affect self-confidence, cause constant low-grade anxiety or even pain, and may progress to infections in the bladder or kidneys.

Saw palmetto is comparable to finasteride (a common prescription drug that slows or stops the progression of BPH) in relieving symptoms of BPH during its early stages. Such symptoms include frequent need to urinate, a delay before being able to urinate, dripping after urinating, and having to get up numerous times throughout the night to urinate. While saw palmetto appears to produce symptom relief in a much shorter time than finasteride, one important difference between the two is that finasteride shrinks the size of the prostate, and saw palmetto only relieves the symptoms of BPH without changing the size of the prostate. Also, studies to date of saw palmetto have not evaluated the safety of the herb for long periods of time.

Prostate Cancer
Saw palmetto is also one of the eight herbal ingredients that make up PC-SPES, a Chinese herbal treatment for prostate cancer that is gaining popularity in the West as a possible alternative to conventional therapy for this condition. Research on PC-SPES is ongoing and may prove to be of particular interest for men who do not respond to surgery, radiation, or medication. (It is important to note, however, that the U.S. Food and Drug Administration [FDA] recently issued a warning to consumers that PC SPES may contain undeclared prescription drug ingredients that could cause dangerous side effects.)

Other
Because it effects both male and female sex hormones, saw palmetto may also be useful in treating such conditions as hirsutism (excessive growth of dark, coarse body and facial hair in women) and polycystic ovarian disease (multiple cysts in the ovaries that leads to irregular or absent menses and, possibly, infertility) in women.

Saw palmetto is a fan palm that can reach heights of 10 feet in warm climates. In the United States, it grows in the warm climates of the southeast, from South Carolina to Mississippi and throughout Florida. Lush, green leaves fan out from thorny stems. The plant bears white flowers, which develop yellow olive-like berries. The berries, when ripe, turn bluish-black and are dried for medicinal use.

Saw palmetto's active ingredients include fatty acids, plant sterols, and flavonoids. However, most likely these are not the only substances within the berries that affect hormone production, and it will take more scientific study to determine exactly how saw palmetto works.

The berries also contain high-molecular-weight polysaccharides, which are usually associated with either anti-inflammatory or immune-stimulant effects.

Saw palmetto can be purchased as dried berries, tea, powdered capsules, tablets, liquid tinctures, and liposterolic extracts. The product label should indicate that contents are standardized and contain 85% to 95% fatty acids and sterols. In a ConsumerLab.com evaluation, approximately 63% of the leading brands of saw palmetto were standardized to this amount appropriately; this means that as many as 37% were not. Again, read labels carefully to make sure that they are labeled as containing 85% to 95% fatty acids and sterols and buy from reputable companies.

Pediatric

There are no known scientific reports on the pediatric use of saw palmetto. Therefore, it is not currently recommended for children.

Adult

The recommended dosages for early stages of BPH is 160 mg, two times per day, of a fat-soluble saw palmetto extract, which has been standardized to contain 85% to 95% fatty acids and sterols.

Because of the potential for side effects and interactions with medications, herbs should be taken only under the supervision of a knowledgeable healthcare provider. That said, saw palmetto is a very mild herb and The American Herbal Products Association gives saw palmetto a class 1 safety rating, which means that it is safe when used as directed. Side effects are very rare, although mild stomach complaints and minor headaches may occur; also, one case of significant bleeding during surgery, attributed to saw palmetto use prior to the operation, has been reported.

It is important that those with BPH be under the supervision of a healthcare provider who can determine the best treatment and monitor its effects.

Saw palmetto has not been studied or used in women who are pregnant or nursing; therefore, it should not be used during pregnancy or while breast-feeding. In addition, saw palmetto may, in theory, interfere with the absorption of iron -- another reason not to use this herb if pregnant or nursing, since iron is necessary for the mother, fetus, and baby.

Finasteride
There are no reports in the scientific literature to suggest that saw palmetto interacts with any conventional medications. However, because saw palmetto may work similarly to finasteride, it has been recommended that this herb not be used in combination with finasteride or other medications used to treat BPH.

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