Natural Products

Saw Palmetto

Palmier nain, Serenoa repens, Sabal Fructus

Efficacy

• Indications with proven efficacy:
  Benign prostatic hyperplasia
• Also used for these other indications, but with no proof of efficacy:
  Alopecia
  Aphrodisiac
  Chronic or subacute cystitis
  Inflammation of the genitourinary tract
  Mild diuretic
  Prostate cancer
  Testicular atrophy
  To increase breast size
  To increase sexual vigor
  To increase sperm production

Security

• Risk of Drug Interactions: Low
• Adverse Effects: Rare

What is it?

Saw palmetto is widely found in the United-States, from the Carolinas to Texas. This small palm tree is 1,8 to 3 meters tall. Its fan-like top is 60 to 120 cm tall and is made of long, dentate leafs. The applicable part of saw palmetto is the fruit.

The saw palmetto berry contains polysaccharides, fixed oils, volatile oil, steroids, including b-sitosterol. Saw palmetto is thought to reduce the symptoms of benign prostatic hyperplasia (by inhibition of dihydroxytestosterone binding at the androgen receptors and inhibition of 5-a-reductase activity on testosterone, thus preventing the conversion of testosterone to dihydrotestosterone). Anti-inflammatory properties also appear to be involved.

The product is available in capsules containing dried berries or lipophilic extracts containing 80 to 95% fatty acids and sterols.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) or homeopathic medicine number (DIN-HM) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plants content varies naturally from plant to plant – just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

Does it work?

Saw palmetto appears to improve the symptoms of benign prostatic hyperplasia:

• Benign prostatic hyperplasia:
  It reduces the need to urinate at night, decreases the volume of residual urine and increases urine flow. A typical dose is 1 to 2 grams of dried berry or 320 mg of lipophilic extract daily. Benefits were reported within 4 to 6 weeks of starting treatment.

There is insufficient reliable information to conclude that saw palmetto is effective in any other indication.

Is it safe?

• Saw palmetto is not associated with any specific toxicity. Rarely, it causes headaches and gastrointestinal problems.
• Because saw palmetto appears to have hormonal properties (antiandrogen and estrogen), it should never be used during pregnancy or breast-feeding.
• For the same reasons, it may, in theory, interfere with hormonal drugs (oral contraceptives, hormone replacement therapy, etc.). Before taking saw palmetto, check with your pharmacist to make sure that there are no interactions with your regular medication.

Clinical notes

• Saw palmetto is a very popular natural remedy. Its medicinal properties in the treatment of benign prostatic hyperplasia are well established. However, always consult your physician before using this product.

References

1. Blumethal M et al. The Complete German Commission E monographs, 1998
2. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
3. Lininger S. et Al. The Natural Pharmacy, Prima Health, 1998
4. Barnes J. et Al. Herbal Medicines, 2nd edition, Pharmaceutical Press, 2002
5. Pierce Andrea, Practical Guide to Natural Medicines, 1999
6. Alan Low "Benign prostatic hyperplasia: a review", Pharmacy Practice, September 2000
7. Passeportsanté.net. Palmier nain. http://www.passeportsante.net
8. Taylor J. CE: Phytomedicinals: Uses, precautions, and drug interactions. Drug Topics 2003;1:79
9. Rotblatt M. et Ziment I. Evidence-Based Herbal Medicine, Hanley & Belfus, 2002
10. Gordon AE et Shaughnessy AF. Saw Palmetto for Prostate Disorders. American Family Physician, March 15, 2003