The Natural Connection

The saw palmetto is a small palm tree indigenous to the sandy low pine woods, savannahs, and thickets of coastal southeastern United States, as well as the West Indies. Known to botanists as Serenoa repens, it is a hardy little palm that bears a blue-black fruit in early winter. These berries have a nutty vanilla flavor, and were eaten by Native Americans and animals at the time of early European settlements in the South. Observing that animals that ate the berries grew “sleek and fat”, early settlers tried them, and discovered their medicinal properties.

My experience with saw palmetto is that you can try to cut it, prune it, or hack it to the ground, but like its native South, it will always rise again. Some tell me that the only way to eradicate it once it takes hold on your land is to dig it up and burn its roots. But I’m not sure that even that will work. Some Yankee tried that once with another Southern treasure called Atlanta, and we all found that sometimes great things can rise from the ashes.

The saw palmetto berry remains today one of the most important and widely used of American medicinal plants. The extract from this berry is the major constituent of commercial herbal products marketed in Europe and the United States for the treatment of a common prostate condition in men.

Benign Prostatic Hypertrophy (BPH) is a noncancerous enlargement of the prostate that occurs frequently in males over the age of 50. Over fifty percent of men older than age 60 have BPH, and by the age of 80, 80% suffer from the disorder. The symptoms of BPH include the need to urinate frequently, difficulty in starting the urine stream, decreased strength and force of urine stream, or dribbling after urination. Sometimes there can be blood in the urine, and in more advanced stages of BPH, the patient may have pain with urination, or even be completely unable to urinate.

Men with symptoms of early BPH should consult their physician to be sure that prostate cancer or infection is not present. When cancer has been excluded by examination and possibly laboratory tests, the doctor may suggest that medication could be helpful. Studies published recently in the medical literature support the fact that extracts of saw palmetto berries can be quite useful in alleviating the symptoms of mild to moderate BPH, without the side effects and the expense of many prescription drugs.

The exact cause of BPH is not known, but it is suspected that a hormone called dihydrotestosterone (DHT) may play a role. One prescription drug, Proscar, is known to lower DHT levels and cause shrinkage of the prostate gland in men with BPH. Saw palmetto, on the other hand, does not seem to shrink the prostate size, but somehow still improves symptoms of nighttime urination, urine flow, and urgency. The effects of saw palmetto appear to be equal to Proscar, and have earned it the nickname of “the catheter herb”.

Over 100 studies appear in the medical literature exploring the role of saw palmetto in BPH. Most conclude that the herb is helpful, although no one is sure how it works. A recent randomized controlled trial on the effects of saw palmetto in men with symptomatic BPH done at the University of California at Los Angeles was published in the May 2000 Journal of Urology. The conclusion was that “saw palmetto herbal blend appears to be a safe, highly desirable option for men with moderately symptomatic BPH”.

The most commonly suggested dose of saw palmetto for BPH is 160 mg of a standardized extract twice a day. It is sometimes sold in preparations that include other herbs and minerals thought to promote prostate health, such as pumpkin seed, pygeum (African plum tree) and zinc. The efficacy of these combination preparations has not been well studied, but there is no  evidence  that  they  are harmful.

In most cases, saw palmetto has very few side effects. Rarely, mild nausea can occur on high doses. While it does not seem to interfere with other prescription drugs, it is important for men to know that saw palmetto can lower their PSA levels, and may sometimes confuse the interpretation of blood tests that are done to screen for prostate cancer. Therefore, it is recommended that men who choose to use this herb consult their physician first. One blend of saw palmetto and eight Chinese herbs, called PC-SPES, has been reported to cause enlarged breasts in men, diarrhea, nausea, and blood clots. NIH is currently studying it as a potential therapy in advanced prostate cancer.

Although saw palmetto is usually thought of as a men’s herb, it appears to have effects on estrogen as well as testosterone. Some herbalists have used it to stimulate breast enlargement in women. However, when used by women, it may change the effects of contraceptive pills or hormone replacement therapy. Women who are on these medications, or who are pregnant or breast feeding should definitely not use saw palmetto.

For further information, please write to: 

The Natural Connection, c/o Dr. Pauline Bellecci, Southeast Internal Medicine, PO BOX 777, Waycross, GA 31502 or visit www.swampdocs.com

©2000-2003 Pauline M. Bellecci, MD