Saw Palmetto

 Saw Palmetto

If you’ve read anything about saw palmetto in the popular press, you probably know that it has come to be known as a guy herb. The guys most likely to want it are primarily middle-aged or older men who find that they’re answering nature’s call two or three times a night.

Typically, that call of nature ends up being an almost-false alarm: Even when it feels like a waterfall is about to pour forth, the result is more of a trickle. This problem is often a sign of benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate gland that constricts the urethra, the tube that leads from the bladder to the penis. Picture what happens to your lawn sprinkler when you step on the garden hose, and you have a good idea of the problem.

Many men who take saw palmetto find that the herb shrinks the prostate and releases the squeeze so that urine flows normally, says Woodson Merrell, M.D., a specialist in alternative and complementary medicine and assistant clinical professor of medicine at the Columbia University College of Physicians and Surgeons in New York City. How well saw palmetto works is still controversial because it may not be strong enough by itself to make a significant difference for some men, says Dr. Merrell. "It may be effective for moderate cases of BPH or when the prostate is just beginning to enlarge, however."

Purging the Pipes

Saw palmetto is a low, scrubby palm that grows in sandy soil in the southern United States, from South Carolina to Florida. The Seminoles of the Everglades ate the berries for food, but it’s not known if they valued the plant as a medicine. European settlers in the region used it as a diuretic to flush excess water from the body. In 1849, one herbal practitioner referred to the herb’s "purgative property, often producing a copious evacuation."

Herbalists of that era also touted saw palmetto’s anti-catarrhal properties, meaning that it seemed to relieve phlegm-producing conditions like colds and flu. The herb was used as an expectorant in some cough formulas. Women took it to relieve painful periods and regulate the menstrual cycle. It has also been used for pelvic inflammatory disease and similar conditions.

Saw palmetto is known to stimulate the production of prolactin, a female hormone that, among other things, promotes breast enlargement and milk production in breastfeeding women, says Tirun Gopal, M.D., an obstetrician and gynecologist who practices holistic and Ayurvedic medicine in Allentown, Pennsylvania. "There also are some claims that saw palmetto can be used for infertility when the problem is the absence of ovulation," he says.

Perhaps that is where the herb got a reputation as an aphrodisiac and a tonic to increase sexual energy and revive low libido in both sexes. Some research demonstrates that a compound in saw palmetto has aphrodisiac effects. Ironically, some herbalists have been known to use saw palmetto to treat honeymoon cystitis, bladder irritation that results from excessive sexual activity.

Saw Palmetto

Botanical name: Serenoa repens.

May help: Prostate problems, bladder irritation, menstrual problems, and pelvic inflammatory disease.

Origin: Southern United States.

Cautions and possible side effects: If you have prostate problems, see your doctor for a diagnosis before using

 A Drug No More

Sexual matters aside, saw palmetto was widely and routinely used in the early decades of the twentieth century to treat urinary tract ailments, particularly chronic cystitis, an inflammation of the bladder. From 1906 to 1950, it was officially listed as a drug in the United States, and it was prescribed both here and in Europe as a treatment for gonorrhea.

After World War II, it fell out of favor in the United States, but research continued in Europe. Scientists found that patients who consumed an extract of the berries had increased urine volume, a decrease in frequent urination, and more ease of urination.

As with many botanical medicines, it’s difficult to identify exactly what active ingredients are working in saw palmetto. Scientists believe that it has steroidlike properties. In the case of BPH, it interrupts a critical chemical process, says William Page-Echols, D.O., an assistant clinical professor of family medicine who teaches alternative medicine at the Michigan State University College of Osteopathic Medicine in East Lansing.

BPH occurs when testosterone, the male sex hormone, is converted by an enzyme to a more potent hormone that causes cells and tissues to grow and proliferate. That growth is perfectly fine when the male sexual organs are developing, but later in life, when the organs are fully developed, the continued cell growth becomes a liability.

Taken daily, saw palmetto inhibits the enzyme so the hormone conversion doesn’t occur, says Dr. Page-Echols. Finasteride (Proscar), the prescription drug most often prescribed in the United States for BPH, has much the same action, he adds.

Several studies in Europe show that saw palmetto is an effective treatment for many men, especially those in the early stages of enlarged prostate. In Germany, it’s sold over the counter as a treatment for BPH. One year-long study of men with BPH found that an extract of saw palmetto reduced prostate size by 13 percent.

Gentle and Effective

Researchers have compared the effectiveness of saw palmetto with that of other drugs prescribed for BPH. Although results were somewhat mixed, tests showed that the herb produces fewer side effects than prescription drugs. Finasteride, for example, sometimes causes headaches, erection problems, loss of libido, and decreased ejaculation volume.

The German Federal Ministry of Health has determined that people experience few side effects from saw palmetto berries. In one three-year study, less than 2 percent of men taking an alcohol-based extract of the herb quit the study because of side effects. More than 80 percent of the men felt that the herb helped and improved their quality of life.

"When your medication is causing you to have decreased interest in sex and decreased capabilities, saw palmetto may be an important alternative to try," says Dr. Page-Echols. "A lot of men have come into my office asking about it. They’ve heard about it from friends."

Where to See Saw

When Dr. Page-Echols suggests saw palmetto, he usually advises using it in combination with zinc and plant-based medicines such as flower pollen. It’s also available in capsule and tincture form.

Since saw palmetto isn’t standardized for any active ingredient, your best bet is to look for a product made solely from the berries by a well-known company, says Dr. Merrell. Also, remember that like many herbs, saw palmetto has a fairly mild action. It may take weeks or months for it to work.

"Don’t just start taking the herb without seeing your doctor," Dr. Merrell warns. "You shouldn’t assume that your symptoms are due to BPH. Make sure that you have a benign condition first, then try the herb."