Saw Palmetto (Serenoa repens)
What is Saw Palmetto?
Saw palmetto is a member of the palm family of plants and is characterized by its razor-sharp, serrated leaf margins.
The berries of saw palmetto are a popular remedy in both modern, and traditional medical systems for benign prostatic hyperplasia, and a list of other male reproductive conditions.
What is Saw Palmetto Used For?
Saw palmetto is primarily used as a male tonic throughout life. It is useful in younger men for varicocele, fertility, sperm motility and morphology, and for promoting adequate testosterone levels. In older men, it is useful for BPH, prostate cancer, and low testosterone. Due to its broad activity in the male reproductive system, saw palmetto is considered a male tonic. It's useful topically and internally for treating male pattern baldness and is used as an aphrodisiac for men with low libido.
Outside from the male reproductive system, saw palmetto is useful for urinary tract infections, and inflammation in the respiratory tract.
Traditional Uses of Saw Palmetto
In traditional medical systems, the berry of saw palmetto has generally been associated with the prostate gland. [1].
Other traditional uses include respiratory complaints, especially in the presence of chronic catarrh, genitourinary infections and inflammation, inflammation of the breast or testes, and as an aphrodisiac for both males and females. [1].
The Eclectics described saw palmetto as "the old man's friend" for its ability to treat chronic respiratory conditions and problems with the prostate. [1].
The British herbal pharmacopeia lists saw palmetto as a diuretic, urinary antiseptic, endocrine agent, and anabolic agent useful for cystitis (chronic or subacute), prostatic hypertrophy, genito-urinary catarrh, testicular atrophy, and sex hormone disorders [9].
Herb Details: Saw Palmetto
Botanical Information:
As a member of the Arecaceae family of plants saw palmetto joins some 2600 other species best known as the palms. This genus contains around 181 genera, most of which grow throughout the tropics worldwide, and are distinguished by large, compound, evergreen leaves known as fronds located at the top of an unbranched stem.
The common name "saw palmetto" refers to the saw-like teeth on the petioles of this palm species. The teeth are very sharp and have the tendency of cutting the skin of those who brush against it.
The fruit is a dark-colored drupe that contains a single seed. This is the part mainly used medicinally for this species. [1].
Constituents
Free fatty acids (lauric, myristic, palmitic, and oleic acids), triglycerides, diglycerides, monoglycerides, phytosterols (mainly beta-sitosterol), fatty alcohols, lipase, flavonoids, and polysaccharides, methyl and ethyl esters (contribute to the berries characteristic scent and flavor), [1].
Liposterolic Extract
A liposterolic extract which is commonly used today contains 85% to 95% fatty acids, and 0.2% - 0.4% sterols. the flavonoid content is likely to fluctuate depending on the extraction method and is suggested to be highest in the 90% ethanol extract [1].
Harvesting Collection, & Preparation:
Saw palmetto extracts are generally made from the dried berries and extracted using 90% ethanol, hexane, or supercritical carbon dioxide. Modern extractions often target the liposterolic extract due to much of the latest research pointing at this fraction as having the highest medicinal value [1].
The higher ethanol extracts will have the highest liposterolic extraction rates and are recommended for use medicinally [1].
Pharmacology & Medical Research
+ Benign Prostatic Hyperplasia (BPH)
BPH is a slowly progressing, non-cancerous, enlargement of the fibromuscular and epithelial structures of the prostate. It is mainly caused by the proliferation of the stromal and epithelial cells. This can eventually lead to an impediment or occlusion of the urethra and cause difficulty with urination. This condition varies significantly from person to person but generally occurs in older age (roughly 50% of men 60 years old and 90% of men aged 85). [1].
The wide variability of this condition makes it hard to treat and poorly understood. Several prominent theories regarding the cause of this condition have been put forward involving insulin and prolactin levels, sex hormone levels, stem cells, growth factors, irritation, and smooth muscle spasming [1].
One of the main theories as of late is that BPH is caused by an immune-mediated inflammatory disease brought on by an infection or autoimmunity. [1].
Keeping all of this in mind can help us understand why saw palmetto works so well for this condition. It is well studied for this condition, and numerous studies have found evidence towards the effectiveness of saw palmetto towards this condition. [1, 3-8 ].
One of the main theories regarding the success of saw palmetto towards BPH is through inhibition of 5-alpha-reductase. This protein converts free testosterone (not bound to SHBG) 5-alpha-dihydrotestosterone which is roughly 5 times as to potent as testosterone. [1, 2].
Clinical Applications Of Saw Palmetto:
The confirmed 5-alpha-reductase inhibitory activity of saw palmetto is thought to be the major reason it is so useful for benign prostatic hyperplasia. It is well regarded for this condition, as well as male infertility, likely due to a different mechanism.
Cautions:
Caution of adulterated saw palmetto products with other fatty acids such as olive oil or palm oil [1].
Prostate cancer should be ruled out before long term application of Saw palmetto as it could mask the symptoms of this condition [1].
Saw palmetto is considered safe to use during pregnancy, although unlikely to be needed [1].
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References:
Bone K, Mills S. (2013). Principles and Practice of Phytotherapy. Elsevier health. China.
Sultan, C., Terraza, A., Devillier, C., Carilla, E., Briley, M., Loire, C., & Descomps, B. (1984). Inhibition of androgen metabolism and binding by a liposterolic extract of “Serenoa repens B” in human foreskin fibroblasts.Journal of steroid biochemistry, 20(1), 515-519.
Stenger, A., Tarayre, J. P., & Carilla, F. (1982). Etude pharmacologique et biochimique de l'extrait hexanique de serenoa repens. B: Gaz Med de France, 89, 2041-2048.
Otto, U., Wagner, B., Becker, H., Schroder, S., & Klosterhalfen, H. (1992). Transplantation of human benign hyperplastic prostate tissue into nude mice: first results of systemic therapy. Urologia internationalis, 48(2), 167-170.
Vela-Navarrete, R., Escribano-Burgos, M., Farre, A. L., Garcia-Cardoso, J., Manzarbeitia, F., & Carrasco, C. (2005). Serenoa repens treatment modifies bax/bcl-2 index expression and caspase-3 activity in prostatic tissue from patients with benign prostatic hyperplasia. The Journal of urology, 173(2), 507-510.
Grasso, M., Montesano, A., Buonaguidi, A., Castelli, M., Lania, C., Rigatti, P., ... & Borghi, C. (1994). Comparative effects of alfuzosin versus Serenoa repens in the treatment of symptomatic benign prostatic hyperplasia.Archivos españoles de urología, 48(1), 97-103.
Carraro, J. C., Raynaud, J. P., Koch, G., Chisholm, G. D., Di Silverio, F., Teillac, P., ... & Hanus, M. (1996). Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. The Prostate, 29(4), 231-240.
Hızlı, F., & Uygur, M. C. (2007). A prospective study of the efficacy of Serenoa repens, tamsulosin, and Serenoa repens plus tamsulosin treatment for patients with benign prostate hyperplasia. International urology and nephrology, 39(3), 879-886.
British Herbal Medicine Association. (1983). British Herbal Pharmacopoeia. Bournemouth, UK: Author.
Bone, K. (2003). A clinical guide to blending liquid herbs: Herbal formulations for the individual patient. Edinburgh [u.a., MO: Churchill Livingstone.
Blumenthal, M., Brinckmann, J., & Wollschlaeger, B. (2003). The ABC clinical guide to herbs. Austin, TX: American Botanical Council.