Saw Palmetto For Prostate Health
Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.
Saw Palmetto is a dietary supplement that’s been used for thousands of years as a natural remedy. It’s most typically used to treat urinary symptoms due to prostate gland enlargement in men. In this post we’ll look at the potential health benefits of saw palmetto. We’ll also look at the roadblocks to achieving those benefits.
Starting at the beginning
Saw palmetto is a shrublike tree with fan-shaped leaves that's native to the southeastern US. You may also see it called Serenoa repens, Serenoa serrulate, or Sabal serrulata. Its berries and their seeds have been used for thousands of years for a variety of medicinal purposes. They contain fatty acids, plant sterols and other compounds that are thought to provide health benefits.
One of the most common uses of saw palmetto is to manage symptoms related to prostate enlargement (benign prostatic hyperplasia, or BPH) in men. Briefly, the prostate gland in men often begins to increase in size over time. When that happens, it can interfere with elimination of urine from the bladder. This change can result in discomfort and frustration in men who experience it. Symptoms include slower flow of urine, leakage, incomplete bladder emptying, and urinary urgency. There are prescription medications that can help relieve symptoms. But if you’re interested in a more “natural” remedy, you may have heard about saw palmetto and wondered whether it's for you.
How does it work?
There’s no clear cut answer here. But experts who have studied the compounds in saw palmetto have some theories.
One of the most popular theories is that saw palmetto may decrease the production of a potent androgen called DHT (dihydrotestosterone). DHT contributes to the gradual growth of the prostate gland in older men, so reducing its availability may decrease symptoms of BPH. Finasteride and dutasteride (Proscar and Avodart) are effective prescription medicines that work in the same way.
Saw palmetto may also have anti-inflammatory effects. And it may benefit the bladder to improve symptoms of urgency and incontinence. Many experts believe that there is more than one mechanism of action at work.
Safety of saw palmetto
Few side effects have been reported in those who use saw palmetto. The worst is digestive discomfort, which may be resolved by taking the supplement with food.
No concerning drug interactions have come to light. There’s a possibility that saw palmetto might decrease blood clotting, so if you take a blood thinner you’ll want to be cautious. But from what we know so far, that drug interaction doesn’t to be a big problem.
A common dose used in research was 160mg twice daily. Some also used 320mg once daily. Many experts believe that those doses only work if the saw palmetto is of “high quality”. And of course, here in the US, that’s very hard to know (more on that below).
So why is Saw Palmetto not recommended more often?
The problem is that research hasn’t shown conclusively that it works. When experts have looked at all the research available, they’ve found that study results just don’t prove that saw palmetto is effective. And many experts have gone so far as to suggest it shouldn’t be recommended at all.
But there is controversy
Saw palmetto is used commonly in Europe. And European experts have looked at many of the same research studies that US experts have reviewed and come to different conclusions about the place of saw palmetto in treating BPH. Why is there a difference of opinion?
It seems that much of it comes down to differences in regulation. If you’ve read my posts before, you already know dietary supplements are loosely regulated here in the US. To put it in simple terms, when compounds are extracted from a plant, you may not get the same result every time. It might differ due to how the plant was grown. Or what extraction technique was used. And we can’t even count on all manufacturers to make sure the final product contains what’s listed on the label. So the saw palmetto products you find on the shelf may be very different from one another. When those products are used in research, one study may show good results and another bad.
Across Europe, though, authorities have approved, and regulated, a form of saw palmetto known as Permixon. The formulation of Permixon is standardized. And it’s been relatively well studied. Experts across Europe know what’s in the product, and that it’s safe. So they’re much more comfortable recommending it to their patients. And one study done in Europe with Permixon did suggest that it was as effective as finasteride in patients with mild-moderate urinary symptoms due to BPH. Unfortunately, the FDA has not authorized the use of Permixon here in the US. That's likely due to concerns about its safety due to hexane that's added to the final product during extraction..
If you’ve heard that saw palmetto is effective you may be wondering why your doctor is reluctant to recommend it. It’s likely due to lack of dietary supplement regulation in the US. Your doctor can’t be sure what you’re going to purchase and take. Will it have the right compounds in it? Will it be safe for you? Your doctor may be more likely to suggest a prescription product that's regulated and standardized..
You’re in charge of your health!
If you’re interested in trying saw palmetto, here are some important things to think about.
Saw palmetto is for symptomatic treatment only. It’s not used to prevent BPH, just lessen the symptoms of BPH. At this point there’s no reason to believe that saw palmetto can prevent BPH or prostate cancer.
It appears to be relatively safe. To minimize GI side effects, take it with food. If you’re taking blood thinners, make sure your doctor is aware of your plans.
Decide on what result you’re looking for. If you take saw palmetto and achieve your goals, great! If not, no need to keep taking it.
If you've used saw palmetto, or have other comments or questions, please comment in the space below. Or you can contact us directly at Better My Meds – we love hearing from you!