You may have been perusing down the aisles of your local natural grocers and noticed a supplement called Saw Palmetto. Saw Palmetto is a plant native to the palm tree and can be found in the southeastern United States, aka Florida. Historically, its fruit has been used for a wide array of conditions, to treat urinary tract infections and reproductive conditions. We’re going to talk about the current therapeutic benefits of Saw Palmetto, how it works, and if its really worth it.
Saw Palmetto (Serenoa repens) is a shrublike palm native to the Southeastern United States. The berries were a staple food for Native Americans who used the berries to treat urinary tract infections, and even to increase sperm production and boost libido. Today, therapeutic use of Saw Palmetto is primarily used to treat benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland.
But what does the research say that saw palmetto is good for?
A large body of research has investigated the effects of Saw Palmetto on Benign prostatic hyperplasia (BPH). BPH is a common cause of bothersome lower urinary tract symptoms (LUTS) in men.
In a 2002 meta-analysis, 21 trials were evaluated for the effects of Saw Palmetto on UTI symptoms and found significantly reduced nocturia, increased self-rated improvement, and improved peak uroflow [R].
However, recent data, has yielded fewer positive results and replication of prior research. An updated review, including nine trials, concluded that there was no significant effect on American Urological Association Symptom Index (AUASI) scores or peak uroflow [R].
The largest trial conducted was the Saw Palmetto Treatment for Enlarged Prostates (STEP) study. 275 men aged 50 years or older with baseline AUASI scores of 8 or higher were randomized at one center and administered either saw palmetto extract (160 mg twice daily) or placebo. No improvement over placebo was found over one year in symptom scores or any secondary end point.
Following publication of the STEP study, a large, multicenter, double blind randomized control trial, doesn’t get much better in study design than this, was conducted to determine if increasing the standard daily dose of saw palmetto extract to a double and then a triple daily dose over 72 weeks would improve LUTS attributed to BPH.
A total of 369 men were randomized, between 19 and 52 men per site, with a mean age of 61. Participants were administered one, two, and then three doses (320 mg/d) of saw palmetto extract or placebo, with dose increases at 24 and 48 weeks.
Despite earlier research, the study found that increasing doses of a saw palmetto fruit extract did not reduce lower urinary tract symptoms more than placebo.
Reflecting these same results, two large, high-quality studies funded by the National Institutes of Health (NIH), each using a different preparation of saw palmetto, found it was no more effective than a placebo (an inactive substance) for BPH symptoms [R].
But then, a meta-analysis evaluating four randomized, double-blind, controlled trials involving 1,080 people with BPH reported that Saw Palmetto Serenoa repens taken daily for six months appeared to improve urinary flow, similar to the effect of Flomax (Tamsulosin) (although there was no improvement in prostate size – unlike the case with tamsulosin)
Research indicates that the use of Saw Palmetto may help treat benign prostatic hyperplasia (BPH) and urinary tract infection is mixed.
Some research shows that Saw Palmetto may benefit and reduce signs of hair loss, by inhibiting an enzyme called 5-alpha reductase.
Saw Palmetto is rich in fatty acids, as well as phytosterols and flavonoids, which block the effect of androgens. Research has shown that Saw Palmetto may be beneficial in blocking 5-alpha-reductase, an enzyme that converts testosterone to a hormone called dihydrotestosterone (a more potent form of testosterone).
Finastride (Proscar) a medication for the treatment of hair loss uses the same mechanism. Finastride blocks the conversion of testosterone to dihydrotestosterone, which is the hormone responsible for male pattern hair loss.
In 2012 study 100 male participants with mild to moderate androgenetic alopecia (AGA) received 320mg of Saw Palmetto while the other 1mg of Finastride over 24 months. The results showed that only 38% of patients treated with Serenoa repens had an increase in hair growth, while 68% of those treated with finasteride noted an improvement [R].
Therefore, both treatments did improve and influence hair loss and can be used in combination. However, more evidence is needed to support the therapeutic use of saw palmetto for the specific indication of hair loss [R].
New evidence has emerged investigating the effects of saw palmetto in patients with chronic pelvic pain syndrome (CPPS). Chronic pain is defined as pain lasting for more than six months, therefore CPPS, is centralized pain in the pelvic area and severe enough to limit function. According to the NIH, chronic pelvic pain is often associated with lower urinary tract symptoms (LUTS) yet defined as a syndrome without an infection.
In a multicenter, randomized, double-blind placebo-controlled trial, including 221 patients with CPPS. Patients adhered to a protocol of 160mg of Serenoa repens 160 milligrams (mg) soft capsule by mouth twice daily for 12 weeks showed significant improvement on pain relief and urinary symptoms compared with the placebo group. However, the study methodology was flawed, as it did not distinguish between patients with or without CPPS.
Other studies of the saw caliber have showed mixed results. More evidence is needed to further establish the use of saw palmetto for CPPS.
Although research has shown that saw palmetto may be effective in the treatment of specific conditions, such as BPH, UTI, CPPS, and hair loss, more research is needed to further establish the therapeutic benefits and use in the treatment of these conditions.
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