yourself these questions:
When you pass water, does it seem to flow with less force
Do you often have to make a special effort to completely empty your bladder?
After passing water, do you often feel as if your bladder isnt completely empty?
Do you notice persistent dripping after a trip to the toilet?
Do you have to pass water again less than two hours after your last trip to the toilet?
Do you find it difficult to put off going to the toilet?
Are there particular times, for example before leaving the house or going to bed, when you
cant have anything more to drink?
Do you frequently have to get up at night to go to the toilet?
If you have answered one or more of these questions with "Yes" you should
consult your doctor or pharmacist.
Benign prostate hyperplasia (BPH) is a problem affecting men from the age of
forty. At 50, 50% of men are affected and at 80, 95% of men have BPH
symptoms and the other 5% have a latent form without symptoms. The main BPH
symptoms are a reduction of urinary flow, a frequent sense of urgency to
urinate, nocturia (frequent nighttime urination), an inability to completely
empty the bladder and a residual urine volume of the bladder. BPH may cause
an important decrease in the quality of life and may lead to serious
complications like kidney infections and illnesses.
Contrary to popular belief, BPH is not a swelling (hypertrophy) but an
increase in the number of cells (hyperplasia) in the prostate. Aside from
surgery, no treatments can reduce the number of cells. However, the symptoms
can be effectively treated and BPH progression can be reduced and even
The clinical picture of BPH contains many elements including tissue
inflammation, an increase of the estrogen/testosterone ratio and spasms of
the urinary sphincters. BPH is due in part to a transformation of
testosterone into dihydrotestosterone (DHT), a hormone that is 10 times more
potent, by the 5-alpha reductase enzyme. DHT is so potent that is stimulates
prostate cell division.
(1)Saw Palmetto has many names: sabal serulata, Saw Palmetto, serenoa repens.
The first inhabitants of America, the Mayas, already used its fruit (or
berry). Traditionally, Saw Palmetto berries were used as a male reproductive
system tonic: Saw Palmetto had a reputation for stimulating male hormone
production (see pharmacology). Moreover, Saw Palmetto berries were used for
every urinary problem and were considered to have breast-enhancing
properties in women and to improve fertility.
The first European settlers considered its fruits as an emergency food
because they keep very well when dried (however, they were not meant to
please our taste buds).
Actions and Pharmacology:
Saw Palmetto is by far the most studied and most effective medicinal herb to
treat benign prostate hyperplasia symptoms. It contains many active
components: some hydrosoluble, like flavonoids, tannins and sugars, and some
liposoluble, like carotene, sterols, fatty acids and fatty alcohols. These
liposoluble molecules are demonstrated to be the most active in BPH
treatment. The extracts in the studies were standardized to 80 to 95%
Saw Palmetto extract works in many different ways. It inhibits the 5-alpha
reductase enzyme, therefore reducing DHT production. This effect seems to be
specific to the prostate.(2) Saw Palmetto also has an antagonist effect on
DHT at the receptor level, reducing the impact of the cellular DHT. It also
has an anti-inflammatory effect via cyclo-oxygenase and lipo-oxygenase
inhibition (these two enzymes are responsible for the synthesis of
inflammation factors like prostaglandins and leucotrienes).(3) Moreover, Saw
Palmetto has an antispasmodic effect that could improve urinary symptoms.(4)
However, it does not modify the circulating hormone levels, which confirms
that it is effective only at the cellular level.(5)
Recently, a few studies have looked into Saw Palmettos reported anti-cancer
effect. Although this data comes from in vitro studies, Saw Palmetto seems
to effectively stop the proliferation of cancerous prostate cells. A special
fatty acid, myristoleic acid, would have cytotoxic properties on these
The German Commission E acknowledges its benefits in cases of: urination
problems in benign prostatic hyperplasia.
The first clinical studies on Saw Palmetto were conducted more than 30 years
ago (1969). Many clinical studies on benign prostate hyperplasia demonstrate
without a doubt the efficacy of 320 mg daily of a Saw Palmetto extract
standardized to 85% fatty acids. A meta-analysis was published in December
2000 on the phytotherapeutic treatments of BPH. Specifically on Saw
Palmetto, the authors found 18 controlled studies conducted in 1996 and 1997
and involving 2939 men. They noticed that Saw Palmetto is the treatment
yielding the best results: objective improvement of symptoms (for example:
reduction of nocturia evaluated by the number of nighttime urinations and
subjective appreciation of effectiveness and side effects by the
Many studies compared Saw Palmetto to prescription medications. For example,
a study published in 1996 has demonstrated that Saw Palmetto was as
effective as finasteride (Proscar®) but much better tolerated.(8)
Precautions, contraindications and interactions
Contraindication: known allergy to one of the ingredients.
Saw Palmetto is very well tolerated. A few side effects have been reported
but the authors noted that they are similar to those reported with a
placebo: gastric discomfort, nausea, diarrhea and/or constipation.
Saw Palmetto is not recommended during pregnancy and nursing.
BPH, prostatitis (prostate infection or inflammation) and prostate cancer
should not be confused. A medical follow up is necessary for all men aged 40
1-Dionne JY, Gazella KA. Protecting your prostate. Impakt communications
2000. Green Bay Wi USA.
2-Bayne CW, Ross M, Donnelly F, Habib FK. The selectivity and specificity of
the actions of the lipido-sterolic extract of Serenoa repens (Permixon) on
the prostate. J Urol 2000 Sep;164(3 Pt 1):876-81
3-Breu W, Hagenlocher M, Redl K, et al. Anti-inflammatory activity of sabal
fruit extracts prepared with supercritical carbon dioxide. In vitro
antagonists of cyclooxygenase and 5-lipoxygenase metabolism.
Arzneimittelforschung 1992 Apr;42(4):547-51
4-Gutierrez M, Hidalgo A, Cantabrana B. Spasmolytic activity of a lipidic
extract from Sabal serrulata fruits: further study of the mechanisms
underlying this activity. Planta Med 1996 Dec;62(6):507-11
5-Casarosa C, Cosci di Coscio M, Fratta M. Lack of effects of a lyposterolic
extract of Serenoa repens on plasma levels of testosterone,
follicle-stimulating hormone, and luteinizing hormone. Clin Ther
6-Iguchi K, Okumura N, Usui S et al. Myristoleic acid, a cytotoxic component
in the extract from Serenoa repens, induces apoptosis and necrosis in human
prostatic LNCaP cells. Prostate 2001 Apr;47(1):59-65
7-Wilt TJ, Ishani A, Rutks I, MacDonald R. Phytotherapy for benign prostatic
hyperplasia. Public Health Nutr 2000 Dec;3(4A):459-72
8-Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon)
with finasteride in the treatment of benign prostate hyperplasia: a
randomized international study of 1,098 patients. Prostate 1996;29:231-40.
10-The Complete German Commission E Monographs, Therapeutic Guide to Herbal
Medicines. Blumenthal M et al 1998. American Botanical Council, 6200 Manor
Rd, Austin, Texas
11-Natural Medicines Comprehensive DataBase 2001. Pharmacist's Letter 3120
W. March Lane, PO Box 8190, Stockton, CA 95208
have not been evaluated by the Food and Drug Administration.
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