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HEADLINE: Saw palmetto: herbal prevention for common male health concerns.

BYLINE: Foster, Steven

BODY: The fruits of the saw palmetto shrubs are particularly valued for treating symptoms of benign prostatic hyperplasia, or non-cancerous enlargement of the prostate gland.

Have you been on vacation yet this summer? Did you and your family, by chance, venture – over to the sunny coasts of Florida or South Carolina? Well, if you did, you probably walked through stands of saw palmetto bushes that you may have dubbed “little palm trees.” But what you may not have realized is that these indigenous shrubs’ berries have some well-documented medicinal benefits in the United States and abroad.

A brief introduction to facts about saw palmetto

Saw palmetto (Serenoa repens), sometimes called “sabal,” is a six- to nine-foot-tall shrubby palm family member found in the southeastern United States. It is found from the lower coastal plains of South Carolina to Florida, west to southeastern Mississippi. It is most common in Florida, where it produces thousands of acres of thickets, especially in the central and southern parts of the state.

The fruits are particularly valued for treating symptoms of benign prostatic hyperplasia (a non-cancerous enlargement of the prostate gland). Tens of thousands of pounds of the fruits are harvested from the wild each year, in Georgia, and in south central Florida, from where the bulk of the supply comes. It is primarily harvested in August and September as the fruits begin to ripen.

A few years ago, I went to Florida during the harvest season and gained new appreciation for the availability of the fruits on commercial herb markets. Harvesting the fruits is no easy task. The plant does not get the name “saw” palmetto for nothing. The leaf stalks are covered with saw-like teeth, and, if you catch your clothes on them, they will tear them to shreds (as you may have found out if you have ever found yourself in a thicket of these bushes).

Once the fruits completely ripen, they soon drop to the ground, although, generally, they are harvested before they completely ripen. The harvest is best done with heavy gloves to avoid getting cut by the sharp teeth on the leaf stalks. PAGE 2 Better Nutrition, August, 1996

As I crossed a ditch to look at a population of the plant, there lounged an alligator, basking in the morning sun. Fortunately for me, he had not warmed up too much. Beneath the shade and protection of the saw palmetto thickets of Florida, eastern diamondback rattlers find their favorite home. This is the largest, and one of the more aggressive, of the American rattlesnakes. Each year, one or two palmetto berry harvesters are bitten.

Historical beginnings of this botanical’s use

According to an interesting historical account of this medicinal herb in Saw Palmetto, published in 1898, Edwin M. Hale says, “There is no doubt that the aborigines of the Florida peninsula depended largely upon the berries of the Saw Palmetto for food.” But early European settlers, who found the flavor distasteful, did not carry on that traditional use, despite the fruit’s rich nutritional value.

In an account published in 1796 by Jonathan Dickinson, describing the experience of ship-wrecked Quakers on the southern coast of Florida, he writes, “We tasted them, but not one among us could suffer them to stay in our mouths, for we could compare the taste of them to nothing else but rotten cheese steeped in tobacco juice.” EventualIy, though, these stranded Europeans developed a “taste,” or at least a tolerance, for the fruits, which were attributed to saving them from starvation.

Hale attributes the first medicinal reference to the plant to Dr. J.B. Read of Savannah, Ga. Read wrote a paper on his clinical experiences with the plant and published it in the April 1879 issue of the American Journal of Pharmacy.

He writes: “By its peculiar soothing power on the mucous membrane, it induces sleep, relieves the most troublesome coughs, promotes expectoration, improves digestion, and increases fat, flesh and strength. Its sedative and diuretic properties are remarkable….Considering the great and diversified power of the saw palmetto as a therapeutic agent, it seems strange that it should have so long escaped the notice of the medical profession.”

Medicinal use increases by the late 19th century

By the 1890s, more practitioners began using saw palmetto in their practice. An “original communication” in the July 1892 issue of The New Idea, one physician wrote: “It also exerts a great influence over the organs of reproduction–mammaries, ovarium, prostate, testes, etc. Its action on them is a vitalizer, and is said to be the greatest known, tending to increase their activity and add greatly to their size.” This is perhaps the first reference relating to the effect of the fruits on reproductive organs.

Saw palmetto treatments found for certain internal irritations

From here, use evolved, by the 1930s, particularly in Europe, into significance toward treatment of irritation of the bladder, urethra, and prostate. The 21st edition of the United States Dispensatory (1926) states, “It has been especially recommended in cases of enlarged prostate of old men sic ; it is not probable that it has a direct influence upon the prostatic gland itself, I but there is much clinical testimony I as to its value and it probably acts l by reducing the catarrhal irritation and the relaxed condition of the mucous membrane of the bladder and urethra, which are almost universally PAGE 3 Better Nutrition, August, 1996

present in prostatic hypertrophy.”

Currently, clinical experience has yielded sufficient evidence C to get the attention of medical practitioners, more so in Europe than the United States, where saw palmetto has continued as a mainstay in the treatment of benign prostatic hyperplasia (BPH), or prostate enlargement, especially in Germany, France, and Italy. Historical documentation of this botanical’s effectiveness has sparked a number of scientific studies that give us a clearer understanding of the medicinal use of saw palmetto.

The medicinal properties are found exclusively in the sweet/bitter berries. The biochemistry of the saw palmetto fruits is complex. The fleshy part of the fruits contain various fats, starches, polysaccharides, sugars, and other compounds. Approximately 75 percent of the fat content consists of free fatty acids. Saw palmetto’s unique fragrance is due to methylic and ethylic esters (organic compounds) in the oil, where there are various plant sterols.

Saw palmetto fruits are available in the American market in many different product forms, including the whole fruits, cut and sifted, or powdered fruits, capsules, tablets, tinctures, and extracts. Most clinical studies have involved products made from fat-soluble solvents, standardized to high levels of free fatty acids in the extracts. Predictable benefits are best achieved with standardized products.

Results of clinical trials

Clinical trials with saw palmetto have shown that it helps reduce certain symptoms associated with BPH, especially reducing the number of times that BPH sufferers need to urinate during the night. Fifty percent of men over 50 develop symptoms of BPH. An urge to urinate at night, especially if occurring four or five times a night, can dramatically affect the quality of life. As aforementioned, BPH is a condition of. prostate enlargement that is non-malignant (non-cancerous). It is estimated that the condition costs American men, collectively, over $ 1 billion per year. The prostate enlargement resulting from BPH narrows the urethra, thus producing poor urinary flow. That can also translate into a host of other urinary symptoms, including hesitancy or straining to urinate, painful urination, increased urinary frequency, and a feeling that the bladder is not quite empty.

BPH is a rather poorly understood condition in terms of what is at work in the body to produce it. What is known is that an enzyme called 5-alpha-reductase increases with age in men; this enzyme converts testosterone into dihydrotestosterone, which is a strong form of the male sex hormone. One way to treat BPH in the past has been to withdraw male sex hormones, but this produces severe side effects. A more common approach to BPH treatments has been to target 5-alpha-reductase inhibitors, such as is found in saw palmetto.

An inhibiting ability of this enzyme was first described for saw palmetto in 1984. A specific active compound has yet to be determined. Various studies have shown that liposterolic fruit extracts reduce testosterone and dihydotestosterone in tissue samples by over 40 percent.

Standardized saw palmetto extracts have been the subject of a number of clinical studies. A shortterm, 28-day, double-blind study on 110 men conducted by French researchers was published in a 1984 issue of the British Journal of PAGE 4 Better Nutrition, August, 1996

Clinical Pharmacology. The number of times participants had to get up in the night to urinate was reduced by over 45 percent, while the urinary flow rate increased by over 50 percent. Post-micturition residue was reduced by nearly 42 percent. Painful or difficult urination was significantly improved in the treatment group over the placebo group, as were subjective ratings by both patients and physicians. After the initial short-term results, the progress of about half the men in the study was monitored for up to 30 months, with continued improvement. The dose in this and other studies has been 320 mg/day of an extract taken in one or two doses per day. The extracts are in fat-soluble form, with high levels of the fatty acids intact.

While no side effects, except rare stomach upset, have been associated with saw palmetto, it is important to remember that BPH is not a self-diagnosable or self-treatable condition.

Given the high incidence of prostate cancer in older men, it is important for men to visit their health practitioner regularly to obtain proper diagnosis and treatment for BPH.

Further suggested reading:

Brown, D. Herbal Prescriptions for Better Health. Rocklin, Calif.: Prima Publishing, 1995.

Champault, G., et al. “The Medical Treatment of Prostatic Adenoma–A Controlled Study: PA-109 versus Placebo in 110 Patients,” Annals of Urology, 6:407-410, 1984.

Hale, E.M. Saw Palmetto. Philadelphia: Boericke&Tafel, 1898.

Leung, A.Y. and Foster, S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. New York: John Wiley & Sons, 1996.

GRAPHIC: Photograph

IAC-NUMBER: IAC 18549483

IAC-CLASS: Health

LANGUAGE: ENGLISH

LOAD-DATE: September 09, 1996