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General practitioner
The positive effects of saw palmetto have been known for a long time. For example, saw palmetto was used as a medicine by Native Americans in the south-east of the USA, and in the early 20th century men used the berries to treat urinary tract problems and increase sperm production - in addition to keeping the prostate healthy.
Today, saw palmetto supplements are among the most commonly taken dietary supplements by men with prostate cancer and benign prostatic hyperplasia (BPH).
Saw palmetto is also said to relieve colds, coughs and sore throats, among other things, and is used as a natural remedy for asthma, chronic bronchitis, chronic pelvic pain syndrome and migraine headaches.
It is also used to promote the flow of urine, to relax and to increase libido.
Saw palmetto extract is obtained from the dark purple berries of the saw palmetto, also known as Serenoa repens. It grows as a tree or shrub with lush green leaves that spread out from its thorny trunk.
In warm climates it can grow up to about 3 meters high, with leaf clusters that can reach a meter or more.
Other names for the saw palmetto are American dwarf palm and cabbage palm and originally comes from the West Indies.
The positive effects of saw palmetto have been known for centuries and the plant is used in traditional, eclectic and alternative medicine. Its active ingredients include fatty acids, plant sterols and flavonoids.
The berries also contain high molecular weight polysaccharides that can reduce inflammation and boost the immune system - strengthening the immune system adds to the list of benefits of saw palmetto.
The most important thing about saw palmetto is that it has been shown to slow down the production of the enzyme 5-alpha-reductase, so taking it is an important step towards improving prostate health. This enzyme converts the male hormone testosterone into dihydrotestosterone (DHT) - a sex steroid and androgen hormone.
DHT is not only important for male development, but also for many common health problems in men such as loss of libido, prostate enlargement and hair loss. By taking supplements or extracts of Serenoa repens, the production of this hormone is inhibited, helping to prevent these problems in middle-aged and older men, including prostate enlargement and BPH symptoms.
Saw palmetto berries can also help to relieve chronic pain and migraines and prevent hair loss.
The most common form of an enlarged prostate is benign prostatic hyperplasia (BPH). In adults, the prostate usually remains about the same size or grows slowly as long as male hormones are present.
When the prostate is enlarged, men experience symptoms of BPH and lower urinary tract problems. As men get older, the prostate can become inflamed or enlarged. The prostate then presses on the urethra, leading to difficulty urinating, which can result in bladder infections or bladder stones.
BPH can be caused by a variety of conditions, including hormonal changes (e.g. excess estrogen), deteriorating blood vessels and zinc deficiency.
Research shows that saw palmetto prevents the binding of testosterone to the prostate cells and their stimulation, thereby reducing prostate cell proliferation and prostate enlargement.
Other treatments for BPH, such as alpha blockers and 5-alpha reductase inhibitors, can themselves cause sexual dysfunction, whereas saw palmetto is a natural supplement that causes few side effects. This makes it one of the best sources to naturally increase testosterone levels and thus improve prostate health in a gentle way.
In a study conducted in Switzerland in 2012, 82 patients were examined in an eight-week trial. The patients took one capsule a day containing 320 milligrams of saw palmetto extract.At the end of the treatment, the International Prostate Symptom Score had fallen from 14.4 ± 4.7 to 6.9 ± 5.2. The evaluations of the investigators and patients confirmed the good efficacy, and the treatment was very well tolerated and accepted by the patients.
Another study from 2019 found that saw palmetto extract has great therapeutic potential, but also that saw palmetto products need to be standardized to ensure consistent efficacy in both the prevention and treatment of BPH.
A systematic review of 11 studies found that saw palmetto supplements were among the five most commonly used alternative treatments by men with prostate cancer.
Supplements containing Serenoa repens act as 5-alpha-reductase inhibitors, i.e. they slow down the conversion of testosterone into DHT by blocking the enzyme and preventing its formation. Research has shown that DHT is responsible for the enlargement of the prostate, which can be a cause of prostate cancer.
The science is not yet fully settled on this, but studies of two prescription 5-alpha-reductase inhibitors, finasteride (Proscar) and dutasteride (Avodart), found that men who took either drug were less likely to develop prostate cancer several years later than men who took an inactive placebo. The real problem lies in the side effects of these drugs - they can cause side effects such as reduced sexual desire and impotence.
Saw palmetto, on the other hand, can also inhibit DHT and help with BPH-related urinary problems such as difficulty urinating and urine leakage. It also regulates testosterone levels, boosts libido and acts as a natural remedy for impotence.
Studies have also shown that saw palmetto inhibits the growth of prostate cancer cells and can destroy dangerous cells. A study conducted at Peking University found that saw palmetto stops the growth of prostate cancer cells LNCaP, DU145 and PC3 and downregulates the hormone DHT, which leads to prostate enlargement.
Another interesting point regarding saw palmetto is the research that has been done to measure its effect on recovery time after surgery. Prostate surgery can require a long recovery time, but research shows that taking 320 milligrams of saw palmetto daily for two months before prostate surgery can shorten the length of recovery time.
Taking saw palmetto also has a positive effect on blood loss, the development of problems during surgery and the overall length of hospital stay.
Saw palmetto extracts act as a natural remedy for hair loss because they keep testosterone levels in balance. With increasing age, testosterone levels fall and the hormone DHT rises.
One of the causes of hair loss is the sensitivity of the hair follicles to DHT, the male androgen hormone, which causes the follicles to shrink, resulting in a shorter lifespan and less hair production.
Normally, after a hair falls out, a new hair starts to grow from the same follicle - but if the DHT level is too high, hair growth is reduced. Saw palmetto can inhibit the conversion of testosterone into DHT, which has a positive effect on hair growth.
Although opinions on saw palmetto as an effective hair growth remedy are divided, especially when it comes to the use of saw palmetto in women, there are studies that prove its effectiveness.
In a study conducted by the Clinical Research and Development Network in Colorado, 34 men and 28 women between the ages of 18 and 48 were examined who applied saw palmetto extract externally in the form of a lotion and shampoo for three months. The results showed that hair density increased in 35 percent of the participants.
This suggests that saw palmetto extract could be a natural remedy for hair loss in both men and women.
A review of the results, published in 2020 in the Cochrane database, PubMed and Google Scholar, showed that Serenoa repens extract led to an improvement in overall hair quality, total hair count and hair density in alopecia patients. The reports also showed that saw palmetto extract was well tolerated and was not associated with serious adverse side effects.
Because saw palmetto inhibits the conversion of testosterone to DHT, the body can maintain normal testosterone levels. This helps with weight loss, muscle building, pain response, hair loss and libido.
Nowadays, testosterone deficiency is rapidly increasing in men, leading to chronic fatigue, reduced libido and a poorer sense of well-being.
A case study published in the American Journal of Medicine examined a 52-year-old man who suffered from erectile dysfunction, low libido and fatigue. He was not taking any medication and was otherwise healthy.The study showed that his metabolism improved dramatically by increasing his testosterone levels. After just three months, he felt more energetic and his sexual function improved.
Saw palmetto has a positive effect on the urological system of men suffering from benign prostatic hyperplasia. This is due to an interaction with the receptors of the lower urinary tract, which can lead to urinary urgency and an overactive bladder.
Serenoa repens is also recommended for treating weakening of the urinary organs in older people or post-menopausal women, as it strengthens the urinary organs and is recommended as a natural remedy for kidney stones.
In 1998, the Journal of American Medical Association published a review in which the effectiveness of saw palmetto in improving urological symptoms and urinary flow was demonstrated. The study evaluated 18 randomized trials with almost 3,000 male participants.
Overall, 28 percent of men who took saw palmetto showed fewer urinary tract symptoms, 24 percent showed an improvement in maximum urinary flow and 43 percent of participants showed an improvement in overall urinary flow.
The results were comparable to those of the group taking the prescription drug Proscar and much more promising than those of the men taking a placebo.
Another randomized, double-blind, placebo-controlled study at the University of Chicago Pritzker School of Medicine involved 85 men who were randomly assigned to receive either saw palmetto or a placebo for six months. The results showed that taking saw palmetto in men with lower urinary tract symptoms led to a significant improvement in urinary tract symptoms compared to placebo.
Sources (in English):
Suter, A., Saller, R., Riedi, E., & Heinrich, M. (2013). Improving BPH symptoms and sexual dysfunctions with a saw palmetto preparation? Results from a pilot trial. Phytotherapy research : PTR, 27(2), 218–226. doi: 10.1002/ptr.4696
Penugonda, K., & Lindshield, B. L. (2013). Fatty acid and phytosterol content of commercial saw palmetto supplements. Nutrients, 5(9), 3617–3633. doi: 0.3390/nu5093617
Yang, Y., Ikezoe, T., Zheng, Z., Taguchi, H., Koeffler, H. P., & Zhu, W. G. (2007). Saw Palmetto induces growth arrest and apoptosis of androgen-dependent prostate cancer LNCaP cells via inactivation of STAT 3 and androgen receptor signaling. International journal of oncology, 31(3), 593–600.
Prager, N., Bickett, K., French, N., & Marcovici, G. (2002). A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. Journal of alternative and complementary medicine (New York, N.Y.), 8(2), 143–152. doi: 10.1089/acm.2002.8.143
Gerber, G. S., Kuznetsov, D., Johnson, B. C., & Burstein, J. D. (2001). Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology, 58(6), 960–965. https://doi.org/10.1016/s0090-4295(01)01442-x
Kwon Y. (2019). Use of saw palmetto (Serenoa repens) extract for benign prostatic hyperplasia. Food science and biotechnology, 28(6), 1599–1606. doi: 10.1007/s10068-019-00605-9