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Saw palmetto extract is an extract of the fruit of Serenoa repens. It is rich in fatty acids and phytosterols. It has been used in traditional, eclectic, and alternative medicine for a variety of indications, most notably benign prostatic hyperplasia.

Contents

Traditional medicine

Saw palmetto is used in several forms of traditional medicine. Aboriginal Americans used the fruit for food and in the treatment of a variety of urinary and reproductive system problems.[citation needed] The Mayans drank it as a tonic, and the Seminoles used the berries as an expectorant and antiseptic.[1]

The taste of saw palmetto fruit is reported to be repugnant.[citation needed] A book by Susan Hales (1898) describes the saw palmetto fruit as a staple food item for the Seminole Indians. The aboriginal American medicine man also kept a medicine bag of saw palmetto around to treat illness and to nourish the body.[citation needed] Other historical uses have included the treatment of infertility in women, treatment of underdeveloped breasts, increased lactation, painful menstruation cycles, reduce prostate, appetite stimulant, and as a tonic.[citation needed]

Eclectic medicine

The crude extract was used for at least 200 years for various conditions including asthenia (weakness), recovery from major illness, and urogenital problems. For instance, the eclectic medicine practitioner H. W. Felter wrote of it, "Saw palmetto is a nerve sedative, expectorant, and a nutritive tonic, acting kindly upon the digestive tract...Its most direct action appears to be upon the reproductive organs when undergoing waste of tissue..."[2]

King's American Dispensatory (1898) describes the extract as:

It is also an expectorant, and controls irritation of mucous tissues. It has proved useful in irritative cough, chronic bronchial coughs, whooping-cough, laryngitis, acute and chronic, acute catarrh, asthma, tubercular laryngitis, and in the cough of phthisis pulmonalis. Upon the digestive organs it acts kindly, improving the appetite, digestion, and assimilation. However, its most pronounced effects appear to be those exerted upon the urino-genital tracts of both male and female, and upon all the organs concerned in reproduction. It is said to enlarge wasted organs, as the breasts, ovaries, and testicles, while the paradoxical claim is also made that it reduces hypertrophy of the prostate. Possibly this may be explained by claiming that it tends toward the production of a normal condition, reducing parts when unhealthily enlarged, and increasing them when atrophied.[3]

Alternative medicine

Saw palmetto extract is the most popular herbal preparation taken for benign prostatic hyperplasia,[4] a common condition in older men. Early research indicated that the extract is well-tolerated and suggested "mild to moderate improvement in urinary symptoms and flow measures".[4][5] Later trials of higher methodological quality indicated no difference from placebo.[6][7] Questions of adequate blinding and delivery of any active ingredients remain.[8]

Inhibition of both forms of 5-alpha-reductase with no reduction in cellular capacity to secrete prostate-specific antigen is indicated.[9][10][11][12]

Other proposals for mechanisms of action include interfering with dihydrotestosterone binding to the androgen receptor, relaxing smooth muscle tissue similarly to alpha antagonist drugs, and acting as a phytoestrogen.[13][14]

Limited in vitro and animal model studies suggest possible anti-tumor activity and potential for use in the treatment of cancer.[9][15][16] These results have not been substantiated with human trials.

Saw palmetto extract has been suggested as a potential treatment for male pattern baldness.[17]

Contraindications and side effects

Few side effects or allergic reactions are associated with saw palmetto extract use. The most common side effects are gastrointestinal, some of which may be reduced by taking the extract with food. Use may increase the risk of bleeding or affect sex hormones, and concurrent use of other drugs with similar action should be avoided.[17]

Beta-sitosterol, one chemical present in saw palmetto extract, is chemically similar to cholesterol. High levels of sitosterol concentrations in blood have been correlated with increased severity of heart disease in men who have previously suffered from heart attacks.[18]

As with other herbal preparations, precise chemical constituents may vary by manufacturer and batch.

References

  1. ^ "Saw palmetto". Mayo Clinic. http://www.mayoclinic.com/health/saw-palmetto/NS_patient-sawpalmetto. Retrieved 2008-04-17. 
  2. ^ Felter's complete text
  3. ^ King's American Dispensatory 1898
  4. ^ a b Markowitz JS, Donovan JL, Devane CL, et al. (December 2003). "Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers". Clin. Pharmacol. Ther. 74 (6): 536–42. doi:10.1016/j.clpt.2003.08.010. PMID 14663456. 
  5. ^ Wilt T, Ishani A, Mac Donald R (2002). "Serenoa repens for benign prostatic hyperplasia". Cochrane Database Syst Rev (3): CD001423. doi:10.1002/14651858.CD001423. PMID 12137626. 
  6. ^ Bent S, Kane C, Shinohara K, et al. (February 2006). "Saw palmetto for benign prostatic hyperplasia". N. Engl. J. Med. 354 (6): 557–66. doi:10.1056/NEJMoa053085. PMID 16467543. 
  7. ^ Dedhia RC, McVary KT (June 2008). "Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia". J. Urol. 179 (6): 2119–25. doi:10.1016/j.juro.2008.01.094. PMID 18423748. 
  8. ^ Allison Aubrey. (9 Feb 2006). Morning Edition: Study Casts Doubt on Saw Palmetto as Prostate Remedy. [Audio recording]. National Public Radio. http://www.npr.org/templates/story/story.php?storyId=5198053. 
  9. ^ a b Wadsworth TL, Worstell TR, Greenberg NM, Roselli CE (May 2007). "Effects of dietary saw palmetto on the prostate of transgenic adenocarcinoma of the mouse prostate model (TRAMP)". The Prostate 67 (6): 661–73. doi:10.1002/pros.20552. PMID 17342743. 
  10. ^ Scaglione F, Lucini V, Pannacci M, Caronno A, Leone C (2008). "Comparison of the potency of different brands of Serenoa repens extract on 5alpha-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells". Pharmacology 82 (4): 270–5. doi:10.1159/000161128. PMID 18849646. 
  11. ^ Abe M, Ito Y, Oyunzul L, Oki-Fujino T, Yamada S (April 2009). "Pharmacologically relevant receptor binding characteristics and 5alpha-reductase inhibitory activity of free Fatty acids contained in saw palmetto extract" (). Biological & Pharmaceutical Bulletin 32 (4): 646–50. doi:10.1248/bpb.32.646. PMID 19336899. http://joi.jlc.jst.go.jp/JST.JSTAGE/bpb/32.646?from=PubMed. 
  12. ^ Habib FK, Ross M, Ho CK, Lyons V, Chapman K (March 2005). "Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression". International Journal of Cancer 114 (2): 190–4. doi:10.1002/ijc.20701. PMID 15543614. 
  13. ^ Di Silverio F, Monti S, Sciarra A, et al. (October 1998). "Effects of long-term treatment with Serenoa repens (Permixon) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia". The Prostate 37 (2): 77–83. doi:10.1002/(SICI)1097-0045(19981001)37:2<77::AID-PROS3>3.0.CO;2-I. PMID 9759701. 
  14. ^ Plosker GL, Brogden RN (November 1996). "Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia". Drugs & Aging 9 (5): 379–95. doi:10.2165/00002512-199609050-00008. PMID 8922564. 
  15. ^ Scholtysek C, Krukiewicz AA, Alonso JL, Sharma KP, Sharma PC, Goldmann WH (February 2009). "Characterizing components of the Saw Palmetto Berry Extract (SPBE) on prostate cancer cell growth and traction". Biochemical and Biophysical Research Communications 379 (3): 795–8. doi:10.1016/j.bbrc.2008.11.114. PMID 19059205. 
  16. ^ Anderson ML (2005). "A preliminary investigation of the enzymatic inhibition of 5alpha-reduction and growth of prostatic carcinoma cell line LNCap-FGC by natural astaxanthin and Saw Palmetto lipid extract in vitro". Journal of Herbal Pharmacotherapy 5 (1): 17–26. doi:10.1300/J157v05n01_03. PMID 16093232. 
  17. ^ a b "Saw Palmetto". MedlinePlus (National Library of Medicine). 2008-02-01. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-sawpalmetto.html. Retrieved 2009-03-16. 
  18. ^ Assmann G, Cullen P, Erbey J, Ramey DR, Kannenberg F, Schulte H (January 2006). "Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Münster (PROCAM) study". Nutrition, Metabolism, and Cardiovascular Diseases : NMCD 16 (1): 13–21. doi:10.1016/j.numecd.2005.04.001. PMID 16399487. 

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