Saw Palmetto

Saw palmetto (Serenoa repens) is a type of palm tree, also known as the dwarf palm. Its primary medicinal value lies in the oily compounds found in its berries. Most dietary supplements are composed of an extract from the berries or a berry powder.

Beta-sitosterol
Beta-sitosterol is a mixture of plant-derived cholesterol-like compounds called sitosterols and their close relatives sitosterolins.

What It Does:

Saw palmetto dietary supplements may provide mild to moderate improvement in symptoms of prostate enlargement (benign prostatic hyperplasia, or BPH). Men with BPH often experience difficulty with urinary flow, increased frequency and urgency of urination, and a fullness of the bladder after urination.

The evidence of saw palmetto's benefit is somewhat conflicting. A recently published study (2006) did not show a benefit with saw palmetto in men with moderate to severe symptoms. However, other, more limited, studies have shown benefit — although one found little benefit in men with mild symptoms. Some research suggests saw palmetto may be as effective as the prescription drug finasteride (Proscar), but with fewer side effects. Alpha-blockers, meanwhile, may be more effective than saw palmetto.

Perhaps the best approach to using saw palmetto is that applied in Europe, where saw palmetto is often the first course of therapy in men with mild to moderate symptoms, particularly due to the lack of side effects of saw palmetto relative to other therapies. If patients do not have effective relief, then stronger medical therapies or surgery is recommended.

Saw palmetto is believed to inhibit the actions of testosterone on the prostate that cause prostate enlargement and interference with urinary flow. It shrinks the inner epithelium of the prostate, but not the prostate's overall size. Saw palmetto has also been used to treat bladder inflammation (cystitis), chronic bronchitis, laryngitis, and asthma-associated nasal inflammation, among other conditions.

Among the main constituents of saw palmetto berry extract are fatty acids and sterols. The sterols (which include beta-sitosterol) are also present in other herbs (such as pygeum bark, stinging nettle root, and pumpkin seed extract) that are used in treating symptoms of prostate enlargement. Depending on the form of saw palmetto used, e.g., extract or whole dried berry, certain percentages of its weight should be expected (or "standardized") to be specific fatty acids and specific sterols. These amounts are based on the composition of saw palmetto products that have been shown to work in clinical trials.

Beta-sitosterol
Most studies of beta-sitosterol, although not all, have found significant improvement in perceived symptoms of BPH and in urine flow rate. Like the BPH drug finasteride (Proscar), beta-sitosterol might inhibit 5-alpha-reductase activity in the prostate.

At a much higher dosage and in combination with other sterols, beta-sitosterol can also lower total cholesterol and LDL cholesterol levels . In this case, beta-sitosterol works in the gut, where it reduces cholesterol absorption.

Preliminary evidence suggests that beta-sitosterol may also help strengthen immunity (and prevent the temporary immune weakness after exercise). Preliminary evidence also suggests an anti-cancer effect.

Quality Concerns
Currently, saw palmetto, beta-sitosterol and other dietary supplements are not considered drugs, and not required to be tested for quality by any governmental or independent agency prior to sale. The quality of plant-based ingredients can vary significantly.

What to Consider When Buying Consumers seeking products most similar to those shown to work in clinical trials should seek saw palmetto berry extract products, although crushed berry (non-extract) products are also available. Products should contain fatty acids and sterols standardized for the specific compounds and generally summarized on labeling as a minimum of 85% fatty acids and a minimum of 0.2% sterols. For example, a 160 mg pill of saw palmetto extract would have a minimum of 136 mg of fatty acids and 0.32 mg of sterols per pill. Also shown to work is a dried extract standardized to 25% fatty acids and sterols taken at a higher dose than the 85% extract, as described further below. Some products may contain saw palmetto in combination with other ingredients. Pygeum bark, for example, has been shown to also provide moderate improvement in prostate symptoms, particularly in reducing the frequency of urination at night. There is also some evidence of an effect for pumpkin seed oil. Stinging nettle root may also help with symptoms, although the research is stronger for saw palmetto. However, it is not clear whether these ingredients in combination with saw palmetto provide more benefit than saw palmetto alone. One product, containing 106 mg of saw palmetto extract along with nettle root extract and pumpkin seed oil extract and other ingredients was not effective. Beta-sitosterol Be sure to purchase a product designed for treating BPH rather than for cholesterol- lowering — the dosage and use instructions will be quite different. Look for products that list the specific amount of beta-sitosterol and not just total sterols. What to Consider When Using The standard dosage of saw palmetto extract is 320 mg per day, usually taken as 160 mg twice per day. Another type of saw palmetto extract in supplements is a spray dried extract containing approximately 25% fatty acids and sterols typically taken as 800 mg per day — 400 mg twice daily. For crushed berry products (not extracts), the dosage is about one to two grams of berry per day. Improvements can take from six to eight weeks to three to four months before noticeable and further improvements may be seen throughout the first twelve months. Beta-sitosterol A typical initial dosage of beta-sitosterol is 60 to 130 mg divided into 2-3 servings daily. It should be taken on an empty stomach to increase its absorption. Effects usually take 4 weeks to develop. The dosage can be reduced to 10 to 65 mg daily after symptoms improve. Beta-sitosterol is also used, at a much higher dosage (800 to 6,000 mg per day), along with other sterols to help lower cholesterols. These sterols work by competing with cholesterol absorption in the gut, so they are most effective when taken before meals. Other ingredients Pygeum bark: The standard dosage for pygeum bark as a single ingredient is 100 mg per day (at once or as 50 mg twice per day) of an extract standardized to 14% triterpenes/sterols and 0.5% n-docosanol. This is taken in cycles six to eight weeks in duration. Pumpkin seed: The typical dose of pumpkin seed is 5 grams of ground pumpkin seeds taken twice daily. Nettle root: The dose for nettle root is 4 to 6 g daily of the whole root or an extract made from the equivalent amount of nettle root — but be sure that you are using nettle "root" and not nettle "leaf," which is used to treat allergies. Concerns and Cautions: Consumers should check with a healthcare professional for a proper diagnosis before using saw palmetto or beta-sitosterol, particularly as the typical symptoms of enlarged prostate may signal other, more serious conditions that require prompt treatment. Neither is a treatment for prostate cancer. Saw Palmetto Saw palmetto is generally safe. A one-year placebo-controlled clinical trial using 160 mg twice daily of an extract showed no evidence of toxicity or adverse events. However, in a limited number of individuals, saw palmetto can cause nausea and abdominal pain — which can also occur with pygeum bark, nettle root, and beta-sitosterol. Dizziness and headache have also been reported. Saw palmetto may prolong bleeding time and reduce platelet activity, which is why you should inform your doctor if you are taking saw palmetto. Beta-sitosterol Like saw palmetto, beta-sitosterol is usually well tolerated but, in some patients, it can cause nausea, indigestion, gas, diarrhea, or constipation. Erectile dysfunction and loss of libido have also been reported when taking beta-sitosterol. Beta-sitosterol may reduce absorption and blood levels of alpha- and beta-carotene and vitamin E. Beta-sitosterol is contraindicated in patients with sitosterolemia, a rare disorder in which total body stores of beta-sitosterol are significantly increased.