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.
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