Saw Palmetto

Saw Palmetto Herbal Tincture


Saw Palmetto

This herb is used for prostate health, fertility, and to reduce body hair on women (see HairLess)

Saw palmetto grows in the southern United States.

Common Names--Saw Palmetto, American dwarf palm tree, cabbage palm

Latin Names--Serenoa repens, Sabal serrulata

What It Is Used For

* Saw palmetto is used mainly for urinary symptoms associated with an enlarged prostate gland (also called benign prostatic hyperplasia, or BPH).
* Saw palmetto is also used for other conditions, including chronic pelvic pain, bladder disorders, decreased sex drive, hair loss, and hormone imbalances.

How It Is Used

The ripe fruit of saw palmetto is used in several forms, including ground and dried fruit or whole berries. It is available as a liquid extract, tablets, capsules, and as an infusion or a tea.

What the Science Says

* Several small studies suggest that saw palmetto may be effective for treating BPH symptoms.
* In 2006, a large study of 225 men with moderate-to-severe BPH found no improvement with 320 mg saw palmetto daily for 1 year versus placebo. NCCAM cofunded the study with the National Institute of Diabetes and Digestive and Kidney Diseases.
* There is not enough scientific evidence to support the use of saw palmetto for reducing the size of an enlarged prostate or for any other conditions.
* Saw palmetto does not appear to affect readings of prostate-specific antigen (PSA) levels. PSA is protein produced by cells in the prostate. The PSA test is used to screen for prostate cancer and to monitor patients who have had prostate cancer.

Side Effects and Cautions

* Saw palmetto may cause mild side effects, including stomach discomfort.
* Some men using saw palmetto have reported side effects such as tender breasts and a decline in sexual desire.
* Tell your health care providers about any herb or dietary supplement you are using, including saw palmetto. This helps to ensure safe and coordinated care.


Saw palmetto. Natural Medicines Comprehensive Database Web site. Accessed March 30, 2006.

Saw palmetto (Serenoa repens [Bartran] Small). Natural Standard Database Web site. Accessed March 30, 2006.

Saw palmetto (Serenoa repens) In: Coates P, Blackman M, Cragg G, et al., eds. Encyclopedia of Dietary Supplements. New York, NY: Marcel Dekker; 2005;635-644.

De Smet PA. Herbal remedies. New England Journal of Medicine. 2002;347(25):2046-2056.

National Cancer Institute. The Prostate-Specific Antigen (PSA) Test: Questions and Answers. National Cancer Institute Web site. Accessed at on March 30, 2006.

Saw palmetto berry. In: Blumenthal, M, Goldberg, A, Brinckman, J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:335-340.

Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. New England Journal of Medicine. 2006;354(6):557-566.

Saw Palmetto berries (Serenoa serrulata or S. repens)
Currently Saw Palmetto is principally associated with the treatment of BPH but also has a generally supportive effect on the whole male reproductive system. Manin active ingredients are found in it s lipid content: free fatty acids (including lauric, myristic and loeic acids), together with triglycerides, diglycerides and monoglyycerides, phytosterols (mainly beta sitosterol) and fatty alcohols. Also contains flavonoids and polysaccharides.
A very active lipase during ripening and drying of the fruit causes splitting of the triglycerides into free fatty acids. This gives the berries their characteristic rancid odour and taste which according to Mills and Bone (2000:524), may account for the occasional digestive upsets, reported from Serenoa usage.
Actions: inhibition of 5-alpha-reductase. This enzyme is responsible for converting testosterone into its more potent form: DHT. It is also thought to inhibit DHT from binding to the prostate androgen receptors. This inhibitory effect on 5-alpha-reductase is 5,600-40,000 times weaker than that produces by the drug Finasteride. The Serenoa extract is normally given in doses 100 times greater than those used with Finasteride, meaning clinical potency is actually only approximately 60 times weaker (Mills and Bone 2000:534-5).
Inhibition of oestrogen and prolactin. Animal studies have demonstrated serenoa’s sitosterol glycosides as having oestrogenic effects, but a more recent study has reversed this view, and it is now thought Serenoa actually inhibits oestrogen. There is some evidence that Serenoa also inhibits prolactin, another hormone connected with prostate growth stimulation (Bone 1998:17).
Spasmolytic activity. A study on rat bladder, aorta and uterus, demonstrated that a liposterolic extract of Serenoa resulted in spasmolytic activity. According to Bone (1988:16) this and other trials have indicated this action results from ‘alpha-adrenoceptor and calcium blocking activities’.
Anti-oedematous and anti-inflammatory actions have been demonstrated through research trials, with the latter action being shown to result from inhibition of cyclo-oxgenase and 5-lipoxygenase (Mills and Bone 2000:526).
Serenoa was previously thought to only relieve the signs and symptoms of BPH, but recent research indicates it can also reduce the size of prostate epithelial tissue (Overmyer 2000:1).
Numerous clinical trials have been conducted on the efficacy and safety of Serenoa. The general consensus of these trials is that Serenoa impr9ves urological symptoms and flow measures and is comparable to finasteride in effectiveness, but produces fewer adverse effects.
Side effects. No contraindications, cautions or known adverse drug interactions are given by the German Commission E. the only side effect noted, was that in rare cases mild gastrointestinal upsets had been reported (Blumenthal et al 2000:338).
The standardised extract used fro 3 months or more is associated with inhibited libido in male patients, whereas it has been noted that this adverse effect is not found when the tincture of Serenoa is used.

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Serenoa serrulata Tincture (Saw Palmetto berries)




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General advice to consumers on the use of herbal remedies from the Medicines Healthcare products Regulatory Agency

From the website of the Medicines Healthcare products Regulatory Agency ( Department of Health, UK

• Remember that herbal remedies are medicines. As with any other medicine they are likely to have an effect on the body and should be used with care. • Herbal remedies may sometimes interact with other medicines. This makes it particularly important to tell your doctor or pharmacist if you are taking a herbal remedy with other medicines such as prescribed medicines (those provided through your doctor or dentist). • Treat with caution any suggestion that a herbal remedy is '100% safe' or is 'safe because it is natural'. Many plants, trees, fungi and algae can be poisonous to humans. It is worth remembering that many pharmaceuticals have been developed or derived from these sources because of the powerful compounds they contain. Any medicine, including herbal remedies, which have an effect on the body should be used with care. • Treat with caution any herbalist or other person who supplies herbal remedies if they are unwilling or unable to provide written information, in English, listing the ingredients of the herbal remedy they are providing. • If you are due to have a surgical operation you should always remember to tell your doctor about any herbal remedy that you are taking. • Anyone who has previously experienced any liver complaint, or any other serious health complaint is advised not to take any herbal remedy without speaking to their doctor first.


Pregnant/Breast-feeding mothers

Few conventional medicines have been established as safe to take during pregnancy and it is generally recognised that no medicine should be taken unless the benefit to the mother outweighs any possible risk to the foetus. This rule should also be applied to herbal medicinal products. However, herbal products are often promoted to the public as being “natural” and completely “safe” alternatives to conventional medicines. Some herbal ingredients that specifically should be avoided or used with caution during pregnancy. As with conventional medicines, no herbal products should be taken during pregnancy unless the benefit outweighs the potential risk.

Volatile Oils

Many herbs are traditionally reputed to be abortifacient and for some this reputation can be attributed to their volatile oil component.(6) A number of volatile oils are irritant to the genito-urinary tract if ingested and may induce uterine contractions. Herbs that contain irritant volatile oils include ground ivy, juniper, parsley, pennyroyal, sage, tansy and yarrow. Some of these oils contain the terpenoid constituent, thujone, which is known to be abortifacient. Pennyroyal oil also contains the hepatotoxic terpenoid constituent, pulegone. A case of liver failure in a woman who ingested pennyroyal oil as an abortifacient has been documented.


A stimulant or spasmolytic action on uterine muscle has been documented for some herbal ingredients including blue cohosh, burdock, fenugreek, golden seal, hawthorn, jamaica dogwood, motherwort, nettle, raspberry, and vervain. Herbal Teas Increased awareness of the harmful effects associated with excessive tea and coffee consumption has prompted many individuals to switch to herbal teas. Whilst some herbal teas may offer pleasant alternatives to tea and coffee, some contain pharmacologically active herbal ingredients, which may have unpredictable effects depending on the quantity of tea consumed and strength of the brew. Some herbal teas contain laxative herbal ingredients such as senna, frangula, and cascara. In general stimulant laxative preparations are not recommended during pregnancy and the use of unstandardised laxative preparations is particularly unsuitable. A case of hepatotoxicity in a newborn baby has been documented in which the mother consumed a herbal tea during pregnancy as an expectorant. Following analysis the herbal tea was reported to contain pyrrolizidine alkaloids which are known to be hepatotoxic.

Breast-feeding mothers

A drug substance taken by a breast-feeding mother presents a hazard if it is transferred to the breast milk in pharmacologically or toxicologically significant amounts. Limited information is available regarding the safety of conventional medicines taken during breast-feeding. Much less information exists for herbal ingredients, and generally the use of herbal remedies is not recommended during lactation.

Paediatric Use

Herbal remedies have traditionally been used to treat both adults and children. Herbal remedies may offer a milder alternative to some conventional medicines, although the suitability of a herbal remedy needs to be considered with respect to quality, safety and efficacy. Herbal remedies should be used with caution in children and medical advice should be sought if in doubt. Chamomile is a popular remedy used to treat teething pains in babies. However, chamomile is known to contain allergenic sesquiterpene lactones and should therefore be used with caution. The administration of herbal teas to children needs to be considered carefully and professional advice may be needed.

Perioperative use

The need for patients to discontinue herbal medicinal products prior to surgery has recently been proposed. The authors considered eight commonly used herbal medicinal products (echinacea, ephedra, garlic, ginkgo, ginseng, kava, St John’s Wort, valerian). On the evidence available they concluded that the potential existed for direct pharmacological effects, pharmacodynamic interactions and pharmacokinetic interactions. The need for physicians to have a clear understanding of the herbal medicinal products being used by patients and to take a detailed history was highlighted. The American Society of Anaesthesiologists (ASA) has advised patients to tell their doctor if they are taking herbal products before surgery and has reported that a number of anaesthesiologists have reported significant changes in heart rate or blood pressure in some patients who have been taking herbal medicinal products including St John’s Wort, ginkgo and ginseng. MCA is currently investigating a serious adverse reaction associated with the use of ginkgo prior to surgery. In this case, the patient who was undergoing hip replacement experienced uncontrolled bleeding thought to be related to the use of ginkgo.

From the website of the Medicines Healthcare products Regulatory Agency ( Department of Health, UK


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