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How to use Cabbage Palm

Scientific Name: Saw Palmetto

Other Names: Cabbage Palm, Fan Palm, Sabal, Sabal serrulata, Scrub Palm, Serenoa, Serenoa repens

Who is this for?

In the western world, saw palmetto is used mainly to relieve the symptoms of benign prostatic hyperplasia (BPH) — a non-cancerous enlargement of the prostate gland. The prostate is part of the male reproductive system. The urethra, the tube that carries urine out of the body, passes through the prostate gland. For most men, BPH is a normal part of aging. An enlarged prostate, however, may cause men to have trouble starting or maintaining urination, need to urinate more often, have urine leaks, or need to urinate during the night.

Saw palmetto contains a number of different chemicals, including plant sterols and fatty acids. Numerous studies have been done to test the effectiveness of saw palmetto for BPH. In general, results have been positive – possibly due to saw palmetto’s potential ability to block at least partially the effects of an enzyme that promotes and maintains prostate cell growth. However, many of the studies were not well-controlled and many of them involved only small numbers of participants. Therefore, some results may not be totally reliable. It should also be noted that while using saw palmetto seemed to help relieve the symptoms of BPH, it had little or no effect on prostate size or on blood levels of prostate-specific antigen (PSA). PSA is a protein that is produced by prostate cancer cells. Because PSA circulates in the blood, it can be tested easily to determine if prostate enlargement is caused by cancer.

Saw palmetto has also been reported to have mild anti-inflammatory, antiseptic, diuretic, and sedative properties. These effects are based largely on case reports with little study evidence to support them. Results from a small study of men who suffered from long-term inflammation of the prostate showed improvement in some markers of inflammation after 3 months of treatment with saw palmetto. A separate, year-long study also involving a small group of men with chronically-inflamed prostates; however, found that taking saw palmetto had no significant effects on either the symptoms or the inflammation, itself. More studies are underway to evaluate these possible effects of saw palmetto.

Some unconfirmed reports seem to indicate that saw palmetto may stimulate hair growth, some women reportedly use it to increase breast size, and it has also been promoted to enhance sexual desire for both men and women. No scientific evidence supports any of these uses.

When should I be careful taking it?

Because saw palmetto contains plant sterols with hormonal effects, pregnant women and women who are breast-feeding should not use it. Women with hormone-dependent breast cancer should also avoid taking it.

Due to its potential hormonal effects, saw palmetto should not be taken by children.

Precautions

Saw palmetto has not been proven effective in treating prostate cancer and it does not have any proven effectiveness for urinary tract infections.

What side effects should I watch for?

One case of non-viral hepatitis has been reported in a man using a combination product that contained saw palmetto. The exact cause of the hepatitis was not identified conclusively, however.

A case report of impotence also seems to be associated with taking saw palmetto, but the incidence of impotence among participants in clinical studies was similar for both saw palmetto and placebo.

Less Severe Side Effects

Individuals taking saw palmetto in clinical studies have reported

  • Constipation
  • Diarrhea
  • Dizziness
  • Headache
  • Nausea
  • Upset stomach

What interactions should I watch for?

Prescription Drugs

In studies and case reports, saw palmetto has been shown to increase the time blood needs to clot. When it is taken with an antiplatelet or an anticoagulant drug, the effect of the drug may be increased, resulting in uncontrolled bleeding.

  • Antiplatelets include Plavix and Ticlid
  • Anticoagulants include heparin and warfarin

Because it has hormonal activity, saw palmetto may interfere with the effectiveness of oral contraceptives and hormone replacement therapy.

Non-prescription Drugs

Saw palmetto can affect the ability of blood to clot after an injury. Aspirin can also delay clotting, so saw palmetto should not be taken at the same time aspirin is being taken.

Herbal Products

If saw palmetto is used with other herbs that affect blood clotting, bleeding may occur. If you take any other herbal product, check with your pharmacist to see if it might affect blood clotting. Some of the most common herbal products that might inhibit blood clotting are:

  • Danshen
  • Devil's Claw
  • Garlic
  • Ginger
  • Ginkgo
  • Ginseng
  • Horse Chestnut
  • Papain
  • Red Clover

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals.

Should I take it?

Saw palmetto grows extensively in warm coastal areas of southeastern North American, parts of Africa, and southern Europe. The saw palmetto is easily recognized by its long, thin "saw tooth-edged" leaves and by its characteristic bushy shape. Its trunks may reach 10 feet or more in length, but they tend to lie along the ground, giving saw palmetto. It is an evergreen with silvery or bluish leaves. In the spring and summer, multiple small white flowers bloom on long stalks, which sprout from the top of the trunk. Its large clusters of olive-sized fruits turn dark blue when they are ripe in late summer and autumn. Although they are said to taste somewhat like soap, saw palmetto fruits frequently are eaten fresh or made into jam. They also provide food for birds and animals native to the areas where they grow. Ripe fruits may also be collected in the autumn and dried for use in medicine, after the seeds are removed. Most saw palmetto fruit comes from plants that grow wild, but saw palmetto may also be cultivated in large greenhouses where cold winters prevent its growing outdoors.

Dosage and Administration

Dried saw palmetto fruits are marketed widely. Saw palmetto is also available commercially as capsules, tablets, and several liquid dosage forms. Oral saw palmetto products should be standardized to contain 80% or more of the active ingredients, which are fatty acids. Standardization by the manufacturer assures the same amount of active ingredient in every batch of the commercial preparation. Standardization of herbal products is not required by the U.S. Food and Drug Administration (FDA), so not every product will contain the same amounts of active ingredients. Recently, an analysis of 14 brands of saw palmetto revealed that many of the products did not contain the amounts of active ingredients that were indicated on the labels.

Regular dosing of saw palmetto may be needed for up to 6 weeks before symptom relief may begin and some study participants did not notice changes until saw palmetto had been used for 6 months or longer. Typical dosing ranges from 320mg to 1800mg of a standardized commercial saw palmetto product daily — in one, two, or three doses. Alternately, 1000mg to 2000mg (one gram to 2 grams) of the dried fruits can be eaten each day. A tea can be made by soaking 500mg to 1000mg (0.5 gram to one gram) of the dried fruits in about 5 ounces of boiling water for 5 to 10 minutes and then straining out the fruits before drinking the tea. Saw palmetto tea is usually taken three times a day, but since the active ingredients are not water-soluble, the effectiveness of saw palmetto tea is questionable.

Combination products that contain saw palmetto with other herbal or nutritional supplements are common. The FDA has warned against the use of specific combination products, however, because some of them may contain an ingredient that could affect bleeding. A healthcare professional should be consulted before self-treatment with any product that contains saw palmetto is started.

Summary

The main use of saw palmetto is to treat the urinary symptoms of benign prostatic hyperplasia (BPH). Saw palmetto has not been proven effective in treating prostate cancer, however, and it does not have any effectiveness for urinary infections.

Risks

Saw palmetto contains plant sterols that have hormonal effects, so children, pregnant or breast-feeding, and women who have hormone-dependent breast cancer should avoid using it.

Side Effects

Rare and unsubstantiated cases of non-viral hepatitis and impotence have been reported in men using saw palmetto, but the exact causes of the side effects are not known. In clinical studies, taking saw palmetto has resulted in constipation, diarrhea, dizziness, headache, nausea, and upset stomach.

Interactions

If it is taken with drugs or other herbals that have antiplatelet or anticoagulant effects, saw palmetto can lengthen bleeding time. Saw palmetto's hormonal effects may interfere with the effectiveness of oral contraceptives and hormone replacement therapy.

References

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Anon: Saw Palmetto. In: DerMarderosian A, Beutler JA, eds. Facts and Comparisons: The Review of Natural Products. St. Louis, MO, Facts and Comparisons. June 2000.

Boon H, Westlake K, Stewart M, et al. Use of complementary/alternative medicine by men diagnosed with prostate cancer: prevalence and characteristics. Urology. 2003;62(5):849-853.

Boyle P, Robertson C, Lowe F, Roehrborn C. Updated meta-analysis of clinical trials of Serenoa repens extract in the treatment of symptomatic benign prostatic hyperplasia. BJU International. 2004;93(6):751-756.

Boyle P, Robertson C, Lowe F, Roehrborn C. Meta-analysis of clinical trials of permixon in the treatment of symptomatic benign prostatic hyperplasia. Urology. 2000;55(4):533-539.

Carraro JC, Raynaud JP, Koch G, Chisholm GD, Di Silverio F, Teillac P et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate. 1996;29(4):231-242.

Carrington ME, Gottfried T, Mullahey JJ. Pollination biology of saw palmetto (Serenoa repens) in southwestern Florida. Palms. 2003;47(2).

Debruyne F, Boyle P, Calais Da Silva F, et al. Evaluation of the clinical benefit of permixon and tamsulosin in severe BPH patients-PERMAL study subset analysis. European Urology. 2004;45(6):773-780.

Debruyne F, Koch G, Boyle P, Da Silva FC, Gillenwater JG, Hamdy FC, et al. Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (Tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study. European Urology. 2002;41(5):497-507.

Djavan B. Lower urinary tract symptoms/benign prostatic hyperplasia: fast control of the patient's quality of life. Urology. 2003 Sep;62(3 Suppl 1):6-14.

Dull P, Reagan RW Jr, Bahnson RR. Managing benign prostatic hyperplasia. American Family Physician. 2002;66(1):77-84 and 87-88.

Eng J, Ramsum D, Verhoef M, Guns E, Davison J, Gallagher R. A population-based survey of complementary and alternative medicine use in men recently diagnosed with prostate cancer. Integrated Cancer Therapy. 2003;2(3):212-216.

Fagelman E, Lowe FC. Herbal medications in the treatment of benign prostatic hyperplasia (BPH). Urology Clinics of North America. 2002 ;29(1):23-29 and vii.

Gerber GS. Phytotherapy for benign prostatic hyperplasia. Current Urology and Reproduction. 2002;3(4):285-291.

Gerber GS, Fitzpatrick JM. The role of a lipido-sterolic extract of Serenoa repens in the management of lower urinary tract symptoms associated with benign prostatic hyperplasia. BJU International. 2004;94(3):338-344.

Gerber GS, Zagaja GP, Bales GT, Chodak GW, Contreras BA. Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Urology. 1998;51(6):1003-1007.

Giannakopoulos X, Baltogiannis D, Giannakis D, Tasos A, Sofikitis N, Charalabopoulos K, Evangelou A. The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens. Advanced Therapy. 2002;19(6):285-296.

Gilman EF. Serenoa repens. University of Florida Cooperative Extension Service Fact Sheet FPS-547. October 1999. Available at: http://hort.ifas.ufl.edu/shrubs/SERREPA.PDF. Accessed September 15, 2004.

Gordon AE, Shaughnessy AF. Saw palmetto for prostate disorders. American Family Physician. 2003;67(6):1281-1283.

Habib FK, Wyllie MG. Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer and Prostatic Diseases. Published online in advance of publication. August 3, 2004. Abstract available at: http://www.nature.com/cgi-taf/dynapage.taf?file=/pcan/journal/vaop/ncurrent/abs/4500746a.html. Accessed August 13, 2004.

Hill B, Kyprianou N. Effect of permixon on human prostate cell growth: Lack of apoptotic action. Prostate. 2004;61(1):73-80.

Jellin JM, Gregory P, Batz F, Hitchens K, et al, eds. Pharmacist's Letter/Prescriber's Letter. Natural Medicines Comprehensive Database, 3rd Edition. Stockton CA: Therapeutic Research Facility, 2000.

Kaplan SA, Volpe MA, Te AE. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. Journal of Urology. 2004;171(1):284-288.

Markowitz JS, Donovan JL, Devane CL, Taylor RM, Ruan Y, Wang JS, Chavin KD. Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers. Clinical Pharmacology and Therapeutics. 2003;74(6):536-542.

Marks L, Partin AW, Epstein JI, Tyler VE, Simon I, Macairan ML, et al. Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. Journal of Urology. 2000;163(5):1451-1456.

McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Product Association’s Botanical Safety Handbook. Boca Raton, FL: CRC Press; 1997.

National Center for Complementary and Alternative Medicine. National Institutes of Health. U.S. Department of Health and Human Services. Recall of PC SPES and SPES dietary supplements. [press release]. Updated June 18, 2002. Available at: http://nccam.nih.gov/health/alerts/spes Accessed February 13, 2003.

National Kidney and Urologic Diseases Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. U.S. Department of Health and Human Services. Prostate enlargement: benign prostatic hyperplasia. NIH Publication No. 02-3012. June 2002. Available at: http://www.niddk.nih.gov/health/urolog/pubs/prostate/#common Accessed February 12, 2003.

Plants for a Future Database. Serenoa repens. No date given. Available at: http://www.ibiblio.org/pfaf/cgi-bin/arr_html?Serenoa_repens. Accessed August 13, 2004.

Plosker GL, Brogden RN. Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia. Drugs and Aging. 1996;9(5):379-395.

Pytel YA, Vinarov A, Lopatkin N, Sivkov A, Gorilovsky L, Raynaud JP. Long-term clinical and biologic effects of the lipidosterolic extract of Serenoa repens in patients with symptomatic benign prostatic hyperplasia. Advanced Therapy. 2002;19(6):297-306.

Reece Smith H, Memon A, Smart CJ, Dewbury K. The value of permixon in benign prostatic hypertrophy. British Journal of Urology. 1986;58:36-40.

Stepanov VN, Siniakova LA, Sarrazin B, Raynaud JP. Efficacy and tolerability of the lipidosterolic extract of Serenoa repens (Permixon) in benign prostatic hyperplasia: a double-blind comparison of two dosage regimens. Advances in Therapeutics. 1999;16:231-241.

Talpur N, Echard B, Bagchi D, Bagchi M, Preuss HG. Comparison of Saw Palmetto (extract and whole berry) and Cernitin on prostate growth in rats. Molecular and Cellular Biochemistry. 2003;250(1-2):21-26.

Taylor M, Coleman E. Saw palmetto. Health Care Reality Check. No Date Given. Available at: http://www.hcrc.org/faqs/sawpalm.html Accessed February 12, 2003.

U.S. Forest Service. U.S. Department of Agriculture. Serenoa repens (Bartr.) Small PALMAE. No Date Given. Available at: http://www.fs.fed.us/global/iitf/pdf/Serenoa%20repens.pdf Accessed February 5, 2003.

Vela Navarrete R, Garcia Cardoso JV, Barat A, Manzarbeitia F, Lopez Farre A BPH and inflammation: pharmacological effects of Permixon on histological and molecular inflammatory markers. Results of a double blind pilot clinical assay. European Urology. 2003;44(5):549-555.

Wadsworth TL, Carroll JM, Mallinson RA, Roberts CT Jr, Roselli CE. Saw palmetto extract suppresses insulin-like growth factor-I signaling and induces stress-activated protein kinase/c-Jun N-terminal kinase phosphorylation in human prostate epithelial cells. Endocrinology. 2004;145(7):3205-3214.

Willetts KE, Clements MS, Champion S, Ehsman S, Eden JA. Serenoa repens extract for benign prostate hyperplasia: a randomized controlled trial. BJU International. 2003;92(3):267-270.

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(Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.)

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