From the Rodale book, Dr. Duke's Essential Herbs: Edit id 1018
Saw Palmetto
Saw Palmetto
LATIN NAME: Serenoa repens
FAMILY NAME: Arecaceae (palm family)
Man's best friend is his dog, the old saw says. I'd like to add a Duke corollary: An old man's best friend may be his saw palmetto.
How could aging shift my allegiance from pooch to palm? Well, I figure a guy owes one helluva debt of gratitude to anything that, all by itself, averts prostate problems, may keep his hair from falling out, possibly bucks up his and his wife's libido and, on top of all of that, purportedly encourages breast growth.
Did the saw palmetto legend bring Ponce de León to Florida in search of the Fountain of Youth? I wonder. Maybe this small palm was actually the grail he held so holy.
FROM MY SCIENCE NOTEBOOK
The prostate gland, which only men have, secretes much of the fluid in semen. About the size of a walnut, it's located right above the rectum and encircles the urethra like a doughnut. As men age, the gland starts to grow, giving rise, sooner or later, to the condition called benign prostatic hyperplasia or benign prostatic hypertrophy (BPH). It's termed "benign" because the enlargement is not necessarily cancer-related nor necessarily associated with tumor growth. But it sure is problematic.
As the prostate enlarges, it chokes off the urethra and restricts the flow of urine. The larger the gland grows, the harder it becomes to urinate. Voiding becomes difficult, if not painful, and it's never completely successful. A man with full-blown BPH can't empty his bladder thoroughly, which explains one of BPH's telltale symptoms: frequent late-night trips to the bathroom. At its worst, BPH causes serious bladder and kidney problems, enough so to justify surgery.
An increased presence of the male hormone dihydrotestosterone (DHT), experts in urology and endocrinology generally concur, prompts the glandular growth by stimulating prostate cells to reproduce. DHT forms when the main male hormone, testosterone, interacts with an enzyme called 5-alpha-reductase.
Pharmaceutical companies spent millions and millions of dollars trying to come up with something that deterred 5-alpha-reductase and thus prevented the creation of DHT. (Don't applaud them for the expenditure; they've already recouped it.) Eventually, they concocted something called finasteride (sold under the brand name Proscar) that inhibits the body's release of 5-alpha-reductase. Without the enzyme, DHT levels drop, which allows the gland to shrink and improves BPH symptoms.
Holed up in laboratories holding up test tubes to Bunsen burners, scientists wasted a lot of time. Instead, they should've flown down to Florida, where they would have found a palm whose berries already contain such substances.
I don't like to chemically dissect a medicinal plant. You can identify hundreds of substances yet never be sure that any given one or ones may be responsible. In many cases, they may work best only when they work together. Some scientists have identified beta sitosterol, campesterol, stigmasterol, and other plant sterols as the key components. Others have cited free fatty acids and long-chain alcohols. Some Floridian scientists claim they've discovered as-yet unnamed sterols unique to saw palmetto, while others still have pointed fingers at one-of-a-kind acylglycerides with biological activity.
I don't doubt any of them. I think they're all correct. But they've all made one similar mistake: They've sought to isolate one key component, and they've failed to realize that saw palmetto, like so many other herbal medicinals, is more than the sum of its chemical parts. Arguing over a specific compound in saw palmetto is an irrelevant diversion. The overriding issue is how saw palmetto, as an extracted whole, is better than anything the pharmaceutical industry has come up with.
When the palm's active ingredients appear together in a standardized extract, they not only work as well as finasteride, they do finasteride one or two better. Besides inhibiting the 5-alpha-reductase enzyme, they block estrogens and already-created DHT from latching on to and affecting prostate cells. Other phytochemicals counter the tissue inflammation, which often occurs in BPH.
The natural medicine not only works on more levels than the synthetic, it works much quicker and works for a greater number of people. Proscar helps less than half of the men with BPH who take it, and they've got to wait at least six months before seeing some sign that it'll work at all.
Is All OK with the PSA?
Once saw palmetto emerged as the obvious, if uncrowned, treatment of choice for BPH, some critics counterattacked by charging that it interferes with a lab analysis, called the prostate-specific antigen (PSA) test, to detect a man's risk of prostate cancer. A higher measurement of this substance may indicate a higher risk of prostate cancer.
The evidence conflicts, so I can't give you a definitive answer. Some research asserts that taking saw palmetto has no effect whatsoever on PSA levels. Other research concludes that any inhibitor of 5-alpha-reductase, whether saw palmetto or finasteride or something else, theoretically should reduce PSA readings. If saw palmetto is guilty in this regard, finasteride is, too. Yet you never hear finasteride criticized for throwing off PSA readings. I wonder why?
And if this does indeed pose a problem, should men avoid eating vegetables entirely? To one degree or another, all plants contain PSA-reducing sterols. For instance, most beans contain genistein, an alpha-reductase inhibitor. Others include black-eyed peas, kudzu, lentils, soybeans, and split peas. Where is the advisory against eating these foods?
Again, no conclusive answer exists, but I'm not worrying about it. As long as you get a baseline PSA reading before you start to manipulate with herbs or pharmaceuticals, I think you'll be fine.
What Saw Palmetto Is and What It Can Do
With fanlike, fingery fronds and small berry-shaped fruit, saw palmetto (Serenoa repens) grows naturally only in the Florida Everglades and certain other parts of the southeastern United States, maybe as far west as coastal Alabama and Mississippi and perhaps as far north as South Carolina.
Modern-day profiteers are trying to rewrite history by saying that saw palmetto has always been a folk remedy for prostate problems. That's B.S. ("bum steer"), to put it bluntly. To Seminole Indians, the American saw palmetto was more of a food than a medicine. Only much later did people realize that its fruit encouraged urinary excretion and supported healthy genital function. Ironically, none of the traditional uses foreshadowed its current use.
In clinical trials, saw palmetto has beat the pants off its pharmaceutical rival, the synthetic drug finasteride (Proscar), for controlling the symptoms and possibly the cause of benign prostate enlargement. Benign prostatic hyperplasy or benign prostatic hypertrophy--BPH, as the condition is known--affects some 10 million American men every year. At least half of all 50-year-old men get it, and the older you grow from there, the more likely you'll be affected: At least 90 percent of all men 70 to 90 years old, by some estimates, must contend with BPH and its symptoms. About 30 percent of them eventually undergo surgery.
DR. DUKE'S NOTES
It's just too bad that a native American plant can't relish victory on home turf. The United State ships an estimated 15 million pounds of saw palmetto fruit to Europe every year and leaves much of the rest for cattle to graze on. Well, at least the bulls out to pasture in the Everglades, where saw palmetto grows, don't have BPH.
Head-to-Head
My mission in life is to force pharmaceutical companies to test their potions and notions directly against natural herbal alternatives. Head-to-head, one-on-one--let the best therapy win. I doubt that such even-handed contests will ever become standard operating procedure in my lifetime, but I'm winning battles here and there in this long war, and saw palmetto is one of the most glorious victories.
The triumphs are both professional and personal. According to the odds-makers, I should right now be one of some urologist's typical BPH patients. After all, as a 70-year-old, I carry about a 70 percent risk. But I do not have BPH.
Almost a decade ago, I decided to defy the long odds. In a wager made before a group of federal health officials, I bet my prostate gland that a preventive herbal approach was superior to finasteride, the first approved pharmaceutical treatment of choice for BPH. Since then, I've been beating ever-increasing odds.
At my most recent checkup, the doctor reported that my prostate was fine--neither seriously swollen nor inflamed, just slightly enlarged. "Whatever you're doing," he advised, "keep it up."
What I gambled on in the early 1990s is almost considered a safe bet today.
A CASE IN POINT
What the Doctor Did
While writing this book, I sent some feelers out for good stories about saw palmetto. Christopher Hobbs, a third-generation medical herbalist and the author of a dozen or so very good books, including Herbal Remedies for Dummies and Peterson's Field Guide of the Western U.S. Medicinals, gave me a dandy.
Chris told me that his father, a long-time university professor and botanist, took the typical prescription route (finasteride) several years ago after recognizing certain prostate-related symptoms, specifically pain upon urination and the need to get out of bed some five to seven times a night to go to the bathroom. About a month after starting finasteride therapy, father called son to talk about side effects and therapeutic options.
"When I asked if he had changed his diet or medications at all," Chris said, "he told me about the new drug. I reviewed the side effects of Proscar, and they matched up perfectly."
Chris, a licensed acupuncturist in California, told his father to stop taking the medication. Instead, he said, take some saw palmetto extract. Chris sent his dad some supplements, and his dad took them faithfully.
After two months, the nighttime problems were no better, but at least all of the drug's side effects had vanished. Chris then decided his dad should double the dosage. Father followed son's orders. Three months later, Chris's dad called to say that the overnight urinary urges and inconveniences were gone. For the first time in untold months, he was able to sleep straight through the night.
This, in itself, is an excellent end to the story, but we're not quite done. There's a punch line.
You see, around the same time that the saw palmetto kicked into action, Chris's father went back to the doctor on an unrelated matter. "How are your prostate symptoms?" the physician asked, making conversation more than anything else during the course of the office visit. When the patient reported that all is now well, the doctor replied, "Great! Then the drug must have worked for you."
No, Chris's dad corrected, explaining that he had stopped taking the prescription drug nearly five months previously in favor of saw palmetto supplements.
"Oh," the doctor exclaimed. "I'm taking that, too."
An amusing anecdote? Sure. Ironic? You bet. A damned shame? Absolutely. Here is a doctor who prescribed a medication to his patient without informing him of an herbal alternative--an alternative that the doctor himself decided is the preferred option.
You and I are supposed to thrive in a society in which doctors are indoctrinated to give us certain authorized medications. They're not the safest medicines, and they're certainly not always the best. But they're almost always the most expensive. What do physicians know that they're not telling us about?
It's true that many doctors are reluctant to prescribe unapproved medicines for fear of litigation. The Food and Drug Administration (FDA) certainly doesn't help. Around the time that the agency approved finasteride, it also issued a warning and a reminder that saw palmetto was an unapproved therapeutic substance. Coincidence or biased conflict of interest?
Maybe we can't blame our nation's rank-and-file doctors for not telling their patients about the obvious superior treatment. But the FDA surely can't shrink from its role in steering American men in the wrong direction.
How Saw Palmetto Can Help
There is strong evidence supporting saw palmetto as a treatment for BPH and other conditions. The clinical trials establishing its therapeutic ability have been done in Europe, mostly Germany, where the palm is a primary urologic option. What Europe recognizes and what American medicine fails to accept is that even the stingiest of studies has found that saw palmetto is as effective as finasteride in relieving BPH. It is better tolerated and less likely to cause side effects.
The little American acknowledgment of the palm's efficacy has come belatedly and reluctantly. Witness a major 1998 analysis of saw palmetto's worth in mainstream medicine's biggest mouthpiece, The Journal of the American Medical Association. Investigators from the Minneapolis Veterans Affairs (VA) Medical Center reviewed 18 studies involving a total of 2,929 men with BPH. Even though the studies under scrutiny were positive, the VA scientists felt compelled to preface their findings with the qualifier that current saw palmetto research "is limited in terms of the short duration of studies and variability in study design, use of phytotherapeutic preparations, and reports of outcomes." But they couldn't avoid the inevitable conclusion for too long.
"However," they continued, "the evidence suggests that S. repens improves urologic symptoms and flow measures." In other words, it allows men with BPH to be better and pee better. The bottom-line determination of this comprehensive analysis? "Compared with finasteride, S. repens produces similar improvement in urinary tract symptoms and urinary flow and was associated with fewer adverse treatment events."
If I may translate: The herbal medicine is better than the drug, because it works just as well yet threatens users with less risk of side effects.
Because of how they work, both saw palmetto and finasteride do carry a potential for adverse effects, specifically lowered libido, an inability to get an erection, a reduction in the amount of ejaculate, breast tenderness, and even breast growth (yes, in men as well as women). But there's a big difference between the potential for such adverse effects and their actual occurrence. Consequences of taking saw palmetto, the Minneapolis researchers noted, were "mild and infrequent." Among the study participants who took finasteride, 4.9 percent experienced erection difficulties; only 1.1 percent of the saw palmetto users suffered erectile problems.
A lot of other research is far more laudatory. Some studies, for instance, conclude that the average 320-milligrams per day dosage of the berry extract is three times stronger than the standard 5-milligrams per day dosage of finasteride. Other research found no significant statistical difference in how well either improved BPH symptoms. Finasteride resulted in a somewhat higher urinary flow compared with saw palmetto, but it also worsened sexual function.
This isn't the extent of the comparisons that can be made between saw palmetto and finasteride. Allow me to add two more:
* The phytochemical extract works faster and for more people. In sharp contrast to the man-made medicine, saw palmetto gets down to business in short order and works for a majority of the men who take it. In a strictly conducted German study, 88 percent of the men taking it and 88 percent of their physicians concluded that the berry extract was effective after just 90 days. Many of them noticed a considerable improvement in urinary symptoms after just a month and a half.
* On the other hand, you have to take Proscar for at least six months before noticing a significant benefit. What's more, you have less than a 50 percent chance that it'll work at all.
It's cheaper. Why shell out more money for something that doesn't work as well as its competition and poses more of a potential for harm? Prices vary from city to city around the country, but a year's worth of saw palmetto, according to one estimate, runs up to about $180. A year's worth of finasteride, in contrast, sets you back some $600--more than three times as much money. Hytrin, another pharmaceutical for BPH that works by a different mechanism, costs about $460 a year.
Surgery to relieve the urinary obstruction of an enlarged prostate can run you many thousands of dollars. Though the number of these operations has declined as finasteride sales have skyrocketed, the procedure is still one of the most common reasons men over the age of 65 go under the knife.
The operation, called transurethral resection of the prostate (TURP), often doesn't work. A study of 400,000 men who had a TURP found that they are more likely to require additional prostate surgery in five years than are men who stayed clear of the operating room. They're also more likely to die than men who had the more serious prostatectomy surgery. And some 6 percent of TURP patients end up impotent.
All in all, BPH management is a $3-billion-a-year business. How much of that, do you suppose, represents purchases of saw palmetto supplements? Are these guys getting their money's worth, or are they getting ripped off?
hair regrowth. Having apparently won my initial wager, I'm taking my gambler's luck from my prostate to my pate. I'll bet my hair that saw palmetto curbs the hair loss of male pattern baldness and promotes regrowth at least as well as mainstream medicine's favored pharmaceutical.
You see, a funny thing happened on the way to testing finasteride's impact on benign prostate enlargement: A lot of study participants noticed the return of lost hair--or at least a significant slowdown or halt in the rate of balding. Further research using much smaller amounts of finasteride (1 milligram a day, as opposed to 5 milligrams) confirmed the reports. Ultimately, pharmaceutical marketing put a different suit on an old chemical and presented a hot new drug, Propecia, backed with its own multimillion-dollar ad campaign.
The science behind the treatment apparently makes sense. Male pattern baldness, most specialists agree, stems from the activity of certain male hormones in the scalp, specifically the presence of that old bugaboo dihydrotestosterone. It's formed when the 5-alpha-reductase enzyme interacts with testosterone. If this mechanism is indeed responsible for baldness, then whatever inhibits the enzyme down below should work up top, too.
That brings us back to saw palmetto. We know that it inhibits 5-alpha-reductase at least as well as (perhaps better) and unquestionably more safely than finasteride, no matter what drug dosage you use (and no matter what pharmaceutical brand name you might give it).
I've collected a handful of anecdotal accounts that the berry extract does trigger renewed hair growth on your head. While in Los Angeles to promote my book, The Green Pharmacy, for instance, I met a radio announcer who told me that taking it had helped to restore hair he lost from a prescription hormone treatment. A few middle-aged gardeners at my herbal vineyard can also doff their caps and point to very fine hair regrowth that's characteristic of finasteride use but apparently is prompted by saw palmetto. They weren't on the drug. They were on saw palmetto.
Other uses. Over the ages, folk medicine practitioners have used saw palmetto for a diverse range of health complaints. None of these other treatments has been verified by science, although some make sense based on the fruit's phytochemical content.
The berries are said to support the entire male reproductive system, stimulating genital blood flow and improving the thyroid gland's regulation of sexual development. For women, the fruit supposedly alleviates ovarian and uterine irritations and cystitis. It purportedly triggers breast growth and lactation, too.
Regardless of gender, saw palmetto has been used for kidney problems, diarrhea, bronchitis, digestive difficulties, fluid retention, nasal congestion, and lack of appetite. Its berries also supposedly ease anxiety. In recent years, bodybuilders and weightlifters have been taking saw palmetto supplements, reasoning that the plant's ability to preserve testosterone will allow them to increase muscle mass.
HERB LORE AND MORE
Breast enlargement is just one of saw palmetto's traditional hormone- related applications. According to the 1898 edition of King's American Dispensatory, it's been used for ovarian enlargement associated with tenderness and pain, low libido, sterility, impotence, and dysmenorrhea, or menstrual cramps. Its berries are also said to ease uterine irritability, stimulate urination, and spark growth in "wasted organs," such as the ovaries and testes.
Today, we have a multimillion-dollar plastic surgery industry, but a century ago, all we had was saw palmetto. The palm was our best-known folk treatment to enlarge a woman's breasts. Naturopathic doctors still suggest it for this purpose.
Does it work? I'm not so certain that saw palmetto is the best plant for more mammary mass. Then again, who am I to argue with satisfied customers? A woman from North Carolina called me out of the blue one day to tell me that after reading my book, The Green Pharmacy, she started to take both saw palmetto and fenugreek to enlarge her breasts. Though she stopped taking the latter herb because she read that it worked hormonally (actually, both work via a hormonal mechanism), she continued to take saw palmetto. And her top measurement did indeed increase.
She is one of three women who have offered unsolicited testimonials to the bust-blooming power of the palm since The Green Pharmacy was published. I've also had three unsolicited offers from supplement manufacturers seeking endorsements for newly created mammary enhancers. And one account that I've read cites the patient experiences of three different practitioners who attest to the palm's breast-building ability.
For a so-called "mastogenic" herb, better scientific justification and more anecdotal evidence falls on the side of fenugreek, although it has a better reputation for encouraging milk secretion than for prompting the need for a larger bra. But in tests on lab animals, one of the plant's active ingredients, diosgenin, indeed stimulated breast growth.
Other lactation-inducing herbs from folklore include alfalfa, anise, basil, caraway, celery root and seed, chickpea, dill, fennel, Iceland moss, kudzu, lettuce, lemon balm, marjoram, nutsedge, okra, pea, purslane, sesame, sponge gourd, and verbena. I'm sure many of them will show up in new "bus-teas" as entrepreneurs capitalize on ostensible alternatives to silicone.
The only one I'd put money down on is fenugreek; of the others, all I can say is that some of them might help enhance fenugreek's flavor. I've read elsewhere that subcutaneous injections of reserpine, a compound in Indian snakeroot that lowers blood pressure, increases mammary gland secretions in rabbits.
If I had discovered the secret to natural breast enlargement and a stronger libido, I'd be hobnobbing in Hollywood, not meandering about in a suburban Maryland garden. I'm still meandering in that Maryland garden--and loving every minute--so take these possibilities for what they're worth.
How to Take It and How Much
It goes without saying that you want to take a standardized extract. That's what I do. Depending on the concentration in the brand you select, you'll need to take anywhere from 150 to 1,200 milligrams per day. A product that contains 90 percent fatty acids and sterols is a good strength. The higher the concentration of sterols, the lower the dosage.
Other forms of saw palmetto, in my opinion, are neither strong enough nor economically feasible. You might need to take between 1 and 2 grams thrice daily of the dried whole fruit, 0.6 to 1.5 milliliters of a liquid fruit extract, or 5 to 6 milliliters of a liquid whole-herb extract. Another option is to brew the dry powder into a tea. Be forewarned, though: As much as I treasure my own saw palmetto (a birthday present from daughter Cissie), the fruit tastes most unpleasant. It stinks, too. I trust the wisdom of the Seminole Indians implicitly, but I can't for the life of me figure out how they ate this stuff. Their palates and yours may differ from mine.
DR. DUKE'S RECIPES
Prostnut Butter
If speed, taste, fuss, and muss are of no concern, you might want to whip up a batch of my "Amazonian Prostnut Butter" cracker and sandwich spread, full of foods that also have prostate-protecting properties.
To make my spread, load the blender with about 10 medium-sized Brazil nuts, 50 to 100 pumpkin seeds, ½ cup of bean sprouts (I prefer black beans to soybeans), and a few sun-dried tomatoes or a little tomato paste. For the saw palmetto, I blend in a small handful of whole seeds, but you'll find it easier just to sprinkle in the contents of a capsule or two. Don't make a big batch, only enough for a few days. You want fresh phytomedicine.
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