Serenoa
repens
is a small shrub belonging to the palm family Arecaceae.
Commonly known
as the saw palmetto or American dwarf palm, it is found in low
pinewoods,
savannas, and thickets in the southeastern US, from South Carolina to
Florida,
and west to Mississippi. S. repens has above-ground
horizontal
stems, palmately compound green leaves that bear saw-like teeth on the
petiole,
white flowers that bloom in late spring, and black drupes that each
hold a
single seed (Foster & Duke 2000).
Native Americans once
regularly consumed S. repens fruit (Foster & Duke 2000)
and used it
to treat genitourinary disorders, mucous membrane inflammation,
testosterone
deficiency in males, or to increase breast size in females (Suzuki et al. 2009). Extracts were
also
traditionally used to relieve colds, coughs, asthma, migraines, and
chronic bronchitis
(Foster & Duke 2000).
Today, S. repens is
still
used
to remedy genitourinary disorders, to increase sperm
production or breast size, as an aphrodisiac, and as a mild diuretic
(Suzuki et
al. 2009). Specifically, extracts of S. repens’ fruits
are most often
administered to treat benign prostatic hyperplasia (BPH) and associated
lower
urinary tract symptoms (LUTS), which are conditions that are frequent
in aging
men (Suzuki et al. 2009, Ernst 2002, Lee et al. 2009). BPH
is enlargement of the prostate gland,
which can cause obstructions in the lower urinary tract, making it
difficult to
urinate (Tacklind
et al.
2009).
S.
repens
contains multiple chemical compounds that have been useful in BPH
therapy
management. For instance, the berry lipid extract (BLE) has shown
increasing promise in the inhibition of the enzyme 5-alpha-reductase
(Angwafor
2008), which blocks the conversion of testosterone to dihydrotesterone
and can
thereby reduce BPH (Wargo et al. 2010).
The
specific
active constituents within the berry lipid extract include
sterols
and free fatty acids (Gordon & Shanughnessy 2003).
A study comparing in
vitro and in vivo analysis of this therapeutic plant proved
that the
combination of S. repens, lycopene and selenium could be
effective in
BPH treatments as it increases the anti-inflammatory nature of S.
repens compounds
(Bonvissuto et al. 2011). Randomized clinical trials on male BPH
sufferers have proven that an herbal blend of the plant can be a safe
and
successful treatment for moderately symptomatic cases of BPH (Marks et al. 2000, Hong et
al. 2009). The combination of anti-androgenic,
anti-inflammatory, and
anti-edema effects has shown useful in therapy management (Suzuki et
al.
2009). S. repens has been examined as a form of
phytotherapy for
other prostate disorders, including prostate cancer, as it may be
useful in
inhibiting the production of new tumors (tumorigenesis) (Sosnowska &
Balslev
2009).
S.
repens extract
has also been proven to increase sexual function (Sinescu
et al. 2011), to reduce both intra- and postoperative
complications in
BPH surgeries, including transurethral resection of the prostate and
open
prostatectomy (Anceschi et al.
2010), and to
treat chronic pelvic pain syndrome (Morgia
et al.
2010).
Aside from their
application to disorders of the urogenital system, liposterolic extract
from the saw palmetto combined with two anti-inflammatory agents,
carnitine and
thiocitic acid, effectively controlled chronic inflammation of hair
follicles in cases of androgenetic aplopecia (AGA), or male pattern
balding. Beta-sitosterol was the specific S. repens compound
studied,
and
had demonstrated in in vitro simulations of human
keratinocytes
(Chittur
et
al. 2009).
The adverse events
associated with the use of S. repens are mild and similar to
those
expected with the placebo. The most frequently reported adverse
events
are abdominal pain, diarrhea, nausea, fatigue, headache, decreased
libido and
rhinitis (Agbabiaka et al. 2009). No drug interactions have been
reported with S.
repens, which makes it a suitable therapy candidate (Izzo &
Ernst 2009,
Gordon & Shanughnessy 2003). However, if used as a form of
self-medication, there is a risk of missing the early detection of
prostate
cancer (Murugusundram 2009).
Serenoa repens has been used as a safe treatment option for benign prostate hyperplasia and associated lower urinary tract sypmtoms, as well as androgenetic aplopecia. S. repens is tolerated by most users and is not associated with any serious side effects. As with all botanical therapies, a physician should be made aware of S. repens supplements and can determine a correct dosage for an individual patient.
Agbabiaka, T.B., M.H. Pittler, B. Wider, et al. 2009. Serenoa repens (saw palmetto): a systematic review of adverse events. Drug Saf. 32(8):637-47
Anceschi, R., M. Bisi, N. Ghidini, et al. 2010. Serenoa repens (Permixon) reduces intra- and postoperative complications of surgical treatments of benign prostatic hyperplasia. Minerva Urol Nefrol. 62(3):219-23.
Angawafor, F., & M.L. Anderson. 2008. An open label, dose response study to determine the effect of a dietary supplement on dihydrotestosterone testosterone, and estradiol levels in healthy males. J Int Soc Sports Nutrition 12:5:12.
Bonvissuto, G., L. Minutoli, G. Morgia, et al. 2011. Effect of Serenoa repens, lycopene, and selenium on proinflammatory phenotype activation: an in vitro and in vivo comparison study. Urology 77(1):248.e9-16.
Chittur, S., B. Parr, & G. Marcovici. 2009. Inhibition of inflammatory gene expression in keratinocytes using a composition containing carnitine, thioctic acid and saw palmetto extract. Evidence Based Complementary Alternative Medicine. Epub ahead of print.
Ernst, E. 2002. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John’s Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Internal Medicine 1:136(1):42-53.
Foster, S., & J.A. Duke. 2000. Eastern/Central Medicinal Plants and Herbs. Houghton Mifflin Co. New York. 411 pp.
Gordon, A.E., & A. F. Shanughnessy. 2003. Saw palmetto for prostate disorders. American Family Physician 15:67(6):1281-3.
Hong, H., C. Kim, & S. Maeng. 2009. Effects of pumpkin seed oil and saw palmetto oil in Korean men with symptomatic benign prostatic hyperplasia. Nutr Res Pract 3:323-327.
Izzo, A.A. & E. Ernst. 2009. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 13:1777-98.
Lee, J., G. Andriole, A. Avins, et al. 2009. Redesigning a large-scale clinical trial in response to negative external trial results: the CAMUS study of phytotherapy for benign prostatic hyperplasia. Clin Trials. 6(6):628-36.
Marks, L.S., A. W. Partin, J.I. Epstein, et al. 2000. Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol. 163(5):1451-6.
Morgia, G., G. Mucciardi, A. Gali, et al. 2010. Treatment of chronic prostatitis/chronic pelvic pain syndrome category IIIA with Serenoa repens plus selenium and lycopene (Profluss) versus S. repens alone: an Italian randomized multicenter-controlled study. Urol Int. 84(4):400-6.
Murugusundram, S. 2009. Serenoa repens: Does it have any role in the management of androgenetic alopecia? J Cutan Aesthet Surg. 2(1):31-2.
Sinescu, I., P. Geavlete, R. Multescu, et al. 2011. Long-term efficacy of Serenoa repens treatment in patients with mild and moderate symptomatic benign prostatic hyperplasia. Urol Int. 86(3):284-9.
Sosnowska, J., & H. Balslev. 2009. American palm ethnomedicine: a meta-analysis. J Ethnobiol Ethnomedicine 24:5;43
Suzuki, M., Y. Ito, T. Fujino, et al. 2009. Pharmacological effects of saw palmetto extract in the lower urinary tract. Acta Pharmacol Sin. 30(3):227-81.
Tacklind, J., R. MacDonald, I. Rutks, et al. 2009. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 15:(2):CD001423.
Wargo, K.A., E. Allman, F. Ibrahim. 2010. A possible case of saw palmetto-induced pancreatitis. South Med J. 103(7):683-5.
Yang, Y., T. Ikezoe, Z. Zheng, et al. 2007. Saw palmetto induces growth arrest and apoptosis of androgen-dependent prostate cancer LNCaP cells via inactiviation of STAT 3 and androgen receptor signaling. Int J Oncol. 31(3):593-600.
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