Saw Palmetto
for
Benign
Prostatic
Hyperplasia
(BPH)

By David Mendosa

Saw palmetto has long been used in Europe to treat an enlarged prostate or benign prostatic hyperplasia (BPH). American use lags far behind Europe in part because Americans are not aware of the extensive European research on the herb, some of which is presented here. The most cited journal article is an early (1984) "letter to the editors" by G. Champault et al. American physicians generally don't prescribe any drug other than Finasteride (Proscar®), Terazosin HCI (Hytrin®), or Doxazosin mesylate (Cardura®) for BPH. But unlike these drugs, particularly Proscar®, saw palmetto usually kicks in quickly. With the saw palmetto extract most men achieve some relief of symptoms within the first 30 days.

Saw palmetto is, according to industry sources that I trust, one species with several different names, including Serenoa repens, Serenoa serrulata, and sabal. The industry is attempted to standardize on the name Serenoa repens, which is the way most research identifies it.

Florida is the biggest producer of saw palmetto. Small patches can be found from the southeast coastline of South Carolina and southeastern Georgia to southern Mississippi. But it does not grow naturally in Texas, Mexico, or the Caribbean. It grows in every Florida county, but much of its production centers in South Florida.

The Associated Press reported on recent saw palmetto developments in Florida in an article extracted here.

In 1994 an important entrant joined this growing field. It's called the Saw Palmetto Berries Co-op of Florida, Inc. Headed by CEO Gregory P. Zaino, this company can harvest more than 3 millions pounds of berries annually. Based in Naples, Florida, Mr. Zaino can be reached at (239) 775-1243. The Naples Daily News had a two-page cover story in its August 25, 1996, issue about Mr. Zaino and his operation. You can read it here at http://www.mendosa.com/vachon.htm. The article was written by Staff Business Writer Michelle Vachon, who happens to be an old friend and associate of mine from when we worked together as editors of a magazine years ago.

The Saw Palmetto Harvesting Company in Frostproof, Florida, is a broker of saw palmetto. Gerald W. Gettel is a pharmacist and the company's president. Especially interesting is a comparison of "Saw palmetto extract vs. Proscar" at http://www.sawpalmetto.com/proscar.html. The company's home page is http://www.sawpalmetto.com/.

I use saw palmetto myself with impressive results. I have, unfortunately, no financial interest in saw palmetto and am a freelance journalist, rather than a medical doctor. Therefore, I cannot vouch for or evaluate the claims made by others.

There are still many questions about saw palmetto in my mind, even though I know from experience that it works for me. How can we determine which brands are reliable? Should we be concerned with manufacturing methods such as extraction using the so-called "toxic solvent hexane or preferably [the more expensive] supercritical carbon dioxide"? And what about freeze-drying? And are there synergies from taking a combination of saw palmetto and Pygeum africanum? Any answers or even leads to answers will be most appreciated and shared as appropriate.

As valuable as saw palmetto is you should not consider it alone for BPH. There is also some evidence suggesting that a low-fat diet, zinc supplements, and essential fatty acids (from sources such as flax oil) and another herb, Pygeum africanum, are useful for treating BPH. Some warn that men with BPH should avoid alcohol. You should also be sure to consult an M.D., especially for a prostate-specific antigen (PSA) test and a digital rectal examination (DRE) to rule out prostate cancer.

Note that there are many more Web sites than those listed here that offer you saw palmetto for sale. I list these sites in the order in which I discovered them. Only those sites that I think offer significant information are listed below.

The recent study by Dr. Johan Braeckman (see below) is the most comprehensive yet of saw palmetto.

A. Saw Palmetto and PSA Tests

A concern about self-medication with saw palmetto was raised by a urologist, Arnaldo F. Trabucco of the Catholic Medical Center of Brooklyn & Queens, New York, in several postings on mailing lists and Usenet newsgroups. He also has a Web site, the Trabucco Urology Institute in Rego Park, New York, at http://www.institute-md.com. Dr. Trabucco warns that men must get a baseline PSA level before taking saw palmetto, since it can decrease prostate cancer detection by interfering with PSA levels.

However, a recent study conducted by Leonard S. Marks, M.D., of the Urological Sciences Research Foundation in California, contradicts Dr. Trabucco's claim. Dr. Marks writes:

"We have conducted a randomized clinical trial, presented at the Annual Meeting of the American Urological Association last May, showing clearly that saw palmetto does not affect the serum PSA levels (either total, free, or % free). But you'd better check the other ingredients in the preparation you're taking. I can only speak for what we tested, which was saw palmetto, plus the other contents shown in the data slides mentioned below.

Dr. Marks added:

"Please feel free to use these comments any way you wish. We stand solidly behind the data shown on the PowerPoint presentation at http://www.usrf.org/auaslides/index.htm Incidentally, two very large studies done prior to ours (the Wilt meta-analysis reported in J.A.M.A. and the Carraro study published in Prostate) also showed no effect of saw palmetto on serum PSA levels. We are continuing to follow our patients, and an 18 month analysis is in progress at this time."

A report in the July 1994 issue of Current Therapeutic Research by Dr. Johan Braeckman of the Department of Urology, University of Brussels in Brussels, Belgium, was the first to determine that saw palmetto—unlike Finasteride (Proscar®)—will not give misleadingly low PSA levels. His study is called "The Extract of Serenoa Repens in the Treatment of Benign Prostatic Hyperplasia: A Multicenter Open Study." In 1992 and 1993 some 112 urologists enrolled 505 patients with BPH into a 90-day study, of whom 16 dropped out and an additional 184 did not fulfilled all inclusion criteria, leaving 305 patients for whom they could evaluate the efficacy of a standardized saw palmetto extract.

"Because administration of finasteride is accompanied by significant decreases in PSA levels (about 50% with a 5-mg dose), this treatment carries the risk of masking the development of prostate cancer during treatment," Dr. Braeckman writes on page 782. "Our study clearly demonstrated the absence of such a risk with the administration of Serenoa repens extract, as the agent does not modify the serum PSA concentration. The clinical implications of this conservative effect on PSA levels remains to be determined."

Here are other important findings from the study:

• Typically, they found that prostatic volume was significantly decreased during the study—averaging 9 percent after 45 days and 10 percent after 90 days.

• Patients subjectively said that saw palmetto helped—83 percent said it was effective after 45 days and 88 percent said it was effective after 90 days.

• Objectively, physicians agreed. After 45 days 81 percent of physicians said it was effective, and this percentage increased to 88 percent after 90 days.

• No serious side effects were reported. Only 25 patients reported a total of 32 side effects, half of which were limited to gastrointestinal symptoms. Side effects warranted premature discontinuation of saw palmetto in only 2 percent of the patients. (In an earlier study by Braeckman of 238 patients for one month he found that only 3 percent reported any side effects—all minor—compared with 4 percent of those receiving placebos.)

• The effects of saw palmetto begin to take place after 30 to 45 days. This is an advantage over most currently available drugs for which delays may be as high as six to 12 months, Dr. Braeckman writes in reference to finasteride.

  Other new studies of saw palmetto in peer reviewed journals include:

  • Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia (Cochrane Review). In: The Cochrane Library, Issue 2 2003. Oxford: Update Software. Reviewers' conclusions: "The evidence suggests that Serenoa repens provides mild to moderate improvement in urinary symptoms and flow measures. Serenoa repens produced similar improvement in urinary symptoms and flow compared to finasteride and is associated with fewer adverse treatment events. The long term effectiveness, safety and ability to prevent BPH complications are not known." Abstract online at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12137626&dopt=Abstract

  • Marks LS, Partin AW, Epstein JI, Tyler VE, Simon I, Macairan ML, Chan TL, Dorey FJ, Garris JB, Veltri RW, Santos PB, Stonebrook KA, deKernion JB. Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. In: The Journal of Urology, 2000 May;163(5):1451-6. CONCLUSIONS: Saw palmetto herbal blend appears to be a safe, highly desirable option for men with moderately symptomatic BPH. The secondary outcome measures of clinical effect in our study were only slightly better for saw palmetto herbal blend than placebo (not statistically significant). However, saw palmetto herbal blend therapy was associated with epithelial contraction, especially in the transition zone (p <0.01), indicating a possible mechanism of action underlying the clinical significance detected in other studies. Abstract online at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&lamp;ist_uids=10751856&dopt=Abstract

  German Commission E Monograph

  The American Botanical Council's long research summary on "Saw Palmetto berry" was adapted from The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. M. Blumenthal, W.R. Busse, A. Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister (eds.) S. Klein and R.S. Rister (trans.). 1998. Austin: American Botanical Council; Boston: Integrative Medicine Communications. The URL is http://www.herbalgram.org/iherb/expandedcommissione/he086.asp

  B. Sources of the Standardized Extract

  The standardized extract of saw palmetto is two capsules daily of 160 mg (or one capsule of 320 mg) containing 85-95% sterols and lipids. The non-standardized extract can be any amount of sterols and lipids—invariably a lot less. Basically the non-standardized extract is almost always the raw powder of saw palmetto. That's why there is usually a lot more of it than in the standardized extract—in order to try to make up for its weak concentration.

  In a nutshell the difference is this: with a standardized extract you know what you are getting, very much like you do with pharmaceutical drugs. With the non-standardized extract you don't. If you use a raw saw palmetto product instead of an extract, you will need to compensate for its reduced potency by taking larger dosages, but there is no easy way to figure out exactly how much of the raw product is equivalent to the extract.

  On the basis of my research to date I think that the best recommendation is to take one 320 mg daily of a standardized saw palmetto extract containing from 85% to 95% fatty acids and sterols. The only companies that I know of that claim to be selling this standardized extract are listed below.

  But how can you know if any of these companies are actually selling what they say they are selling? Short of paying for somewhat expensive laboratory analyses yourself, you really can't, experts say. The FDA doesn't regulate these companies, as long as they stop short of making health claims. I have two suggestions: First, use at least two different brands of saw palmetto and alternate them daily in case one is not up to par. Second, never buy from a company where the only address you have is a P.O. box. You must know their physical address, so you can track them down, if necessary. That's why I show the street address of each of the mail order companies listed below.

  What are the commercial sources of standardized saw palmetto extract in the United States?

  Here they are listed in ascending order of price per 320 mg. Where there is a choice of quantity for any one brand, the least expensive is used. Of course, prices change and some of these will certainly no longer be current, but it is a guide for where to start among so many suppliers:

  • 19.9¢/day. Prostate Rx Inc. in Naples, Florida, sells a 12-month supply of Prostate Rx 320mg softgel 1-a-day doseage for $5.99 per month. Two-month and six-month supplies are also available. Shipping and handling within the U.S. is free. Prostate Rx is standardized saw palmetto extract and is 92-98% sterols extracted by the preferred (safest) method, supercritical CO2. The company, one of the major saw palmetto growers, ships directly to the consumer. Order toll free 1-888-772-2741 or their Web page is http://www.prostaterx.net

  • 20.6¢/day. NuNaturals Inc., of 2220 W. 2nd Ave. #1, Eugene, Oregon 97402, is the new price leader for standardized saw palmetto extract—in a special offer to readers of this page. Visitors to this Web page can take advantage of "the NuNaturals David Mendosa Online Deal on NuNaturals Saw Palmetto." NuNaturals Saw Palmetto Extract is standardized for 85-90% fatty acids and is 160 mg per softgel capsule. The introductory offer is for a two-month supply for $12.35. The price is even less for bigger orders. Thanks to NuNaturals President Warren F. Sablosky for establishing this special and writing me about it. Thanks too to Tom Watson for originally bringing this brand to my attention. The URL is
    http://www.nunaturals.com/discount/rick_mendosa_deal.html

  • 22.1¢/day. Puritan's Pride in Oakdale, New York, currently has a "three for one" sale until September 21, 2001. Their "Extra Strength Prosta-Metto" consists of a standardized extract of 160 mg of saw palmetto containing 85-95% fatty acids and sterols plus pygeum africanum, bearberry extract, pumpkin oil extract, zinc, and Vitamin B-6. Product number 6053 has 240 capsules at $79.45. However, during the sale you get three bottles, i.e. 720 capsules, for that price. Thanks to Warren Morey for bringing this source to my attention. The toll-free phone is (800) 645-1030 and the Web page is http://www.puritan.com/scriptsp/start.exe/puritan/mainnew.html

  • 22.2¢/day: The Saw Palmetto Harvesting Company in Frostproof, Florida, one of the largest suppliers of saw palmetto, recently began to market standardized saw palmetto capsules directly to the consumer. ""We package only USP-NF grade raw materials and advertised them as such," writes company President Gerald W. Gettel. "Manufacturers advertising products as USP-NF grade can be have severe action brought about by the FDA, including being shut down, if their products are tested and then found not to be USP-NF grade." It offers 90 softgels of 320 mg of 85-95% pure extract for $19.99. The company's Internet store is http://www.store.yahoo.com/sawpalmetto/sawpalprod.html.

  • 24¢/day: Trader Joe's stores sell 100 capsules of 160 mg each containing 90% fatty acids and sterols—standardized saw palmetto—for $11.99. Thanks to Wayne Pennington for bringing this great source to my attention. Trader Joe's has stores all over California plus a few in Arizona, Oregon, Nevada, Washington state, and Masachusetts. I have the list of addressess, if you are interested. Trader Joe's does not sell by mail order. They have a Web page at http://www.traderjoes.com/

  • 24.9¢/day: Puritan's Pride Vitamins at 1233 Montauk Highway Oakdale, NY 11769-9001, sells several formulations that include saw palmetto in various strengths ranging from unstandardized to 80 mg., 160 mg. and 320 mg. Currently, their best value among standardized products is their product number 000293, 60 320 mg. softgels for $14.95. Jeff Haferman notes that "each month Puritan's Pride has 'Buy 1 get 1 free' or 'buy 2 get 3 free' offers that drop the per pill price substantially. I have bought from them for years, and they have always had this deal, although they always advertise it as 'this month's special'." Thanks also to Paul Serbu and Jim Kinard for bringing the new price to my attention. The toll free phone numbers for Puritan's Pride are (800) 645-9584 and (800) 645-1030. Their Web page is http://www.puritan.com/

  • 25¢/day: The AARP Pharmacy Service from Retired Persons Services Inc. in Roanoke, Virginia, sells 240 capsules (two bottles) of 80 mg each "standardized to not less than 85% free fatty acids" for $14.98. Thanks to Victor H. Auerbach, Ph.D. for bringing this great source to my attention. "They will ship any order of any size for $1." Dr. Auerbach notes. "Many seniors already use their services." They have a toll-free number, (800) 305-6992 and a Web page at http://www.rpspharmacy.com/

  • 25¢/day: The Vitamin Shoppe, 4700 Westside Avenue, North Bergen, New Jersey 07047, a chain of stores with a huge catalog operation, sells "Super Saw Palmetto Extract," at a very reasonable price. The catalog blurb states, "Each softgel contains: 160 mg Saw Palmetto Berries Extract, standardized to contain 85-95% fatty acids and biologically active sterol compounds in a base of olive oil." The company's phone number is (800) 223-1216. Their usual price for 160 mg softgels is $13.96 for 100, item number VS-2115, and $37.06 for 300, item number VS-2116. But Bruce Kallick, who brought this resource to my attention, says that when he ordered in December, "They gave me the price in their Fall/Winter catalog, which is discounted from their complete catalog—100 for $11.97, 300 for $31.77—but you have to know to ask for it, evidently."

  • 28¢/day: Fields of Nature, a division of American Vitamin Products Inc., 505 Halls Mill Road, Freehold, NJ 07228, sells a standardized extract of saw palmetto containing 85-95% free fatty acids and active sterols. The company's phone number is (908) 308-3000. Martin J. Weitzman found this product at a Costco warehouse store. The price was $12.97 for 90 softgels of 160 mg each.

  • 32¢/day: "Prost-Aid w/Saw Palmetto and Pygeum" is sold under the brand name Nature's Pride and manufactured by Nature's Products Inc., 2025 Davie Road, Suite 330, Davie, Florida 33317, phone (800) 789-0399—but the product is sold only through stores and not directly from the manufacturer. Ken Goodrich writes, "At a Columbus, Ohio, health food store, I am able to buy 120 softgels [of Prost-Aid w/WSaw Palmetto and Pygeum], each containing standardized saw palmetto extract (95% free fatty acids and sterols) 80 mg, pygeum africanum extract 10 mg, pumpkin seed oil extract 40 mg, and bearberry extract (Uva Ursi) 5 mg, for $9.80. This is the equivalent of 60 160 mg. softgels for $9.80, or 16.3 cents per 160 mg capsule." The manufacturer confirms that the saw palmetto is a standardard extract (although it is 200 mg, rather than the standard 160 mg) of 85-95% free fatty acids and esterols. The company has no Web site.

  • 33¢/day: "Paradise Herbs Saw Palmetto" is 85-95% fatty acids and sterols in a base of cold pressed borage seed oil for its synergistic activity and nutrient dense GLA content without isolating, fractionizing or using toxic solvents, harsh chemicals, or gases. The manufacturer, at http://www.paradiseherbs.com/sawpalm.html, does not sell the product directly. It is available in natural food stores. The best price that I have found is from iHerb.com, $20 for 60 320 mg vegetarian capsules. The URL is
    http://store.yahoo.com/iherb/sawpalmetto18.html.

  • 36¢/day: Home Health Products Inc. at 949 Seahawk Circle, Virginia Beach, Virginia 23452, sells a standardized extract of saw palmetto (together with 500 mg. of pumpkin seed oil, 15 mg. of zinc and 5 mg. of Vitamin B-6) in their catalog. Customer service tells me that the 80 mg of saw palmetto in their product is 85-95% fatty acids and sterols. Price is $17.95 for 90 softgel capsules or $16.45 for two or more bottles. Their order phone is (800) 284-9123.

  • 38¢/day: Healthsmart Vitamins at 1921 Miller Drive, Longmont, Colorado 80501, sells 100 soft gels, 160 mg of saw palmetto for $19.49 in their June 1997 catalog. The ad doesn't claim that this is a standardized saw palmetto extract, but I have purchased it before (when they had a special), and the label says that it is standardized to 85-95% fatty acids and sterols. The phone number for Healthsmart Vitamins is (800) 492-3003.

  • 42¢/day: NOW FOODS at 550 Mitchell Road, Glendale Heights, Illinois 60139, says it their print catalog that "our Saw Palmetto 2x is manufactured in Europe where it is standardized to contain biologically active fatty acids and sterols." The catalog says that their products, labeled "NOW," are sold only in health food stores, not direct. One Web vendor is Total Health Network Inc. at 170 Fulton Street, Farmingdale, New York 11735, Their URL is http://localweb.com/hre/totalhealth/ and their phone number is (800) 283-2833. Their Web page says the price for 60 capsules is $23.95, up from $14.95 in the recently printed NOW catalog. However, even more recently I've found the same product in a natural foods store, labeled as containing 85-90% fatty acids and sterols, for $13.15.

  • 44¢/day: Swanson Health Products, at 1318 39th Street NW, Fargo, North Dakota 58108 sells Swanson Ultra^TM, a standradized saw palmetto guaranteed to provide 85-95% fatty acids. It sells 100 softgels of 160 mg for $21.99, and its toll-free phone is (800) 437-4148.

  • 47¬¨¬®¬¨¬¢/day: NuNaturals Inc., of 2220 W. 2nd Ave. #1, Eugene, Oregon 97402, offers saw palmetto standardized for 85-90% fatty acids for $28.29 for 120 capsules. NuNaturals' toll-free phone is (800) 753-4372 and their Web page is http://www.nunaturals.com/. Thanks to Tom Watson for originally bringing this brand to my attention.

  • 48¢/day: Becker Pharmacy Inc., 27 Water Street, Red Creek, New York 13143, phone (315) 754-6351, sells Super Saw Palmetto, stock number 1836. Each capsule contains 160 mg of saw palmetto berry extract, standardized to contain 85-95% fatty acids and sterols. The cost for 120 capsules is $29.25. Thanks to Galley B. Critzer for bringing this source to my attention. Becker Pharmacy's URL is http://www.beckerpharm.com/

  • 50¢/day: Melaleuca Inc. offers ProstAvan. Each gel cap contains 320mg of standardized saw palmetto extract containing 85-95% fatty acids and sterols along with 80mg of pumpkin seed extract, 50mg of lycopene extract, and 15mg of zinc. The cost for 30 gel caps (1 month's supply at normal dosage) is $14.95 plus shipping ($2.80 + 4%) plus your state's sales tax. Thanks to Mike Clouser at 826 Easton Trail, Fort Wayne, IN 46825, for bringing this to my attention.

  • 50¢/day: Enzymatic Therapy Company at 825 Challenger Drive, Green Bay, Wisconsin 54311, sells a saw palmetto extract, but only through health food stores. It is standardized to contain 85-95% fatty acids and sterols. I found 120 capsules of 160 mg each at a local health food store in April 1996 for $29.45. Enzymatic Therapy has a Web page at http://www.enzy.com/

  • 51.6¢/day: "TruNature" brand Saw Palmetto Extract says that it is "standardized to 80-95% fatty acids and active sterols" and is 160 mg per capsule. It is currently on sale by Costco Online for $11.99 for 250 softgels plus $7.55 shipping and handling plus $45 for an annual membership for a total of $64.54. The URL is
    http://www.costco.com/frameset.asp?trg=product%2Easp&catid=589&subid=770&hierid=1008&prdid=31079&log=

  • 52¢/day: Netrition at 20 Emery Ave., Albany, New York 12205-4143, toll free 1-888-817-2411, sells 60 softgels of Nature's Herbs Saw Palmetto-Power 160 for $15.95. This product is standardized for 85-95% fatty acids and biologically active sterols. Netrition's Web page is http://www.netrition.com/

  • 52¢/day: Nutraceutical Corporation at 1104 Country Hills Drive No. 300, Ogden, Utah 84403-2400, sells a standardized saw palmetto extract of 85-95% liposterolic acid in health food stores. Its phone numbers are (801) 626-4900 and (800) 669-8877. The suggested retail price is $31.48 for 120 gelcaps (or $15.98 for 60).

  • 54¢/day: Bio-Nutritional Formulas Inc. at 106 E. Jericho Turnpike, Mineola, New York 11501, sells Prosanoa, a standardized extract of 85-95% fatty acids and sterols. Please note that although Bio-Nutritional Formulas and Nutrition Warehouse have the same address, they are separate companies. Bio-Nutritional Formulas sell to retailers, wholesalers, and direct. Their direct price for 60 capsules of 160 mg each is $19.95. For six or more bottles the price comes down to $16.00 per bottle. Their toll-free line is (800) 950-8484.

  • 56¢/day: Natural Organics Inc., 2500 Grand Avenue, Long Beach, California 90815, phone (800) 937-0500, sells saw palmetto in its Nature's Plus line as #7256. Although Natural Organics has a Web page at http://www.natplus.com/, it sells only to health food stores. Its saw palmetto exceeds the usual standards since it is 95% free fatty acids and is 200 mg per capsule. The per-capsule price given here is on a 160 mg basis. Thanks to Ed Balch for providing this information. He gets this product at Marietta Health Foods, (770)-973-4364 for $20.95 for 60 softgels of 200 mg per capsule.

  • 60¢/day: PhytoPharmica at 825 Challenger Drive, Green Bay, Wisconsin 54311, sells a standardized extract, but only to pharmacies and doctors. Thanks to Myron Walters for telling me about this product. A company officer tells me that PhytoPharmica is a subsidiary of Enzymatic Therapy Inc., and that the products of the two companies are identical, but sold to different markets. PhytoPharmica's Super Saw Palmetto 160 contains 85-95% fatty acids and sterols and is sold only through pharmacies and doctors. Myron Walters says that he has found 120 capsules selling for $35.95. The company tells me that it will soon have a Web page. Its phone number is (800) 553-2370.

  • 60¢/day: Herbal Resources Inc. at 720 N. Main Street, Hutchinson, Kansas 67504, is perhaps the most expensive mail order source of standardized saw palmetto extract. This firm also has one of the strangest Web pages filled with typographical and spelling errors. One feature is a page listing products by stock numbers only and a separate page listing the prices. The Web page lists a fax number but no voice number to call, nor does it list the street address, which I had to work to find. I also finally tracked down a voice number, (316) 663-6220, which is listed to one James E. Downey, who I understand is a chiropractor. My guess is that Herbal Resources is just a distributor or re-labeler for another company. The Herbal Resources Web page offers a "sm" and a "lg" container of "Super Saw Palmetto-160 No. 1836 standardized to contain 85-95% fatty acids and sterols" for $23.95 and $35.95 respectively—but fails to say how small is sm and how large is lg. A clerk tells me by phone that small is 60 capsules and large is 120. The one good thing I can say about this Web page is an article on "Understanding the Herbal Standardization Process." The URL for Herbal Resources Inc., if you are still interested, is http://www.herbsinfo.com/default.htm

  • 62¢/day: L&H Vitamins Inc. at 37-10 Crescent St., Long Island City, New York, sells 60 capsules of Bio Botanical saw palmetto standardized to contain 85-95% fatty acids and sterols for $18.36. The toll-free phone is (800) 221-1152 and the URL is http://www.lhvitamins.com/

  • 64¢/day: The Life Extension Foundation at 995 S.W. 24th Street, Ft. Lauderdale, Florida 33315, sells 60 capsules of the standardized extract for $19 at the non-member price. They sell mail order direct and their phone number is (800) 841-5433.

  • 66¢/day: Vitamin Research Products, Inc., at 3579 Highway 50 East, Carson City, Nevada, 89701, sells a standardized extract that is 85-95% fatty acids. According to their print product literature it is "extracted by a preferred, non-solvent process," the only company that I know of besides Prostate Rx (see above) and Solaray (below) that makes that claim for a standardized saw palmetto extract. Their price for 60 capsules is 19.95, and their toll-free phone number is (800) 877-2447.

  • 66¢/day: Kordial Products at 1701 W. Walnut Hill Lane, Irving, Texas 75038, phone (800) 527-9512 sells Saw Palmetto #K488, a standardized Serona repens extract that is 95% free fatty acids. The price for 60 capsules is $20.00 in the spring/summer 1997 catalog.

  • 68¢/day: Solaray Inc., at 1104 Country Hills Drive, Suite 412, Ogden, Utah 84403, makes what I think is a fine, albeit expensive product. It is 85-95% fatty acids and sterols, and they use non-toxic supercritical fluid extraction. They sell only through retail stores (many of them), but anyway their phone number is (800) 669-3009. Doug Crockett at extension 4957 is helpful. Thanks to Bob Ludlum for price information: He found 60 perlecaps of 160 mg at $26.48 and 120 perlecaps at $40.48 at a health food store in Panama City, Florida.

  • 88¢/day: In Canada, Natural Factors (Burnaby, B.C. V3N 4S9) sells a standardized extract containing 85-95% fatty acids and sterols as Herbal Factors. According to Kurt on the Prostatitis mailing list on August 24, 1996, "This product line is sold in many health food stores in Alberta, and the cheapest I've seen it sold for is $39.99 for 90 softgel capsules."

  • 88¢/day:USANA Nutritionals sells a standardized extract containing a minimum of 85% fatty acids plus lycopene and soy isoflavones as Palmetto Plus. According to the company's Web site at http://www.usana-nutritionals.com/products/USNUPRODUCT_21635.html the retail price of 30 soft gelcaps is $26.50. But according to correspondent Mike Beck, you can get it as a "preferred customer at $19.94, or 66 cents per day. Becoming a preferred customer costs nothing but must be done through an existing associate. Should your readers want the USANA alternative, they can call USANA directly and they will refer them to an associate or send an email to me at: Mike Beck."

  • 90¢/day: Nature's Herbs Saw Palmetto-Power 160 (30 softgels, 160 mg at $13.39 is "sporadically available" at General Nutrition Stores, according to Myron Walters. He says that it is a standardized extract, 85-95% fatty acids and biologically active sterols.

  • $1.22/day: Shaklee sends a standardized extract of "Saw Palmetto Plus" containing 85-95% fatty acids and sterols through its independent distributors. The retail price for 60 capsules of 160 mg each is $43.35, and the price to members is $36.85. Four Shaklee distributors brought this product to my attention: Elizabeth Van Pelt, phone (888) 308-3800, Kevin Mack, 4276 Winding Hollow Way, Memphis, TN 38125, phone (901) 753-2895 or (901) 753-3928, Harry Notowitz, phone 800-707-8482, and Jim Campbell. Mr. Campbell sent me a copy of an excellent two-page "Health Care Professionals Technical Bulletin" that Shaklee puts out about the use of saw palmetto in the management of BPH; he offers to send copies to all readers who request it from him. The Shaklee site is http://www.shaklee.net/watson/product/20607

  These prices were current the last time I checked, anywhere from February 1996 on. Please let me know if you find anything more about these or other sources.

  If you live in Canada, Eric Bierman kindly provided an update in July 1998:

  "Herbal Factors 60 softgels of 160mg each containing 95% fatty acids and sterols, from Natural Factors of Burnaby, BC (suburb of Vancouver), was $18.69 plus tax = $21.49 Canadian which comes to 72 cents Canadian per day or, at the current exchange rate, 48 cents US. This was purchased in Ottawa, ON at a natural food store, and the softgels are a satisfying black gummy elongated gel. The saw palmetto extract is 'in a base of pumpkin seed oil and certified organic flaxseed oil.'

  "Our Price Club/Costco does not carry the TruNature you describe, but instead a NaturVite, 120 capsules of 80mg each containing "not less than 80% of Free Fatty Acids", manufactured by Pharmetics (1997) Inc. of Laval, Quebec (suburb of Montreal). This cost $16.99 plus tax = $19.54, or 65 cents Canadian per day, or 44.3 cents US. It is a clear yellow small football shaped gel not unlike those 400mg artificial vitamin E gels."

  C. Commission E

  Germany's Commission E, a division of the German Federal Health Agency (Bundesgesundheitsamt), collects information on herbal medicines, evaluates their safety and efficacy, and publishes its results. These monographs "represent the most comprehensive, up-to-date herb information in the world," according to "The Latest Word on Herbs," a column by Mark Blumenthal, the executive director of the American Botanical Council in Austin, Texas, writing in the November 1995 issue of Vegetarian Times.

  "Ideally, their U.S. publication sometime this winter will have a significant impact on health professionals, who have had little access to authoritative scientific information on the responsible use of herbs and phytomedicines." His group, a non-profit research and educational organization, has since published 312 monographs on 190 herbs and combinations for $189.

  Blumenthal summarized the commission's monograph on saw palmetto:

  "Saw palmetto berries (Serenoa repens): The fruits of this North American native plant are approved for men's urinary complaints in the early stages of a benign enlarged prostate. The commission requires saw palmetto labels to note that "this medication relieves only the difficulties [pain and frequent urination] associated with an enlarged prostate without reducing the enlargement. Consult a physician at regular intervals. No contraindications."

  Subsequently, the American Botanical Council published the English-language translation of the Commission E monograph on saw palmetto and authorized me to reproduce it on my Web site. You can read the complete monograph, © Copyright 1995, American Botanical Council, by clicking here.

  D. Nutrition Action Healthletter

  The Center for Science in the Public Interest in Washington, D.C., regularly shakes up corporate America by blasting all sorts of sacred cows, like theater popcorn and the amount of fat in hamburgers. Headed by Michael Jacobson, the organization publishes a monthly Nutrition Action Healthletter, which reviewed the range of popular prostate supplements in the June 1996 issue. The article, "'P' is for Prostate," by David Schardt and Stephen Schmidt, concluded that "only one remedy—saw palmetto—seemed to work significantly better than a placebo." The other supplements that the article considered were Pygeum africanum, pumpkin seeds, zinc, glycine, glutamic acid, alanine, nettles, and animal prostate glands.

  The study's "bottom line" is that "saw palmetto is the only over-the-counter ingredient that appears to relieve—but not eliminate—the symptoms of an enlarge prostate...at least in some men." It also cautions that you should see a doctor to be sure that you don't have a more serious problem like a kidney infection or prostate cancer.

  The article reported that "Three good studies in France and Italy looked at a total of 280 men who were waking up to go to the bathroom an average of about four times a night. The 140 of them who took 320 mg of saw palmetto a day for one to three months averaged one less nightly trip to the bathroom than the 140 men who were given a placebo. The saw-palmetto takers also said that urinating wasn't as painful or difficult as before, and they were able to empty more of their bladders." The article, however, cited only one study, Urologia 55:547, 1988, and I have written Schardt and Schmidt to determine what three studies they are talking about.

  I also wondered why the Braeckman study detailed above was not considered. Schardt subsequently wrote me that it wasn't considered because it was an open trial. "We considered only double-blind studies," he wrote.

  A fourth "good study" in the British Journal of Urology 58:36, 1986, "of 33 men found no benefit from saw palmetto. Conflicting results aren't unusual with small studies."

  The article carefully points out that saw palmetto has not been tested for safety. It quotes a toxicity authority, Ryan Huxtable of the University of Arizona, as saying that it appears to be safe, "other than causing diarrhea in heavy users." When I spoke with Dr. Huxtable, he told me that the source for this statement was The Lawrence Review, citing David G. Spoerke, Jr. Herbal Medications, Santa Barbara, California: Woodbridge Press Publishing Company, 1980.

  Dr. Spoerke, who was then associate clinical professor of clinical pharmacy at the University of Utah College of Pharmacy and managing director of the Intermountain Regional Poison Control Center, writes in full about the toxicity of saw palmetto as follows: "Large amounts might cause diarrhea. There are no reports of serious toxicity."

  Even if saw palmetto is not toxic, the article continues, it points out that companies do not have to follow rigid manufacturing guidelines, "so you always run the risk that the bottle you buy is contaminated. [My note: all the more reason to buy from a source that has a good reputation.]

  Another good point the article makes is that "you're more likely to get the same amount of saw palmetto dose after dose if you buy a brand that's 'standardized.' Check the label. If you take 320 mg of saw palmetto that is 'standardized to be 85%-95% fatty acids,' you'll be getting the amount that was used in the good studies."

  E. Dr. Andrew Weil's Recommendations

  Dr. Andrew Weil, the famed author (Spontaneous Healing; 8 Weeks to Optimum Health; Natural Health, Natural Medicine; and more) and lecturer on integrative medicine, has several recommendations to prevent and treat prostate disease on his Web site in his July 21, 1997, column on "Prevention for Prostate Disease?" If you already have BPH, this is what he recommends:

  "I'd advise taking saw palmetto, an herbal remedy made from the partially dried berries of Serenoa repens, a small, scrubby palm native to the southeastern United States. Saw palmetto protects the prostate from the irritating effects of testosterone and promotes shrinkage of the gland. The best form is a standardized extract, taken as 160 milligrams twice a day. It is nontoxic. Another herb, Pygeum africanum, also is beneficial to the prostate and may be added to saw palmetto formulas."

  F. Consumer Reports and Tyler

  The magazine Consumer Reports, published by the non-profit organization Consumers Union, keeps getting more supportive of saw palmetto all the time. Its September 2000 issue reports that the United States Pharmacopeia and its National Formulary reinstated saw palmetto as a medicine for prostate problems this year for the first time since 1950, when they dropped it for half a century. The article also notes that "saw palmetto doesn't interfere with the standard prostate specific antigen (PSA) cancer-screening test."

  The magazine also tested 13 brands and found that only eight of them had the right amount of the right stuff. The acceptable brands are CVS Premium Quality Herbs Saw Palmetto, GNC Herbal Plus Standardized Saw Palmetto, Solaray Saw Palmetto Berry Extract 160 mg., One-A-Day Prostate Health with Natural Saw Palmetto and Zinc, Nature's Herbs Power Herbs Saw Palmetto Power 160 Std. Extract, Quantera Prostate Saw Palmetto, Your Life Saw Palmetto Standardized Herbal Extract, and Shaklee Saw Palmetto Plus.

  The magazine had an article about herbs in its November 1995 issue "Herbal Roulette." Considering how negatively Consumer Reports has written on anything other than standard Western medicine, that article—to say nothing of the current article—is surprising. While trashing many herbal remedies, the magazine actually has some good words about saw palmetto and a few other herbs. It recommends, for one thing, that you buy herbs that at least claim to be "standardized."

  Among many cautions, the magazine lists—but does not recommend—10 herbs "for which there is reasonably strong evidence of beneficial physiological effects, and which appear to merit further study." Among these is saw palmetto. This is what the magazine writes:

  "Saw palmetto. Used for enlarged prostate. Was prescribed for a variety of urogenital ailments until 1950. Several studies suggest the extract can improve urinary flow in men with benign prostate enlargement. Also shows anti-inflammatory effects. Slows conversion of testosterone into a more active form that enlarges the gland."

  The magazine also recommends two books by Varro Tyler, "an expert in the medicinal use of plants." Pharmaceutical Products Press (Haworth) publishes both books:

  The Honest Herbal--A Sensible Guide to the Use of Herbs and Related Remedies (third edition, 1993) is organized by herb.

  Herbs of Choice--The Therapeutic Use of Phytomedicinals (1994) is organized by disease.

  Tyler, a professor of pharmacognosy at Purdue University's School of Pharmacy and Pharmacal Sciences, wrote in The Honest Herbal about saw palmetto. Here are the most important paragraphs:

  "...During the 1960s, investigators found relatively high concentrations of free and bound sitosterols in the dried berries. Various plant extracts as well as pure -sitosterol, which was also isolated, exhibited estrogenic activity when injected into immature female mice. Although the activity was found to be relatively high compared to other estrogens isolated from plants, it was rather low in comparison to the female sex hormones themselves. A saw palmetto extract was only about 1/10,000 as potent as estradiol, and even pure -sitosterol was less than 1/10 as strong.

  "More recent studies have concluded that saw palmetto exerts at least some of its effect not through its estrogenic properties per se but because it has an antiandrogenic (anti male sex hormone) action. The compounds responsible for this property have not been identified, but they occur in the fraction obtained from the berries by extraction with nonpolar solvents, such as hexane. (That is, they are fat-soluble, not water-soluble, constituents)."

  More recently, in his 1994 book Herbs of Choice, Tyler wrote more about saw palmetto:

  "To be most effective in the treatment of BPH, a drug must act to reduce the effects of androgens...European scientists [studied] saw palmetto and recognized that in patients suffering from BPH, an extract of the fruits produced increased urinary flow, reduced residual urine, increased ease in commencing micturition, and decreased frequency of urination.

  "The mechanism of action is antiandrogenic, at least in part. Studies have show that a liposterolic extract of the berries reduced the uptake by tissue specimens of both testosterone and DHT by more than 40 percent....In addition to their antiandrogenic properties, anti-inflammatory or antidematous activity has also be demonstrated in the berries....

  "Together, the antiandrogenic and anti-inflammatory effects seem to account for the beneficial role of the herb in treating BPH. Placebo-controlled, double-blind clinical studies carried out on more than 2,000 BPH patients in Germany confirmed the effectiveness of a saw palmetto extract in such conditions (citing Breu, W., Stadler, F., Hagenlocher, M., and Wagner, H. Zeitschrift für Phytotherapie, Vol. 13, 1992, pp. 107-115)."

  An earlier Consumer Reports article, "Berries for the prostate?" March 1994, was less positive. The magazine wrote, in part:

  "A commercial extract of saw palmetto berries, called Permixon, is manufactured by a French company. It is available in Europe, where it has been used in some research, but is not sold in the U.S.

  "We did a computer search of Serenoa repens in the medical literature and found that only a handful of studies have been done over the past decade - almost all published in European journals. We could find abstracts of only two that had measured the effects of saw palmetto extract on symptoms in men with an enlarged prostate. One study found that saw palmetto extract relieved some symptoms, but it is not clear whether the study was well controlled; the other study, which was double-blind, found Permixon no more effective than a placebo."

  "Without better evidence, CU's medical consultants cannot recommend saw palmetto extract for a prostate problem."

  G. Michael Murray

  Michael T. Murray, N.D., has good information about BPH in his booklet The Saw Palmetto Story, (Healing Wisdom Publications, 2067 Broadway, 7th Floor, New York, New York 10023, 1990, 14 pages, cost $2.95, although Consumer Vitamin Values at (800) 777-2200 sent me a copy free in June 1996 along with one of their catalogs, and Bio-Nutritional Formulas at (800) 950-8484 also offers a free copy) and in his book Male Sexual Vitality (Prima Publishing, P.O. Box 1260BK, Rocklin, CA 95677, 1994, phone (916) 786-0426, 150 pages, cost U.S. $8.95/Canada $11.95).

  Murray's advice about dosage in his booklet is well worth repeating: "The recommended dosage for a liposterolic extract of saw palmetto berries containing 85-95% fatty acids and sterols is 320 mg. per day (160 milligrams twice daily is best). A similar dose using the crude berries would require at least 10 to 20 grams twice daily. Proper dosages for fluid extracts and tinctures would involve the consumption of extremely large quantities of alcohol; therefore, they cannot be recommended."

  This is the most important part of what he has to say about saw palmetto in his book:

  "Saw palmetto (Serenoa repens) is a small scrubby palm tree native to the West Indies and the Atlantic Coast of North America, from South Carolina to Florida. It bears berries that have a long folk history as an aphrodisiac and sexual rejuvenator. These berries have also been used for centuries in treating conditions of the prostate. This historical use led to the development of a purified fat-soluble extract that contains from 85% to 95% fatty acids and sterols. Over a dozen double-blind clinical studies have shown that this extract greatly improves symptoms of enlarged prostate.

  "Like Proscar, the therapeutic effect of the saw palmetto extract appears to be due to its inhibition of dihydrotestosterone, the compound that causes the prostate cells to multiply excessively. However, saw palmetto extract goes well beyond Proscar. The extract not only inhibits the formation of dihydrotestosterone, it also inhibits dihydrotestosterone from binding at cellular binding sites. Since Proscar has no effect on binding, saw palmetto has a much greater effect than Proscar--as clinical results prove.

  "Numerous studies show that saw palmetto extract is effective in nearly 90% of patients, usually in a period of four to six weeks. In contrast, Proscar is effective in reducing the symptoms in less than 50% of patients who took it for one year....

  "Clearly, saw palmetto extract is superior to Proscar. It is also significantly less expensive--it is at least one-fourth the price. The standard dosage of the fat-soluble saw acids and sterols is 160 milligrams, twice daily. For best results, make sure you are using the right extract at the right dosage. Detailed toxicology studies of the extract have been carried out on mice, rats, and dogs. None indicates that the extract has toxic effects. No significant side effects have ever been reported in the clinical trials of the extract or after saw palmetto berry ingestion."

  H. Permixon Package Insert

  Life Extension magazine, effectively the catalog for the Life Extension Foundation, which sells herbs including saw palmetto, provided an interesting service in its April 1997 issue by translating and publishing the package inserts for equivalent preparations sold as regulated drugs in Europe. One of the package inserts is for Permixon, the French "lipidic-sterolic extract from Serenoa Repens" or saw palmetto.

  The description and indications sections add little to our understanding. But the side effects and dosage sections are worth reprinting here, even though the translation is often awkward:

  Side Effects: In the short- and long-term pharmacological and clinical studies, Permixon has been shown to be very well tolerated. Occasionally, nausea may show up, especially in cases where the product is taken on an empty stomach.

  Dosage: In general terms - 160 mg oral capsules = one capsule twice a day (morning and evening) in light or moderate cases. - 320 mg oral capsules = one capsule twice a day (morning and evening) in more serious symptomotalogical situations. - 640 mg rectal capsule = one rectal capsule once a day (in new acute phases with a marked inflammatory component).

  Except for another medical prescription, treatment with oral capsules would be earned out in cycles not less than 30 days, possibly to be repeated. The duration of administration of rectal capsules is according to the development of the clinical picture.

  I. Saw Palmetto in the Press

  • There's an excellent new book about saw palmetto. By Ray Sahelian, M.D., Saw Palmetto: Nature's Prostate Healer (New York: Kensington Publishing Company, March 1998, $5.99). is a 150-page paperback book that reviews the professional literature and presents it in an easy to understand format. It also reviews alternate treatments, including herbs and nutrients like Pygeum africanum, stinging nettle, Epilobium, green tea, beta-sitosterol, South African star grass, pumpkin seed, zinc, plant estrogens, flavonoids, and cartenoids, and melatonin. Dr. Sahelian also reviews the pros and cons of the prescription medications Proscar and the alpha-blockers (including the new Flomax) and surgery. More information is available at http://www.raysahelian.com/saw.html.

  • Urology Times, the leading newsmagazine for urologists, features in its June 1999 issue the recent finding that taking saw palmetto shrinks the prostate. The article is on-line here at Saw Palmetto Shown to Shrink Prostatic Epithelium.

  J. Literature Search: Saw Palmetto for Benign Prostatic Hyperplasia (BPH)

  • The results of a Medline search. Medline, the most popular online medical search tool, is the online version of Index Medicus, an index to medical, pharmaceutical, dental, optometric and dental journals. It is compiled by the National Library of Medicine (NLM).

  • Additional journal articles from a Excerpta Medica search.

  • Reports from International Pharmaceutical Abstracts.

  • Articles from popular magazines.

  • Sources in Michael Murray's book.

  • Finally, Patty Hatch kindly searched several databases, including AGRICOLA, BasicBIOSIS, and BioDigest, and came up with three other articles about saw palmetto detailed here.

  K. Online Talk: Saw Palmetto for Benign Prostatic Hyperplasia (BPH)

  A summary of some interesting messages dealing with saw palmetto found online.

  L. Online Information about Saw Palmetto

  1. Mailing Lists:

  All messages to subscribe or signoff (unsubscribe) to mailing lists must be sent to the listserv address, not the addresses used to send mail to other members. Do not use a subject line or a signature. The form of the body of the message is different for each list and must be precisely as shown below.

  a. Prostate is an unmoderated discussion list for questions and information relating to the variety of problems common to the prostate gland—prostatitis, (benign prostatic hyperplasia (BPH) and prostate cancer. Ocassional messages deal with saw palmetto as a treatment for BPH.

  To join the Prostate list send email to LISTSERV@LISTSERV.ACOR.ORG with the message in the body of the email: subscribe prostate Firstname Lastname

  Using your real name is mandatory.

  To get off this list send email to LISTSERV@LISTSERV.ACOR.ORG with the message: unsubscribe prostate

  Do not give your name. The listserver will pick it up from the automatic header information.

  Contributions sent to this list are automatically archived. You can get a list of the available archive files by sending an "index prostate" command to LISTSERV@LISTSERV.ACOR.ORG.

  b. The Prostatitis mailing list allows you to receive and post to the sci.med.prostate.prostatitis newsgroup via email (see below). This means that public postings and replies to one group also appear on the other. To join Prostatitis send email to listserv@sjuvm.stjohns.edu with the message in the body of the email: subscribe prostatitis Firstname Lastname

  2. Usenet newsgroups:

  a. sci.med.prostate.prostatitis sometimes has messages about saw palmetto.

  b. sci.med.prostate.bph is a new Usenet newsgroup dealing specifically with benign prostatic hyperplasia.

  3. World Wide Web, FTP, and gopher:

  a. Non-Profit Sites:

  (2) The non-profit—albeit controversial—Life Extension Foundation in Hollywood, Florida, http://www.lef.org/ has an excellent article "Saw Palmetto Reborn " reprinted from the February 1999, issue of Life Extension Magazine at
  http://www.lef.org/magazine/mag99/feb99-prostate.html

  (3) For those who suffer from prostatitis, there is much useful information on The Prostatitis Foundation home page at
  http://www.prostate.org/

  b: Commercial Sites:

  Companies are beginning to use the World Wide Web to advertise their products and services. I have tested none of these products and cannot of course recommend any of them. Commercial businesses promoting saw palmetto include:

  (1) Dr. Weed's "Better Way—Herb & Nutrition Page" http://www.a-better-way.com/ has some information on BPH and saw palmetto at:
  http://www.webcom.com/drweed/prostate.html

  (2) WholeHealthMed.com http://www.wholehealthmd.com/about/biofull/1,1302,20,00.html is the medical practice in Arlington, Massachusetts, of Glenn Rothfeld, M.D. He regularly posts articles about aspects of his practice. His section about saw palmetto is at
  http://www.wholehealthmd.com/refshelf/substances_view/1,1525,819,00.html

  M. The Plant Itself

  Click here for a great photograph ©1995 Jim Bickerstaff

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