Saw Palmetto

As a supplement, extract from the saw palmetto plant (Serenoa repens) has been promoted as a powerful prostate cancer preventative. Research has shown it also may help in the treatment of urinary tract infections. The question is, is it ready to make the jump to foods and beverage applications.

By Mark Anthony, Ph.D.

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We generally value dietary supplements or functional foods for their ability to increase energy or improve general health in a large population. Saw palmetto is different in that it's known primarily as a "one-trick pony." The question is; how well does it do that trick?

Saw palmetto (Serenoa repens or Sabal serrulata), are palm-like plants that can grow to heights of 10 feet. It's native to the warm climates of the southeastern United States, from South Carolina to Mississippi and throughout Florida. It has thorny stems, lush green leaves, and white flowers that produce yellow berries.

The berries, which turn bluish-black when ripe, were a staple food among native Americans who used them to treat digestive problems, urinary tract disorders and to boost libido. It is the extract from the berries that is used by millions of people today to treat Benign prostatic hyperplasia (BPH) -- an overgrowth of cells in the prostate.

There are other claims made for this ancient herbal remedy. Saw palmetto is sometimes suggested as a treatment for baldness, low libido, bladder disorders, prostatitis and migraines. Most available forms of saw palmetto are in supplement form -- powdered capsules, tablets, liquid tinctures and liposterolic extracts.

But there is no guarantee that all products contain the 85-95 percent fatty acids and sterols considered the industry standard. "Our labs found three of 13 saw palmetto supplements tested did not provide the claimed or expected amount of key components," notes Tod Cooperman, MD, president of the independent testing group ConsumerLab.com LLC. (www.consumerlab.com), White Plains, N.Y.

The dried berries are available and with more investigation could be considered for incorporation into food formulations. Saw palmetto tea is already marketed by a number of companies and so is more readily accessible for other beverage formulations. Some concerns, however, are possible adverse reactions to the product in a small number of people.

BPH may be due to changes in hormone levels that occur with age. It's not cancer, nor does it cause cancer. But an enlarged prostate that presses on the urethra (the tube that carries urine from the bladder) can interfere with urination. BPH is a common male health problem, increasing exponentially with age, affecting 8 percent of men at 40 years, and spiking to 60 percent of men in their 70s, and 90 percent of those over 80.

Though rarely a cause of death, BPH can wreak havoc with health-related quality of life. A quarter of affected men will develop moderate to severe lower urinary tract symptoms (LUTS), which can include bladder outlet obstruction, recurrent urinary tract infections, stones in the bladder, blood in the urine, and even end-stage kidney disease.

Evidence from several small clinical trials suggests that extracts from saw palmetto berries may improve symptoms beyond a mere placebo effect. The active ingredients involved may include fatty acids, sterols, flavonoids and high molecular-weight polysaccharides. These compounds are associated with either anti-inflammatory or immune-stimulant effects.

While it is not yet clear, the mode of action may be to inhibition of the 5-alpha reductase enzyme that converts testosterone to the more potent dihydrotestosterone (DHT) found in the prostate, and thus reduce its growth. Saw palmetto has no affect on PSA levels, and will not mask the detection of prostate cancer. It appears to be safe and may lead to mild or moderate improvement in symptoms.

A 2005 evaluation of the medical management of BPH, published in Mayo Clinic Proceedings, included an analysis of the clinical trials on saw palmetto. The authors concluded that the plant was safe and proved to be as effective as the standard drug (finasteride) in relieving symptoms when compared to placebo, in a large European trial.

Not all studies are in agreement with the effectiveness of saw palmetto in treating BPH symptoms. A placebo-controlled, year-long study published early last year in the New England Journal of Medicine found saw palmetto was no more effective than a dummy pill in relieving the signs and symptoms of BPH. These discrepancies in results mean that further testing is needed to confirm the effectiveness of this popular alternative medicine.

It will take more research into the long-term effects of this potentially promising plant before it can appear as a functional food. For now, it is a hopeful and apparently safe treatment for a specific set of symptoms in a gender-specific demographic. But with women's health concerns being more popularly addressed in wellness food and beverage development, perhaps a "men's health bar" with saw palmetto berries isn't far off.

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