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Serenoa: Eclectic materia medica for Saw Palmetto

by Paul Bergner

Medical Herbalism 10-31-97 9(3): 1, 16-17

We continue our series of reprints from the Eclectic Medical Journal materia medica articles by Dr. William. E. Bloyer, turn-of-the-century professor at the Eclectic Medical Institute in Cincinnati. Saw palmetto berry and its extracts are famous today because of their possible effectiveness in cases of benign prostatic hypertrophy. The fame has not come without its cost — under the relentless pressures of science and marketing, the broader uses of the plant have now been all but forgotten. Bloyer relates them in detail.

Saw Palmetto

This is the Sabal serrulata or the Serenoa serrulata of Benthan and Hooker. Recently it has received much attention, especially from Eclectic physicians. Prof. Goss of Georgia has been pronounced in heralding its virtues. For some time it has been used as a general tonic. It aids digestion, promotes assimilation and nutrition, and consequently a rapid gain in strength follows it use. Sedative and diuretic properties have also been ascribed to it. It is said, too, to act as a special tonic, sedative, and expectorant to the mucous membrane of the respiratory apparatus. Besides these, it exerts a special vitalizing action upon the reproductive organs of both the male and female. It increases the functional activity of the whole reproductive system. As far as our own observations go, we are not prepared to say whether these effects are due to its general tonic effects, or whether it has a special or specific action upon these parts or organs. We are positive that it is an active remedy, and we believe that the future will single out for us the exact cases in which it will prove beneficial. Like other remedies, it will not cure everybody. The specific medicine contains an abundance of oil, and perhaps the activity of the remedy depends on this. It is said that animals which eat the saw palmetto berries fatten rapidly.

From the fact of its being a general tonic, saw palmetto may be hopefully prescribed in any depraved condition. Its special tonic and expectorant action on the respiratory mucous membrane makes it a valuable remedy in phthisis, in tuberculous laryngitis, in acute and chronic laryngitis, in bronchitis, in asthma, in whooping cough, and in cough generally when due to irritation of the respiratory mucous membrane. It is also highly recommended as a special remedy in catarrh, both acute and chronic. Two or three doses are said to have aborted severe attacks of acute nasal catarrh. In these cases an inhalation of the vapor of saw palmetto is beneficial and not unpleasant.

The saw palmetto, on account of its tonic effects, together with it special diuretic action, becomes an efficient remedy in many urinary troubles. In this respect it is said to be the friend of the old man — the most positive remedy we possess for the relief of some of the difficulties that beset the declining years of about four-fifths of our old men. We are not sure why it is so valuable in these cases. Many of these are attributed to an enlarged prostate, and when improvement follows the administration of saw palmetto, it is said to have reduced the size of the prostate gland. Of such action we are not positive. An enlarged prostate, together with the lessened muscular force due to age or debility, prevents a complete emptying of the bladder. The residual urine becomes stale, decomposed, and vesical irritation follows, and with it a number of distressing symptoms. Now, we believe that the tonic effect of the saw palmetto increases the powers of contraction of the muscular fibers of the bladder, so that there is less sagging down behind the prostate. The bladder is consequently more completely emptied, and through this and the tonic action of the drug, vesical irritation and tenesmus are relieved. In short, it is through its general tonic effect, rather than through a specific action in reducing the size of the prostate that it becomes “the most positive remedy we possess” in these old men’s troubles, Professor Webster says.
 
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    Medical Herbalism: Materia Medica and Pharmacy    

The special vitalizing action of saw palmetto affects the reproductive organs generally. The mammae, under its continued use, increase in size; the atrophied uterus and its inactive appendages are awakened; and by it the cold female is aroused from her sexual lassitude. In the male, the action of saw palmetto is just as prompt and efficient. The cold, atrophied testes and penile organ, even when in part due to masturbation or varicocele, are given new life and a more generous supply of blood through the influence of saw palmetto. Waning sexual power is restored; impotence is dethroned, and man is made new.

Looking at all of these things as we do we can not explain why saw palmetto should increase the size of the mammae, the testes, the reproductive organs generally, and reduce the size of the prostate. We do not believe that it does. But we are open to conviction. We hope that Eclectics will so study saw palmetto that we will soon know exactly what it will do. The dose of specific saw palmetto is from ten drops to one or two drachms, taken when in water every three or four hours.

Commentary

Bloyer’s assertions about saw palmetto being an effective treatment for the symptoms of prostatic hyperplasia have been verified by modern science, but science has not yet definitively answered his questions about the mechanism of action, or the paradoxical effect he describes of enlarging mammary and testicular tissues while shrinking an enlarged prostate. These effects are not noted in the modern literature. The effectiveness of lipid extracts of saw palmetto berries as a treatment for the symptoms of benign prostatic hyperplasia has been demonstrated in a number of modem clinical trials (Plosker and Brogden, 1996). Possible mechanisms of action include (Bombardelli and Morazzoni):

- Inhibition of 5 alpha-reductase, thus reducing the level of dihydrotestosterone (DHT) in the blood. DHT, which promotes growth of the prostate is formed from testosterone by the action of 5-alpha reductase.

- Interference with the binding of DHT to receptors in the prostate.

- Inhibition of estrogenic activity in the prostate

- Anti-inflammatory effects in the prostate leading to a reduction of edema.
 
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    Medical Herbalism: Materia Medica and Pharmacy

Despite the assertions of herbal product marketing promotions, the exact mechanism of action has not been proven (Paubert-Braqet, et al; Bombardelli and Morazzoni), and the superiority of lipid extracts over alcoholic ones has not been demonstrated (Bombardelli and Morazzoni). Five-alpha reductase inhibition is the mechanism of the common pharmaceutical drag finesteride (Proscar) commonly used to treat BPH allopathically. Although saw palmetto extracts inhibit 5-alpha-reductase in animal and petri dish studies, they do not appear to have a clinically significant effect in humans. Effective inhibition of 5 alpha-reductase should lead to decreased serum DHT. Finesteride does cause such a decrease in humans, but standard doses of saw palmetto products do not (Strauch et al, 1994). The extracts may, however, inhibit binding of already circulating DHT to androgen receptors in the prostate (Plosker and Brogden, 1996). If this inhibition of binding is specific to receptors in the prostate, it could answer Bloyer’s question about the specific action of saw palmetto on that organ.

Infiltration of the prostate by inflammatory cells is one of the factors involved in the development of prostatic hypertrophy. These inflammatory cell types produce chemicals that contribute to the development of the disease. A number of trials have shown that saw palmetto extracts have anti-inflammatory properties, and such anti-inflammation may account for some of the shrinking of the prostate (Paubert-Braquet, et al). This could also explain Bloyer’s paradox if the anti-inflammatory and edema-reducing tendency of the extracts is stronger than any supposed tendency to promote growth of tissues, as Bloyer noted in the testes and breast.

There is no support for the assertion of the herb marketers that liposterolic extracts are any better than a standard tincture, one of the forms used by the eclectics in Bloyer’s day, as no head-to-head trials of such forms have been performed. Several trials of ethanolic extracts in Europe have shown effectiveness for symptoms of BPH (Romics et al; Bach and Ebeling).

References

Bach D, and Ebeling L. Phytomedicine (1996) 3:105

Bloyer, WE. “Saw palmetto.” Eclectic Medical Journal 1896;56(12):581-582

Bombardelli E, and Marazzoni, P. Serenoa repens (Bartram). Firoterapia (1997) volume 58(2):99-113

Paubert-Braquet M, Mencia Huerta JM, Cousse H, Braquet P. Effect of the lipidic lipidosterolic extract of Serenoa repens (Permixon) on the ionophore A23187-stimulated production of I eukotriene B4 (LTB4) from human polymorphonuclear neutrophils. Prostaglandins Leukot Essent Fatty Acids 1997 Sep;57(3):299-304

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

Romics I, Schmitz H, Frang D Experience in treating benign prostatic hypertrophy with Sabal serrulata for one year. Int Urol Nephrol 1993;25(6):565-569

Strauch G, Perles P, Vergult G, Gabriel M, Gibelin B, Cummings S, Malbecq W,Malice MP. Comparison of finasteride (Proscar) and Serenoa repens (Permixon) in the inhibition of 5-alpha reductase in healthy male volunteers. Eur Urol 1994;26(3):247-252
 
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