Saw Palmetto Uses and Plant Monograph
What is the first association that comes to mind when you think of saw palmetto… the prostate gland? If so, you’re correct! It’s widely known for the treatment and prevention of benign prostatic hypertrophy (BPH).
Saw palmetto also strengthens and soothes the genitourinary organs, promotes fertility, repletes the body after childbirth and prolonged illness, and enhances lactation. It may not have the most appetizing aroma or flavor, but it’s a deeply nourishing fruit that is rich in fatty acids and sterols (plant-derived, cholesterol-like compounds), as well as flavonoids, carotenoids, and trace minerals. This monograph delves into the versatile uses of saw palmetto.
Reproductive Tonic
Saw palmetto strengthens the reproductive organs and bladder, improving the overall tone and function of the genitourinary organs.1 It is a reproductive tonic that aids in treating uterine hypertrophy and dysmenorrhea resulting from poor tissue and muscle tone.2,3It is an adjunct for treating pain and inflammation of the ovaries.4 Saw palmetto reduces congestion in the pelvic region and can relieve dull, achy sensations associated with congestion in the uterus and ovaries.
Saw Palmetto Uses & Plant Profile Summary:
- Botanical Name: Serenoa repens (syn. S. serrulata, Sabal serrulata)
- Other Common Names: saw palmetto, palmetto, palmetto berry, sabal palm, sabal, American dwarf palm tree, cabbage palm, old man’s friend, palmier de l’Amérique du Nord (French), bolitas (Spanish)
- Family: Aceraceae (Palmae)
- Parts Used: the fruits (drupes)
- Energetics: warm, moistening (unctuous)
- Taste: umami, salty, mildly bitter and sweet
- Plant Properties: soothing diuretic, urinary antiseptic, anti-inflammatory, anabolic tonic, antiandrogenic, aperient, potential aphrodisiac, expectorant, galactagogue, nutritive, restorative, and uterine tonic
- Plant Uses: upset stomach, stagnant digestion, fever, colds and flu, uplifting mood, respiratory infection, bug bites, insect repellant
- Plant Preparations: standardized extract, capsules
Strengthens the Bladder
Saw palmetto enhances bladder tone and aids in treating urinary incontinence and decreasing urinary dribbling and leakage.5,6It is a soothing diuretic that reduces inflammation in the mucous membranes lining the urinary tract. In addition to Kegels and other bladder tonics, saw palmetto aids in treating stress incontinence or a cystocele (bladder hernia) resulting from injuries related to childbirth. The tea, capsules, or extracts of mullein root (Verbascum) and corn silk (Zea) can also be consumed as a long-term tonic for individuals with urinary incontinence, recurring bladder infections, interstitial cystitis, and benign prostatic hypertrophy.7
Soothes the Bladder and Urinary Tract
Saw palmetto is a valuable adjunct for treating cystitis or urethritis, as well as long-term interstitial cystitis.8,9,10It decreases dysuria, is a mild urinary disinfectant, and strengthens tissues. These actions are especially helpful for people assigned female at birth with difficulty resolving a urinary tract infection, in spite of repeated use of antibiotics.11
Replenishing Tonic
Saw palmetto is a nourishing anabolic tonic — a substance that encourages tissue building. It contains numerous lipids, vitamins, and minerals that are essential building blocks of healthy cells and tissues.12,13Additionally, it enhances digestion and assimilation, improving nutrient metabolism and utilization.14,15Saw palmetto aids in replenishing people depleted from childbearing and nursing, those who are malnourished, thin-bodied, or catabolic. It is an adjunct treatment for people with a prolapsed uterus or bladder following a birth, and is also a mild galactagogue.
Enhances Fertility
Saw palmetto promotes fertility, and can be incorporated into formulas for people having difficulty conceiving, or who have had miscarriages.16 It can enhance conception in people who are undernourished or malnourished, when combined with making appropriate dietary modifications. Saw palmetto increases fertility most effectively when it is consumed a minimum of six months to one year.
Please note that many factors can influence fertility in childbearing people, including progesterone deficiency, hypothyroidism, hyperthyroidism, insulin resistance, stress, severe depletion, and structural abnormalities. In order to obtain optimum results when treating infertility, each of these potential factors must be considered and addressed.
Eases Benign Prostatic Hypertrophy (BPH)
Standardized saw palmetto aids in treating the early stages of benign prostatic hypertrophy (BPH), characterized by enlargement of the epithelial and fibromuscular structures in the prostate gland.17 The accumulation of testosterone in the prostate is considered the primary cause of BPH.18 Testosterone is converted to 5-α-diyhydrotestosterone (DHT) by the enzyme 5-α-reductase in the prostate.19,20DHT causes prostatic cells to multiply excessively, resulting in an enlarged prostate.21,22 DHT has five times the biological potency of testosterone.23
The liposterolic extract of saw palmetto (LESP) helps to treat BPH because it limits intraprostatic conversion of testosterone to DHT, and prevents intracellular binding and transport of DHT.24,25,26Liposterolic extracts can be made using one of three methods: ultra-higher pressure, supercritical CO2, hexanoic (ɳ-hexane), or 90% ethanol weight for weight standardized to 70-95% free fatty acids. These methods are much more effective in extracting the free fatty acids and sterols from saw palmetto than an alcohol and water extraction. Clinical studies demonstrate that LESP reduces the symptoms of BPH in nearly 90% of patients.
LESP is a standardized extract containing 85–95% free fatty acids and sterols; when administered in a dosage of 160 mg twice daily, it increases urinary flow, alleviates or decreases difficulty initiating urinary flow, and reduces the frequency of urination and residual urine, dysuria, and nocturia.27,28,29,30,30 LESP also exerts an antiestrogenic effect in prostatic cells.32 Estrogen inhibits the hydroxylation and elimination of DHT, thus contributing to BPH.33
Saw palmetto has additional effects on the prostate, reducing inflammation, edema, and spasms by inhibiting the biosynthesis of prostaglandins and leukotrienes.34 Clinical studies indicate that LESP is more effective, faster acting, and has considerably fewer side effects than the prescription drug finasteride, commonly used to treat BPH.35,36 However, LESP has no significant influence on prostate volume or serum PSA (prostate specific antigen), the clinical markers used to evaluate BPH (although finasteride does, indicating that LESP has minimal action on 5-α-reductase inhibition).37 The antispasmodic effects of saw palmetto that decrease urethral obstruction caused by increased smooth muscle tone are attributed to the α-adrenoceptor and calcium-blocking actions.38
In summary, the combined therapeutic properties of LESP, including the androgen inhibitory, antispasmodic, anti-inflammatory, and antiedemic actions, contribute to the efficacy of saw palmetto for treating BPH.39 Additionally, formulas containing nettle root (Urtica), mullein root (Verbascum), pygeum (Prunus africanum), and/or yellow pond lily root (Nuphar) aid in treating BPH.40
Historical Uses
Saw palmetto berries were a dietary staple of the Seminole people (Indigenous Floridians).41 They also utilized the herb for urinary problems.42 Relying on Indigenous tribal knowledge, early American settlers also supplemented their diet with saw palmetto berries.43 The fruits continue to be incorporated into livestock feed.
Eclectic physician Dr. Goss observed the beneficial effects of animal consumption of the mature berries, noting that these animals grew fat with sleek hair.44 This attracted the attention of Eclectic physician Dr. J. B. Read, who began utilizing saw palmetto in his practice.45 In 1879, he published an article in the American Journal of Pharmacy, extolling the digestive benefits of saw palmetto, in addition to its ability to increase flesh, strength, and weight, and soothe irritated mucous membranes — especially in the respiratory tract.46, 47 Saw palmetto was later included in the U.S. Pharmacopoeia (1906).48, 49
Eclectic physician Finley Ellingwood administered saw palmetto as a nutritive that also increased the appetite and enhanced assimilation. He prescribed saw palmetto for men suffering from an enlarged prostate with a dull aching pain, bladder irritability, and conditions related to prostate enlargement, including sexual weakness, epididymitis, and testicular pain and inflammation.50 He also recommended the herb for women to reduce irritability of the ovaries and treat dysmenorrhea resulting from atonicity, in addition to increasing the size and secreting capacity of small, inactive mammary glands. He mentions its use for treating sterility, and noted that saw palmetto restored ovarian action. Dr. Hale considered the herb one of the most effective uterine remedies.51 As the use and popularity of herbs declined in the U.S., saw palmetto was excluded from the National Formulary. However, it continued to be used in Europe, and studies of standardized extracts were conducted, confirming its therapeutic applications.52 By 1998, the herb was reintroduced in the U.S. National Formulary.53
Constituents
Saw palmetto fruits have a high lipid content. It is rich in a fixed oil with free fatty acids, triglycerides, diglycerides, monoglycerides, phytosterols, and fatty alcohols. Additional components include carotenes, flavonoids, lipase, polysaccharides, invert sugars, tannins, and mucilaginous compounds (pectin).54,55,56,57,58
Saw palmetto also contains high amounts of chromium, fiber, iron, magnesium, manganese, niacin, phosphorus, potassium, riboflavin, selenium, silicon, thiamine, and zinc. It contains average to low amounts of calcium, cobalt, protein, sodium, and vitamins A and C.59
What’s in a Name?
The genus Serenoa was named in honor of botanist Sereno Watson (1826–1892).60 The epithet repens (“creeping”) derives from Latin. The common name saw palmetto (“saw-like palm”) refers to the sharp stems that can cut clothing or skin.
Botanically Speaking
Saw palmetto is a long-lived, shrubby palm endemic to the southeastern U.S. It grows in sand-pine scrub, mesic hammocks, coastal sand dunes, and pinelands, often in large homogenous stands.61,62
Usually reaching 3-10 feet tall, the plants have a sprawling, colonizing habit, and rarely have upright trunks.63 The stiff, yellow-green, green, or silver-green palmate leaves lack a midrib.64 The lanceolate leaf segments are together at their bases with forked tips and serrated edges.65 The leaves’ stalks are armed with teeth.66
Long, branching clusters of flowers are born in the leaves’ crowns.67 The tiny, fragrant, white flowers (4-5 mm) bloom in the spring. When ripe, the fruit is a dark reddish-brown to black oval-shaped drupe (2 cm long by 1 cm wide) with brown oval-shaped seeds.
Saw palmetto fruits are often marketed as berries, but they are actually drupes — thin-skinned fruits with a central stone that contains the seed of the plant. Saw palmetto drupes are coveted by black bears, whitetail deer, raccoons, foxes, opossums, and birds.68
Plant Preparations and Dosage Suggestions
- Capsules: Consume 160 mg of standardized liposterolic extracts of saw palmetto (containing 85–95% free fatty acids and sterols) twice daily.69 Consume 2–3 “00” capsules containing either freeze-dried fruit or standardized extract, two to three times daily. Consume 2–10 grams of dried fruit powder, up to three times daily
- Note: tinctures and fluid extracts are considered far less effective than capsules because the fruits have limited alcohol solubility.
Special Considerations
Saw palmetto is considered safe, and has no toxic effects.70 ,71 There are no known contraindications with saw palmetto.72,73,74 In rare cases, the extracts may cause gastrointestinal problems, including nausea or stomach upset, if taken on an empty stomach.75,76 Before self-prescribing saw palmetto for BPH, consult a physician to rule out prostate cancer.77
Footnotes
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