Suter, Andy; (2012) New perspectives on saw palmetto (Serenoa repens): a medico historical/analytical comparison of preparations derived from it and a clinical pilot trial in patients with benign prostatic hyperplasia and sexual dysfunctions. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Saw palmetto berries (Serenoa repens) are used today for treatment of symptoms of benign prostatic hyperplasia (BPH) which is an age dependent disease leading to lower urinary tract symptoms (LUTS) and impacts negatively sexual functions. I carried out the first clinical pilot trial to assess if a saw palmetto treatment in patients with BPH and concomitant sexual dysfunctions (SDys) is effective and safe in both groups of symptoms. After 8 weeks of treatment with 320mg saw palmetto extract daily, BPH symptoms measured with the International Prostate Symptom Score IPSS were reduced from 14.4 ± 4.7 to 6.9 ± 5.2 (p<0.0001). At the same time SDys measured with the brief Sexual Function Inventory bSFI improved from 22.4 ± 7.2 to 31.4 ± 9.2 (p<0.0001), and with the Urolife BPH QoL-9 sex questionnaire from 137.3 ± 47.9 to 195.0 ± 56.3 (p<0.0001). The treatment was very well tolerated and accepted by the patients. Another subject of this thesis was to examine the quality of commercial preparations from eight countries which contained saw palmetto and are sold as treatments for BPH symptoms. For each of the 46 analysed products the amount of the main active constituents, the fatty acids was determined using gas chromatography. The quantity of fatty acids per daily dosage varied widely between the products and also the composition of the samples was very heterogeneous. A medico-historical investigation how saw palmetto was introduced firstly into U.S. American medicine and how the plant became popular as a treatment in Germany was the last aspect of the thesis. The eclectic physicians pioneered in using this plant in the United States supported by homeopathic doctors and pharmacists. In Germany, mainly the homeopaths favoured the use of saw palmetto and were the trailblazers making it a popular treatment for BPH symptoms. In conclusion, this thesis shows comprehensively how saw palmetto made its way into medical practice in the United States and Germany, that preparations on the markets containing saw palmetto differ widely in their content of the main active constituents, the fatty acids, and thus higher quality demands from regulatory authorities are warranted, and in a pilot trial it could be shown that saw palmetto is not only an effective and safe treatment for BPH symptoms but also for concomitant SDys.

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