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Saw palmetto: Natural hormones regulator

A chemical substance produced in the body that controls and regulates the activity of certain cells or organs is called a hormone

201603ehm31A chemical substance produced in the body that controls and regulates the activity of certain cells or organs is called a hormone. Hormones are essential for every activity of life, including the processes of digestion, metabolism, growth, reproduction, and mood control. Many hormones, such as neurotransmitters, are active in more than one physical process.

Problems of hair are also related to hormonal imbalance. The general scientific term for hair loss is alopecia.

Subtypes of alopecia include:

Alopecia Areata: An autoimmune disease that causes the body to form antibodies against some hair follicles. Alopecia Areata causes sudden smooth, circular patches of hair loss. There are no known cures and in many cases the hair grows back on its own.

Alopecia Totalis: An autoimmune disease similar to Alopecia Areata but that results in the loss of all hair on the scalp. It may begin as Alopecia Areata and progress into Alopecia Totalis.

Alopecia Universalis: An autoimmune disease that results in the complete loss of all hair over the entire body, including eyelashes and eyebrows.

Telogen effluvium: Telogen effluvium is an abnormal loss of hair due to alteration of the normal hair cycle. Normally, most of the hairs are in the growth stage and only one hundred hairs per day fall from the scalp. When telogen effluvium occurs, a greater proportion of the hairs enter the resting phase of the cycle and hair shedding is greater than normal.

Androgenetic Alopecia: It is the most common cause of hair loss, presenting as loss of hair over the top (vertex) and the anterior mid-scalp area (receding hairline) in affected men. The term androgenetic alopecia denotes that both a genetic predisposition and the presence of androgens are necessary to cause expression. AGA is also referred to as male pattern hair loss and typically begins gradually in men in their 20s with incidence increasing 10 per cent per decade. This is the most common form of hair loss and can also affect women. Other terms for this condition include: MPB, male pattern baldness, female pattern baldness, hereditary Alopecia and Androgenic Alopecia.

Chronic inflammation of the hair follicle (HF) is considered a contributing factor in the pathogenesis of androgenetic alopecia (AGA). (R. M. Trüeb, Experimental Gerontology, vol. 37, no. 8-9, pp. 981–990, 2002)

Hirsutism

201603ehm32Hirsutism is the presence of excess hair in women. This phenomenon is usually an androgen-dependent process. 25 to 35 per cent of young women have terminal hair over the lower abdomen, around the nipples, or over the upper lip. Most women gradually develop more androgen-dependent body hair with age. Nevertheless, normal patterns of female hair growth are unacceptable to many women. At the other extreme, severe hirsutism may rarely be the earliest signs of masculinising diseases. More often, however, severe hirsutism reflects only increased androgen production in women with a non serious underlying disorder.

It’s often caused by genes, hormones, or medication. Sometimes, hirsutism runs in families. It’s also more common in people from the Middle East, South Asia, and the Mediterranean. Many times, the condition is linked to high levels of male hormones (called androgens). It’s normal for women’s bodies to make these, and low levels don’t cause excess hair growth. But when these amounts are too high, they can cause hirsutism and other things, like acne, a deep voice, and small breasts. High levels of male hormones and hirsutism are common in women who have Polycystic ovarian syndrome, Cushing’s syndrome etc.

Acne and Seborrhoea: There are other diseases associated with 5a reductase activity such as acne and inflammatory skin disorder (seborrhoea) and eczema.

The key for treating all of these diseases is the modulation of 5a reductase activity.

5 -Alpha Reductase inhibitors: Drugs in this class work by inhibiting the enzyme 5 alpha reductase, which limits the conversion of testosterone to DHT.

Finasteride: The first drug in this class to undergo extensive clinical trials in men. Finasteride has selective activity against 5 alpha reductase. As a result, serum and follicular DHT levels are significantly reduced.

Saw palmetto extract: Studies have shown that Saw palmetto is an effective anti-androgen. It acts in a similar way that Finasteride does. Firstly it lowers levels of DHT in the body by blocking 5 alpha-reductase. Secondly, Saw palmetto blocks receptors sites on cell membranes required for cells to absorb DHT. Studies have been performed on the use of Saw palmetto in the treatment of benign prostatic disease, which is similar to androgenetic alopecia in that it also depends on the production of dihydrotestosterone.

What is Saw palmetto?

Saw palmetto is an extract derived from the deep purple berries of the saw palmetto fan palm (Serenoa repens), a plant indigenous to the coastal regions of the southern United States and southern California. There is an estimated one million acres of wild saw palmetto palms in Florida, where the bulk of commercial saw palmetto is grown.

Pharmacology of Saw palmetto: Saw palmetto is widely used as a therapeutic remedy for urinary dysfunction due to enlarged prostate or benign prostatic hyperplasia (BPH) in the US and more so in Europe.

Based on mechanisms of action, Saw palmetto extracts are also used for male pattern baldness (alopecia), excess hair in women (hirsutism), acne, inflammatory skin disorder (seborrhea) and eczema.

Mechanisms of action

Anti-androgenic and anti-inflammatory activities: Saw palmetto extracts inhibit 5a-reductase, which is an enzyme responsible for conversion of testosterone to dihydrotestosterone. Inhibition of such conversion maintains prostate health.

There are two commonly associated male physiological events that have a similar etiology. Enlarged prostate or benign prostatic hyperplasia (BPH) and male pattern baldness are both related to the enzyme 5-alpha reductase.

Studies with a liposterolic extract of Saw palmetto berries showed that it reduced the uptake by tissue specimens of both testosterone and dihydrotestosterone (DHT) by more than 40 per cent suggesting anti-androgenic activity.

Further, the extract inhibited binding of DHT to its receptor and blocked the conversion of testosterone to DHT by inhibiting the activity of 5-alpha-reductase. The berries also inhibit cyclooxygenase and 5-lipoxygenase pathways, thereby preventing the biosynthesis of inflammation – producing prostaglandins and leukotrienes.

Hirsutism in women is also related to this enzyme.

Role of Saw palmetto

Recently, a number of clinical trials have confirmed the effectiveness of saw palmetto in treating BPH. Many of these trials have shown saw palmetto works better than the most commonly used prescription drug, Finasteride. Saw palmetto is effective in nearly 90 per cent of patients after six weeks of use, while finasteride is effective in less than 50 per cent of patients. In addition, finasteride may take up to six months to achieve its full effect. Since finasteride blocks the production of testosterone, it can cause impotence and breast enlargement. Other prescription drugs used to treat BPH are doxazosin, terazosin, and tamsulosin hydrochloride. Originally prescribed to treat hypertension, doxazosin and terazosin can drop blood pressure, causing light headedness and fainting. Presently, saw palmetto is being evaluated by the US Food and Drug Administration (FDA) for treatment of BPH. If approved, it would become the first natural derived product to be licensed by the agency as a treatment for a specific condition.

Since the 1960s, extensive clinical studies of saw palmetto have been done in Europe. A 1998 review of 24 European trials involved nearly 3,000 men, some taking saw palmetto, others taking finasteride, and a third group taking a placebo. The men taking saw palmetto had a 28 per cent improvement in urinary tract symptoms, a 24 per cent improvement in peak urine flow, and 43 per cent improvement in overall urine flow. The results were nearly comparable to the group taking finasteride and superior to the men taking a placebo.

A randomised, double-blind, placebo-controlled trial was also conducted to determine the effectiveness of a preparation, containing 50 mg ß-sitosterol and 200 mg saw palmetto extract (standardised to contain 85-95% liposterols) per capsule, two capsules daily, in treatment of AGA (85). Healthy male subjects with moderate to severe AGA were randomly assigned to either the treatment arm (n=10) or the placebo arm (n=9) for a treatment period of approximately 21 weeks. At study completion 60 per cent of the men in the treatment group reported improvement, compared to only 11 per cent in the placebo group. Significance was neither reported nor achieved.

Saw palmetto has been extensively studied and is seen to lessen hair loss and improve hair density in women with hair loss related to testosterone levels. For women with PCOS especially if they have elevated DHT, saw palmetto helps to block 5-alpha-reductase activity – thereby reducing the amount of testosterone converted to DHT. It does not change hair that is already altered by excess testosterone back to fine, soft light coloured hair; it prevents new hair growth, or dark coarse hair re-growth in women who have had laser therapy or electrolysis.

It is suggested for use over a six-week period, taking notes of any improvements over that time. In case of improvement, may be continued on for best results. Saw palmetto has been found safe for long-term use in most cases

Suggested dosage: 400mg a day

According to the Southbury Clinic for Traditional Medicines and Catalina Lifesciences, researchers have found that when testosterone undergoes the conversion process to DHT, the shifting in hormone levels can result in acne in both men and women. The cause of an increase in pimples is due to the overproduction of sebum within your oil glands. This overproduction clogs your pores, which results in inflammation and pimples.

Although initial research of saw palmetto for the treatment of acne is promising, Dr Richard Fried writes in the report ‘Saw palmetto as a Treatment for Acne’ that the effectiveness of saw palmetto for acne treatment varies from person to person.

Conclusion

Saw palmetto is better known for its ability to help treat BPH in men; however, the primary active constituents within saw palmetto also help reduce the severity of acne. According to the University of Maryland Medical Center the primary constituents of saw palmetto include plant sterols, fatty acids and flavonoids. Saw palmetto contains a high concentration of polysaccharides, which are used by the human body to enhance the immune system as well as work as an anti-inflammatory. One of the primary benefits of saw palmetto is its ability to hinder the transformation of testosterone to dihydrotestosterone, which is also known as DHT.

Saw palmetto has been proven safe to use. It has no known drug interactions and is well tolerated by most people. The only noted side effect in a very small percent of people is upset stomach. Saw palmetto can be taken with zinc, vitamin b6, and azelaic acid for a synergistic effect.

References:
Castor TP. (2010). Compositions and Methods for Inhibiting 5- Reductase.
Dvorkin L. (2013). Introduction To Herbal Supplements for Pharmacists and Other Health Care Professionals. Center for Integrative Pharmacy, Massachusetts College of Pharmacy and Health Sciences. http://www.longwoodherbal.org
Feifer A, Fleshner N and Klotz L. (2002). Analytical accuracy and reliability of commonly used nutritional supplements in prostate disease. J Urol. 168:150-4.
Fagelman E and Lowe F. (2002). Herbal medications in the treatment of benign prostatic hyperplasia (BPH). Urol Clin N Am. 29:23-9.
Suzuki M, Ito Y, Fujino T, Abe M, Umegaki K, Onoue S, Noguchi H and Yamada S. (2009). Pharmacological effects of saw palmetto extract in the lower urinary tract. Acta Pharmalogica Sinica. 30: 271-281.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001876/
PubMed Health: Acne
http://www.bottomlinesecrets.com/article.html?article_id=44661
Bottom Line Secrets: Saw palmetto as a Treatment for Acne
http://www.umm.edu/altmed/articles/saw-palmetto-000272.htm
University of Maryland Medical Center: Saw palmetto
Palatsi, R., Ruokenen, A., Oikarinen, A. (1997) Isotretinoin, tetracycline and circulating hormones in acne. Acta Derm Venereol. 77(5):394-396.
Mauvals-Jarvis, P. (1986) Regulation of androgen receptor and 5 alpha-reductase in the skin of normal and hirsute women. Clin. Endocrinol. Metab. 15(2):307-317.

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First published on: 09-03-2016 at 12:17 IST