Podcast 158: Saw Palmetto Doesn’t Discriminate On Gender

Have you heard that black cohosh is “for menopause”? Or that red clover is a “natural estrogen replacement”? Or that saw palmetto (Serenoa repens) is “for men” or “for BPH”?

Herbs are not gendered, and they’re not “for” conditions. They have qualities and actions, and they act in context – the context of each individual body. Herbs act on particular types of tissue, and it turns out that in the reproductive system, the various forms and functions mask a deeper similarity, a more fundamental identity. Saw palmetto doesn’t check your chromosomes or your estrogen/testosterone ratio before it goes to work in your system: it acts on the pelvic floor organs, regardless of their shape.

In this episode we deconstruct saw palmetto’s famous ability to help out with BPH, widening our scope to consider other patterns of pelvic stagnation and atrophy this herb can help us correct. We even look outside the reproductive system entirely, noting historical precedent for this herb as a digestive tonic and respiratory expectorant. Historical traditions, contemporary science, and our own direct experiences with the herb all provide helpful points of contact which help us draw a much fuller picture of the herb than “good for BPH”.

Saw palmetto is a complex herb, with actions that can seem – at first glance – contradictory. Taking this in-the-round view of the herb helps us see it more clearly and resolve some confusion. This lesson goes beyond this one herb, though – we always need to be aware of our culture’s tendency for reductionism and putting herbs in neat boxes.

Mentioned in this episode:

This episode includes content from our Reproductive Health herbal training course, so if you enjoyed this discussion you might want to sign up for the whole shebang! We’ll be discussing the whole range of human reproductive variability and herbal medicines to support all kinds of people. Like all of our online herbalism courses, this one includes free access to our twice-weekly live Q&A sessions, so you can connect with Ryn & Katja directly. Plus you get hours of video instruction, in-course discussion threads, and downloadable materials to keep. Course access does not expire – it’s yours for life, along with any updates we add later on!

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Our theme music is “Wings” by Nicolai Heidlas.

This episode was sponsored by Mountain Rose Herbs. We thank them for their support!

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Episode Transcript

Katja (00:00:13):
Hi, I’m Katja.

Ryn (00:00:15):
And I’m Ryn.

Katja (00:00:15):
And we’re here at the Commonwealth Center for Holistic Herbalism in Boston, Massachusetts.

Ryn (00:00:19):
And on the internet everywhere thanks to the power of the podcast. So this week we have an extra long episode for you. We missed one. We missed a week there, but we’ve got a little extra long one for you to make up for it. This week we’re going to be talking about Saw Palmetto berry, and more broadly than that, about how this herb and all of the herbs don’t check your gender before they go to work in your system. Yes.

Katja (00:00:46):
Yeah. We have these herbs that we say are for men or for women. And I think that the herbs are probably like, excuse me. I, what?

Ryn (00:00:56):
I’m here for myself, thank you very much. I’m here for the earth. Yeah.

Katja (00:01:00):
And so first off we want to just acknowledge that there’s no need to say that. Herbs are for people, or actually herbs are for themselves.

Ryn (00:01:11):
Or herbs can be with people in many ways. Yeah. Right. So yeah. We’re going to dig into all of that, breakdown some binaries and try to explore that a bit.

Katja (00:01:20):
Yes. And also try to explore a little bit our own biases that we have as we learn about herbs, you know, based on the first thing that we heard or whatever else. And how do we break those down so that we can let new information come in and keep learning.

Ryn (00:01:41):
Yeah. So that’ll be our dive today, but first let’s give you our reclaimer. That’s where we tell you that we are not doctors. We are herbalists and holistic health educators.

Katja (00:01:50):
The idea is discussed in this podcast do not constitute medical advice. No state or federal authority licenses herbalists in the United States. So these discussions are for educational purposes only.

Ryn (00:02:02):
We want to remind you that good health doesn’t mean the same thing for everyone. Good health doesn’t exist as an objective standard. It’s influenced by your individual needs, experiences and goals. So, we’re not trying to present a dogmatic right way that you should adhere to.

Katja (00:02:17):
Everybody’s body is different. So the things that we’re talking about may or may not apply directly to you. But we hope that they’ll give you some good information to think about, and some ideas to research further.

Ryn (00:02:27):
Finding your way to better health is both your right and your own personal responsibility. This doesn’t mean you’re alone on the journey. But it does mean that the final decision when considering any course of action, whether it’s discussed on the internet or prescribed by a physician, is always yours to make.

Katja (00:02:43):
You know, one other thing before we launch in is we want to thank Mountain Rose Herbs for sponsoring our podcast. We are so grateful to them, not just for sponsoring our podcast, but also for providing great herbal products.

Ryn (00:02:58):
Yes, indeed.

Katja (00:03:00):
And because saw palmetto is our topic today, and because it’s so common to see saw palmetto as a capsule, and frequently that’s it. That’s like the only way that we come across it. I want to point out that MountainRoseHerbs.com actually has saw palmetto in every form that you could want it, right? They do have capsules that they encapsulate themselves. They have powdered saw palmetto berry. They have whole saw palmetto berries. Well actually like kind of crushed a little bit, cut and sifted. And then they have saw palmetto extract, a tincture that they make in-house.

Ryn (00:03:40):
Yeah. I feel like they’ve really expanded their line of in-house tinctures in the last few years pretty substantially. So yeah. Lots of options. And if you were interested in exploring saw palmetto in all of its fullness, you would be really delighted to find somewhere that you could get it as a tincture and a capsule and a powder and dried berry bits. So, thanks, Mountain Rose.

Katja (00:04:00):
Right. And that’s actually something that we’re going to talk about throughout the course of this episode. So I encourage you, if you are inspired to work with saw palmetto, to head on over to mountainroseherbs.com. And get some in each form, because the form actually matters, and we don’t have good data around all of it. So sometimes the only way to get good data is to try it yourself, and you can.

Ryn (00:04:29):
Cool. So one more time, that’s mountainroseherbs.com.

Katja (00:04:32):
Thank you so much. You know, the material that we’re going to share here is material that we wanted to include in the reproductive health course that we are launching right now. And we really wanted to start this course off with this concept of challenging our own ideas that we’re coming to this material with. You know, we all have these ideas around reproductive health, and not all of them are serving us. And so before we sit down and really try to learn about reproductive health, we kind of need to let go of things of ideas that aren’t serving us like that things can be for men or women and not people.

Ryn (00:05:24):
So if this captures your attention and you’d like to dig deeper, then you should check out our course on reproductive health. You can find that and all of our course offerings at online.commonwealthherbs.com. Yeah.

Katja (00:05:37):
All right. Let’s dig in.

Ryn (00:05:39):
So saw palmetto has a great reputation when it comes to one particular problem. So, this problem is called BPH or benign prostatic hyperplasia, and that basically just means that the prostate has gotten swollen. And there’s a set of symptoms that comes along with that. There can be feelings of urinary urgency, feeling like you need to pee. Also an inability to completely empty the bladder. And so you get this very frustrating situation where you have to pee often, and you never feel like you’re all the way emptied. And it often wakes you up multiple times at night, and it’s really disruptive. So this is a very common issue that’s suffered by a great many folks. Usually people say that it suffered by men who are, you know, getting older in age and all of that. But it turns out that lots of people can run into this issue. So the thing about saw palmetto is that, yeah. It is helpful for that problem, and we’re going to talk about some reasons why. But it has applications that are much broader than just this one pathology or indeed the prostate itself. This herb, it turns out, is not actually just for men.

Katja (00:06:49):
And it’s not just for prostates. We like to think of saw palmetto as a pelvic floor a stringent. So in that regard it’s going to be active also on the bladder, on all of the tubes, whichever tubes we’re talking about here, whether that’s the tubes even from the kidneys to the bladder, or the urethra and ureter. But there’s other tubes happening in this pelvic area as well. Saw palmetto has action on the musculature and the connective tissues that hold all these organs in place. Really, if you just sort of think about your pelvic region, your pelvic like basically everything kind of under your intestines and before your pelvic floor, all of that stuff. Saw palmetto can be really stringent here. And actually even that is too specific. As we go on we’re going to find that that saw palmetto has other actions that don’t have anything to do with the pelvic region whatsoever. So that’s kind of cool.

Moistening, Tonifying & Tissue Building

Ryn (00:07:56):
Yeah. So if we were to look at this first and give you our impressions of the herb, and look at this in a sort of materia medica kind of a way, we’d say first off this herb has an interesting set of qualities, because it’s warming and also it’s got a moistening quality to it. And yet it also has a tonifying effect. And oftentimes that combination, especially of moistening and tonifying, can really be something to perk your ears up about. Because we generally think of moistening herbs as like helping water to be there, and tonifying herbs as like squeezing out or astringing out excess fluid. So when we see both qualities in the same plant, something intriguing is going on.

Katja (00:08:33):
Yeah, it’s really important also to recognize this, because often we have people who are really dehydrated, really depleted, and we want to do work to help them. But in our culture right now, it is possible to be both damp physiologically, because of a lack of movement, a lack of lymphatic flow. And so everything is sort of stagnating, and also dry because we all have this tendency to under hydrate. Everybody’s running a little depleted. So when we have an herb like this, that’s, moistening and tonifying, it means that we can deal with that stagnation, help to move the fluids out of a place where there’s too much, but without drying the person out as a whole. If you think about somebody with a body like Ryn’s, if we were going to work with…Let’s say you had BPH, and we were going to work with straight up nettle root, which is just super astringent and super drying. You wouldn’t be able to do that for more than a day or two before you would start to feel super uncomfortable.

Ryn (00:09:42):
Right, yeah. Now we could do it, but we have to compensate, right? We’d have to say, well, we’ve got a really drying herb in here. We’ve got to get a moistening herb in there to compensate for that. And it can be done. It’s the magic of herbal formulation and a well-rounded protocol. But in the herb itself it’s going to have that kind of mismatch to the body. So saw palmetto, if we’re doing a single herb choice for someone, that would be a much better choice for somebody like me. Now, if we look at the actions of this herb, we’re going to be investigating these in a little more detail as we go along. But just as like a starter set, we see this herb being nutritive. We see it having tonic effects, and actually I mean pretty much all of the meanings of the term tonic. So if you’re familiar with how that can sometimes mean astringent, and it can sometimes mean like general restorative herb, and sometimes it can mean like restoring a specific quality or energy in the body. Actually this one hits all of those definitions at the same time.

Katja (00:10:34):
Yeah. That’s kind of, I feel like it’s kind of unusual. Maybe you can get two of them, but getting all of them…

Ryn (00:10:40):
Yeah. Also the fact that this herb is antispasmodic in certain contexts, but can also be tonifying or tightening in other contexts. That also is very interesting and kind of unusual for a single plant to have both powers. So this herb also can be a diuretic. It can be an antiseptic to the urinary tract in particular, a nice anti-inflammatory for all your pelvic organs. And we think of this in some ways being amphoteric, balancing. Because again, we’ve got that astringency squeezing out fluids and that oily moisture to it. Replenishing healthy fluids and getting them in a good balance. So it has these kind of balancing powers to it. And you also see the term anabolic often applied to this plant. We’re going to kind of poke on that one a little bit. Anabolic means like building or restorative in that kind of a tissue maintenance sense.

Katja (00:11:35):
Yeah. I mean, that is I think the place where people hear this word most commonly is with like anabolic steroids. But it has the same meaning there too, like build me bigger muscles. Build me bigger stuff, right? And so anabolic is like in the building up kind of meaning there.

Ryn (00:11:52):
For sure. We’ll also see this herb does have some other effects that are outside of your reproductive system. It has an expectorant quality to it, and it can be a digestive tonic. And there in the sense of like restoring normal function and improving good digestive fire, that kind of activity. Yeah. When we look at affinities for this herb, we see, of course, a strong affinity for your pelvic floor, your pelvic floor organs, pelvic floorgins. Yeah? And especially for the urinary and the reproductive systems in there. Yeah.

Katja (00:12:24):
Pelvic floorgins.

Katja (00:12:26):
Right, right. Some specifics on a few of those activities, right? Again, that antiseptic power, that’s in that urinary system. A lot of that’s becoming or rising because of its effects on the bladder itself, where it’s toning up that tissue, helping that to have good integrity. When this system gets infected it starts to lose integrity, especially in the barriers, like the linings and that kind of thing. Saw palmetto also seems to help promote good, healthy, strong contractions of the bladder so that you can fully empty it. Remember one of those big symptoms of BPH is that inability to empty all the way. But this is kind of pointing us to say that it’s not just that one problem. But if there are other issues of an inability to fully empty or to feel like you’ve done what you needed to do into the potty, then yeah. This is going to be a helpful plant.

Katja (00:13:17):
You know, a few instances where that could happen in bodies without prostates or…Well, yeah, let me just leave it in that realm of examples for a minute here. We can think of prolapsed bladder. We can think of interstitial cystitis. But actually both of those things, I was going to say, both of those things actually could happen in a person with a prostate as well. Those are both things that could actually happen to any person. I personally think about prolapsed bladder a little bit more in tandem with prolapsed uterus. But it’s actually, you can have a bladder prolapse without a uterus too. So both of those kinds of situations could also be causing that inability to feel like you’ve fully emptied your bladder or actually the complete inability to fully empty your bladder, especially if we’re talking about bladder prolapse. Maybe you get kind of just like a little bit of a fold, not like a full on kink in the bladder. I don’t mean it that way. But just like kind of like a little sagginess in the bladder. And then like some stuff gets kind of stuck and doesn’t quite get over the hump, you know, to get all the way out .and strengthening those contractions is going to help all of it come up and out. Plus if we are adding that astringency to the pelvic floor region, that’s also going to assist in bringing the bladder back into place. It’s not like it’s going to crank it all the way back up to its original factory preset condition. But it is going to like give it just a little lift, you know, and that helps as well.

Amphoteric/Balancing Actions

Ryn (00:14:57):
Yeah. Right. So yeah, and those kind of nourishing tonifying effects, they’re going to extend to the whole reproductive system, you know? So this herb has long been recognized as a tissue building plant. That it can really rebuild, help to kind of plump up dry or atrophied tissues. Think of that moistening quality that it carries, right? And again, this is where that idea of it being an anabolic herb is expressed most clearly. One of our herbal reference books that we like a lot was commenting that the herb strengthens and builds body tissues and encourages weight gain. And that it can be given to people who are suffering from wasting illnesses and a general failure to thrive. So again, that’s pretty far removed from only take it for BPH, right? Like here we’re thinking of somebody who’s maybe got some digestive difficulty perhaps, and that’s inhibiting their ability to access nutrients and to like build that body. We can think of specific cases where there’s been atrophy to a tissue from poor circulation, from malnourishment of a specific kind to that organ or that tissue. And here we’re seeing it get full and healthy and get your juices flowing and all that kind of good stuff going on.

Katja (00:16:06):
I even think about like, if you think about failure to thrive and strengthening tissue, and then think about those words like in a more modern context, digestively, are we maybe talking about leaky gut? And then we’re looking at a plant that has this astringent action and this ability to restore tissue. And that’s actually what we need in leaky gut where everything is like kind of falling a little bit apart from itself. And there’s like a holiness going on. Well, if we can suck that up a little bit, like everybody look sharp, right? Then that is going to allow you to absorb nutrition from your food much more easily.

Ryn (00:16:55):
Yeah. It’s an interesting example, because a lot of times that problem is going to come with some spasms as well. And the same is actually true down in the reproductive organs, the urinary organs. So like with saw palmetto we’re talking about those tonifying effects, like getting things into place. But at the same time the herb has antispasmodic effects. And there can be like spasmodic issues with the bladder, with the muscles and the connectives there, where they’re spasming. They’re like jittering like this, and saw palmetto can help. That can be one of the things that contributes to that feeling of oh, I need to pee, right? Often a spasm, right? And this herb can relieve the spasm, which is like usually a relaxing action, but it can also help with things that are too lax and get them back into place. So we’re seeing that kind of amphoteric or like balancing quality going on here.

Katja (00:17:44):
And if you may be are someone or know someone who a diagnosis for MS. And one of their symptoms include spastic bladder, then your ears might be perking up and saying like, well, I’ve never seen anybody say that saw palmetto is an herb for MS. And yet like, again, it isn’t an herb for MS. It’s that we’re looking at the symptom set. We’re looking at what’s going on in this body, and what do we need to do to make life more comfortable in this body?

Ryn (00:18:16):
Yeah. That’s an example of a case where like having a label or having an understanding of the dominant problem in a given case makes us say everything has to be filtered through that lens. Like for somebody with “MS”, to take an herb for “MS”, those are the only ones they should be working on. And if saw palmetto isn’t on my list of herbs for MS somewhere, then clearly it’s not appropriate to my problem. But that’s really a different approach, a different view from what we’re taking here. Yeah. So, you know, we’re seeing already some seemingly contradictory things here, right? They seem to be contradictory on the surface. And I guess we’ve already been kind of showing ways that you can look at it from another angle, and see where it actually does make sense,

Katja (00:19:02):
But if all you did was just read that straight through and not, you know, maybe that was all printed in a book somewhere. Actually a lot of this we’ll read different things that are printed in books, and they’re going to have tons of contradictory things. But if all you did was read a book and you were reading fast. It was late. You were tired. You were trying. Maybe you wouldn’t question that all that contradicted, but then if you didn’t question it, then you wouldn’t really understand how is this herb actually working. Or maybe you would read it and say like…And I think this is very common in our sort of conventional culture that is very, I don’t really want to say science dominated, because we really like science, but maybe that sort of skepticism dominant. Where you read something, and it all looks contradictory on the surface and you’re like, well that’s just a bunch of magical thinking. Instead of like, no. There is an explanation for this, and it’s even a science-y one. But we have to like really sort of pick it apart and think it through slowly to be able to find it.

Ryn (00:20:10):
Yeah, yeah. It didn’t jive with some preconceptions. Yeah. Right. And again, you’re not always aware of those preconceptions when you have those thoughts. It’s why Tammi says don’t believe everything you think.

Katja (00:20:21):
Yes, yes. Another favorite quote of mine. Yeah.

Ryn (00:20:26):
But, you know, let’s take a minute and go back in time, and look a little bit at the history of this herb in some older writings about it, and see what we can discover there.

Katja (00:20:35):
I feel like we need to just take a minute and like put on hats and like fancy history clothes, and you know, maybe a nice cane or an ascot or something. Well, anyway.

A Brief History of Saw Palmetto

Ryn (00:20:50):
So this herb in the world, it’s native to what today we call Florida, that area, that part of the world. And it’s been historically and traditionally important, and still is important to the people who live there, right? Like the Seminole nation and other surrounding peoples. And when we look at what we know, or what information we’ve got from the field of ethnobotany, then we can see some interesting things in there. For instance, there’s references in that kind of literature to the Seminole and other folks working with powdered dried berries, saw palmetto berries, for urinary problems, respiratory problems, and digestive problems. Three areas where we’re going to see other folks kind of like building on that foundation. Also there’s a reference to this herb being taken to increase milk in nursing mothers. And if today we’re looking at that and we’re immediately thinking oh, well, prolactin. That’s a hormone. It’s probably doing something with that hormone, right? Okay. Let’s hold that for a moment. There were a lot of other applications for the herb. Like many plants, it wasn’t all about medicine. It wasn’t all about food even. There were some medicinal applications aside from the berry. It turns out that the inner bark was applied topically as a poultice for inflammation, for infections, for bites and stings. So you know, a number of different applications for the bark of the palmetto there. And then fiber, you know, for basketry and so on. And here we give that like two sentences, but…

Katja (00:22:31):
It was really important.

Ryn (00:22:33):
Yeah, yeah. In a living off the land kind of a situation, plants that make great fiber are the difference between life and death.

Katja (00:22:41):
Yeah. It turns out that string, string and rope are really, really important. And also baskets because now you can carry things. You don’t have to just sort of like juggle.

Ryn (00:22:52):
Like you can carry a whole harvest of palmetto berries home in your palmetto basket.

Katja (00:22:56):
Yep.

Ryn (00:22:57):
Great. All right. So moving on forward a little bit, actually I have a quote here from a book from 1911. And this is a book from John Yuri Lloyd. And this one isn’t like a straight herbal. It’s like a history of the herbs that this person and his colleagues worked with. These were folks who would be referred to as either eclectics or physiomedicalists in the kind of history of medicine in America, in particular. And that was a group of folks who were really active in basically the 1800s, a little before, a little after as well. And this was a time when they were the doctors. They were the leading medical authorities. And they worked with the best physiology that they had at the time. And they worked with herbs as their primary medicines. So again, this is a book about the history of their herbs. And what Lloyd was writing here was that the berry of the saw palmetto, practically unknown in medicine before 1879.

Katja (00:24:02):
Okay. So, practically unknown by white guys.

Ryn (00:24:06):
That’s what that means.

Katja (00:24:07):
Yeah.

Ryn (00:24:09):
Came rapidly into conspicuity both in pharmacy and in medicine after that date. It had been observed by the settlers of the south that animals feeding on the matured fruit grew very sleek and fat. A fact that was ascribed to the therapeutic qualities of the berries, reasoning from which they prepared a decoction of the fruit for domestic medication. And then he goes on to talk about some specific doctors, MDs and whatever, who started to work with it and found different preparations for it. And then shared that information in their little medical journal newsletter things that they sent around to each other. And that it became popular really rapidly after that.

Katja (00:24:50):
Yeah. They were posting it on Facebook.

Ryn (00:24:52):
Right, exactly. That’s exactly what was happening. Yeah. So look, big, bold note here. This is not to be taken as a settled fact or as the whole story, because it’s not right. It’s extremely likely in our opinion, I’d say definitely the case, that what really happened here was that indigenous herbalists shared their knowledge about this plant with settlers or with slaves. And then it was passed on to other white people from there.

Katja (00:25:21):
You know, one other thing as a note there is that when we think about animals who grow sleek and fat, that doesn’t necessarily translate directly into human bodies, right? So when we’re talking about animal stewardship, and we’re thinking about, you know, like…Just think about if you’ve been to the park in the fall, and you see like a plump squirrel. And like all of his fur is in great shape and looks very well tended to. And he’s well-groomed, or she, you know, whatever. It’s a little squirrel, friendly little squirrel. And like the tail is really puffy and everything is just plump about this squirrel. And you’re like, that’s a squirrel that’s going to be warm this winter. That is an indication of overall good nourishment for a squirrel. So, that kind of a description in an animal is ah, this animal is well-nourished and healthy. But that doesn’t necessarily translate like, it’s not going to make you fat. You know?

Ryn (00:26:36):
You can imagine someone being turned off from working with saw palmetto upon that description.

Katja (00:26:41):
Right. Right.

Ryn (00:26:41):
Yeah. I hear you.

Katja (00:26:44):
I mean, but also later that’s going to be relevant. Because they’re going to take that like sleek and fatness and be like, oh, let’s plump everything up, you know?

Ryn (00:26:56):
Yeah. Yeah. So like I mentioned, this was an author from the era of the eclectics and the physiomedicalists. And a number of authors from that period wrote about saw palmetto. As an example, the author William Bloyer, writing in 1896, had a number of interesting things to say. So, I’m going to read a somewhat extended quote here, and then we’re going to have commentary on it as we go along. All right.

Katja (00:27:22):
I’ll try not to comment until the end of it.

Ryn (00:27:24):
Yeah. You know, that’s good. So Bloyer says for some time saw palmetto has been used as a general tonic. It aids digestion, promotes assimilation and nutrition, and consequently a rapid gain in strength follows its use. That sounds pretty good. Strength. Yes.

Katja (00:27:40):
I mean, that also sounds logical, right? If you eat food, you get strong.

Ryn (00:27:45):
Yeah. Sedative and diuretic properties have also been ascribed to it. And it is said, too, to act as a special tonic sedative and expectorant to the mucous membrane of the respiratory apparatus. So we’ve already got digestive quality, urinary quality, respiratory quality.

Katja (00:28:04):
And here, I think the definition of this use of the word special is like, especially, you know. It acts particularly as a tonic. Not like as…

Ryn (00:28:16):
Shiny sparkles. Yeah. Okay. it goes on to say besides these it exerts a special vitalizing action upon the reproductive organs of both the male and the female. It’s just right there, both the male and the female. Okay. It increases the functional activity of the whole reproductive system. All right. And then later it goes on to say the saw palmetto, on account of its tonic effects, together with its 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. That’s interesting to me in part, because this is a good reference point for a period in time like our own when this problem is common amongst the men of the society, right? It’s an open question to some extent, whether this extends all the way back in human history. And if we talk to some of our hunter-gathering ancestors, if they had these kinds of urinary difficulties as they aged. Maybe not, because they walk a lot, and they squat a lot, and they move their bodies in various ways.

Squatting & the Effects of Saw Palmetto on the Reproductive Regions

Katja (00:29:29):
By what was it? 1896. Yeah. By then people in this country were not squatting to eliminate any more. They were sitting on outhouse benches to pee and poop. And part of my understanding of BPH, sort of my clinical understanding of BPH, is that the more you squat, the less of a problem BPH is. And so if they were seeing, like we can’t just go back to 1896 and say, oh, I guess this has always been a problem. Ya’ll,1896 was really not very long ago. My own grandmother was born in 1898. So, not that long ago. But when we look at that, we have to think about that from the whole cultural standpoint and be like well, why would four-fifths of them be seeing something that we also are seeing commonly. Okay, they didn’t necessarily have a sedentary lifestyle the same that we do. But already some movements had fallen out of human behaviors in that place in that time, necessary human behavior, right? Squatting to eliminate is necessary for pelvic floor health. And that is a rant that you can hear more of in the musculoskeletal health course and also the urinary health course, because I’m really on about it. We have to squat. But just to be clear that that already was a problem then.

Ryn (00:31:01):
Right. Right. You know, it’s interesting, because Bloyer goes on to say here, we’re 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 disability prevents a complete emptying of the bladder. The residual urine becomes stale, decomposed, and vesicle 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 there is less sagging down behind the prostate.

Katja (00:31:43):
Less prolapse.

Ryn (00:31:43):
Right. Yeah.

Katja (00:31:45):
But also I want to note that that is true today as well. Like when we get to the modern, conventional scientific understanding of saw palmetto, today we also notice that like, oh, saw palmetto doesn’t actually decrease the size of the prostate. It just reduces or eliminates the symptoms. Like different studies have different ranges of reduction. And my feeling on that is nobody’s going to get down there and measure your prostate with like a measuring tape. And so if your symptoms are gone, excellent.

Katja (00:32:18):
Yeah. And there could even be an effect where like, okay. The prostate, it’s a tube essentially. So maybe it’s swollen. And maybe some of the effects of the saw palmetto are happening on the inner tube, right, that’s going through the middle of it. And like, it’s still remaining swollen on the outside, but like there’s a little more space on the inner part. That can be part of what’s on as well.

Katja (00:32:40):
And also the swelling here in hyperplasia is not the same swelling as a sprained ankle. It is not only swelling due to increased fluid just hanging around. There is some. But part of the swelling is actually enlargement, an increased number of cells themselves. So, it’s not just like it has puffed up. It actually has also grown. Well, okay. It grew. Like thyroids grow sometimes too. There are different types of problems with thyroid where the thyroid is saying, oh, I better grow more of me because I’m not as effective as I used to be. Whatever. That’s a whole different issue. But it may not be necessary to shrink it as long as the pressure is not on the ureter anymore.

Ryn (00:33:32):
Right. So, you know, Bloyer says in short it’s through this general tonic effect, rather than through a specific action reducing the size of the prostate, that it becomes the most positive remedy possess in these old men’s troubles. So again, he’s presenting this as a theory or as like his determination of what he thinks is going on. All right. Some other things from this 1896 book. The special vitalizing action of saw palmetto affects the reproductive organs generally. The mammae, the breasts, under its continued use increase in size. The atrophied uterus and its inactive appendages are awakened. And by it, hold on, hold on, hold on, 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 – which is like a varicose vein on the scrotum – 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.

Katja (00:34:47):
Oh, so dramatic. I can’t even.

Ryn (00:34:50):
Yeah. All right. So, we’ve got a few things going on here, but pay attention to some of the energetics language. The eclectics, the physiomedicalists, they didn’t always say this is a warming herb. We use it for cold conditions. But sometimes that language does kind of sneak in here. So here we’re talking about the cold female or male, you know, person or organs in particular. And essentially the claim here is that this herb is going to warm things up in this here region.

Katja (00:35:20):
Yeah. It really sounds disgusting. But actually, if we just look at it energetically, like cold slow down of function. And some people would not like to have sexual lassitudes. Some people would like to increase their libido. And if there is a cold state of depression or slowing down of the libido, then this one particular way that this person wrote the sentence is ghastly. But what this is really saying is if you feel that you would like to increase your libido, and your libido is low because of cold, stagnant situations, this could help.

Ryn (00:36:11):
Yeah. And again, here Bloyer is a little uncertain about some of these claims, right? He says, looking at all of these things as we do, we cannot explain why saw palmetto should increase the size of the mammae, the testes, the reproductive organs generally, and yet reduce the size of the prostate. We do not believe that it does, but we are open to conviction. And it essentially ends like any other scientific study in the entire world, which says more study is required.

Interpreting Historical Herbal Writings in Context

Katja (00:36:41):
You know, it’s really worth thinking about this, because aside from the sexual lassitude or whatever it was he said, another thing that really irritated me reading this was the whole, like it will increase your boobs. Because the first glance, when in my own head reading that, I just thought about the last time I was in San Antonio. And literally every other billboard I saw, like every second billboard, was a plastic surgeon advertising that women should have breast enlargement surgeries to make them more attractive. And so like, that’s the modern kind of thought when we see that sort of thing. But if you think about this in the historical context. And this is why, like, it’s just so important to kind of check yourself, and be like, hmm, is this really what they were saying even though it sounds terrible. In the historical context it’s likely that what they were describing here with regard to the breasts was something more like resolves problems of depletion in mothers who don’t have enough milk supply, right? Or even if we’re talking about sexual lassitude, resolves the problem of not being able to reproduce in a society for whom reproduction was really vitally important. So we can take our issues with women only being defined by having babies. And let me tell you, I have a lot of issues about that. But especially if we’re thinking in terms of milk supply, I can really see the value here. And honestly, I can also see it even when we’re talking about not being able to have a baby. Because lots of people even today are sad that they can’t have a baby. Lots of people would like to not be pressured to have babies and not be defined by whether or not they’ve had a baby. But also lots of people want to have them.

Ryn (00:38:28):
Right. And these aren’t actually in conflict at all. Like people want to be able to make their own decisions, and that’s it. Like how… Okay.

Katja (00:38:36):
So, one thing, you know, to be aware of when we’re reading these is that our modern biases aren’t necessarily wrong, but we have them. And the way that they were writing is also not necessarily wrong. Sometimes we have to kind of like really interpret the language. And that is not the same as saying, well. It was a different time then, and people just didn’t know better, right? Like you hear that all the time about slavery and about all kinds of things that, let me tell you, people knew better. There were people who knew that slavery was wrong. There is no excuse. So that’s not the stuff I’m talking about here. But in a case like this, the thing that was at the top of people’s minds a hundred years ago is not necessarily the thing that’s on the top of my mind today as I’m reading this. And the top of my mind today is, hey, I don’t want my friends to be pressured to have children. I don’t want as a woman to be defined by whether or not I had a child, you know, as a very sort of feminist. And for that matter I don’t want a person who is asexual to feel defined about whether or not they are having sexual lassitude or not. Like I just don’t want anybody to be defined by these factors. I want us to be able to find ourselves in our own terms. But maybe a hundred years ago, 150 years ago, somebody’s top priority was I really want to have a kid. Or I have had a child and I cannot nourish it. And so it’s hard to read historical texts. But to think about it in all those ways, even when the first thought is to be really mad or reviled about something that you read.

Ryn (00:40:29):
Yeah. Yeah. For sure. So, yeah. A lot of these actions are definitely from that nutritive quality, first and foremost. So we like many English speaking herbalists often like to refer back to a book by Ms. Maude Grieve from 1931.

Katja (00:40:49):
Well, she was married, but I prefer to not define her by her marriage.

Ryn (00:40:52):
There we go. Yeah. Right on. It’s an important book in the western or the American and British herbal traditions. And in that book she’s writing, and you can actually see some texts, that’s honestly – no shade or anything – lifted straight out of some of those eclectic people. One of the first lines in her section on medicinal actions and uses of saw palmetto where she says that it’s a diuretic, a sedative, and a tonic. She says it is milder and less stimulant than cubeb or copaiba, or even the oil of sandalwood. That sentence is lifted straight out of an eclectic text. And that’s fine, right? That’s not a problem at all. But you know, she goes on to say like these herbs it has the power of affecting the respiratory mucus membrane. And it is used for many complaints, which are accompanied by chronic catarrh. That’s like snot, yeah.

Katja (00:41:49):
Like thick, gross mucus.

Ryn (00:41:51):
Yeah. It has been claimed that sabal, which is one of the older names for saw palmetto, is capable of increasing the nutrition of the testicles and mammae in functional atony of these organs. Basically saying when they’re atrophied, not fed, under nourished, under formed, then this herb can help to feed them and bring them back. And then she goes on to say, it probably acts by reducing catarrhal irritation and a relaxed condition of bladder and urethra. It is a tissue builder. Remember to look out for key words, like relaxed, because this doesn’t just mean like your bladder and urethra chilling out, right? It means that they are lax. They are slack. They have lost the proper tone that they require.

Katja (00:42:33):
Saggy. Yeah. You know, and a more modern way to say catarrhal irritation, right? Like that’s not a word that even is easy to say, much less like..

Ryn (00:42:43):
Catarrhhhhh.

Katja (00:42:43):
Like it’s not even useful in today’s speech or whatever. But listen, that translation of that in words that we work with today, or that we would say today, are lymphatic stagnation, or even rheumatic inflammation. Now, when we hear the word rheumatic, we think rheumatoid, and then we think arthritis. But actually rheumatic is damp, stagnant inflammation, not just in the joints. It can be anywhere in the body. Edema would be rheumatic as well, right? So, okay, good. If we think about the application for BPH, benign prostatic hyperplasia, hey, look. That has a stagnant component. It has that like too much fluid-not enough movement kind of component. And also stay tuned, because it’s going to turn out that prostates are not the only thing in your body that can have benign hyperplasia, right? We can see that in lots of places. And I’m very excited to talk about it, but hold on. We’re not there yet.

Ryn (00:43:48):
Yeah. So, you know, our takeaways from looking at some of these classic herbal books, you know historic traditions, folkloric traditions. One key takeaway here is that they all report saw palmetto to be a genitourinary tonic in both sexes. And again, that fundamental fact is like really lost on, I don’t know, marketing for supplements in the 2020s.

Katja (00:44:18):
Yeah. Today I think it would be, well in any day. It’s not just today. But today we acknowledge that it’s more accurate to say that it’s a genitourinary tonic in all people.

Ryn (00:44:28):
There you go.

Katja (00:44:28):
But okay.

Ryn (00:44:31):
Yeah. Good. And also another big takeaway here is that they were working with this herb for a lot of actions that are entirely unrelated to the reproductive organs and the pelvic floor. Remember those repeated references to this being a digestive tonic for the respiratory catarrh. And so again, this herb really, really got pigeonholed. Lots of herbs are susceptible to that. But certain plants have just gotten into a really tiny box, and saw palmetto is definitely one of them.

Katja (00:45:01):
You know, and saw palmetto actually is kind of a prickly plant. I’m surprised that they managed to get it into that little tiny box.

A Modern Microscopic Method of Action of Saw Palmetto

Ryn (00:45:09):
Yeah. Okay. So, let’s take a minute and look now at what the modern world thinks about saw palmetto. And we can start by talking about its most famous apparent molecular level mechanism of action.

Katja (00:45:27):
Oh, this is such a thing, right? Because when we talk about mechanism of action on this kind of a level, like the kind of mechanism of action you can only see through a microscope, we have to understand that whatever it is that we think we know is not the whole story. It’s only what we’ve seen so far. There may be many other mechanisms of action. There may be many other kinds of cells involved in the situation. These are just the ones that we bothered to look at.

Ryn (00:45:59):
Right. Yeah. So if you go and you Google, what does saw palmetto do, right? Or how does saw palmetto help BPH, you’re going to get something like this. The herb can cause an inhibition of the enzyme five alpha reductase, and this will then reduce the conversion of testosterone to dihydrotestosterone or DHT. What? Okay. So they’re saying that something in saw palmetto is inhibiting the activity of this particular enzyme. An enzyme does a transformation or a breaking down or a changing of some other chemical inside of your body. And what this five alpha reductase enzyme does is that normally it would take your testosterone and convert it into DHT. If you inhibit that conversion, if you inhibit that enzyme activity, then you reduce the amount of conversion of testosterone to DHT. In addition to that, something in saw palmetto seems to compete with DHT for what’s called receptor site binding. Basically any chemical in your body has to actually go to a cell and attach to it in order for its job to be done, for it to have its effect on that cell, right? If you can block those receptor sites, if you can fill in those sites where the DHT in this case would be doing its binding, then you can prevent it from having its effect on your system. And ideally what will happen at the same time is that it will get cleared out of the system and just be you’re done with it now, right?

Katja (00:47:26):
So what we have here is two different mechanisms that have currently been identified to effectively reduce DHT in the body.

Ryn (00:47:35):
Yeah. Reduce the signal, the conversion, the conveyance of that signal in the system. So what is DHT, right, and why do we want to reduce it? Well excess amounts of DHT, like your T to DHT ratio. When that gets too much DHT in your body, that can contribute to prostate swelling and also some kinds of hair loss, and actually it turns out a number of other hormonal imbalances in the body.

Katja (00:48:06):
I think the word contribute is doing a lot of work there. Because this is not necessarily the only cause. In fact it is definitively not the only cause. But it is a cause that has been identified, and this cause has been identified because it’s something that we can control, right? Like that’s how conventional medical science works, is they identify a problem. And then they say, well, let’s find something we can control that contributes to this problem, and then we’ll control it.

Ryn (00:48:37):
Right. Yeah.

Katja (00:48:39):
And we can’t necessarily control how many Oreos a person eats, but we can make drugs that will change the way that DHT functions in the body. And then we can sell them.

Ryn (00:48:50):
Yeah. That seems better to me. I don’t need to be controlling people anyway. So, you know, there are multiple…

Katja (00:48:56):
I mean I think that people should know that their choices about Oreos might play a role here.

Ryn (00:49:00):
Yeah. We want to educate people rather than controlling them. That seems like a general idea to me, yeah.

Katja (00:49:07):
We want people to have the information that they need to choose their own controls.

Ryn (00:49:11):
There we go. That’s what’s up. Yeah.

Katja (00:49:14):
Wait, wait, hold on. I’m not done. To choose their own controls, even if the control that they choose is I’m eating the Oreos, and I’m taking the pharmaceutical. That is a valid choice.

Ryn (00:49:23):
Yeah, for sure. So, you know, on this effect of like basically reducing DHT signaling in the body, there are many, many studies about that. We’ll include a good review article in references for this, but there are a lot out there. This has been really intensively investigated. And this is where you’re going to see people take away an idea that saw palmetto can be antiandrogenic. Androgens, the normal definition would be hormones that cause the expression of male characteristics, something along those lines. Testosterone would be your most famous androgen. What they’re basically saying is that DHT is like testosterone that’s turned up in terms of its volume or its potency or its power in the body. And so if you reduce the T to DHT conversion, you’re reducing this overall androgenicity in your body, right? And there are some folks who have taken that concept and really run with it.

Katja (00:50:24):
Yeah. In doing some research, I came across this product called TestoQuench. TestoQuench for women claims to be an androgen antagonist formula. And I could do a whole hour just on that alone and the ingredients of this particular formulation and other things. But…

Ryn (00:50:52):
But the approach that they’re taking with the formula, right? The idea is we’re going to get a bunch of herbs in here that are going to interfere with androgen signaling. They’re going to block androgens or maybe try to reduce your production of them. And we’ll see why this approach is taken, and why it’s associated with saw palmetto as we look at some other studies as we go along here.

Katja (00:51:13):
Yeah. And in this they’re targeting maybe people with PCOS, and even specifically people with PCOS who are displaying some of these androgen mediated characteristics, like maybe more hair growth, for example, and who don’t want those. Who would prefer not to have that type of hair growth. So I don’t want to say that like the desire to modify those expressions in the body is wrong. I can’t necessarily get behind that particular product, but there are a lot of different approaches to manage symptoms like that that are unwanted, and androgen antagonism is not the only way to do it.

Ryn (00:52:07):
Yeah, for sure. Okay.

Katja (00:52:09):
Or wait, and one other sentence there. And saw palmetto’s helpfulness in that regard, in that cascade of symptoms, is also not only because of its perceived ability to be an androgen antagonist. That may play some role, but that’s not the only factor that’s going on.

Ryn (00:52:27):
Yeah, absolutely.

Katja (00:52:29):
Okay. Now I got it all out.

Phytochemistry, Fatty Acides & Hormones

Ryn (00:52:30):
Yeah. So, you know, when we get this kind of like microscopic mechanism of action, that usually comes together with some constituents that are supposed to be responsible for that action, right. In this case, when you look at saw palmetto from a phytochemistry standpoint, you see this is one of those plants that makes a lot of fatty acids. And if you were to grab a berry and squeeze it, you’d be like this feels oily.

Katja (00:52:55):
Yeah, they’re kind of gross.

Ryn (00:52:56):
It’s the presence of those fatty acids. Yeah. It’s one you definitely don’t want to let it like rot or go bad near you. Because you know how rotting fat smells. It’s not great, right?

Katja (00:53:07):
Yeah. It wouldn’t be awesome.

Ryn (00:53:08):
Yeah, so anyway, there’s some free fatty acids in there. And then there are some that are bound up with another compound called a phyto-sterol, and most famously beta-sitosterol is one that we’re going to investigate here. And then those can get bound up together and form what are called liposterols. And we’re going to see that term come up a lot in the folks who are looking at these molecular mechanisms. Okay. But the thing that I would like to point out here though, is that not everything the herb does is actually explained by hormonal mechanisms. In fact, there was a scientific study from 1999 about saw palmetto shrinking the epithelium of the prostate, kind of the tissue around the edges of it. And in that one they concluded that saw palmetto was beneficial in reducing the swelling of prostate tissues by an unidentified, but non-hormonal mechanism in patients with BPH. So I found that to be particularly worth pausing a moment on. Because pretty much every other study about saw palmetto is going to be all mediated through hormonal interactions.

Katja (00:54:10):
Yeah. And again, I think that simply reflects the perspective of that type of study that they’re looking for that. If they were looking for the non-hormonal mechanism…

Ryn (00:54:25):
They might find it.

Katja (00:54:27):
They might find it. Yeah.

Ryn (00:54:29):
Yeah. For sure. And you know, it’s funny because with saw palmetto, again, we’ve run into a lot of seeming contradictions, right? So we had talked about how this herb in some contexts is referred to as antiandrogenic, but it’s also considered antiestrogenic in some sources as well. And in trying to figure out what could be going on there, there’s often a focus on those phytosterols that I mentioned, especially beta-sistosterol. Those are sometimes categorized as phytoestrogens. And phytoestrogens can get complicated. But one of the things that they can do in the body is they can go and they can bind to the same receptor sites that estrogen would like to bind to, except they have a weaker action on the cells that they attach themselves to. And so if you have a bunch of phytoestrogens in your body, and depending on what point you are in the course of your life, if you’re basically between puberty and menopause, then at that point working with phytoestrogens can reduce your overall estrogenic activity. Okay.

Katja (00:55:35):
Maybe we say estrogenic impact.

Ryn (00:55:37):
Signaling. Yeah. Right, Right.

Katja (00:55:39):
Because like you still may be producing the same amount of estrogen, but the receptors are getting filled up by a lower, less effective version. Or less effective is also not quite accurate. They’re differently effective. And this is where we’re going to get into alpha and beta estrogens. And we’re not quite ready to talk about all that yet. But sort of like maybe we say a quieter estrogen, right? Like a less intense estrogen. And because of that, if you’re filling all your receptors up with a lower volume, then the overall impact of estrogen in your body is going be reduced. Or it’s going to appear to have less expression.

Ryn (00:56:27):
Yeah. So where you turn your focus is going to alter the way that you see this herb, right? If you look at it, and you get really hooked on the phytosterols, and you connect them to being phytoestrogens. And then you go and you look at the way those can impact your body, you can be like, all right. I could see where this could reduce estrogen activity or estrogen signaling. If you focus more on those effects on testosterone and DHT, then you might say more of an anti-androgenic effect. So these things can all be kind of swirling around each other. And we’re going to let them kind of hang there for just a little while longer. All right. So…

Katja (00:56:59):
Even though it’s really uncomfortable, and I don’t want to do it.

Ryn (00:57:01):
Yeah. It’s going to be okay. You know, one other way to look at that is that maybe it’s reducing that estrogenic activity specifically in the pelvic floor organs. Like not everywhere in the body, but right here where it has its affinity. Okay. That could be part of it too. But if you look for saw palmetto for women, what you’re going to find is actions centered around it for hair loss or excessive hair growth.

Katja (00:57:25):
Yeah. Which is really like…Yeah.

Ryn (00:57:29):
But where these are associated with hormonal imbalances, right? That’s the place you’re going to see these recommendations, and where they’re written for women.

Katja (00:57:38):
Right. Like if you sort of put that whole thing in quote marks in your search term, like saw palmetto for women, then this is what will come up.

Modern Herbalists’ Take on Saw Palmetto

Ryn (00:57:49):
Yeah. And of course, you know, this is in some sense what we’re really talking about here is humans who have a uterus and some ovaries and that kind of like equipment going on. This is mostly what they mean by that. Well, let’s look at a couple of these and we can start with Jill Stansbury. She’s writing here in the Medical Herbalism journal that saw palmetto may be of use for women with polycystic ovaries, PCOS, or a Stein-Leventhal disease. Another case where there is elevated testosterone relative to estrogen. Hirsutism, which is excess hair growth, cysts on the ovaries and ovulatory cycles and menstrual irregularities. Liposterol constituents in Serenoa plants have been shown to inhibit the formation of dihydrotestosterone – okay – and may improve reproductive function in such women. Right. So again here this is really centered around these problems of what’s always shorthanded as hormone imbalance, and I always hesitate to even pronounce that phrase. But that is the kind of concept set that people are working with when they think about this plant. Another author, another herbalist, Sharol Tilgner writes that saw palmetto is indicated for wasting of sexual organs. You see a call back to some of that eclectic work there, right? Underdeveloped breasts, lack of sexual desire. Okay. So again, that’s kind of referring back to those comments. Saw palmetto supports tissue nutrition of the urinary tract, and has been widely used to treat benign prostatic hyperplasia, BPH. Saw Palmetto acts on the primary signaling pathway by limiting DHT activity. It also decreases inflammation, which is actually super important.

Katja (00:59:36):
Yeah. I actually feel like that’s so much more important than all this DHT stuff.

Ryn (00:59:39):
Right. Yeah. It’s indicated for antony of pelvic organs. We’ve heard that before. Urethritis, inflammation of the urethra, impotence, and all wasting diseases of the male pelvic organs. Okay. Crossing some gender binaries here. Good, good. Beneficial for undeveloped mammary glands, enuresis, incontinence in children and the elderly. Bedwetting, you know.

Katja (01:00:03):
I love that they leave people out in the middle. Like there are so many reasons that incontinence can be a thing. And it’s not just for kids and the elderly.

Ryn (01:00:12):
Especially with interstitial cystitis following right afterwards. I mean, it’s an inflammatory problem around the bladder. It can lead to a little leaking here and there, you know. But she goes on…chronic bladder infections, and then jumps over to the respiratory system. Respiratory conditions like head cold, sore throats, bronchitis. And then, you know, other things that we’ve already seen there. So these are examples of modern herbalists who at least have some awareness of the variety of activities that the herb can exert, right? Yeah. Okay. We also had some text here from restorativemedicine.org. I think this was written by a number of authors together. And here they’re much more focused on these hormonal activity.

Katja (01:00:56):
That is the…I was just about to say AARP, but…

Ryn (01:01:00):
American association for Restorative Medicine?

Katja (01:01:03):
Yeah. AARM, that’s right. AARP is a different organization.

Ryn (01:01:08):
Yeah. But so in this monograph about saw palmetto they write that genitourinary health and symptoms of conditions, including BPH, nonbacterial prostatitis, and chronic pelvic pain syndrome. This is a hormonal modulator of estrogen and testosterone helpful for PCOS with hirsutism, that hair growth situation. They go on to talk about the fatty acids in here, the esters of them, the way they can act. And then we get our friend five alpha reductase, right, that enzyme, saying here that five alpha reductase is found in the adrenal glands and in the prostate. And it converts testosterone into its most active form DHT. And then they also comment about the beta sitosterol and the phytoestrogenic effects, right? So they’re kind of layering on these different hormonal activities, and trying to keep them all in working memory at the same time. They comment that the liposterols are also doing that inhibition of receptor binding of the androgens. That’s that other side of like you reduce production, you prevent binding. Those are like two sides of the same coin in the end. It’s worth noting though, that the reference they have about the receptor binding is in, hold on, cultured human foreskin fibroblasts. So this was an in vitro study. And it’s important to remember that. A lot of what’s referenced in this monograph about hormonal activity is about in vitro studies. And whether that translates directly into a free-living human is not actually a settled question.

Katja (01:02:43):
Right. In vitro means in a Petri dish, in controlled laboratory conditions where they were specifically trying to stimulate one specific action. Whether or not your body is going to stimulate that specific action is unclear.

Ryn (01:02:58):
Yeah. But they definitely regard this as what they’d call an antiandrogenic compound. And the comment that women with hirsutism and elevated testosterone may have excessive five alpha reductase activity, which basically means too much DHT. Male pattern baldness, also called androgenic alopecia, and thinning of the hair in women or men may also be initiated and promoted when this enzyme is upregulated. Saw palmetto has been shown to promote hair growth compared to placebo in men who have this particular kind of baldness pattern going on, androgenic alopecia. And the herb might benefit women as well. And then they comment that those elevations in androgen are the hallmark of PCOS, polycystic ovarian syndrome. And basically that saw palmetto is a promising herb to consider in cases like that, because of this effect on these enzymes and on these hormone balances.

Katja (01:03:56):
You know, actually as you’re reading that I really want to draw attention to the adrenal glands here. And just say like, we have all this data that comes from these studies, but something that they are not referencing is what else is going on in the adrenal glands. Are these adrenal glands healthy? If they were healthy, would they be making the appropriate conversions for that person? And today I kind of don’t think that anybody’s adrenal glands are healthy. In fact I think that most of us have endocrine cascade problems, because most of us are eating too much sugar, right? Like, no matter how hard you try, it is very difficult to not eat too much sugar. Because your need for sugar, especially like added sugars, is zero in fact. And you know, like your need for an apple maybe, but like your need for granulated sugar is zero. And it’s very difficult to have zero sugar.

Ryn (01:05:03):
And of course there’s so many other things that are going to interfere with normal functioning of your adrenal glands, right? Stress, sleep deprivation, sedentary habits, right? All the things that we love.

Katja (01:05:14):
All things that people have. Today everybody has too much stress. Everybody has sleep deprivation. And what was the other thing you said?

Ryn (01:05:20):
Sedentary habits.

Katja (01:05:20):
Right. Everybody has sedentary habits. I was like, nobody’s getting enough movement. No, everybody has sedentary habits. Right.

Ryn (01:05:27):
Yeah. And absolutely all of those are going to be relevant, especially when we’re talking about the impacts of like these organs of the stress response and the organs of your pelvic floor, where our sedentism manifests as sitting or as being like curled down and in. And there are stagnation patterns that develop. So yeah, it’s all going to fit in. It’s all going to feed together. And it would be lovely if we could have all of that in mind when we’re looking through the microscope.

Katja (01:05:54):
None of that means that the data that they have seen so far is wrong. I’m not saying, oh, well y’all are stupid. And everything you saw was wrong because you didn’t think of the adrenal gland health. I just would like to have that as part of the context. I think that it would make the data much more relevant if we also had the other factors involved in the picture.

Ryn (01:06:18):
Yeah. Well, you know, so there again we also saw these more modern herbalists and research groups thinking about again, quote unquote, both genders there. But it’s helpful to kind of break that binary and look at some more varied expressions of human sexuality and reproductive functions. So Larken Bunce and Vilde Chaya Fenster-Ehrlich put together a great resource called Competent Care for Transgender, GenderQueer, and Non-Binary Folks, and including some herbal notes and considerations there. And they mention in it saw palmetto as potentially helpful for hair loss associated with testosterone therapy. But they note that it might interfere with some of the effects of exogenous testosterone, like when people are getting injections or getting treatments to increase testosterone in their system. And going through their presentation, you know, you’ll find that saw palmetto is mentioned both as a potentially masculinizing plant, and also as a potentially feminizing plant. On the masculinizing side, they comment that it can slow conversion of testosterone to DHT, and then increasing serum levels of testosterone and decreasing scalp hair loss. That’s that androgenic alopecia thing. But also body hair development decreased as a result here. And they comment that it’s an unknown impact on hormone levels when it’s combined with synthetic hormones, right? So that’s an area, that’s a statement we could say about lots of plants, right? That this hasn’t been deeply investigated yet, but thankfully there is some progress, you know, getting along. On the feminizing side, they comment again that it can slow conversion of testosterone into DHT, potentially decreasing scalp hair loss and also blocking some of the masculinizing effects of endogenous testosterone. So this would be somebody who’s transitioning male to female and is trying to reduce the activity of their own testosterone in the body. And they comment that it may cause small amounts of breast development. Again, you can see that call back to the eclectics there, right?

Katja (01:08:20):
Yeah. I think that is unclear if that would be universal across all bodies. Or also whether that would be universal across all times in the same body. Right?

Ryn (01:08:31):
Yeah. But again, we’re seeing this kind of like binary or this kind of some things argue in this direction. Some things argue that direction. It’s a little bit kind of fuzzy in the middle there. So I’ll told so far what we’ve got are some theories about mechanism of action. We’ve got a variety of signals that the herb can support or inhibit in the body. And then based on all of that, or emerging from all of that, we have an array of different visible effects. Okay.

Energetic Actions of Saw Palmetto

Katja (01:08:58):
So now we can…we’ve looked historically. We’ve looked at the more modern perspective, both in the conventional realm and also in the herbal realm. Let’s take a modern look at energetic actions, right? So energetics again, that is the way that we would identify what’s going on in the body and match that up with what’s going on in a plant, the skills that a plant has, the jobs that it can do. And we use those same strategies, that same understanding, in modern herbalism as well, with like maybe updated a little bit from its origins. But so we can look in our practice and say, all right. What’s going on in this body, and figure out what actions we need to take. And we can think about the situations where we would work with saw palmetto and look at that energetically from this more modern perspective.

Ryn (01:09:58):
Right. So the herbalist Peter Holmes has a book called Energetics of Western Herbs, and has a great monograph about saw palmetto in there. And in it he writes from the energetic perspective saw palmetto berry’s dominant, sweet oily, moist, warming qualities restore and nourish weakness and cold in the urogenital and digestive tract. The remedy is a particularly effective nutritive tonic or trophorestorative to the reproductive organs. So identifying there some key qualities, right? Moistening, warming, appropriate for cold and for weak or deficient states. And then also having like that trophism or that like area in the body where it acts most notably.

Katja (01:10:46):
By weakness we can also hear that as laxity. And so, especially because we’re talking about urogenital, then we can think about prolapse, that kind of sort of like sagginess in general. So if we’re thinking about BPH, we’re thinking about swelling of the prostate, also some general area sagginess. We’re thinking about stagnant fluids. We have muscular and connective tissue laxity. And hold on a second, we also very commonly have insulin resistance or diabetes. It is super, super common to see these things together, so much so that insulin resistance and diabetes are considered a very prominent risk factor for BPH and for prostate problems in general.

Ryn (01:11:41):
Among other things.

Katja (01:11:43):
Right. Well, and that gets us into our other factor here. What does hyperplasia really mean? So that area, you can have hyperplasia in lots of different places, that area is producing too many cells causing some swelling, causing enlargement, and also there are some retained fluids, right? So what are some really common other places to have hyperplasia? Guess what? The ovaries and the uterus. Ovarian hyperplasia is sometimes called hyperthecosis. The words are sort of interchangeable. And in the uterus most commonly we see that as endometrial hyperplasia, right? The risk of both of these is much, much higher in people who are insulin resistant or people who have diabetes. All right. Well, let’s think about insulin resistance and diabetes. That is a cold state, right? That is a state of some stagnation, some coldness, some laxity.

Ryn (01:12:43):
Damp accumulations.

Katja (01:12:44):
Yes, right. All of these things are things that saw palmetto can help with. So if we are working backwards, hyperplasia can happen regardless of what kind of reproductive organs you have. And it is much more likely to happen in a state of insulin resistance. So would I just say, well, I’m not going to work with saw palmetto for this person with ovarian hyperplasia, because saw palmetto is for prostates. That would be so silly. The factors are so similar. Of course I would consider saw palmetto, right? Like energetically, it wouldn’t make any sense to rule out, even if historically nobody had ever tried it for things other than prostates. It still wouldn’t make sense for me to not try it, because all of the energetic factors, like the environment that I’m working with, is the same. Just the difference is is it an ovary or a prostate. Is it an endometrial lining or a prostate. Well, goodness. Those are also very, very similar.

Ryn (01:13:46):
Yeah, absolutely. So what does this all mean for you, Dear listener? What does this mean for you? Well, as is often the case likely you’re going to need to try it and see how it does for you.

Katja (01:13:57):
Hey, I did.

Ryn (01:13:58):
She did that. That’s why we’re talking about this. Well, one of the many reasons, but yeah.

A Small Case Study & A Lot of General Experience

Katja (01:14:02):
And so this is, like always the final and I think maybe most important aspect of herbal learning is you go to every possible source. You learn as much as you can. And then you have to try it and find out what your personal experience is. And try to understand that in the context of everything that you’ve learned so far. All right. So I tried it. And some background here, like very tiny case study. I often work with mullein root and with uva-ursi to help with pelvic floor insufficiency, which for me is mild prolapse and mild incontinence issues that are common in people my age in this culture. As expected, as you would probably guess, especially if this is not your first time studying with us, I have some pelvic stagnancy due to my participation in the sedentary culture, but also my own personal constitutional tendency towards stagnation. And so this is work I already had been doing for a long time.

Ryn (01:15:17):
And with mullein root and uva-ursi, what we’ve got there is diuretics, pelvic floor tonics, astringent herbs with an affinity to this region.

Katja (01:15:27):
Right. So I wanted to see would saw palmetto be as effective or be similarly effective as these other two plants that I already had been working with and seeing good effects. And I had already been working with those two for 8 or 10 years at the point at which I started working with saw palmetto to see if I could have similar effects. So often we talk about formulation, but in this case, typically I work with these as simples. For a while I will take mullein root, usually for like a month or so. I don’t, like, do it on a calendar, but it just sort of works out that way. And then I’ll switch up and take some uva-ursi. That I typically do for only like two weeks. When I work with mullein root I do that as tincture. When I work with uva-ursi I do that as tea. And more than two weeks of uva ursi tea is kind of rough on the kidneys, so I sort of leave it right around that week and a half or two weeks. So I added in saw palmetto as a capsule. I took the Gaia brand saw palmetto capsules. And in my experiments I typically took it for a month at a time, because that’s about how long a bottle would last before switching in the rotation to mullein root as tincture or uva-ursi as tea. And what I found was that it was basically equally effective pretty much straight across the board. I didn’t see any disruption in benefit, right? Like the benefits that I already expected to see from the mullein root and the uva-ursi continued with the saw palmetto, which also checks with my hypothesis, right? It should have provided the same sort of benefit. Now what I have not yet tried is as a tincture or a decoction. I do plan to do both of those things, but I haven’t gotten to it yet. But I have done I think four rounds with the capsules over time. So swapping that in and out at different times of the year. Because again, you’re not the same all the time, so trying it multiple times to make sure. And for me I saw very positive results. And that’s an important data point.

Ryn (01:17:53):
Yeah, yeah, absolutely. And you can’t take Katja’s. You’ve got to make your own.

Katja (01:18:00):
I mean, my data point is a point of data for you, but it still isn’t completely relevant in your body. No matter what I like or don’t like, no matter what works for me or doesn’t work for me, we won’t know for sure how it works for you until you try it. Or any person.

Ryn (01:18:18):
Yeah. And so the logical next question when someone says, well, you should probably try it for yourself, is how safe is it for me to try it out like that? Great question. All right. So let’s try to answer that one.

Katja (01:18:32):
You know, and in this particular case, it’s an easy answer. Because there’s so much experience happening, and there’s so much study happening. So we have a lot of data.

Ryn (01:18:44):
Right. Yeah. By experience this is one of the most popular herbs on the market, and it has been for decades. Like it’s one of your top selling plants, you know? So there is a lot of good information about it that way. If there were like rampant, serious safety problems, we would know by now because of how many people have been taking it for how long. Our favorite safety reference is called the Botanical Safety Handbook. Second edition really matters. And they have like a rating system. And this herb is a 1A herb in their system. That means that it’s low risk for any kind of adverse events, and also that it doesn’t have any known drug interactions to be concerned about. Great, that’s good news for us. When they looked for adverse events they found that they were similar to placebo in all cases. So again, it doesn’t seem to be a dangerous kind of a substance. Interestingly in looking through the writeup about this in the Botanical Safety Handbook, we both noted that in vitro studies, in a Petri dish study, they did find some action of this herb or its extract on liver enzymes. And that’s relevant because if you alter the way those liver enzymes work, you can alter the metabolism of other medications or drugs or things that you might take into your body. So, in vitro, in the glass study, they saw that happen, but this same effect was not observed in human trials. And that’s a very important point. In this case, it basically means that if you only looked at the Petri dish study, you might think, oh, I’m going to have problems, because that’s going to alter the metabolism of my Prozac or my Allegra or my whatever else. But that’s not actually born out in human experience, and it’s been directly tested in this case. But it’s an important point that’s broader than just that one example. This may be true about many of the known or the discovered micro level activities of the herb and its constituents. And this is true for every plant. It’s not unique to saw palmetto.

In Vitro vs. In Vivo Studies & Types of Extracts Can Yield Contradictory Results

Katja (01:20:50):
Right. Just because you can see it in a Petri dish with a microscope does not mean that it is going to happen in your body.

Ryn (01:20:57):
Yeah. That problem is particularly acute when it comes either to, well anti-microbial herbs would be a really big category there. Any of your antibacterial, antiviral, antifungal plants, like always try to make the connection or see if there is any possible connection between I squirt the substance onto a colony of critters in a Petri dish and they die versus where do they live in my body and how is it going to get there if I take it orally or put it on topically? Is that even possible? Can it get at the right concentration? So with those antimicrobial herbs, that’s a really big break between an in vitro study and an in vivo study, like in living critters. Another big category we run into problems like that is hormonally active herbs, right? Because a lot of times when people say that this herb has activity on a hormone, what they base that on might be, well, we took some uterine cells out of a Chinese hamster. That’s a species, like a type of hamster. They just use them a lot in these studies. We put them into a Petri dish, and gave them some stuff to grow on and to cultivate. And made a little, like, you know, a little nest of them in there. And then we put some extract of our saw palmetto berry or some other herbs on it. And we measured how much hormones was in it before and after. And that’s where we say it causes this hormone to be secreted or whatever. So a lot of them are based on that, right? Some of them are based on like, we take your blood. We give you the herbs for some amount of time, and then we take your blood again. That’s a much different situation.

Katja (01:22:24):
And even that is still imperfect, right? Because serum hormone levels, like the amount of a particular hormone in your blood at any given moment, is not necessarily a reflection of what’s going on in your body in that moment.

Ryn (01:22:39):
Yeah. Right. So not to say we’re throwing out all of the bath water and the baby and everything else. We want to take from these kind of information sources what we can, but we just have to keep these kind of awarenesses in mind whenever we’re talking about herbal activities, but especially these ones that are primarily understood through the use of microscopes and lab devices. Yeah. About safety, I did find a couple of case reports of, these were pre-pubescent girls, and they were basically growing too much hair. And they, or their parents, or whoever was making this decision was trying to get that to stop. They were taking saw palmetto berry supplements, and they ended up getting hot flashes. So my advice for you is don’t really give this herb to kids. We had mentioned the bedwetting thing previously. That would be a short-term kind of intake, right? That’d be very different from a case like this, where it would have to be a chronic, kind of a long term intake situation.

Katja (01:23:41):
Also, honestly, if it was bad wedding, like…

Ryn (01:23:46):
Oh, come on. I mean yarrow, even corn silk, if it was made from organic.

Katja (01:23:50):
There are so many other herbs. And if I really was going to work with saw palmetto for bedwetting, I think it would be a decoction.

Ryn (01:23:57):
Probably.

Katja (01:23:58):
Or tincture, but it definitely wouldn’t be capsules. We also have to recognize that the capsules are standardized, and they’re standardizing towards BPH efficacy. And that is not the same as working with the whole plant.

Ryn (01:24:13):
Exactly.

Katja (01:24:13):
So it is not necessarily bad, but it’s not the same as old data from the 1800s about bedwetting.

Ryn (01:24:24):
Right, right. Exactly. Yeah. So, you know, also keep in mind that when there is conflicting data, including in some of the lab reports and things, but also about these questions of safety or adverse event reports or that kind of thing, that a lot of it is due to variants in the material that they’re studying. And by that I mean specific products or preparations of the herb, right? You can make a lot of different preparations of saw palmetto berry. And that’s true whether we’re talking about like decoction versus tincture versus some kind of extract. But within the realm of extracts you could use like alcohol to make your extraction, and then boil it off and be left with what’s there. You could also use this other menstruum called hexane. And a lot of the saw palmetto products are made with a hexane menstruum initially, because that’s going to get you a lot of what are called lipophilic constituents. And when we’re talking about fatty acids or phytosterols, those are all lipophilic. They would be drawn out by an oily kind of a medium. Hexane is like a chemical that behaves like an oil, even though it’s not one in this regard. So they’re often used to make these products. And, but again, if you don’t know exactly. If you’re looking at a study, if you’re looking at a case report and it says that it was a saw palmetto product, that doesn’t tell you really what they were taking or what they were working with, right?

Katja (01:25:52):
You need to actually get to the methods part of the study, which might be behind a paywall. You might not be able to see that without giving somebody money. But you need to get to the methods part of the study to find out what were they studying? Was it a particular brand of something with a particular type of ratio of different constituents. It was never a decoction of the berries and rarely was it a tincture.

Ryn (01:26:18):
Right. Yeah. And especially because with this particular herb a little further back, maybe in the, nineties or so there were a lot of studies that were about a particular product that had saw palmetto as one of its ingredients, but it had like eight other herbs in it. And also later investigations revealed that it had a bunch of medications in it, pharmaceutical drugs put into that supplement-all-natural thing. And so I would basically throw all of those out if I was trying to put together material about saw palmetto. I’d say this is not relevant. It’s just not relevant.

Katja (01:26:54):
Any study done on that particular product needs to be like, I don’t know.

Ryn (01:27:01):
Set it aside, you know?

Katja (01:27:01):
But also relabeled in the literature. It needs to be relabeled as not a saw palmetto study, you know?

Ryn (01:27:08):
Right. Yep. So, you know, about preparations, decoction is probably the oldest known method for working with this, aside from just straight up eating it straight away. Tincture, alcohol extract is what our eclectic and physiomedicalist friends were working with primarily. Towards the end of their run, you know, up until like the 1910s or so they were experimenting with some more complicated chemistry to try to do different sorts of extracts there. But still mostly they were just working with standard tinctures. Nowadays most of the supplements you’re going to find are going to be an extract. And those are generally, like you said, standardized. A lot of times you’ll see them give a fatty acid content or a percentage. Usually it’s like 85%. And so that’s very different from what’s occurring in the plant itself, where there would be fibers and starches and other stuff along with them. Maybe relevant for medicine, maybe not. But these products assume that they’re not right. Like you said, they’re targeted towards what seems to be, or what’s understood to be, the most important thing for BPH in particular.

Katja (01:28:17):
There is so much more in the plant than just…you know. And to say like only this part of the plant is important and all the rest of it just isn’t relevant feels folly.

Ryn (01:28:30):
It’s a little limiting, right? And we shouldn’t expect that those products are going to have the full range of impacts that some of these older authors were describing, right? Where they were working with tincture, expect to get that effect from tincture. But an extract like this, standardized, concentrated may not give you that same range. On the other hand the fact that those kinds of capsules are pretty consistently standardized in basically the same way, and because there’s such a high market volume of them, one little piece of information you can take from that is that they’re standard across different sellers. And so you don’t really need to spend too much time chasing down a claim from one product manufacturer that ours is so much better than all of the others. Everybody makes that claim, everybody with a business, and hey, that’s fine. You know, you do your thing. But from what I can tell from looking at the labels and what they reveal to us about their proprietary process, it’s basically the same one repeated over and over again.

Katja (01:29:30):
Right. Unless they’re putting other things in there, then the effects would be the same if their standardized product is the same.

Ryn (01:29:37):
Yeah. So find a brand you trust, but not because they say that they’ve got a magic process that’s going to give you the best saw palmetto extract on the planet, right? Yeah. Also one of our favorite teachers, Paul Bergner, and this is from 1997. So I should maybe write, and check in and see if he still thinks this today. But he’s writing in the Medical Herbalism journal and says there’s no support for the assertion of the herb marketers that the liposterolic extracts are any better than a standard tincture, one of the forms used by the eclectics in Bloyer’s day. As, because no head-to-head trials of the forms have been performed, right? Like we get a group of people. We have a placebo. We give you the capsule extract. And we give you the tincture and try to make the doses equivalent and all that kind of stuff, and then see what happens. So that hasn’t been done. And so we can’t make that direct comparison. But several trials of ethanolic extracts, tinctures, in Europe have shown effectiveness for symptoms of BPH. So we at least have that much data.

Katja (01:30:38):
Right. Yeah. I would really love to see that kind of study. But the purpose of studies is not public education. The purpose of studies is to find something that they can make money with. And like that’s not bad, but it’s just important to recognize that they’re not going to just study something for the public good. They’re not just going to say, huh, I wonder. Let’s just study this for fun. That’s not really how studies work. They’re trying to find something that they can make a product out of. And when we keep that in mind, it’s very helpful. Because then we say, okay, well that doesn’t imply that it wouldn’t be better some other way. It merely implies that this is the most direct route they could see to a profitable product. And so that is what they’re going to study.

Ryn (01:31:33):
Yeah. So again, if you’re interested in working with saw palmetto, try a supplement from a brand new trust. Try a tincture. Try a decoction while you’re at it. See if they’ll do the same kind of job in your body or whether one of them is preferable for you. It’s really worth trying. Yeah. But stepping back a little, looking broader than just this one herb. What are some lessons we can take away from this exploration that we’ve been doing today?

Katja (01:32:00):
You know, I think one of them right off the top is just that we need to let go of what we think we know about herbs for reproductive health. Honestly, maybe we need to let go of what we think we know about a lot of things. And allow ourselves to think and rethink curiously, creatively and critically, but not skeptically. Critically like in an analytical kind of way.

Ryn (01:32:26):
Yeah. And we also can take this example here as inspiration for the variety of ways we can look at all of the research available, the research and the experience available, right? Historical, modern, conventional, energetic perspectives, personal experience. How we can draw on all of these different sources of information. Bring them together and come to some conclusions about how we can best work with herbs. Or at least recognize that we might have been limited in what we thought was possible to do with that plant, together with that plant previously.

Katja (01:33:03):
Yeah, this work is constant. You never get to stop doing this part no matter how long you’ve been in practice. Every body is different. My body, Ryn’s body, your body, the bodies of your friends, the bodies of our friends, every single one of us is different. And so every time that we work with a plant and a new person, we learn new things. We can’t go into any situation…we can go in with a hypothesis. We can go in with an educated guess. We can go in with a theory that we want to test. But we can’t go into a situation saying this is what’s going to be true in your body. I’m not in your body. I can’t know what’s true in your body. Only you can know that. And so we can say, all right, we’ve studied a lot of things. And based on all of that we have an idea that this could be a good thing. Let’s try it and find out if in fact it is right for your body. And then sort of the flip side is just because you read in a book somewhere, or I read in a book somewhere, or anybody reads in a book somewhere that says, well, this is only for a particular gender, or this is only for a particular problem. That’s not how herbs work. Herbs don’t check your gender. They don’t check what somebody else thinks your gender should be. They don’t check what diagnosis you have. They look at the environment and say, wow, it’s really boggy and stagnant around here. I guess I better squeeze some of this extra fluid out, because that’s what I know how to do. Yeah.

Ryn (01:34:42):
Yeah. All right.

Katja (01:34:44):
So I hope that this was interesting for you and gives you some new ways to think about what you already know about plants and people, and what you want to know about plants and people, and how you might get there.

Ryn (01:34:58):
Yeah. It’s always good to have a lot of options for the way that we understand our plants and ourselves. Cool. All right. So we’ll be back again next time with some more Holistic Herbalism podcast for you. Until then take care of yourselves. Take care of each other. Drink some tea.

Katja (01:35:14):
Drink some tea.

Ryn (01:35:15):
And also maybe take some tincture or perhaps some supplements, depending on what’s the right thing for you. Bye.

Katja (01:35:24):
Bye-Bye.

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