Saw Palmetto: History and Traditional Use

Saw palmetto is a low, hardy fan palm of the Florida and Gulf-Coast scrub whose dark, ripe berries fed and treated the indigenous peoples of the Southeast for many generations before any of it was written down. Its documented history is short by the standard of the ancient Mediterranean herbs — the first American medical paper appeared in 1879 — but it is unusually well attested: a named Savannah physician, a named pharmaceutical factory, official listings in the national drug books, and, a century later, one of the largest bodies of clinical-trial evidence collected for any botanical. This article traces that story honestly, marking tradition as tradition and the modern science as modern science.

Table of Contents

  1. The Plant and Its Name
  2. Indigenous Food and Medicine of the Southeast
  3. Spanish Explorers and Early European Contact
  4. Dr. J. B. Read and the 1879 Paper
  5. The Eclectic Physicians and the Drug Books
  6. Eli Lilly and the Florida Berry Trade
  7. The European Revival and Permixon
  8. Folklore, Tonic Reputation, and Honest Limits
  9. From Tradition to Modern Research
  10. Research Papers and References
  11. Connections
  12. Featured Videos

The Plant and Its Name

Saw palmetto is Serenoa repens, a small, slow-growing fan palm that forms vast low thickets across the sandy pinelands, scrub, and coastal flats of the southeastern United States, most abundantly in Florida and along the south Atlantic and Gulf coastal plains. It is famously long-lived: botanists estimate that some Florida clones may be several centuries old, with figures of 500 to 700 years commonly cited for the oldest plants. The common name comes from the sharp, saw-like teeth that line the leaf-stalks (petioles); "palmetto" is a diminutive of the Spanish palma, a little palm.

The botanical name carries its own small history. The plant was first described by the early American naturalist William Bartram, who published it in 1791 as Corypha repens. The genus Serenoa was later erected by the British botanist Joseph Dalton Hooker (published in Bentham & Hooker's Genera Plantarum, 1883), who named it in honour of the American botanist Sereno Watson (1826–1892), long the curator of the herbarium at Harvard University. The American botanist John Kunkel Small subsequently transferred Bartram's species into that genus, giving the name its modern form, Serenoa repens (Bartram) J. K. Small. The species epithet repens is Latin for "creeping," describing the plant's low, often horizontal trunk. The older synonym Sabal serrulata still appears in some pharmacy and older clinical literature, which is worth knowing when reading historical sources.

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Indigenous Food and Medicine of the Southeast

Long before European contact, the ripe berries of saw palmetto were a familiar food and medicine for the indigenous peoples of the Southeast, and the leaves were among the most important materials for thatching shelters and weaving. Vernacular names for the plant survive in several Native languages of the region — among them Choctaw, Creek, Mikasuki (Miccosukee), Koasati, Alabama, and the Timucua — a spread of names that itself testifies to how widely the palm was used. The dark, olive-sized berries ripen in autumn to a purple-black and were eaten fresh or dried.

The fullest documented traditional uses come from the historic peoples of Florida and the wider Southeast, including the Seminole. The berries were taken as a general tonic and as food during lean seasons, and they appear in the ethnobotanical and herbal record as a remedy used for digestive complaints and as an expectorant for coughs and chest congestion. The most frequently repeated traditional indication — and the one that would later draw Western physicians to the plant — is support for the male urinary and reproductive organs, the cluster of complaints we would now recognise as the lower-urinary-tract symptoms of an enlarging prostate. Because these uses were transmitted orally and recorded only later by outside observers, they are best described as documented tradition rather than as anything the original users themselves wrote down; the specific attributions vary from source to source, and some are firmer than others.

What is not in doubt is the central place the plant held. A palm that supplied food, roofing, basketry, and medicine from the same abundant thicket was, like mullein in Europe, the kind of plant a whole community knew intimately — and that intimacy is the true headwater of saw palmetto's medical reputation.

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Spanish Explorers and Early European Contact

The first Europeans to encounter saw palmetto were the Spanish explorers and colonists who moved through Florida in the sixteenth century. The expedition of Hernando de Soto, which landed in Florida in 1539, is reported to have eaten the tender hearts (the apical growing tip, or apical meristem) of the palm — a use very plausibly learned from the Native peoples they met, who ate palm hearts as well. The cabbage-like heart of the related and larger cabbage palm remained a Southern food for centuries; the saw palmetto's smaller heart belongs to the same tradition.

Spanish contact did not, so far as the record shows, launch saw palmetto into European medicine the way the New World introductions of cinchona bark or tobacco were launched. The berry stayed a regional, largely indigenous resource for roughly three more centuries. Its passage into the printed medical literature would wait until after the American Civil War, and it would happen not in Europe but in the American South.

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Dr. J. B. Read and the 1879 Paper

Saw palmetto's documented career in Western medicine has an unusually clear starting point. In the April 1879 issue of the American Journal of Pharmacy, Dr. J. B. Read, a physician of Savannah, Georgia, published a paper on the medicinal properties of the berry — widely regarded as the first substantial American medical account of the plant. Read described a broad, gentle tonic action and is quoted as writing that, "by its peculiar soothing power on the mucous membrane it induces sleep, relieves the most troublesome coughs, promotes expectoration, improves digestion, and increases fat, flesh and strength." He noted sedative and diuretic effects and recommended the berry for a wide range of complaints, including enlargement of the prostate.

Read's paper is significant less for the sweep of its claims — nineteenth-century tonics were routinely credited with curing almost everything — than for what it set in motion. It carried a remedy long known to the people of the Southeast into the professional pharmaceutical press, where other physicians could read it, try it, and write about it in turn. Within a few years saw palmetto had a foothold in American medical practice, and the indication that survived hardest was precisely the one the indigenous tradition had emphasised: the ageing male urinary tract.

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The Eclectic Physicians and the Drug Books

In the late nineteenth and early twentieth centuries saw palmetto became a favourite of the Eclectic physicians — a reform movement of American doctors who built their practice around botanical medicines and documented them in detail. The Eclectic pharmacist and author Harvey Wickes Felter described saw palmetto as "a nerve sedative, expectorant, and a nutritive tonic," acting "kindly upon the digestive tract," and judged that its "most direct action appears to be upon the reproductive organs." Eclectic and conventional practitioners of the era used it for an enlarged prostate, for cystitis and other irritations of the urinary tract, and for assorted reproductive and "wasting" complaints. Felter and his collaborator John Uri Lloyd are named here as historical authors of the Eclectic materia medica rather than as modern citations.

This professional adoption is marked by saw palmetto's entry into the official American drug compendia. The berry was recognised in the United States Pharmacopoeia in the early twentieth century — commonly cited as a listing from 1906 to 1916 — and, most durably, in the National Formulary from 1926 to 1950. (Sources differ slightly on the exact span of the Pharmacopoeia listing, so the firm, consistently reported anchor is the National Formulary period.) Being written into these books meant saw palmetto was, for a generation, an officially recognised drug in mainstream American medicine, not merely a folk remedy — before the rise of modern pharmaceutical urology pushed it back to the margins by mid-century.

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Eli Lilly and the Florida Berry Trade

The early-twentieth-century demand for saw palmetto was large enough to support a genuine commercial harvest in Florida. According to the historical record drawn together by writers such as Cynthia Bertelsen (citing Steven Foster and Rebecca Johnson's reference work on natural medicines), the pharmaceutical firm Eli Lilly & Company built a palmetto-berry drying facility at Vero Beach, Florida, in 1906, to process the wild-gathered fruit for the drug trade. The berries were picked from the endless wild thickets — saw palmetto has never needed cultivation in its home range — dried, and shipped north to be turned into the fluid extracts and tinctures of the day.

This detail matters because it grounds the herb's reputation in something concrete. A major drug company does not build a factory for a remedy nobody is buying; the Vero Beach plant is physical evidence that, in the first decades of the twentieth century, saw palmetto was a real article of the American pharmaceutical economy. When the National Formulary dropped it in 1950 and pharmaceutical alternatives took over, that trade collapsed — only to be reborn, decades later and on a far larger scale, to supply the modern dietary-supplement market and the European prescription extracts.

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The European Revival and Permixon

After saw palmetto faded from the American mainstream around 1950, the centre of gravity for serious study shifted to Europe. From roughly the 1960s onward, European researchers — principally in France, Germany, and Italy — developed concentrated, fat-soluble extracts of the berry and put them through clinical trials for the urinary symptoms of an enlarging prostate. The result was that saw palmetto re-entered medicine not as a frontier tonic but as a standardised phytomedicine.

The best-known of these products is Permixon, a hexanic lipidosterolic extract of Serenoa repens manufactured by the French firm Pierre Fabre (Castres, France) and standardised to a high content of free and esterified fatty acids with small amounts of sterols. In several European countries saw palmetto extracts of this type are licensed medicines, prescribed as a first-line option for the lower-urinary-tract symptoms of benign prostatic enlargement — a regulatory status quite different from their over-the-counter, dietary-supplement standing in the United States. It was the accumulation of European trials through the 1980s and 1990s, much of it on Permixon and similar extracts, that revived worldwide interest in the herb and set the stage for the large independent reviews that followed.

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Folklore, Tonic Reputation, and Honest Limits

Like every long-used plant, saw palmetto has gathered folklore around its documented record. The most persistent story — commonly repeated in herb books, though it is hard to trace to a firm primary source and is best treated as tradition — holds that nineteenth-century Americans first took an interest in the berries after noticing that livestock and wild animals which fed on them grew notably sleek, fat, and vigorous. Whether or not the anecdote is literally true, it captures the herb's old reputation perfectly: saw palmetto was the archetypal "tonic," a remedy thought to build flesh, strength, and reproductive vitality. Read's own 1879 phrase — "increases fat, flesh and strength" — belongs to exactly this nourishing-tonic tradition.

That tonic reputation also attached the berry to ideas of male vigour and fertility, and saw palmetto has been marketed for libido, virility, and "male vitality" for well over a century. Here honesty matters, because real people read pages like this one. The folk reputation as a sweeping aphrodisiac and cure-all is not supported by modern evidence; what the careful traditional record and the modern science actually agree on is a narrower and more believable claim — that the berry was used, and is still used, chiefly for the urinary discomforts of an enlarging prostate in older men. The grander promises are lore; the prostate-and-urinary use is the durable thread that runs from the Seminole berry-eater to the European pharmacy shelf.

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From Tradition to Modern Research

The arc of saw palmetto's history is therefore unusually tidy: a plant used by the indigenous peoples of the Southeast for the ageing male urinary tract, carried into print by Dr. J. B. Read in 1879, formalised by the Eclectics and the National Formulary, harvested commercially by Eli Lilly, revived as a standardised extract in Europe, and finally subjected to large, rigorous clinical testing. Few herbs let us watch the whole journey from oral tradition to randomised controlled trial so clearly.

That modern testing has also delivered a genuinely complicated verdict, and an honest history has to say so. Early reviews were encouraging: the 1998 JAMA systematic review by Wilt and colleagues, pooling eighteen trials, found that saw palmetto modestly improved urinary symptoms and flow with few side effects. But as the trials grew larger and more rigorous — using higher, standardised doses and proper blinding — the benefit shrank. The successive Cochrane reviews (2012 and the 2023 update) concluded that, compared with placebo, Serenoa repens provides little to no improvement in urinary symptoms, flow rate, or night-time urination, even at double and triple the usual dose. The herb remains strikingly safe and well tolerated, and individual European extracts such as Permixon continue to be defended in their own trial literature; but the best current evidence does not support the broad efficacy once hoped for. The detailed clinical picture — what the trials measured, where the disagreement lies, and how to weigh it — is taken up in the companion Prostate Health and BPH, Urinary Function, Hair Loss, and Hormonal and Cautions articles.

The thread running from a Seminole berry, through Read's soothing tonic and the Vero Beach drying sheds, to a modern Cochrane meta-analysis is unbroken — and its lesson is a good one. Tradition raised a real and specific question about an abundant Florida palm and the troubles of the ageing prostate; modern research has taken that question seriously, which is exactly what it deserved, and is still working out the answer. That is how folk medicine is supposed to meet science: not dismissed, and not believed uncritically, but tested.

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Research Papers and References

The list below combines key peer-reviewed reviews of Serenoa repens with curated PubMed topic-search links into the clinical and historical literature. Historical primary sources — Dr. J. B. Read's 1879 paper in the American Journal of Pharmacy and the Eclectic materia medica of Felter and Lloyd — are named in the article as historical sources rather than as modern citations. Each peer-reviewed entry below carries a real, resolving DOI or PMID; the search links open at PubMed (National Library of Medicine) in a new tab.

  1. Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA. 1998;280(18):1604-1609. — doi:10.1001/jama.280.18.1604 · PMID 9820264
  2. Tacklind J, MacDonald R, Rutks I, Stanke JU, Wilt TJ. Serenoa repens for benign prostatic hyperplasia. Cochrane Database of Systematic Reviews. 2012;(12):CD001423. — doi:10.1002/14651858.CD001423.pub3 · PMID 23235581
  3. Franco JVA, Trivisonno L, Sgarbossa NJ, Alvez GA, Fieiras C, Escobar Liquitay CM, Jung JH. Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement: an updated Cochrane review. Cochrane Database of Systematic Reviews. 2023;(6):CD001423. — doi:10.1002/14651858.CD001423.pub4 · PMID 37345871
  4. Gerber GS. Saw palmetto for the treatment of men with lower urinary tract symptoms. Journal of Urology. 2000;163(5):1408-1412. — PMID 10751846
  5. Saw palmetto (Serenoa repens / Sabal serrulata) traditional and historical use — PubMed: Serenoa repens history and traditional use
  6. Permixon and the lipidosterolic extract of Serenoa repens in benign prostatic hyperplasia — PubMed: Permixon and Serenoa repens in BPH

External Authoritative Resources

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Connections

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