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Paying heed to the prostate
The prostate (not "prostrate" -- there's no "r") is a walnut-sized, donut-shaped gland located below a man's bladder. It produces most of the fluid in semen. It also has a tube running through it -- the urethra -- which carries urine and semen out of the body.
Unless it gets infected, the prostate is so unobtrusive that many men hardly know they have one. But after a man reaches age 30, the pesky little gland starts growing, and by the man's mid-40s he may start having to get up regularly at night to urinate, a sign of "benign prostatic hypertrophy" or BPH ("benign" means noncancerous, "hypertrophy" means enlarged).
As BPH progresses, the swelling prostate pinches the urethra. This process is painless, but it causes urinary difficulties: the need to urinate immediately (urgency), difficulty getting started (hesitancy), decreased flow, difficulty finishing (dribbling), and the most annoying, having to get up at night to urinate (nocturia).
BPH is caused by hormonal changes, notably an increase in the male sex hormone, dihydrotestosterone, in the prostate. An enzyme, 5-alpha-reductase, converts testosterone to dihydrotestosterone. Many BPH treatments -- including pharmaceutical options and saw palmetto -- work by interfering with this enzyme's action.
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Latest News
Studies showing that saw palmetto reduces symptoms of prostate enlargement have used 320 mg a day, split into two or three doses. But the more doses there are to take each day, the less likely people are to take their medicine. Recently, researchers in Brussels, Belgium, conducted a one-year study of 132 men with enlarged prostates to compare two different saw palmetto regimens: the standard two doses (160 mg each) per day, or one large dose (320 mg). The single large dose produced the same symptom improvement as the two smaller doses. Side effects were similar in both groups: a few reports of mild abdominal upset. [1]
Existing Medical Research
Many studies have shown that saw palmetto shrinks enlarged prostates and relieves BPH symptoms:
- One of the most impressive studies, conducted at 87 urology clinics in nine European countries, compared a standard European saw palmetto extract (Permixon, a French preparation) to the pharmaceutical 5-alpha-reductase inhibitor, Proscar. The researchers gave the 1,098 participants either the herb (160 mg twice a day) or the drug (5 mg a day). After 26 weeks, both treatments showed about equal effectiveness. Proscar decreased BPH symptoms 39% vs. 37% for saw palmetto. Urine flow improved 30% in men taking the drug vs. 25% for those on the herb. But saw palmetto caused fewer erection problems and less libido loss. [2]
- A similar German comparison of saw palmetto and Proscar showed the same results. The researchers gave 309 men one substance or the other. Three years later, both groups showed about a 30% decrease in symptoms.
- Belgian researchers measured prostate size, urine flow rate, and quality of life in 505 men with BPH and then gave them saw palmetto extract. Six weeks later, the men's prostates were smaller, their urine flowed more freely, and they reported significantly improved quality of life. After 90 days on the herb, 88% of the men called the treatment "effective."
- Finally, German researchers gave saw palmetto to 320 men with BPH. Six months later, their urine flow had increased significantly. Three-quarters of them were getting up less at night, and half reported less frequent daytime urination. These improvements were maintained for three years.
The only reported side effect of saw palmetto is occasional abdominal distress.
Sources
1Braeckman, J., et al. "Efficacy and Safety of the Extract of Serenoa Repens in the Treatment of Benign Prostatic Hyperplasia: The Therapeutic Equivalence Between Twice Daily and Once Daily Dosage Forms," Phytotherapy Research (1997) 11:558.
2Carraro, J.C., et al. "Comparison of the Phytotherapy Permixon with Finasteride in Treatment of BPH: A Randomized International Study of 1,098 Patients," The Prostate (1996) 29:231.
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Common Uses
Saw palmetto may be helpful in treating:
Remember that no health claims for saw palmetto have been evaluated by the Food and Drug Administration (FDA).
Historical and Folkloric Use
Saw palmetto is a small palm tree native to Florida and the Gulf Coast that produces a brownish berry. Centuries ago, Native Americans discovered that the berry has diuretic action and used it to treat urinary problems.
White settlers adopted the plant for use, and during the 19th century, physicians throughout the South recommended it for urinary tract infections in women and prostate problems in men. But by the early 20th century, as herbal medicine fell from favor among mainstream American doctors, saw palmetto was abandoned.
Fortunately, European researchers remained interested in the plant. During the 1960s, they discovered that saw palmetto fruits contain fatty acids (liposterols) that help counteract prostate enlargement.
Commission E, the German expert panel that judges the safety and effectiveness of herbal medicines for that nation's counterpart of the FDA, approved saw palmetto for treatment of BPH.
Dosage and Administration
Saw palmetto may be found in the following forms:
- Fresh or dried berries
- Capsules and tablets
- Tincture
- Teas
Teas: Steep one-half to one teaspoon of fresh berries in one cup of boiling water for 10 minutes. It's ready to drink.
Tinctures: Mix one-half teaspoon of tincture in water. Drink one to two cups a day.
Capsules: Take up to three capsules per day, or as directed on the label.
Storage
Keep any form of saw palmetto in a cool, dry area.
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How to Use Saw Palmetto Safely
The dose typically used to treat BPH is 160 mg of saw palmetto extract twice a day, but the latest study shows that a single daily dose of 320 mg works just as well.
Side effects, if any, are mild: stomach upset and headache. Allergic reactions are possible.
Because saw palmetto has hormonal action, men with hormone disorders should consult a physician before taking it.
Saw palmetto does not cure BPH -- it simply relieves its symptoms. However, continued prostate enlargement may get the better of this treatment, and pharmaceutical therapy or surgery may become necessary.
If you are already taking medication for BPH, do not take saw palmetto instead of the medication except upon the advice of your physician.
Although saw palmetto seems to be effective in treating BPH, it has not been found to be effective in combating prostate cancer.
If you are having trouble urinating or if you pass blood in your urine, talk to your doctor.
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Sources & Further Reading
Books
American Botanical Council. The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston:American Botanical Council/Integrative Medicine Communications, 1998.
Duke, J. The Green Pharmacy. Emmaus, PA:Rodale Press, 1997.
Tyler, V. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York:Pharmaceutical Products Press/Hawthorn Press, 1994.
Weiner, M. and J. Weiner. Herbs That Heal: Prescription for Herbal Healing. Mill Valley, CA:Quantum Books, 1994.
Werbach, M. and M. Murray. Botanical Influences on Illness. Tarzana, CA: Third Line Press, 1994.
Articles
Anon. "Saw Palmetto," Review of Natural Products 3-94.
Bach, D., "Drug-Based Long-Term Treatment of BPH: Results of a Prospective 3-Year Study with Sabal extract IDS 89," Urology [B] (1995) 35:178.
Bach, D., et al. "Phytopharmaceutical and Synthetic Agent in Treatment of BPH," Phytomedicine (1997) 3/4:309.
Braeckman, J., et al. "Efficacy and Safety of the Extract of Serenoa Repens in the Treatment of Benign Prostatic Hyperplasia: The Therapeutic Equivalence Between Twice Daily and Once Daily Dosage Forms," Phytotherapy Research (1997) 11:558.
Braeckman, J. "Extract of Serenoa Repens in Treatment of BPH," Current Therapeutic Research (1994) 55:776.
Brown, D., et al. "BPH and Prostate Cancer Prevention," monograph, 1997.
Carraro, J.C., et al. "Comparison of the Phytotherapy Permixon with Finasteride in Treatment of BPH: A Randomized International Study of 1,098 Patients," The Prostate (1996) 29:231.
McCaleb, R. "Phytomedicines Outperform Synthetics in Treating Enlarged Prostate," HerbalGram #40, 1997.
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