Saw Palmetto

For Prostate Problems

About 10 million American men are thought to suffer from the effects of benign prostatic hyperplasia, or BPH. This condition, seen in men over 45 years of age, causes diminished urinary flow that results from the nonmalignant enlargement of the prostate gland. About one in every two men over age 70 is thought to have symptoms of BPH.

The cost of treatment for BPH is significant. In the United States alone the cost exceeds $2 billion annually. Further-more, there are almost 2 million office visits to physicians annually from men seeking relief from the symptoms of BPH.

Since the prostate sits under the bladder, the enlargement of the prostate gland will cause a narrowing of the urethra. This leads to difficult or painful urination, retention of urine, a weak urine flow, an increased sense of need to urinate, frequent nighttime trips to the bathroom, and the potential for a kidney infection. Prostate growth is stimulated when testosterone from the blood is converted by 5-alpha-reductase to the more potent androgen dihydrotestosterone. An enlarged prostate usually contains abnormally high levels of dihydrotestosterone.

Three-way Relief
Standard treatment options for BPH include the use of drugs such as Proscar, or surgical removal of some prostatic tissue. Proscar inhibits the activity of 5-alpha-reductase. Side effects may result from the use of the synthetic drugs, including hypertension, dizziness, and impotence.

Symptomatic relief of urinary difficulties in men with an enlarged prostate may also be provided by a number of botanicals, often without the side effects. The most widely used botanical for treatment of mild to moderate cases of BPH is saw palmetto (Serenoa repens), a low-growing palm of the Southeastern region of the United States. The palm grows to a height of three to four feet in pine woods and on the sandy dunes of South Carolina, Georgia, and Florida and has leaves that grow in an attractive fan-shaped arrangement. However, it is the fruit that attracts medical interest. The palm produces one-inch berries that ripen between August and October. The fruit is a green or yellow color that turns dark blue when ripe. Inside the berries there is pale-brown spongy pulp. Saw palmetto berries contain a variety of phytosterols, flavonoids, and phenolic acids.

Palmetto Power
There are a number of well-controlled clinical studies that confirm the safe and effective use of saw palmetto for the treatment of BPH. Saw palmetto extracts can reduce the activity of 5-alpha-reductase by about 40 percent, and hence reduce the uptake of dihydrotestosterone by the prostate gland. The active substances in saw palmetto berries, such as the phytosterols, provide beneficial effects such as increased urinary flow, increased ease in commencing urination, reduced post-voiding residual volume, decreased frequency of urination, and a decreased urge to void during the night.

While saw palmetto effectively diminishes the symptoms of BPH, it appears to act without reducing the size of the prostate. In addition, the spasmolytic and antiinflammatory effects produced by extracts of saw palmetto berries help explain its beneficial role in treating BPH.

Experiments have shown that men with an enlarged prostate who received an extract of saw palmetto for 30 days experienced 45 percent less nocturnal trips to the bathroom, a 50 percent increase in urinary flow rates, diminished residual urinary volume, and less pain during urination. After three months 90 percent of the patients using the saw palmetto considered the therapy successful with few, if any, side effects.

One-half to one teaspoon of the dried berries, or two to three capsules (each 500 milligrams), is the typical daily dose. As with all herbal preparations, therapeutic benefits are most predictable when standardized products are used. A recent study found that saw palmetto extract had a higher benefit-to-risk ratio and a lower cost to patients than did the conventional synthetic drugs.

Prostate Cancer

The symptoms of BPH and prostate cancer are similar, so the use of saw palmetto may reduce the symptoms of prostate problems and mask the signs of a more serious prostate problem. Since saw palmetto may skew the results of the blood test used to screen for prostate cancer, your physician should be informed when you are taking saw palmetto.

Cancer of the prostate, the second most common cause of death from cancer in American men, is a more serious condition than BPH. About 185,000 new cases of prostate cancer were identified during 1999 in the United States. Among the dietary factors, a high intake of vegetables and a regular use of soy appear to protect against prostate cancer. Lycopene, the red pigment in tomatoes, pink grapefruit, and watermelon, accumulates in the prostate gland. A regular intake of lycopene-rich tomato products significantly reduces the risk of prostate cancer by 30 to 40 percent. On the other hand, a high consumption of fat, saturated fat, red meat, and dairy products possibly increases the risk of prostate cancer.

Conclusion
Saw palmetto can successfully provide symptomatic relief to men with an enlarged prostate gland. It is well tolerated, with very few reports of side effects. Extracts of saw palmetto berries are currently approved by both French and German governments for the treatment of BPH.

Remember: Herbal products and dietary supplements can have pharmacological effects, may produce adverse reactions in some people, and could interact with over-the-counter and prescription medications you may take. Discuss with your physician your decision to use any herbal product. Anything mentioned in this article is not intended to diagnose, prescribe, or treat any ailment.

Winston J. Craig, Ph.D., R.D., is a professor of nutrition at Andrews University, Berrien Springs, Michigan.