Saw Palmetto and Prostate Relief

Bad Science

Living a long life can be a wonderful thing. Of course, there are some drawbacks – and if you’re a man, one of them is benign prostatic hyperplasia (BPH). Fifty percent of all men will experience an enlarged prostate, a condition known as benign prostatic hypertrophy, by the time they hit their 60^th birthday – and almost 90 percent of men over age 80 develop BHP.

So is BPH inevitable? According to more than two dozen clinical trials, it isn’t – if you take saw palmetto, an effective herbal defense against prostate enlargement. But now, all of those well controlled, double-blind studies have suddenly been called into question by a recent study published in The New England Journal of Medicine.

See saw

As a man ages, the prostate gland increases in size, making BPH one of the most common age-related conditions in men. The prostate can get so big that it puts pressure on the urethra – acting like a partial clamp – which causes a number of uncomfortable and inconvenient urinary problems. More seriously, left untreated, BPH can damage the bladder and the rest of the urinary tract.

Fortunately, science has rediscovered an age-old remedy for this bothersome condition – saw palmetto. In one study of 110 men, saw palmetto decreased night-time urination by 45 percent, increased urinary flow rate more than 50 percent and reduced the amount of urine left in the bladder after urination by 42 percent. Other studies have shown even more improvement. A three-year preliminary study in Germany found that 160 mg. of saw palmetto reduced night-time urination in 73 percent of patients and improved urinary flow rates significantly. In another double-blind trial, saw palmetto was just as effective as the popular BPH drug finasteride – without the side effects, such as loss of libido, common to pharmaceuticals used to treat the condition.

It’s no wonder this herb works so well. Like finasteride, saw palmetto inhibits 5-alpha-reductase, an enzyme that converts testosterone to dihydro-testosterone (DHT). Although normal prostate cells require DHT for growth and survival, it has also been established as a contributing factor to both BPH and prostate cancer. Saw palmetto not only blocks DHT, it may also inhibit inflammation and growth factors that contribute to BPH.

Third degree

Despite the mounting evidence and the broad acceptance of saw palmetto for BPH, a group of San Francisco scientists decided to put it to the test once again – but instead of using men with mild to moderate BPH, the researchers turned to 225 patients with more severe forms of the disease – sometimes called Stage III BPH.

Even though the study was placebo-controlled and double-blind, the patients were given the same dose of saw palmetto used for men with mild to moderate BPH. So it’s no surprise that, overall, the men didn’t see an improvement in their symptoms. It seems that urinary symptoms resulting from mild to moderate prostate enlargement respond more readily to a typical dose of saw palmetto than symptoms due to severe enlargement. And since this study didn’t look at how an increased dose might impact symptoms of severe BPH, it isn’t known if the herb is even effective for advanced cases. But because saw palmetto has not been shown to aggressively shrink the size of the prostate, most herbalists don’t rely on the herb for advanced cases. 

Yet, even though saw palmetto is an effective way to control mild to moderate BPH, you may not hear about it from your doctor. Physicians have a whole arsenal of tools to address BPH. Unfortunately, drugs and surgery are among the tools most often mentioned. Unless you suffer from severe BPH, talk to your health provider about saw palmetto. If you and your doctor decide to give saw palmetto a try, look for a supplement containing 85% to 95% fatty acids and sterols. Some saw palmetto products don’t have these high potency fatty acid extracts and may not be as effective. The typical dose used to treat mild to moderate BPH is 160 mg. taken twice a day and it’s extremely safe. Just be aware that it may take four to six weeks to see results.

One last thing . . .

All men should be concerned about BPH. Fortunately prevention can be as easy as taking a multivitamin containing zinc. Zinc helps balance your testosterone levels, particularly in your prostate, and helps control the conversion of testosterone to DHT. Not only will this help prevent BPH, some studies show that it can treat mild cases of prostate enlargement.

In one small clinical trial, a group of men took 150 milligrams of zinc sulfate every day for two months, followed by 50 to 100 milligrams a day as a maintenance dose. The researchers found that 14 of the 19 men experienced shrinkage of the prostate.

But don’t think that taking more zinc will give you more protection. When it comes to this mineral, a little goes a long way. In fact, the recommended daily dose is just 15 mg. Taking more than that can be detrimental in the long run and may even boost your risk of developing prostate cancer.

This just in . . .

If you have been diagnosed with early stage localized prostate cancer, your doctor may suggest waiting and watching to see if this normally slow-growing cancer spreads. This cautious approach has helped many men – especially older men – avoid aggressive treatments like radiation and surgery that can have life-altering side effects. While these radical procedures can indeed stop prostate cancer in its tracks, they can also leave a man impotent and incontinent.

But a new study involving more than 44,000 prostate cancer patients, age 65 to 80, is trying to turn the practice of “watchful waiting” on its head. The University of Pennsylvania researchers who conducted the study say they’ve discovered that elderly patients whose early cancer was treated with radiation or surgery had a 31 percent lower risk of death than those who did not undergo treatment.

Convinced? Neither are two urologists at UCLA. Noting that the findings are preliminary, Dr. Mark Litwin and Dr. David Miller said that doctors “must remain steadfast in their efforts to reduce over-treatment and under-treatment by thoughtfully defining each patient’s unique balance between the natural history of prostate cancer and that individual patient’s life expectancy.” They also stress that the patient’s personal preference is still one of the most important considerations while making a treatment plan.

So what should you do? If you are over the age of 75 and have early stage prostate cancer, don’t let your doctor push into a treatment you don’t want. Learn about the disease, talk with your doctor and, if necessary, get a second opinion. And don’t think that watchful waiting means doing nothing. This approach entails regular PSA tests, digital rectal exams and possibly other tests. It’s also smart to adopt a healthy diet and exercise routine. By keeping on top of the disease, you and your doctor can stay on the lookout for any indication that the cancer has developed to the point that it really may require surgery or other treatment. But aggressive treatment shouldn’t automatically be the first choice. After all, the vast majority of prostate cancers – 90 percent – remain dormant, never causing symptoms.

References:

Bent S, Kane C, Shinohara K, et al. “Saw Palmetto for Benign Prostatic Hyperplasia.” New England Journal of Medicine. 2006;354:557-566.

Bush IM, Berman E, Nourkayhan S, et al. “Zinc and the prostate.” Presented at the annual meeting of the American Medical Association Chicago, 1974.

Rhodes L, Primka RL, Berman C, et al. “Comparison of finasteride (Proscar), a 5_ reductase inhibitor, and various commercial plant extracts in in vitro and in vivo 5_ reductase inhibition.” The Prostate. 1993;22:43-51.

Wong Y, Mitra N, Hudes G, et al.  “Survival Associated With Treatment vs Observation of Localized Prostate Cancer in Elderly Men.” Journal of the American Medical Association. 2006;296:2683-2693.