Prostate gland enlargement

Townsend Letter for Doctors and Patients, May, 2006 by Martin W. Banschbach

Herbals: Saw palmetto (serenoa serrulata) berries are obtained from plants that grow from the sandy soil of South Carolina all the way around the coast of Florida to the west Texas coast. Saw palmetto is a dwarf palm tree that grows to a height of six to ten feet. Native American Indians gathered saw palmetto berries and ate them when they had urinary problems or poor urine stream flow. Many health claims have been made for these berries. In Germany, the saw palmetto berry is approved for the treatment of BPH. Eighty percent of Germans use this and other natural treatments for BPH.

A large number of human clinical trials have been conducted with standardized extracts of saw palmetto berries. The active components of the berry are in a lipid extract of the berry. This extract has been shown to inhibit dihydrotestosterone binding to androgen receptors in the prostate gland, and it also inhibits 5-alpha-reductase action on testosterone. The extract also inhibits 3-alpha-ketosteroid reductase activity on dihydrotestosterone. Testosterone is converted to dihydrotestosterone (DHT) in the prostate gland, and DHT is thought to cause a significant increase in size of the human prostate gland. (29) Prescription drugs that inhibit the 5-alpha-reductase can reduce the size of the human prostate by 20% to 30%.

Saw palmetto does this naturally. Saw palmetto also acts on other areas that cause prostate enlargement, areas on which the current class of prescription drugs can't act. (30) Finasteride lowered DHT from an average of 4.9 ng/g to 1.0 ng/g in the prostates of 22 patients with BPH. Finasteride is a drug approved in the US for treatment of both BPH and male pattern baldness. A saw palmetto extract (320 mg/day of a standardized extract) lowered DHT from an average of 6.49 ng/g to 4.40 ng/g in the prostates of 44 patients with BPH. (31) The saw palmetto effect was significant. The lipid extract from saw palmetto can also inhibit lipoxygenase and further help decrease the symptoms of an enlarged prostate gland--i.e., pain and inflammation. (32)

Saw Palmetto has worked so well (and with minimal or no side effects) that it is now in the select list of herbals that equal or surpass pharmaceutical prescription medication treatments for specific human diseases. (33) Other herbals in this select list include St. John's Wort and ginkgo. While Australia now appears to be ready to accept saw palmetto and other herbal products as offering plant chemicals that can help with human disease, the United States is still fighting this effort to use natural remedies for BPH and other human diseases.

A paper published in the New England Journal of Medicine on February 9, 2006 states that over two million American men are now using saw palmetto for the treatment of BPH, but a double-blind, placebo-controlled clinical trial conducted in the US (NCT00037154) using 222 men and 160 mg of saw palmetto berry extract twice a day showed no benefit. (34) An editorial in the same issue states that saw palmetto berry extract provides absolutely no benefit to men suffering from BPH and US physicians should discourage its use. This New England Journal of Medicine editorial received a large amount of media attention in the United States. The authors of the paper, describing the first clinical trial on a saw palmetto berry extract run in the US, state that their negative results could be due to not using enough of the active ingredient in saw palmetto berries or, they continue, all the previous clinical trials were flawed.