Saw Palmetto for Prostate

Boucher Institute of Naturopathic Medicine was of a male patient suffering from BPH, or benign prostatic hyperplasia.  BPH is a condition that causes an enlargement of the prostate which then presses on the male urethra, obstructing urinary flow and causing frequent and sometimes painful urination, urinary hesitancy (start-and-stop flow), an increased risk of urinary tract infections and urinary retention.  Some attention will be paid here to this condition as if often begins in middle age for men and approximately three quarters of males over the age of 75 will suffer from it.

My patient’s chief complaint at the time was nocturnal urination – he was rising up to four times per night to greet the toilet with sleepy eyes.  Lethargic in the morning, he was seeking a quick and permanent resolution.  His medical doctor was suggesting medication but he wanted to try the natural route.

I hit the books to determine the best natural therapies to treat BPH and the herb saw palmetto (Serenoa repens) popped up in the literature time and time again.  Under the advisement of my supervising physician, I concocted an herbal tincture with saw palmetto as the main ingredient.  The patient agreed to try it.  Several weeks later he was back in my office with a smile on his face.  I asked him about his nightly urinary habits and he happily replied he’s only getting up once to twice a night now to pee.  I had to hide my shock that my herbal formula had worked so well (we had also adjusted his dietary and physical activity habits which may have played a role in his body’s response).

Several months ago a systematic review on saw palmetto came out.  It concluded that, “Serenoa repens therapy does not improve LUTS [lower urinary tract symptoms] or Q(max) [maximum urinary output] compared with placebo in men with BPH, even at double and triple the usual dose.  Adverse events were generally mild and comparable to placebo.”

This didn’t seem to fit with my experience in clinic that day, nor my experience since.  Upon digging a little further, I came across a great article written by GreenMedInfo.com.   They state that the findings of this study and another negative metanalysis conducted in 2009 “conflict with numerous randomized, double-blind studies and previous reviews that have found Saw palmetto reduces prostate symptoms.”  An example of the conflicting evidence is a Cochrane review from 2000 in which 18 studies from 1966 – 1997 were assessed and found that saw palmetto improved BPH symptoms by an average of 72%.

So why the conflicting evidence?  And, doesn’t it seem to always be the case that certain studies will show positive results for a substance (whether a drug, supplement, herb or food) while others will show the opposite?

The Green Med Info article determined the discord has much to do with study design.   Among their findings were:

• good quality research studies are being left out of the reviews because they don’t meet increasingly tighter protocols being set out by pharmaceutical research
• varying amounts of the bioactive ingredient in different saw palmetto herbal products were using in different studies
• studies involving combination herbal products were omitted from the reviews, and it has been found that, like most herbs, saw palmetto works synergistically with other herbs to produce greater benefits
• BPH is a result of a combination of factors (obesity, low physical activity, alcohol, saturated fatty diet, stress, smoking, etc.) and therefore when saw palmetto is prescribed in a traditional medicinal setting, a combination of herbs and lifestyle changes may be recommended..  Saw palmetto has worked this way for many years, for thousands of patients, although the positive benefits to this holistic approach will not be picked up in large, clinical “single active constituent” studies.

Based on findings in my clinical practice, and positive research study designs that reflect the intricacies of herbal prescribing,  I continue to recommend saw palmetto to my patients for BPH.