If you're a male, or have
a man in your life, when age creeps up over 40, as
mine did this year, you begin to think about your
prostate. Over 50 percent of men over 50 years of
age may experience prostate problems. A common
problem often treated with herbal preparations is
benign prostatic hyperplasia, characterized by a
benign (non-malignant) hyperplastic (enlargement)
of the prostate. This can affect quality of life,
including the number of times a man feel the
urge to urinate, particularly at night, with an
urge to urinate 3 to 4 times. The prostate
enlargement resulting from BPH narrows the urethra,
thus producing poor urinary flow. That can also
translate into a host of other urinary symptoms
including hesitancy or straining to urinate,
painful urination, dripping after urination,
increased urinary frequency, and a feeling that the
bladder is not quite empty. BPH is a relatively
poorly understood condition in terms of what is at
work in the body to produce it. This condition
costs American men over $1 billion per year.
A number of conventional
drugs are used in the treatment of BPH, most
notably finasteride (Proscar®). Several
clinical studies have shown that it produces a
moderate improvement over placebo. In Europe, up to
90 percent of BPH patients are treated with
phytopharmaceuticals or herbal-derived products. A
survey of German urologists also indicated that as
much as 50 percent of these physicians prefer
plant-based treatments to chemical drugs. The four
primary plant materials used in Germany and other
European countries for the treatment of BPH include
Pygeum extracts, stinging nettle root extracts,
pumpkin seed oil, and extracts of saw palmetto
fruits. Our primary focus will be on saw
palmetto.
Extracts of the fruits (berries)
of saw palmetto (Serenoa repens) is the best
known herbal treatment for BPH. In some European
literature, the plant is referred to by its
century-old obsolete name Sabal serrulata.
In a number of German scientific papers, the herbal
product is referred to as "sabal" fruits, but the
name Serenoa repens is the correct botanical
name for this small member of the palm family. It
is important to know these name problems, because
you can do a computer search on saw palmetto and
miss important articles if "sabal" is not used in
search terms.
The best-studied
phytomedicine for the treatment of BPH are extracts
of saw palmetto fruits. This past year in doing
various call-in radio talk shows, inevitably a
listener calls in with questions about saw
palmetto. Most relate to how to best use it in
terms of product forms, dosage and duration of
treatment. These callers are for the most part
already using saw palmetto products. Saw palmetto
is number six on the list of the ten best-selling
herbs in health and natural food markets at this
point.
Saw palmetto is an
American medicinal plant. It is a small woody
member of the palm family that occurs from the
coast of South Carolina to Georgia (especially
southern Georgia), west to coastal Alabama, south
throughout Florida. Florida is the state where saw
palmetto is abundant, blanketing millions of acres
in the state in saw palmetto thickets. Most land
now used for Citrus production is in what used to
be palmetto thickets. The vast majority of the
commercial supply is harvested in wild habitats in
Florida. The harvest, itself, is a daunting task.
The berries ripen in the high humidity and heat of
August and September. The plant comes by its name
honestly. The thick, tough, leaf stems are lined
with very sharp, saw-like teeth that can easily
tear your clothes. Hidden beneath the cool shade of
the saw palmetto shrub is a favorite resting haunt
for the eastern diamondback rattlesnake, North
America's largest rattlesnake. Each year, there are
reports of rattlesnake bites during the saw
palmetto harvest.
Several years ago, during the saw
palmetto berry harvest, I went out with a
harvesting crew on a photo shoot of the process.
A crew of three pickers, their buyer and I
left for the harvest at 4 a.m. We drove over 100
miles north of our meeting point to somewhere
outside of Tampa, where the crew had staked-out a
large field of palmetto berries not far from the
coast. The actual harvest of the berries commenced
just before sunrise. I had to use a flash to take
my first set of pictures. It was still dark. I
shot, and they picked to about 11 a.m., getting a
full pick-up load, about a half ton of the fresh
berries. The work was hard, involving filling five
gallon buckets with the fruits, then transferring
them to feed sacks. The workers were covered in
sweat and the unusual scent of fresh saw palmetto
fruits. A half a day's work by any standards was
a day's work. Sometimes, it's important to stop and
think on what it takes to get herb products from
the field to your shelves. The berries then went to a
large drying facility. The dried, cleaned
berries are shipped to extractors, mostly in
Europe, from where it comes back to the United
States in the form of finished extracts for saw
palmetto products.
Saw palmetto was
introduced to the medical profession by Dr. J. B.
Read, of Savannah, Georgia who published a paper on
his clinical experience with the plant in the
April, 1879 issue of the American Journal of
Pharmacy. Read states, "By its peculiar
soothing power on the mucous membrane it induces
sleep, relieves the most troublesome coughs,
promotes expectoration, improves digestion, and
increases fat, flesh and strength. Its sedative and
diuretic properties are remarkable. . . .
Considering the great and diversified power of the
saw palmetto as a therapeutic agent, it seems
strange that it should have so long escaped the
notice of the medical profession." By the 1890s the
effect of the fruit preparation on the sexual organs became
known. An "original communication" in the July 1892
issue of The New Idea , stated that "It also
exerts a great influence over the organs of
reproduction, mammoa, ovarium, prostate, testes,
etc. Its action on them is a vitalizer, and is said
to be the greatest known, tending to increase their
activity and add greatly to their size." Largely used by Eclectic
physicians in the United States into the 1920s, an
interesting comment in the twenty-first edition of
the United States Dispensatory, published in
1926 suggested its use for the future. The authors
note, "It has been especially recommended in cases
of enlarged prostate of old men."
Usage of American
medicinal plants in the United States began to
decline in the 1920s. However, at the same time,
use expanded in Europe. By the 1930s, European
physicians were widely using saw palmetto for the
treatment of irritation of the bladder, urethra,
and prostate. Now, saw palmetto, an American
medicinal plant, has become largely a European
phytomedicine.
Recently a major clinical
study was published in the journal The
Prostate. This large multicenter study involved
dozens of researchers in France, Scotland, England,
Italy, Portugal, the Czech Republic, Greece,
Switzerland, Slovakia, and the United States
comparing the use of Permixon® with the
convention drug finasteride (Proscar®) in the
treatment of 1,098 patients diagnosed BPH.
Permixon® is a commercial saw palmetto extract
product available in Europe, composed of 90 percent
free and 7 percent esterfied fatty acids, among
other components. It was given to patients for 26
weeks at a dose of 160 mg (two times a day morning
and evening). Finasteride was given at a dose of 5
mg per day in the morning (following manufacturers
stated dosage).
The researchers concluded
that both treatments do relieve symptoms of BPH in
about two-thirds of patients. The conventional
drug, finasteride, produced a significant decrease
in prostate volume size. The saw palmetto product
did not reduce prostate size, suggesting different
mechanisms of action for the efficacy of both
drugs. One of the known side effects of finasteride
is decreased libido and impotence. The saw palmetto
product produced fewer complaints of decreased
libido or impotence. This study confirms that
the saw palmetto product is equally effective as
the conventional drug in relieving symptoms of
benign prostatic hyperplasia while producing fewer
side effects.
The German health
authorities, through the Commission E monograph on
saw palmetto, allow use of the berry extract in the
treatment of BPH stages 1 and 2, (at relatively
early stages of the condition. Rare stomach upset
is generally the only side effect attributed to saw
palmetto. Prostate specific antigen (PSA)
measurements are currently used as a diagnostic
tool for determining chances of getting prostate
cancer. Some physicians monitoring patients taking
saw palmetto suggest that the fruit extracts may
lower PSA levels, and warn fellow practitioners to
be aware of this potential action, which could skew
considerations for determining if prostate cancer
is present. It is also very important for consumers
to remember that BPH cannot be self-diagnosed nor
is it a condition amenable to self-treatment. It is
important to discuss the use of saw palmetto or
other phytomedicines for BPH with your health care
provider.
References:
- Anon. 1892. "Saw
Palmetto." Western Druggist(December):
355-356.
- Brown, D.
J. 1995. "Saw Palmetto: Herbal Prescription for Treatment
of BPH." Drug Store News for the
Pharmacist(April): 23-30.
- Buck, A. C. 1996.
Phytotherapy for the Prostate. British
Journal of Urology, 78: 325-336.
- Carraro, J.-C. et al.
1996. Comparison of Phytotherapy (Permixon) With
Finasteride in the Treatment of Benign Prostate
Hyperplasia: A Randomized International Study of
1,098 Patients. The Prostate, 29:
213-240, 1996.
- Hale, E. M.
1898. "Saw
Palmetto, Its History, Botany, Chemistry,
Pharmacology, Provings, Clinical Experience and
Therapeutic Applications." : 1-96.
- Lowe, F. C. and J. C.
Ku. 1996. Phytotherapy in Treatment of Benign
Prostatic Hyperplasia: A Critical Review. Urology 48(1):12-20.
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