Wednesday, September 28, 2011

Saw Palmetto Doesn't Improve Prostate Symptoms

One of the inevitable challenges men face as we grow older (besides erectile dysfunction) is benign prostate hypertrophy (BPH), eg an enlarged prostate, such that we have urgency, frequency, difficulty fully emptying our bladder, starting and/or stopping our stream, poor sleep from frequent nocturnal awakenings to empty our bladder.

There are two pharmaceutical classes to fix the issue.  One uses alpha blockers to relax the prostate capsule.  The other uses 5 alpha reductase inhibitors to shrink the prostate. The former takes effect in days to weeks but does run the risk of floppy iris syndrome (so go see your ophthalmologist to check for cataracts ready for surgery prior to starting) while the latter takes months (and has been linked to lower risk of prostate cancer but higher grade if/when diagnosed).  The latter also upsets the balance of testosterone byproducts such that less is converted into dihydrotestosterone (which allows for more hair) and more is converted into estradiol (which may decrease sex drive and also lead to erectile dysfunction).

Given the issues associated with prevailing pharmaceutical options, it's not surprising that many men would rather try herbal & dietary nutraceuticals, most commonly saw palmetto.  However, in a randomized, double-blind, placebo-controlled tudy just published in today's Journal of the American Medical Association, the authors found no benefit from even higher than normal dosing.  Specifically, the authors randomized 369 men w/moderately symptomatic BPH to 320mg/d of saw palmetto vs placebo x 24wks.  At that time, the dose was increased to 2/d and at 48 weeks, it was increased yet again to 3/d for the last 24wks of the study.  Unfortunately, there was no improvement compared to placebo at any time using the validated American Urological Association's Prostate Symptom Score.

Previous findings published in February 2006 in the New England Journal of Medicine came to a similar conclusion at just 320mg/d dose alone.  Even the dietary supplement industry gave kudos to the study design and quality of supplement used.  They could not explain the unexpected results either which tells me that these findings are probably close to the truth than they'd like to admit.  With that said, if you want to believe in it or at least try something before succumbing to Big Pharma, go ahead.  Just remember that there is no 3rd party oversight such that you aren't guaranteed the same quality, potency & lack of contamination as the product used in this study.

Of course, if all else fails, there's always surgery.  Seriously!  I'd just suggest taking it a step at a time w/your family physician before crossing the doorway to the urologist.

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