 |
| Saw Palmetto helps prostate enlargement |
Some questionable findings
Researchers from the University of Minnesota and Veterans Affairs have published a new review showing that saw palmetto’s effects on prostate enlargement are no better than placebo.However, their review only covered three studies. While their initial analysis looked at 17 studies that included 2,008 patients and a previous study by some of the same researchers examined 21 studies with 3,139 patients, now the researchers eliminated all but three studies, which covered only 661 patients.
In this most recent review, the VA researchers eliminated any study that did not use American Urological Association Symptom Index scores or International Prostate Symptom Scores to evaluate improvement.
This said, the researchers found that among these three studies, Saw palmetto (Serenoa repens) supplements – even when one study increased doses by two times and then three times during the study – were no better than placebo in reducing prostate symptoms.
This finding conflicts with numerous studies and several previous reviews that found Saw palmetto reduces prostate symptoms.
Other research shows more benefit for Saw Palmetto
For example, in a previous Cochrane review, this one also from the Veterans Affairs’ Center for Chronic Disease Outcomes Research and updated with recent studies through 2009, reviewed 21 studies involving 3,139 men. Of these, 18 were found to be double-blinded, and of those, seven were eliminated to leave 11 studies of high-quality controls and fully randomized under Cochrane review criteria.Unlike the recent three-study review, this review found that Saw palmetto supplementation produced better urinary symptom scores (by about 7.5%) than placebo, and reduced nighttime urination (nocturia) by 24%. Furthermore, self-reported improvement in symptoms was 76% higher among the saw palmetto patients.
In two of those studies, Saw palmetto supplementation showed similar improvement in symptom scores as the pharmaceutical Finasteride, but with fewer side effects and 18% fewer people withdrawing from the studies.
The researchers of this 2009 review concluded that:
"The evidence suggests that Serenoa repens provides mild to moderate improvement in urinary symptoms and flow measures. Serenoa repens produced similar improvement in urinary symptoms and flow compared to finasteride and is associated with fewer adverse treatment events.”Curiously, a study from 2000 by the same researchers reviewed 44 studies and eliminated all but 18 high-quality studies. This review found similar results as the 2002 and 2009 reviews found, with Saw palmetto providing symptom improvement over placebo, similar to pharmaceutical treatment but without the side effects.
The one study that doubled and tripled dosage during the study period showed no difference in symptom scores between placebo. This appears, from the authors’ reviews, to have been the linchpin of the assessment. They concluded, based on these three studies that: “Serenoa repens therapy does not improve lower urinary tract symptoms or maximum urinary flow rate compared with placebo in men with BPH, even at double and triple the usual dose. Adverse events were generally mild and comparable to placebo.”
The elimination of all the previous studies was based not upon whether the symptom assessments were scientifically valid, but whether the symptom assessments were scored using new assessment criteria. A formalization of symptom assessment.
The issue that seems to have escaped these analyses completely lies with the quality of the actual supplements used. Saw palmetto supplements come in a variety of shapes and sizes. Some have been more successful than others.
Issue of selection of Saw Palmetto extract
Confirming this, Ray Sahelian, M.D. has stated in a discussion of saw palmetto extract: “In order for a saw palmetto product to be effective, it should either supply a daily dose of 320 mg of 85 to 95% fatty acids, or 640 mg of a 45% fatty acid extract. Some products that do not have these high potency fatty acid extracts may not be as effective.”Furthermore, most Saw palmetto supplements are standardized extracts, typically standardized to the fatty acids within the fruit. The modern extract method now typically used for saw palmetto extracts is called supercritical CO2 with ethanol.
In a study of this method that tested CO2 supercritical extraction with Saw palmetto, St. John’s Wort, Kava and Echinacea, where the standardized ingredients (such as kavalactones from Kava) were found to have yielded from 2% to 12% by mass, the study found that: “Other desirable actives, such as chichoric acid and associated polyphenolic derivatives were not extracted.”
In other words, these standardized extracted herbal products do not readily convey to the final product the full breadth of the original herbs’ complex of active compounds.
While modern researchers conclude that the effectiveness of a medicine is typically due to a single chemical producing a biological mechanism in the body, this is not applicable in traditional applications of herbal medicine. Herbal medicines typically contain dozens if not hundreds of active biochemicals that work synergistically to produce a whole body effect.
Modern extract methodology often leaves behind many important active constituents through the extraction process.
This is a symptom of the same disease that modern pharmaceutical medicine has: The single-bullet theory. The notion that a single chemical will produce the healing effect.
This theory has led to more profits and patents along with adverse side effects, often from the very pharmaceutical-grade compounds originally derived from plants. More than 50% of pharmaceuticals can be traced to the plant compounds.
Departure from traditional use
Historically, medicinal herbs have been used as whole roots, fruits or leaves, or through natural extraction methods such as water infusion (e.g., tea). This renders an array of plant compounds that balance each other and buffer each others effects.If we examine the research, prostate enlargement relates not only to a single cause but to a combination of factors. Diets that maintain a high proportion of saturated fats, fried foods and other artery-damaging foods increase the risk of prostate enlargement, along with stress, lack of exercise and other lifestyle factors. Meanwhile, diets that maintain a variety of whole food plant-based nutrients have been shown to decrease the risk of prostate enlargement.
Holistic practitioners thus add dietary and lifestyle recommendations to saw palmetto and other beneficial herb formulas for a balanced approach to a healthier prostate. See your holistic health professional for personal recommendations.
REFERENCES:
Macdonald R, Tacklind JW, Rutks I, Wilt TJ. Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int. 2012 May 2. doi: 10.1111/j.1464-410X.2012.11172.x.
Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(3):CD001423. Update in: Cochrane Database Syst Rev. 2009;(2):CD001423.
Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA. 1998 Nov 11;280(18):1604-9. Erratum in: JAMA 1999 Feb 10;281(6):515.
Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(3):CD001423. Review. Update in: Cochrane Database Syst Rev. 2009;(2):CD001423.
Wilt TJ, Ishani A, Rutks I, MacDonald R. Phytotherapy for benign prostatic hyperplasia. Public Health Nutr. 2000 Dec;3(4A):459-72.
Cathpole OJ, Perry NB, da Silva BMT, Grey JB, Smallfield BM. Supercritical extraction of herbs I: Saw Palmetto, St John's Wort, Kava Root, and Echinacea. Jour Supercr Fluids. 2002. Feb; 22(2):129-138.