reviewed by X. Li, Ph. D.
(credential)
You are man over 40, you start to feel more frequent need to urinate, feel dripping after urinating
and feel not emptied your bladder, and you start to wake up several times in the night to urinate. If this occurs to you,
you are not alone. Men over 40 are common with such symptoms and a majority of men over 60 have them. These
symptoms are called lower urinary tract symptoms (LUTS). Commonly they are associated with prostate enlargement.
In such cases, they are specifically called benign prostatic hyperplasia (BPH).
BPH or LUTS do not have to go under treatment. It may be improved without treatment, may remain the same, and may
get worse.
First choice of treatment for BPH or LUTS is saw palmetto in Europe. In fact, saw palmetto extract counts for
90% of prescriptions written for BPH in Germany.
Use of saw palmetto in BPH has been the subject of over 100 clinical trials around the world, mostly in
Europe. In these clinical trials patients with BPH were treated with saw palmetto extracts and were evaluated for
any change of their disease, better, same or worse. Ideally and in FDA trial standards, a clinical trial should be
placebo-controlled, double-blind, and randomized trials. In such trials, patients are randomly
divided into two groups, one group receives the experimental drug and the other receives the dummy.
Neither patients nor researchers know if he is taking the drug or dummy. Such a design can reveal the
real effect of a potential treatment and minimize the bias of both researchers and patients.
Most saw palmetto trials do not meet the strict FDA standards because of lack of randomization, lack of controls, or
flaw in methodology. However, some of saw palmetto trials are in compliance with the FDA standards. These saw palmetto trials
were analysed critically and systematically1 in a study published in JAMA
(the Journal of the American Medical Association), a highly regarded
and peer-reviewed medical journal. In the study, researchers from Minneapolis Veterans Affairs
Medical Center found 18 randomized controlled saw palmetto trials conducted in Europe. These trials
involved 2939 men with BPH. The BPH patients treated with a variety of saw palmetto extracts or placebo
for 4 to 48 weeks. Compared to patients who took placebo, patients who took saw palmetto had
statistically significant reductions in urinary symptom scores and nighttime urination times. Saw
palmetto treated patients also had statistically significant improvements in peak urine flow and
self-rating of urinary symptoms. In addition, saw palmetto is found to be quite safe.
In summary, the results of these saw palmetto trials support that saw palmetto can effectively relieve
the symptoms of BPH and improve quality of life. This is the reason saw palmetto is approved in Europe as
prescription medicine and prescribed as first line treatment in Europe for BPH.
Lately, saw palmetto trials has been conducted in USA.
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Saw palmetto was also compared with Proscar for BPH.
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Reference
1. 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.
