Saw Palmetto for BPH Enlarged Prostate and a Supplement That Actually Works
Saw palmetto berry is “undisputedly” the most common herbal supplement used for prostate enlargement, also known as BPH or benign prostatic hyperplasia. More than a million Americans report taking saw palmetto. And up until 20 years ago we even thought it worked! A 2002 Cochrane review concluded that saw palmetto supplements seemed to provide “mild to moderate improvement in urinary symptoms,” and furthermore, the improvements were COMparable to finasteride, without the drug’s side effects. However, most of the head-to-head trials lacked a placebo control. If a study shows that both an herb and a drug relieve symptoms equally well, that means it could just as well equally fail to offer more than a placebo effect. Between 25 and 50 percent of BPH sufferers respond as well to a sugar pill as they do to the drugs, underscoring the importance of including a placebo arm. These early studies did, however, inspire more rigorous investigations.
The tide turned in 2006 with the publication of a major non-industry funded trial in the New England Journal of Medicine that found saw palmetto failed to beat out placebo on any measure, whether subjective or objective. No significant differences were found in symptoms, prostate size, urinary retention, or flow rate. Taking this, and eight other new trials involving thousands more men into account, the next Cochrane review and the latest, acknowledged that saw palmetto works little or no better than placebo. Different doses were tried, and still nothing.
One supplement that may help prevent and treat BPH is vitamin D. Men with low vitamin D levels tend to have larger prostates and be at higher risk of BPH… and BPH symptoms… But vitamin D status also correlates with a range of potential confounding lifestyle and demographic variables, so in 2021 researchers decided to put it to the test. Asymptomatic older men or those with only mild BPH symptoms were randomized to 50,000 international units of vitamin D3 once every two weeks for six months and ended up with smaller prostates and a greater drop in BPH symptoms compared to the control group. What if you already have moderate to severe symptoms? Men with more serious prostate enlargement were randomized to the drug tamsulosin (sold as Flowmax) with or without 600 units of vitamin D a day for two years. Although there was no significant effect on prostate volume or symptoms, there was a reduction in residual bladder volume in the vitamin D group, which may explain the significant reduction in recurrent urinary tract infections.
Saw palmetto berry is “undisputedly” the most common herbal supplement used for prostate enlargement, also known as BPH or benign prostatic hyperplasia. More than a million Americans report taking saw palmetto. And up until 20 years ago we even thought it worked! A 2002 Cochrane review concluded that saw palmetto supplements seemed to provide “mild to moderate improvement in urinary symptoms,” and furthermore, the improvements were COMparable to finasteride, without the drug’s side effects. However, most of the head-to-head trials lacked a placebo control. If a study shows that both an herb and a drug relieve symptoms equally well, that means it could just as well equally fail to offer more than a placebo effect. Between 25 and 50 percent of BPH sufferers respond as well to a sugar pill as they do to the drugs, underscoring the importance of including a placebo arm. These early studies did, however, inspire more rigorous investigations.
The tide turned in 2006 with the publication of a major non-industry funded trial in the New England Journal of Medicine that found saw palmetto failed to beat out placebo on any measure, whether subjective or objective. No significant differences were found in symptoms, prostate size, urinary retention, or flow rate. Taking this, and eight other new trials involving thousands more men into account, the next Cochrane review and the latest, acknowledged that saw palmetto works little or no better than placebo. Different doses were tried, and still nothing.
One supplement that may help prevent and treat BPH is vitamin D. Men with low vitamin D levels tend to have larger prostates and be at higher risk of BPH… and BPH symptoms… But vitamin D status also correlates with a range of potential confounding lifestyle and demographic variables, so in 2021 researchers decided to put it to the test. Asymptomatic older men or those with only mild BPH symptoms were randomized to 50,000 international units of vitamin D3 once every two weeks for six months and ended up with smaller prostates and a greater drop in BPH symptoms compared to the control group. What if you already have moderate to severe symptoms? Men with more serious prostate enlargement were randomized to the drug tamsulosin (sold as Flowmax) with or without 600 units of vitamin D a day for two years. Although there was no significant effect on prostate volume or symptoms, there was a reduction in residual bladder volume in the vitamin D group, which may explain the significant reduction in recurrent urinary tract infections.
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