By | September 20, 2017
BPH treated by saw palmetto

Saw Palmetto shown to reduce BPH

Research has established that Chinese and Western herbal medicines hold the promise for safely and effectively treating enlarged prostate – also called benign prostatic hyperplasia (BPH). Let’s take a look at some of the research.

Saw palmetto plus for prostate

In a Cochrane review 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.

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.

curcumin from turmeric and prostate

Turmeric extract lessens prostate enlargement

Saw Palmetto combined with nutrients

A review of research from medical scientists from Italy’s University of Messina investigated the data on Saw Palmetto (Serenoa Repens). They found clear evidence illustrating that Saw Palmetto mechanisms support its ability to reduce inflammation and balance androgen hormones, allowing the ability to reduce hyperplasia.

While they (as others have) found the human clinical evidence proving Saw Palmetto’s single-herb effectiveness unconvincing, the researchers did find significant evidence that Saw Palmetto combined with Selenium and Lycopene has the potential for reducing inflammation related to BPH.

Selenium is an important trace element that provides antioxidant activity, helping to reduce inflammation among the selenoprotein cells. Lycopene is a carotenoid phytonutrient found in tomatoes, fruits and other plant foods, and has been found in independent research to help prevent or slow progression of BPH.

This combination of Saw Palmetto combined with Selenium and Lycopene has been strengthened recently by a new multicenter clinical trial by Italian researchers using 168 patients with BPH. This controlled and randomized study tested the effects of a combination of the three (Saw Palmetto, Selenium and Lycopene) against control groups, with and without the addition of pharmaceutical alpha-adrenergic blocker treatment, for three and six months.

The research found reduced inflammation among the Saw Palmetto-combination groups, and significantly reduced levels of T-cells associated with the inflammation mechanisms of BPH. The researchers concluded:

“Serenoa repens plus Selenium plus Lycopene may have an anti-inflammatory activity that could be of interest in the treatment of chronic prostate inflammation in BPH and/or prostatic intraepithelial neoplasia.”

 

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.

Turmeric extract and prostate enlargement

Clinical research from Italy has confirmed what laboratory research has found: That the Ayurvedic herb turmeric (Curcuma longa) increases quality of life and reduces symptoms of enlarged prostate – also known as benign prostatic hyperplasia or BPH.

The ancient Ayurvedic herbal remedy joins the list of several other nutraceuticals that have now been scientifically confirmed to reduce enlarged prostate.

For six months the researchers gave 33 patients diagnosed with benign prostatic hyperplasia with a turmeric extract of curcumin in a product called Meriva® in addition to standard conventional BPH treatment. A control group of 28 BPH patients matched for age and severity received only the conventional BPH treatment.

After the treatment the researchers utilized the International Prostate Symptom Score (IPSS) to evaluate the results of the two groups treated. While both groups experienced improvement in most symptoms, the curcumin-treated group experienced greater improvement. The curcumin-treated group also experienced higher quality-of-life scores than did the conventional treatment group.

The researchers concluded:

“In patients with BPH, the addition of Meriva® to the standard treatment contributed to the reduction of signs and symptoms of the disease without causing any significant additional side effect. This pilot experience suggests a potential novel clinical application of curcumin…”

The Meriva product is a lecithinized curcumin product. Lecithinized refers to lecithin being sprayed onto the product before packing. This gives the product the ability to deliver into the intestines with a minimal breaking down.

Lab tests confirm turmeric effectiveness

This isn’t the first study that has indicated curcumin’s ability to treat enlarge prostate. A study from the Seoul National University College of Medicine found that curcumin inhibited hypoxia-inducible factor 1alpha (HIF-1alpha) in both animal and human prostrate cell tests. This inhibition resulted in a reduction of inflammation – hyperplasia – among the prostate cells. This in turn mediated epithelial-mesenchymal transition (EMT) markers, directly related to inflammation.

In addition, University of Rochester Medical Center researchers confirmed that epithelial-mesenchymal transition (EMT) markers were modulated by curcumin. Wayne State University School of Medicine researchers also found that curcumin reduce inflammation among prostate cells.

Other Herbs show efficacy for BPH

Several other herbs have shown promise in clinical research. These include Pygeum africanum (African plum tree), Cucurbita pepo (pumpkin seed), and Epilobium parviflorum (Smallflower herb).

A formula of these three herbs plus lycopene and Saw Palmetto was clinically tested (a phase II trial) at the University of Queensland’s School of Medicine in Australia. In this randomized double-blind placebo-controlled trial using 57 men with benign prostate hypertrophy, the herbal formulation resulted in a significant improvements compared to the placebo group.

The group receiving the herbal formula saw a 36% reduction in IPSS (International Prostate Symptom Score) results. The herbal formula group also experienced a 15% reduction in daytime urination frequency and nearly a 40% reduction of nighttime urination frequency. The researchers concluded:

“The herbal preparation was shown to be well tolerated and have a significant positive effect on physical symptoms of BPH when taken over 3 months, a clinically significant outcome in otherwise healthy men.”

Chinese Herbal medicine and prostate enlargement

While research on the use of herbs and nutrients for BPH is progressing, there is another entirely different angle on natural prostate treatment, one that has been overlooked by Western medicine and even Western herbalism. That is, the treatment of enlarged prostate in Traditional Chinese Medicine.

And needless to say, the research on Chinese herbs has been more rigorous and extensive, likely because there is more financial support for the funding of herbal medicine research among Chinese universities and hospitals.

Researchers from the University of Hong Kong’s School of Chinese Medicine reviewed 13,922 citations and found 31 clinical studies that tested 2,493 patients with enlarged prostates (volumes ranging from 22.8 to 52.4 ml). While over 80% of the studies were carried out in China, the rest were conducted in India, Peru and Japan.

These studies ranged in design, which included placebo-control, comparison to pharmaceutical treatment, and comparison to known Western herbal therapy treatment including Saw Palmetto and Pygeum africanum. The researchers then focused upon eleven of these 31 studies, as they satisfied their most rigorous protocols to quality and peer-review. These included studies that compared Chinese herbal medicine to tamsulosin and finasteride, either independently or both.

After their metadata calculations and various comparisons were completed, the research found that Chinese herbal therapies outperformed conventional Western pharmaceutical therapy in terms of reducing prostate inflammation and improvement quality of life among the patients.

Among the 31 studies, the herbs that were most tested – in order of frequency – included Cassia Cinnamon (called Rou Gui in TCM and studied in 17 of the 31 studies), Astragalus propinquus (called Huang Qi in TCM), Rehmannia sp. (Shu Di Huang in TCM), Cornus officinalis (Shan Zhu Yu in TCM), Fructus Corni and Poria mushroom/fungus (Fu Ling in TCM), Turmeric (E Shu), Phellodendron amurense (Huang Bo), Alisma plantago-aquatica (Ze Xie) and Vaccaria segetalis (Liu Xing).

Treatment periods in the studies ranged from one month to a year. The metadata results found that Chinese herbal medicine – using both single herbs and combination therapy – was only slightly more effective than the pharmaceutical therapy (about 6% better).

However, the study found that Chinese herbal medicine was significantly more effective at reducing prostate volume and significantly more effective at increasing the quality of life among the prostate patients than both the pharmaceutical therapy and the western herb therapy.

This said, the researchers did note that further studies are suggested to confirm the evidence. But more importantly, they found that adverse side effects among those treated with Chinese herbal therapy was similar to side effects of the placebo patients studied.

In other words, there were little or no adverse side effects among those taking the Chinese herbal medicine.

Traditional Chinese medicine focuses upon the movement of the Chi (or Qi) through the body and blockages of this Qi is considered as  producing disease. In Chinese medicine BPH is often considered “Long Bi” or blocked urination, along with “Zheng Jia” which indicates an abscess or swelling. As a result, tonification of the Ying among the kidneys is one of the goals for therapy in traditional Chinese medicine.

ancestors-diet-3d-1

Learn about the perfect diet to reduce the risk of enlarged prostate.

While conventional medicine continues to look upon herbal medicine with suspicion and mistrust regarding its ability to treat BPH, the research is continuing to provide ample evidence of the efficacy of herbal therapy, assuming close attention by trained and experienced providers.

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:

Morgia G, Cimino S, Favilla V, Russo GI, Squadrito F, Mucciardi G, Masieri L, Minutoli L, Grosso G, Castelli T. Effects of Serenoa repens, selenium and lycopene (Profluss®) on chronic inflammation associated with benign prostatic hyperplasia: results of “FLOG” (Flogosis and Profluss in Prostatic and Genital Disease), a multicentre Italian study. Int Braz J Urol. 2013 Mar-Apr;39(2):214-21. doi: 10.1590/S1677-5538.IBJU.2013.02.10.

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. Review. 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.

Minutoli L, Bitto A, Squadrito F, Marini H, Irrera N, Morgia G, Passantino A, Altavilla D. Serenoa Repens, lycopene and selenium: a triple therapeutic approach to manage benign prostatic hyperplasia. Curr Med Chem. 2013;20(10):1306-12.

Cathpole OJ, Perry NB, da Silva BMT, Grey JB, Smallfield BM. Supercritical extraction of herbs I: SawPalmetto, St John’s Wort, Kava Root, and Echinacea. Jour Supercr Fluids. 2002. Feb; 22(2):129-138.

Coulson S, Rao A, Beck SL, Steels E, Gramotnev H, Vitetta L. A phase II randomised double-blind placebo-controlled clinical trial investigating the efficacy and safety of ProstateEZE Max: a herbal medicine preparation for the management of symptoms of benign prostatic hypertrophy. Complement Ther Med. 2013 Jun;21(3):172-9. doi: 10.1016/j.ctim.2013.01.007.

Ma CH, Lin WL, Lui SL, Cai XY, Wong VT, Ziea E, Zhang ZJ. Efficacy and safety of Chinese herbal medicine for benign prostatic hyperplasia: systematic review of randomized controlled trials. Asian J Androl. 2013 Jul;15(4):471-82. doi: 10.1038/aja.2012.173.

Ledda A, Belcaro G, Dugall M, Luzzi R, Scoccianti M, Togni S, Appendino G, Ciammaichella G. Meriva®, a lecithinized curcumin delivery system, in the control of benign prostatic hyperplasia: a pilot, product evaluation registry study. Panminerva Med. 2012 Dec;54(1 Suppl 4):17-22.

Li Y, Ahmad A, Kong D, Bao B, Sarkar FH. Recent progress on nutraceutical research in prostate cancer. Cancer Metastasis Rev. 2013 Dec 28.

Parsai S, Keck R, Skrzypczak-Jankun E, Jankun J. Analysis of the anticancer activity of curcuminoids, thiotryptophan and 4-phenoxyphenol derivatives. Oncol Lett. 2014 Jan;7(1):17-22.

Kim HJ, Park JW, Cho YS, Cho CH, Kim JS, Shin HW, Chung DH, Kim SJ, Chun YS. Pathogenic role of HIF-1α in prostate hyperplasia in the presence of chronic inflammation. Biochim Biophys Acta. 2013 Jan;1832(1):183-94. doi: 10.1016/j.bbadis.2012.09.002.

Lu T, Lin WJ, Izumi K, Wang X, Xu D, Fang LY, Li L, Jiang Q, Jin J, Chang C. Targeting androgen receptor to suppress macrophage-induced EMT and benign prostatic hyperplasia (BPH) development. Mol Endocrinol. 2012 Oct;26(10):1707-15.