Palmetto and the Prostate.

You find that you no longer can sit through a movie or a long car room. And sometimes when you get there, not much happens.

The problem: a swollen prostate gland, or benign prostatic hypertrophy (BPH). It plagues one out of every two men over the age of 60. If the enlarged gland presses against the urethra, the tube that carries urine from the bladder out of the body, the simple act of urinating can become difficult.

Surgery can open up the flow, but because the prostate is surrounded by nerves, patients run the risk of incontinence or impotence. Prescription drugs provide some relief for some men, but with the risk of diminished sex drive (Proscar) or dizziness (Hytrin). And there's no good evidence that changing your diet will help.

But saw palmetto might. Since we last looked at prostate supplements (see "`P' is for Prostate," June 1996), the evidence for this berry extract has gotten stronger.

Berry Good

Native Americans traditionally used the berries of the saw palmetto plant to treat the symptoms of urinary tract problems. Since 1983, seven good European studies have compared standardized saw palmetto extracts with look-alike (but palmetto-less) placebos in men with urinary problems caused by BPH. About 350 men took the extracts for one to three months.

In five of the seven studies, saw palmetto was better than the placebo in relieving some symptoms. On average, the saw-palmetto-taken felt less urgency to urinate, got up less often at night to go to the bathroom, or had greater urine flow.

In another large study, European researchers gave either saw palmetto or the prescription drug Proscar to more than 1,000 men for six months.(1) Both proved equally effective in relieving--but not eliminating--the symptoms of BPH (though both failed to help about a third of the men). While Proscar was better at increasing the maximum rate of urine flow and shrinking the prostate, the men taking saw palmetto reported fewer problems with sex drive and performance.

Results like these led the United States Pharmacopoeia (USP) to conclude last April that there is "moderate evidence of effectiveness" for saw palmetto in men with BPH. USP is a quasi-governmental agency that sets manufacturing standards for drugs and advises health professionals on their appropriate use.

Saw palmetto appears to be safe, causing no more short-term side effects than a placebo. Still, there are no long-term studies looking at possible side effects in humans. Probably the biggest risk is taking saw palmetto to relieve the discomfort of BPH without first seeing your physician to rule out prostate cancer, which can have the same symptoms.

What to Take?

Which brand is best? The studies showing that saw palmetto can help relieve the symptoms of BPH used:

* extracts of saw palmetto berries, not crushed whole berries,

* a typical 320-mg dose (160 mg taken twice a day),

* extracts containing at least 85 percent fatty acids, which are likely to contain the active ingredients.

Your chances of getting the right amount of the right ingredients are about two out of three, according to a survey by a supplement testing company, consumerlab.com.

"Only 17 of the 27 leading brands of saw palmetto we purchased at the end of 1999 passed our test," says consumerlab.com president Tod Cooperman.

Six of the 27 didn't claim to contain 85 percent fatty acids. When the company analyzed the remaining 21 brands, 17 passed.

The company tested only one sample of each brand. But its results are the only ones available. (For a list of brands that passed, see www.consumerlab.com.)

(1) Prostate 29: 231, 1996.

For more information and links to the studies mentioned in this article, see www.cspinet. org/nah/sawpalmetto.html.