Saw Palmetto for BPH (Benign Prostatic Hyperplasia)

Saw palmetto performed well in early trials but failed in the largest, best-controlled studies.

Overview

Saw palmetto performed well in early trials but failed in the largest, best-controlled studies.

Verdict

Mixed evidence

How It Works

Saw palmetto lipid extracts are proposed to inhibit 5-alpha-reductase and reduce prostatic androgen and inflammatory signalling, though effects on serum DHT are minimal.

Dosing & Protocol

Typical dose

Recommended dose: 320mg standardized extract daily
Expected timeframe: 6-12 weeks for early change; 6 months to judge

Protocol

form: Hexane- or CO2-extracted liposterolic extract - dried berry powder and ethanolic extracts were used in the negative trials and are not equivalent
duration: 6 months, with an IPSS score at baseline and end
co factor: Take with food to reduce stomach upset. Evidence is mixed and this is the key nuance: the large, well-conducted STEP and CAMUS trials found no benefit over placebo, while European trials of specific hexanic extracts report symptom improvement comparable to tamsulosin. The extract type used appears to explain much of the disagreement.
titration: No escalation above 320 mg/day is supported
starting dose: 320 mg/day of a liposterolic saw palmetto extract (85-95% fatty acids and sterols), as 320 mg once daily or 160 mg twice daily with food

Evidence

What the studies say

The STEP and CAMUS trials, including doses up to three times standard, found no benefit over placebo on urinary symptom scores. A Cochrane review concluded saw palmetto is no more effective than placebo for BPH symptoms, contradicting earlier positive but lower-quality studies.

Efficacy and safety of a combination of sabal and urtica extract in lower urinary tract symptoms: a randomized, double-blind study versus tamsulosin

Score: 6/10

2006

rct

n=140

Engelmann U, Walther C, Bondarenko B

A saw palmetto plus nettle root combination was non-inferior to tamsulosin for IPSS improvement over 60 weeks, with fewer adverse effects.

View source

Safety

Caveats

Get a proper urological assessment before self-treating - lower urinary tract symptoms can arise from prostate cancer, bladder stones or neurological disease, and saw palmetto is often claimed to interfere with PSA interpretation, so tell your doctor you are taking it. Inability to pass urine is acute retention and needs emergency care. Safety ceiling: above 320 mg/day is unstudied; side effects are mild but include gastrointestinal upset and headache. Saw palmetto may add to bleeding risk with anticoagulants and antiplatelets, and cases of hepatitis and pancreatitis have been reported. Not applicable in pregnancy; women who are or may become pregnant should not handle it because of antiandrogenic activity.

Less likely to help if

Men with severe symptoms or a large prostate, who respond better to alpha-blockers and 5-alpha-reductase inhibitors.

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