"I get many questions from patients about saw palmetto and its efficacy for the treatment of BPH or enlarged prostate. Here is an interesting article discussing a head to head trial of saw palmetto versus placebo for symptoms of enlarged prostate." – D.R.
Saw palmetto no better than placebo for prostate problems
By Anne Harding, Health.com updated 6:34 PM EST, Tue September 27, 2011
In clinical trials, saw palmetto has consistently failed to outperform placebo. STORY HIGHLIGHTS Clinical trial
finds herbal extract no better than sugar pills for enlarged prostate Saw palmetto has long been marketed as a
remedy for symptoms Doctor: "I wouldn't object, given the no side effects, if men wanted to try it"
(Health.com) -- The millions of middle-aged men who take saw-palmetto supplements to cope with the symptoms of an
enlarged prostate might as well be popping sugar pills. That's the conclusion of a new clinical trial,
published this week in the Journal of the American Medical Association, that found that the herbal extract is no
better than placebo at reducing bathroom trips or otherwise improving the urinary-tract symptoms associated with
prostate enlargement. "There's probably no real benefit," says Simon J. Hall, M.D., the chairman of
the urology department at the Mount Sinai School of Medicine, in New York City, who wasn't involved in the new
research. "Ultimately, the way I would look at it is: Is it worth spending $20 or $30 a month to take something
that is probably not going to do anything?" Health.com: Must-know facts about male incontinence Nearly all men
experience some prostate-gland growth as they age. Most have no obvious symptoms, but because the prostate surrounds
the urethra, this otherwise harmless enlargement (known as benign prostatic hyperplasia) sometimes causes symptoms
such as dribbling after urination, a weak urine stream, and the frequent need to wake up at night to urinate. Saw
palmetto has long been marketed as a remedy for these symptoms, but in clinical trials it has consistently failed to
outperform placebo. A 2009 review of 30 randomized controlled trials -- including a rigorous 2006 study published in
the New England Journal of Medicine -- concluded that the herbal extract was no more effective than placebo. In the
new study, the largest of its kind to date, the researchers randomly assigned 369 U.S. and Canadian men with
prostate-related symptoms to take saw-palmetto capsules or an identical placebo. After 18 months, the men taking saw
palmetto were doing no better than those on placebo, even though the dosage of saw palmetto was increased twice
during the study, to 960 milligrams -- three times the typical daily dose. Health.com: Bladder training tips to
reduce bathroom trips Neither saw palmetto nor placebo made a substantial dent in the men's symptoms. At the
beginning of the study, the average severity of the men's symptoms measured about 14.5 on a 35-point scale
commonly used by urologists; by the end, the average severity had declined by three points in the placebo group and
just two points in the saw palmetto group. Lead author Michael J. Barry, M.D., a primary care physician at
Massachusetts General Hospital, in Boston, points out that between 40% and 45% of the men in both groups saw a
"perceptible improvement" in their symptoms, however. That improvement can be chalked up only to the
placebo effect, not to any active ingredients in the saw-palmetto extract. But that doesn't necessarily mean
that men shouldn't take saw palmetto, Barry says. "We can't show, on the one hand, that it's
better than placebo, but some men do have an improvement in their symptoms, and there seem to be virtually no side
effects," he says. "I wouldn't object, given the no side effects, if men wanted to try it."
Health.com: 12 myths and facts about incontinence Hall says he doesn't discourage his patients from taking saw
palmetto if the placebo effect appears to be working. "Certainly I've had patients tell me...'I'm
taking saw palmetto and it's great,' and I tell them to keep taking it," he says. Saw palmetto, with
just under $19 million in sales, was the second bestselling herbal supplement in the United States in 2010 (behind
cranberry), according to the SymphonyIRI Group, a Chicago-based market-research firm. Barry and his colleagues used
a proprietary brand of saw palmetto manufactured in Germany. Since other studies using different brands have had
similarly disappointing results, it's unlikely that one brand is more effective than another, he says.
Health.com: Natural remedies for incontinence The study was funded and partially overseen by the National Institutes
of Health, although the supplement manufacturer provided all of the saw palmetto and placebo capsules. Other
treatment options for prostate-enlargement symptoms include prescription drugs and surgery. In most cases, Hall
says, treatment is actually not necessary unless there's a true medical problem -- if a man is not able to
completely empty his bladder, for example, or if he experiences recurrent bladder infections.
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