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The prostate is a small, walnut-shaped gland located just below the bladder. The prostate surrounds the urethra, the tube through which urine passes out of the body. One of the prostate’s main functions is to provide fluid for the semen.
It is common for the prostate to enlarge as a man gets older. This condition is known as benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy. Over 50% of men in their 60s, and up to 90% of men in their 70s and 80s have BPH.
As the prostate enlarges, it causes greater constriction of the urethra, which can result in bothersome urinary symptoms such as urinary frequency, urgency, and decreased urinary flow. Fortunately, there are a number of treatments that may lessen the symptoms of BPH, including prescription drugs, minimally invasive procedures such as laser and microwave, and prostate surgery. Certain nutritional or herbal ingredients may also help manage urinary symptoms. Most of the nutritional ingredients have few side effects, and are often recommended for men with mild to moderate urinary symptoms.
When the BPH symptoms are mild or moderate, many men will try an over-the-counter herbal supplement. Many published studies have demonstrated the potential efficacy and safety of this approach. In Europe, where they are sold in prescription form, herbal products are actually the most popular form of BPH treatment. These herbal supplements contain various fatty acids and phytosterols (naturally occurring plant sterols), which are believed to be responsible for the symptom relief.
Saw palmetto
• Saw palmetto, also known as Serenoa repens, is the herb most commonly used by men with the symptoms of BPH, or prostate enlargement. The active components of the saw palmetto plant are extracted from its berries. The saw palmetto plant grows mainly in the coastal regions of the southeastern U.S. Saw palmetto has been used for centuries, with its first use by Native Americans in the 1700's. Although its exact mechanism of action remains unknown, proposed mechanisms include anti-androgenic action, anti-inflammatory effects, and antiproliferative action. Many well-designed studies have shown that saw palmetto relieves the symptoms of an enlarged prostate when compared to placebo, and can provide symptom relief while causing fewer sexual side effects. Overall, saw palmetto has been shown to be safe, causes minimal side effects, and does not falsely lower PSA levels (which could mask the diagnosis of prostate cancer). Mild gastrointestinal distress has been reported infrequently, and can be alleviated by taking saw palmetto with food.
• Beta-sitosterol
• Beta-sitosterol is a phytosterol that research has shown improves urinary tract symptoms and urinary flow in men with an enlarged prostate. Beta-sitosterol is generally used in nutritional supplements as part of a mixture of phytosterols. Although their exact method of action is unknown, these phytosterols are thought to work due to anti-inflammatory effects. They also interfere with cholesterol metabolism, and are added to some foods to promote healthy cholesterol levels. Beta-sitosterol is often used by men with mild to moderate urinary tract symptoms. It has been well-tolerated in clinical trials, with mild gastrointestinal upset occurring in only 1-2% of men.
• Pygeum africanum
Pygeum africanum is a tall evergreen tree that grows mostly in Southern Africa, Madagascar, and in some areas of Central Africa. The medicinal use of Pygeum bark dates back to ancient times, when it was used as a tribal remedy for bladder pains. Pygeum bark extract contains phytosterols (beta-sitosterol), pentacyclic triterpenes, and ferulic esters, which are thought to be the active ingredients. It is thought that beta-sitosterol is the primary active component, although this is not known for sure. The exact mechanism of action of Pygeum is not fully understood, but it has been shown to have anti-inflammatory effects and anti-edema properties. Clinical trials have shown that Pygeum may decrease the severity of urinary tract symptoms in men with BPH.
• Other Herbal Extracts for BPH
Although the most evidence exists for saw palmetto, beta-sitosterol, and pygeum, there are a limited number of studies suggesting that other botanicals may also be beneficial for men with BPH. These include Nettle root, pumpkin seed, rye pollen, etc. However, more studies need to be conducted to determine the safety and efficacy of these products.
If you try an herbal product for BPH symptom relief, be aware of two factors. First, it may take 8 to 12 weeks to see improvement in your symptoms, so give it a chance before you decide if it's working. Second, because the FDA does not regulate these products as stringently as they do prescription drugs, content accuracy and product purity cannot be taken for granted. Look for a product that has been independently certified for content purity and accuracy by one of the non-profit certification programs in the U.S (NSF or USP).