Conditions:
Benign Prostatic Hyperplasia
Related Terms
•
Prostate Enlargement
Principal Proposed Treatments
•
Saw Palmetto, Pygeum, Nettle Root, Beta-Sitosterol, Grass Pollen
Other Proposed Treatments
•
Pumpkin Seeds, Zinc, Flaxseed Oil
If you're a man, and you live long enough, you will almost certainly develop benign prostatic hyperplasia (BPH). Ninety percent of all men show signs of such prostatic enlargement by the age of 80. Symptoms include difficulty in starting urination, a diminished force of urinary stream, a sensation of fullness in the bladder after urination, and the need to urinate many times at night. Ultimately, the obstruction can become so severe that urination is impossible.
The most common treatment for BPH is surgery that removes most of the prostate gland. Although this surgery is fairly safe, it is traumatic. The drugs Cardura, Flomax, Hytrin, and Proscar can relieve symptoms of BPH. In addition, Proscar has been shown to shrink the prostate and cut by half the need for surgery.
Principal Proposed Treatments for Benign Prostatic Hyperplasia
Men who suspect they may suffer from BPH should make sure to see a physician to rule out prostate cancer. After this has been done, many natural options are available that have good scientific backing. Indeed, it's hard to think of another condition for which so many natural therapies have been shown effective.
Saw Palmetto: A Well-Documented Alternative to Prostate Medications
The best-documented herbal treatment for BPH is the oil of the berry of the saw palmetto tree. Saw palmetto is a native of North America; although Europeans are the principal consumers of saw palmetto, it is still grown mainly in North America.
Historically, Native Americans used saw palmetto berries for the treatment of various urinary problems in men and for breast disorders in women. European and U.S. physicians took up saw palmetto as a treatment for BPH, but in the United States the herb ultimately fell out of favor.
European interest endured, and in the 1960s French researchers discovered that, by concentrating the oils of the saw palmetto berry, they could maximize the herb's effectiveness. Subsequently, a standardized version of saw palmetto oil became an accepted treatment for prostate enlargement in New Zealand, France, Germany, Austria, Italy, Spain, and other European countries.
This herb is so well accepted in Europe that synthetic pharmaceuticals are considered alternative therapy for BPH. In Germany, saw palmetto is the seventh most common single-herb product prescribed. Studies suggest that benefits will develop after about 4 to 6 weeks of treatment in two-thirds of men who try it.
Saw palmetto offers two potential advantages over conventional drug treatment. The most obvious is that it usually causes no side effects. Another advantage is that saw palmetto does not change protein-specific antigen (PSA) levels. Lab tests that measure PSA are used to screen for prostate cancer. However, the widely used drug Proscar can artificially lower PSA levels, which may have the unintended effect of masking prostate cancer.
Saw palmetto is also sometimes used to treat chronic prostatitis, but it may not be effective. An open trial that compared saw palmetto to the drug Proscar for the treatment of chronic nonbacterial prostatitis found that, while the herb produced no improvement in symptoms, the drug did prove effective.1
The scientific evidence for saw palmetto in prostate enlargement is quite impressive, although not perfect.
At least seven double-blind studies involving a total of about 500 participants have compared the benefits of saw palmetto against placebo over a period of 1 to 3 months.2–8In all but one of these studies, the herb significantly improved urinary flow rate and most other measures of prostate disease.
A double-blind study followed 1,098 men who received either saw palmetto or the drug Proscar over a period of 6 months.9 According to the results, the two treatments were about equally successful at reducing noticeable symptoms, and neither produced much in the way of side effects. However, Proscar lowered PSA levels, presenting a risk of masking prostate cancer (see the previous discussion under the heading Saw Palmetto: A Well-Documented Alternative to Prostate Medications). Saw palmetto did not cause this problem. On the other hand, careful measurements showed that Proscar caused men's prostates to shrink by 18%, while saw palmetto only caused a 6% decrease in size. Although prostate size does not correlate well with severity of symptoms, such a decrease in size might indicate a reduced likelihood of need for surgery. This is a potential advantage for the drug.
A 52-week double-blind study of 811 men compared saw palmetto to a standard drug in another class: the alpha-blocker tamsulosin.10 Once again, both treatments proved equally effective. However, saw palmetto caused fewer side effects than the drug. In addition, the herb caused some prostate shrinkage, while the drug caused a slight prostate enlargement.
Although there are many theories about how saw palmetto works, none have been conclusively established. The best evidence suggests that the herb affects male hormones.
For important dosage and safety information, see the full saw palmetto article.
Pygeum: Another Well-Documented Natural Choice
The pygeum tree is a tall evergreen native to central and southern Africa. Its bark has been used since ancient times for urinary problems. In recent years, pygeum has become a popular European treatment for BPH—a use that is supported by good scientific evidence—although it's more widely used in France and Italy than in Germany. Pygeum is expensive and difficult to grow.
Pygeum is also sometimes used for prostatitis, as well as impotence and male infertility; 16,17 however, there is little real evidence that it works.
What Is the Scientific Evidence for Pygeum?
At least seventeen double-blind trials of pygeum for BPH have been performed, involving a total of almost 1000 individuals, and ranging in length from 45 to 90 days.18-22,57 Many of these studies were poorly reported and/or designed. Nonetheless, overall, the results do suggest that pygeum can reduce symptoms such as nighttime urination, urinary frequency, and residual urine volume.
The best of these trials was conducted at 8 sites in Europe and included 263 men between 50 and 85 years of age.23 Participants received 50 mg of a pygeum extract or placebo twice daily. The results showed significant improvements in residual urine volume, voided volume, urinary flow rate, nighttime urination, and daytime frequency.
We don't really know how pygeum works. Unlike the standard drug finasteride, it does not appear to work by affecting the conversion of testosterone to dihydrotestosterone.24 Rather it is thought to reduce inflammation in the prostate, and also to inhibit prostate growth factors, substances implicated in inappropriate prostate enlargement.25,26,27 We don't know whether pygeum can reduce the need for prostate surgery or whether it affects PSA levels.
For more information, including dosage and safety issues, see the full pygeum article.
Nettle Root
Anyone who lives in a locale where nettle grows wild will likely discover the powers of this dark green plant. Depending on the species, the fine hairs on its leaves and stem cause burning pain that lasts from hours to weeks. Both its leaves and roots can be used as medicine. The root is a popular European treatment for BPH. Over a period of several months, nettle appears to reduce obstruction of urinary flow and decrease the need for nighttime urination.
Nettle leaf (not the root) is sometimes used for allergies.
What Is the Scientific Evidence for Nettle Root?
Nettle root has not been as well studied as saw palmetto or pygeum.
A double-blind placebo-controlled study of 50 men over 9 weeks found a significant increase in urination volume and urine flow rate.32 In another double-blind placebo-controlled study, treatment of 67 men with nettle produced a 14% improvement in urine flow and a 53% decrease in residual urine.33
Finally, a double-blind placebo-controlled study of 40 men found a significant decrease in frequency of urination after 6 months.34
For more information, including dosage and safety issues, see the full nettle article.
Beta-Sitosterol
Numerous plants contain cholesterol-like compounds called sitosterols and their close relatives sitosterolins. A special mixture of these called beta-sitosterol is used for the treatment of BPH.
A review of the literature, published in 1999, found a total of four randomized double-blind placebo-controlled studies on beta-sitosterol for BPH, enrolling a total of 519 men.37–40 All but one of these studies found significant benefits in both perceived symptoms and objective measurements, such as urine flow rate. The largest trial followed 200 men with BPH for a period of 6 months.41 After the study was completed, many of the participants were followed for an additional year, during which the benefits continued.42 Similar results were seen in a 6-month double-blind trial of 177 individuals with BPH.43
For more information, including dosage and safety issues, see the full beta-sitosterol article.
Grass Pollen
Grass pollen is also used to treat BPH. The grasses used for this preparation are 92% rye, 5% timothy, and 3% corn. Related grass pollen extracts are used for allergy shots. However, the grass pollen extracts described here are different in that they have their allergenic component removed. Grass pollen is also an entirely different product than bee pollen.
What Is the Scientific Evidence for Grass Pollen Extract?
Two double-blind placebo-controlled studies found that grass pollen extract can improve symptoms of prostate enlargement.45,46 There have also been open studies that compared grass pollen to different treatments for BPH.47,48
In the first double-blind placebo-controlled study, 103 individuals with BPH were assigned to take either placebo or 2 capsules of a standardized grass pollen extract 3 times daily for a period of 12 weeks.49 At the end of the study, 69% of the participants who had been taking the grass pollen had reduced the number of trips they had to make to the bathroom at night. In the placebo group, only 37% reported improvement in this symptom. The amount of urine remaining in the bladder following urination was reduced in the treatment group by 24 ml and by 4 ml for the placebo group. Both of these were statistically significant improvements for those taking grass pollen.
The second double-blind placebo-controlled study lasted longer but enrolled fewer participants.50 Fifty-seven men with prostate enlargement were enrolled in the study, with 31 taking 92 mg of the grass pollen extract daily for 6 months and the remaining 26 taking placebo. As with the previous study, statistically significant improvements in nighttime frequency of urination and emptying of the bladder were found with use of grass pollen extract. Additionally, 69% of the participants receiving treatment reported overall improvement, while only 29% of the group taking the placebo felt they had improved, another statistically significant difference.
An important finding in this study was that the prostates of the men taking grass pollen significantly decreased in size according to ultrasound measurements taken.
No one is certain how the grass pollen extract causes the beneficial results seen in the studies. One theory is that it inhibits the body's manufacturing of prostaglandins and leukotrienes, which might relieve congestion and act as an anti-inflammatory.51
For more information, including dosage and safety issues, see the full grass pollen extract article.
Combination Treatment
A 48-week double-blind trial of 543 men with early BPH compared combined saw palmetto and nettle root against Proscar and found equal benefits.55
A 6-month double-blind placebo-controlled trial of 44 men given a saw palmetto herbal blend (containing, in addition, nettle root and pumpkin seed oil) found shrinkage in prostate tissue.56 No significant improvement in symptoms was seen, but the authors pointed out that the study size was too small to statistically detect such improvements if they did occur.
Other Proposed Treatments for Benign Prostatic Hyperplasia
There are a few other treatments often recommended for BPH, but they lack any real scientific evidence. Pumpkin seeds are approved for use in BPH by Germany's Commission E. The mineral zinc is also commonly recommended in both Europe and the United States as a treatment for prostate disease, as is flaxseed oil. But in the absence of meaningful studies for these treatments we'd suggest sticking with one of the proven herbs above.
View References
Last reviewed August 2002 by Medical Review Board
Back to Top
