Enlarged prostates may cause urinary symptoms such urinating often during the day or night, having a weak stream and having a feeling of not completely emptying the bladder. The symptoms are bothersome and have a significant impact on quality of life.
Natural approaches to enlarge prostate have been used for a long time in other cultures. One natural approach is an herb called saw palmetto (aka serenoa repens or sabal serrulatum) which can be taken as a supplement. Saw palmetto comes from the berry fruit of the American dwarf palm tree and has been used for centuries to address enlarged prostates in other cultures. More than 50% of cases in Italy and Germany are treated with natural approaches! The main benefit of natural approaches is the lower risk of side effects such as low libido and erectile dysfunction, when compared to medication approaches.
What is the evidence for saw palmetto?
Saw palmetto appears to be an effective treatment for enlarge prostate symptoms. It may be as effective as finasteride, better tolerated and less expensive. A Cochrane review (meaning good quality research) in 2002 collected and summarised the findings from all previous studies (capturing 3,139 men in 21 studies across 48 weeks) and concluded that saw palmetto may provide mild to moderate improvement in urinary symptoms and flow measures that is similar to the improvement seen with the common medication finasteride, but with fewer side-effects (Wilt et al., 2002).
Another more recent Cochrane review, published in June 2023, found little to no benefit (Franco, 2023). However, after reading the finer details, this finding should not negate the possibility of improvements form saw palmetto. One study of 101 people was ignored for not being clinically relevant because it was only a marginal improvement in urinary symptoms. Other longer studies comparing saw palmetto with placebo identified clear benefits, including one study of 101 men (Bauer 1999) and another study of 1011 men (BASTA 2010).
What's the right dosage?
If you want to try saw palmetto the ‘going dose’ is 160 mg twice daily or 320 mg once daily. The supplements must be good quality because the important part of the plant seems to be the volatile sterols and free fatty acids found in the berry of the plant which are extracted in different quantities in different products (Habib, 2004).
What if it doesn't work for me?
If saw palmetto doesn’t work for you then it may be because the underlying cause of your urinary symptoms are triggered by irritation of the prostate muscles (due to a different cause). This is more likely if you see benefits with alpha-blocker medications such as Flomax with tamsulosin which relax the prostate muscles. In this case amore personalised approach targeting diet (especially adrenal hormones and omega-3s) may be more successful.
Conclusion
It is 100% worth investigating natural approaches to addressing the bothersome symptoms of an enlarged prostate. There are many things that can be done from a nutrition standpoint that can bring significant benefits. However the approach is individual and nuanced. If you would like to try saw palmetto (or other natural approaches) please get in touch for a consultation. If talking about your prostate with other people is not high on your list of things to do then I offer phone consultations where you can remain as anonymous as possible.
References:
Di Silverio F, D'Eramo G, Lubrano C, Flammia GP, Sciarra A, Palma E, et al. Evidence that Serenoa repens extract displays an antiestrogenic activity in prostatic tissue of benign prostatic hypertrophy patients. Eur Urol. 1992;21:309-14.
Franco JVA, Trivisonno L, Sgarbossa NJ, Alvez GA, Fieiras C, Escobar Liquitay CM, Jung JH. Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement. Cochrane Database of Systematic Reviews 2023, Issue 6. Art. No.: CD001423. DOI: 10.1002/14651858.CD001423.pub4. Accessed 18 September 2023.
Habib FK, Wyllie MG. Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis 2004;7:195-200.
Wilt T, Ishani A, MacDonald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;3:CD001423.
Gerber GS, Kuznetsov D, Johnson BC, Burstein JD. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology. 2001;58:960-4.
Ghadian, A., & Rezaei, M. (2017). Combination therapy with omega-3 fatty acids plus tamsulocin and finasteride in the treatment of men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Inflammopharmacology, 25(4), 451–458. https://doi.org/10.1007/s10787-017-0343-2
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