Saw Palmetto: Start when Prostate Symptoms First Appear

November 30th 2006 -
It is estimated that 2 million men in the United States are taking formulations containing saw palmetto to ease or prevent symptoms related to enlargement of the prostate gland. In February a study was published (N Engl J Med. 2006 Feb 9;354(6):557-66) that found saw palmetto to be no more effective than a placebo in men with moderate to severe prostate symptoms. The study has been widely quoted to discourage the use of saw palmetto preparations for management of prostate-related symptoms.

Interestingly, a European study that was published in June (Eur Urol. 2006 Jun 27) reported that 43 % of men taking saw palmetto experienced significant relief of their prostatic symptoms compared to 57 % on finasteride (Proscar). Alpha-blocking drugs produced the greatest response, with 68 % of men who were prescribed the drug reporting benefit.

The European study findings were consistent with many previous studies involving saw palmetto, nearly all of which have demonstrated significant improvement in men taking the herbal extract. For example, a Russian study (Urologiia. 2002 Jan-Feb;(1):23-5.) found that saw palmetto supplementation resulted in significantly improved urine flow and quality of life. Furthermore, the improvements were maintained over a 5-year period. A comprehensive review of the available medical literature (Cochrane Database Syst Rev. 2002;(3):CD001423) found that saw palmetto was as effective as finasteride in relieving prostate-related symptoms while producing fewer side effects.

The primary difference between the NEJM study and the many studies that have demonstrated the effectiveness of saw palmetto is the stage at which the supplement was introduced. Studies in which saw palmetto has been introduced when prostatic symptoms were mild to moderate in severity have consistently demonstrated an improvement in those symptoms that is maintained over time. The NEJM study looked at the use of saw palmetto in men with moderate to severe prostatic symptoms and found that the herbal extract was ineffective in reversing relatively advanced disease. The same is true of pharmaceutical agents.

While opponents of herbal supplementation will continue to quote the one negative study to support their contention that a great deal of money is being wasted on worthless products, I have learned that a single study does not adequately define the benefits and risks of a substance, be it an herb or a pharmaceutical agent. There is a lesson to be learned from the NEJM study, but it is not what is being promoted. The message of the study is not that saw palmetto is ineffective in the management of prostatic enlargement, but rather that saw palmetto should be started as soon as symptoms appear and continued indefinitely.

Fats obtained from other plant sources (beta-sitosterols) may be even more effective than saw palmetto in dealing with prostatic enlargement. When I recommend saw palmetto, I do so as part of a comprehensive formulation, Prostazyme, that contains not only saw palmetto extract, but also pygeum africanum extract and zinc, which provide additional benefit.

Dale Peterson, M.D.

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