Editorial by David Mulvain
A study recently published in the Journal of the American Medical Association (JAMA) reported that use of the herb, saw palmetto, did not improve the symptoms of benign prostate hypertrophy (BPH), the medical term for enlarged prostate gland. These results conflict with the many studies on this topic that have found that saw palmetto is as beneficial as drugs for BPH, is safer and has fewer side effects. This is important, because over half of men over 60 have some prostate enlargement. By age 70, 90% of men will have prostate enlargement. Most, but not all, will have symptoms and seek treatment. Saw palmetto is the most commonly used herb for BPH in the U.S., and the first choice of treatment in several European countries.
The medical theory is that both BPH, and prostate cancer are caused by dihydrotestosterone (DHT). DHT is 10 times more active than testosterone. In healthy young men, 80% of testosterone is converted to DHT. The drugs that are used to treat BPH; Proscar, Flowmax and Avodart block the conversion of testosterone to DHT. In other words, we are supposed to believe that DHT is a young man’s friend, but becomes his foe as he ages. This does not make sense. It is older men with low levels of testosterone, not younger men with high levels that develop BPH.
The most important contributor to symptom improvement with saw palmetto is that it relaxes the smooth muscles surrounding the urethra in the bladder neck and prostate gland, which reduces resistance to urine flow without reducing the prostate size. However, saw palmetto also has the same action as the drugs; it blocks the conversion of testosterone to DHT, but is weaker, which accounts for its safety.
The accepted recommendation for saw palmetto is 160mg twice a day of a standardized concentration of the fatty acids extracted from the berries. The study in question used 3 times that much, 960 mg a day. That is enough to seriously reduce DHT levels. If whoever designed the study would have referred to a biochemical textbook, they would have learned that, like the testes, the prostate gland, requires DHT to maintain its size and function. That much saw palmetto would be expected to drop testosterone levels low enough to shrink both the testes and prostate, and interfere with their proper function. That could easily account for the poor results of this study.
A large body of research and years of saw palmetto use have proven it safe and usually beneficial for the treatment of BPH when used as recommended. This JAMA study demonstrates a reckless lack of knowledge about herbology and biochemistry.
The theory about DHT causing BPH and prostate cancer is based on 60-year-old research, and is not supported by newer research. As men age, or put on extra fat, more testosterone is converted to estrogen, and less to DHT. Higher estrogen levels may contribute to BPH, but the real culprit for BPH and prostate cancer is man-made chemicals that have powerful estrogenic effects. Medically lowering DHT with drugs to treat prostate cancer may explain why a disproportionately large number of men develop very fast progressing cancer. DHT is protective. Their life expectancy is reduced to 18 to 22 months. Compare that to the new medical recommendation for prostate cancer, “watch and wait”. Most men with prostate cancer will live to a ripe old age with no treatment. The most advanced practitioners are using bio-identical hormone replacement therapy and herbs or drugs that lower estrogen levels to prevent and treat BPH, and in some cases, prostate cancer.