Alternative Therapy

You may see advertisements of herbal or other plant-based therapies for treating BPH. Many plants do contain substances that can have important effects on the body, whether helpful or harmful. The issue is that if you take a supplement or therapy that has been labeled as “natural,” “herbal,” or “alternative,” it is usually not regulated by the U.S. Food and Drug Administration (FDA).

That means that the FDA cannot control how the substance is manufactured and sold to you. Without FDA regulation, there is no control over whether the substance is pure or contaminated; whether it contains the same amount of active ingredient from batch to batch; whether there is any proof that it works or causes harmful side effects; and what information about the substance is made available to you. The FDA provides you with these protections by enforcing legal requirements for approved medications in the United States.

Saw palmetto is an herbal treatment made as an extract from the fruit of the saw palmetto plant, a dwarf palm tree found in the southern coastal United States. It is one of the more popular herbal therapies for LUTS due to BPH and is widely used in countries, such as Italy and Germany.

Although saw palmetto has been previously reported as mildly to moderately effective in treating urinary tract symptoms due to BPH, it is very likely that many of these studies were flawed. It is difficult to draw solid conclusions from studies that include only a small number of men, or that use nonstandard, anecdotal ways to measure how bad (or how much better) a man’s urinary symptoms are. In addition, men who know that they are taking a treatment that they believe should work are likely to sense an improvement in symptoms based on this belief. Saw palmetto has a strong smell that is difficult to disguise.

A study of 225 men published in the New England Journal of Medicine in 2006 used rigorous methods to make sure the study subjects and staff did not know whether saw palmetto or dummy capsules (placebo) were being administered. The dummy capsules were filled with an inactive, oily looking fluid that had been colored brown to look very much like saw palmetto. Urinary symptoms were measured using the American Urological Association Symptom Index. This study found no difference between saw palmetto and inactive dummy capsules (placebo) in reducing urinary symptoms due to BPH.