Wednesday, June 19, 2019

Saw Palmetto and BPH

I have had great success in treating my beagle with saw palmetto for benign prostatic hyperplasia (BPH), a condition in which the prostate gland is enlarged which is the most common prostate disorder seen in intact male dogs. He displayed clinical symptoms so I began treating him right away with a supportive protocol of saw palmetto. He is much better now, but I am considering neutering him because it is really the only way to prevent a recurrence.

Is saw palmetto effective at improving symptoms of BPH in humans, too? 

Yes, as it contains phytotherapeutic agents that have a very long history of being effective. In the 1990s, phytotherapy, which is the use of plants and plant extracts for the treatment of medical conditions, became a common form of alternative therapy used in Europe, Asia, and the United States. Throughout the world, its prevalence rate is 50% , largely due to the increased availability via health food stores and online vitamin shops. Phytotherapeutic agents are commonly used in urology, especially in the treatment of BPH.1

Phytotherapeutic agents are commonly prescribed in Europe in the treatment of lower urinary tract symptoms (LUTS) with BPH. In the United States they are self-prescribed by patients because they are easily available over the counter without a prescription. Access to these agents has become easier with the expansion of health food stores and vitamin shops. Thirty to ninety percent of patients seen by urologists for BPH/LUTS are taking these agents, and one of the most commonly used agents is saw palmetto berry extract.2

Saw palmetto berry (SPB) extract is the most popular phytotherapeutic agent used in the treatment of BPH/LUTS and it is derived from the berry of the American dwarf tree or Serenoa repens. The plant is found primarily in areas of the southeastern United States. Its historical use in the treatment of prostatic conditions dates back to the 1800s.2

The n-hexane lipidosterolic extract of Serenoa repens called Permixon, is a drug that has been available for many years now for the treatment of men with BPH. It is a complex mixture of various compounds. Its multiple mechanisms of action include in vitro inhibition of both type 1 and type 2 isoenzymes of 5 alpha-reductase and interference with binding of dihydrotestosterone to cytosolic androgen receptors in prostate cells. In controlled clinical trials in men with BPH, the frequency of nocturia, or urinating at night, was reduced by 33 to 74%, while urinary frequency during the day decreased by 11 to 43% and peak urinary flow rate increased by 26 to 50% with the extract. The corresponding values for the placebo group were 13 to 39%, 1 to 29% and 2 to 35%.3

In addition to the inhibition of type 1 and type 2 isoenzymes of 5α-reductase and the antiandrogenic effects as described in Drugs and Aging (1996), SPB has anti-inflammatory effects and it inhibits prolactin and growth factors that affect cell division, causing involution - or shrinkage - of the prostatic epithelium.2,4

Evaluations of SPB extract in terms of safety have not been performed in the United States as they are not required by law. Herbal medicines are regulated as dietary supplements under the 1994 Dietary Supplement Health and Education Act. This means that herbal products can be sold without any specified efficacy or safety testing, as long as the product was marketed in the United States before October 15, 1994. Product safety is the responsibility of the manufacturers. Approval by the Food and Drug Administration (FDA) is not required to sell these products.5

References
 
1. Maccagnano, C., Salonia, A., Briganti, A., Teillac, P., Schulman, C., Montorsi, F., & Rigatti, P. (2006). A critical analysis of Permixon™ in the treatment of lower urinary tract symptoms due to benign prostatic enlargement. European Urology Supplements, 5(4), 430-440. doi:10.1016/j.eursup.2006.02.006

2. Fagelman, E., & Lowe, F. C. (2001). Saw palmetto berry as a treatment for BPH. Reviews in Urology, 3(3), 134-8. PMCID: PMC1476047

3. Plosker, G. L., & Brogden, R. N. (1996). Serenoa repens (Permixon®). Drugs & Aging, 9(5), 379-395. doi:10.2165/00002512-199609050-00008

4. Gordon, A., & Shaughnessy, A. (2003, April). Saw palmetto for prostate disorders. American Family Physician, 67(6), 1281-3. PMID: 12674456

5. Marks, L. S., & Tyler, V. E. (1999). Saw palmetto extract: newest (and oldest) treatment alternative for men with symptomatic benign prostatic hyperplasia. Urology, 53(3), 457-461. DOI: https://doi.org/10.1016/S0090-4295(98)00635-9

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