It’s almost a given that as men age, they develop prostate enlargement and are increasingly plagued by a frequent need to urinate. A walnut-sized gland located below the bladder, the prostate is important in sexual function, providing much of the seminal fluid that carries sperm. With advancing age, prostate cells proliferate—a condition called benign prostatic hyperplasia (BPH), which causes the gland to grow slowly and press on the bladder and part of the urethra. The obstruction caused by the enlarged prostate can prevent the complete emptying of the bladder, so it fills more quickly. The result: a recurrent urge to urinate, especially at night, but difficulty doing so. Half of all men have symptoms of BPH by age 60, and the rate rises to 9 out of 10 by age 70. By age 80, about 20 to 30 percent of men get some form of medical treatment (drugs or surgery) for BPH.
The condition can be a real hassle, so much so that older men will try almost anything. No wonder vitamin shops, health food stores, and drugstores have shelves filled with dietary supplements for “men’s health,” which often means prostate care.
Remedies for urinary urgency caused by BPH have been around for thousands of years—long before people knew about the function of the prostate. Traditional Chinese and Japanese medicine has used many herbs as treatment forurinary symptoms.
Almost three dozen plant compounds are used in an attempt to manage BPH, according to a review paper in the Canadian Journal of Urology in 2015. In European countries such as Germany, France, and Austria, phytotherapeutic (that is, plant-based) products are considered the first-line treatment for mild to moderate urinary symptoms of BPH. Some of these supplements are proprietary formulas for which the manufacturers have sponsored research, making it hard to judge their objectivity and making comparisons with other products difficult.
Here are some of commonly promoted prostate herbs.
This herbal extract comes from the purple berries of the American saw palmetto plant (Serenoa repens). It may help shrink the prostate and improve urinary symptoms, in part, by reducing the activity of the enzyme 5-alpha-reductase, which is how drugs like finasteride and dutasteride work.
Natural Medicines, a database that evaluates dietary supplements and other alternative therapies, has rated saw palmetto as “possibly ineffective” with regard to BPH, since research has had inconsistent and contradictory results.
One of the best studies, in the Journal of the American Medical Association in 2011, tested several doses of a standardized extract in middle-aged men over a 72-week period. Even at three times the standard 320-milligram dose, the saw palmetto did not reduce prostate symptoms. An updated review by the Cochrane Collaboration in 2012 looked at 32 controlled clinical trials on men with BPH and concluded that saw palmetto didn’t improve urine flow, nighttime urination, or other symptoms compared to a placebo. Another review by the same authors that year, in BJU International, looked at 17 trials on saw palmetto productsand again found no benefits. It noted, however, that it was unclear whether this was true of standardized proprietary products.
Indeed, one difficulty in evaluating saw palmetto (like other herbs) is the lack of standardizationin most products, meaning that active compounds (notably sterols, fatty acids, and flavonoids) vary considerably. This is partly due to different extraction methods. Among the most studied extracts is a French proprietary product called Permixon, which the European Medicines Agency (something like our FDA) has concluded is effective and safe; however, it found insufficient evidence to support the use of other extracts.
Be cautious about taking saw palmetto if you have a bleeding disorder or are taking blood thinners, though a 2014 review article on the effect of various herbs on warfarin concluded that an interaction is “doubtful.” Do not take it prior to surgery—it may increase bleeding. It may also not be safe to take the herb with finasteride or some other BPH drugs. Despite concerns that saw palmetto may deceptively lower the results of PSA tests (for prostate cancer), a 2013 study found no such effect. Don’t take it if you are allergic to plants in the Arecaceae(palm tree) family.
Beta sitosterol and other plant sterols
Among the key compounds in saw palmetto is beta sitosterol, a phytosterol (plant sterol) that is marketed on its own and in various prostate formulas. Found in many fruits, vegetables, soybeans, seeds, nuts and other plant products, phytosterols are related to the cholesterol found in animal (including human) cells and, when consumed in large amounts, help lower blood cholesterol by blocking cholesterol absorption in the intestine. Plant sterols also have effects on the hormone system and prostate.
Natural Medicines rates beta sitosterol as “likely effective” for treating BPH.The last Cochrane review, back in 2000, looked at four large, well-designed clinical studies and concluded that beta sitosterol may help relieve the urinary symptoms caused by BPH but that research into long-term effects was still needed. Research since then has not always upheld these positive findings. In 2008, researchers from the Cleveland Clinic and other urology centers concluded in Reviews in Urology that while “nutraceuticals” (including beta sitosterol) had shown some potential in treating BPH and other prostate disorders, there are many uncertainties. Herbal preparations, they warned, “may have drastically different composition, durability, contaminants, and even efficacy.”
Beta sitosterol should be used with caution by people who have diabetes or bleeding disorders or are taking blood thinners, hormone therapy, or drugs that affect blood sugar.
Another herbal extract containing phytosterols and marketed for prostate health is African wild potato (Hypoxis rooperi, a member of the lily family). It is sold in Germany and some other countries under the brand name Harzol. However, there is insufficient evidence to assess its efficacy. Natural Medicines rates it as “possibly effective” for treating BPH.
The bark of this African evergreen tree (Pygeum africanum) has long been used in traditional medicine to treat urinary problems. A French Pygeum extract called Tadenan has been the focus of many studies sponsored by its manufacturer, which mostlysuggest that Tadenan has a modest beneficial effect in men with BPH. But since the studies were short and small and had methodological problems, good evidence is lacking. Surprisingly, Natural Medicines rates Pygeum as “likely effective” for treating BPH. Side effects may include diarrhea, constipation, or gastrointestinal distress.
Rye grass pollen
A pollen extract from rye grass (Secale cereale) is also used for BPH. The most studied rye pollen product is Cernilton, made in Sweden and registered as an herbal drug in Western Europe, Japan, Argentina, and Korea. A review in 2000 inBJU Internationalfound that it modestly improved urinary symptoms but that there was no significant objective improvement in measures of urinary function. Overall, the evidence has been inconsistent, with most of the studies being small, short, and methodologically flawed. Nevertheless, Natural Medicines rates rye grass extracts as “possibly effective” for treating BPH. Side effects include allergic reactions (respiratory and skin) as well as gastrointestinal distress.
If you have urinary symptoms, talk with your doctor to make sure the cause is BPH and not some other condition. If it is BPH and you need help with it, discuss the pros and cons of prescription medications. These do alleviate symptoms, and their potential adverse effects are well understood. We advise avoiding herbal products, since they are of unproven value and you can’t be sure of what’s really in the bottles. If you still want to try herbal supplements, keep in mind that they are, at best, something of a crapshoot. Better clinical trials are needed to determine which ones, if any, are effective and at what doses, as well as to better evaluate side effects and interactions with drugs and other supplements. At this point, it’s impossible to make comparisons among the various products, particularly because of the different extraction methods and formulations, as well as the lack of standardization. Beware of combining prostate supplements or combining them with BPH drugs.
For specifics about different products and brands, ConsumerLab.com is a good resource.
Also see BPH: Coping with Enlarged Prostate.