When it comes to benign prostatic hyperplasia (BPH), the herb saw palmetto berry is better than the best drugs the pharmacy has to offer

A massive new systematic review and meta-analysis confirms what many in the natural health realm already knew. When it comes to benign prostatic hyperplasia (BPH), or the enlarged prostate that is so annoying and common in older men, the herb saw palmetto berry is better than the best drugs the pharmacy has to offer.

BPH is so much a part of aging for men that more than half of all men will suffer from it in their lifetime. It will burden 85% of men over 85.

BPH causes frequent urination, including during the night, increased urgency and decreased force. It can lead to urinary tract infections and infections and damage in the kidney, and it can cause loss of libido and erectile dysfunction. Although there are pharmaceutical treatments, like all pharmaceutical treatments, they have a number of side effects. Considering that the drugs are designed for men's reproductive health, perhaps the most disturbing of the common side effects is erectile dysfunction. So, a natural alternative that works at least as well while being safer would be a huge advance in men's health.

That natural alternative is the herb saw palmetto berry. Saw palmetto has proven to be as good or even better than finasteride (Proscar) in head-to-head studies. It has been found by a research review to be just as effective.

Saw palmetto berry has fared just as well against the alpha-blockers that have supplanted finasteride as the most prescribed drugs for BPH. The herb is at least as good as tamsulosin (Flomax) (see here, here, here and here), and, in men with severe BPH, it works even better.

The other really big advantage of saw palmetto is that these studies consistently found it to be safer, leading to fewer side effects, including the common prostate drug side effect of erectile dysfunction. Not only does saw palmetto berry not negatively affect sexual function, it actually improves it by 30%.

Now, a 2018 meta-analysis has put all the research together and slammed the door on the prostate herb-drug debate: the winner is the herb.

The meta-analysis included 27 studies published between 1983 and 2016 that included a total of 5,800 men. Twelve of the studies were observational and 15 were controlled. All of the studies used 320mg of saw palmetto berry extract. Saw palmetto was compared to placebo or to drugs that included alpha-blockers, like tamsulosin; 5-alpha-reductase inhibitors, like finasteride; and others.

Compared to placebo, saw palmetto berry significantly reduced the number of times men woke up at night having to urinate: they had to go 64% less often. Urine flow increased significantly on the saw palmetto.

High quality studies compared saw palmetto to alpha-blockers, like tamsulosin, and, though the difference between them was not significant, International Prostate Symptom Scores (IPSS) improved more on saw palmetto, meaning that the herb is at least as good as the drug. Saw palmetto was equal to tamsulosin for night time awakening, urine flow and prostate size.

When saw palmetto was compared to 5-alpha-reductase inhibitors, like finasteride, IPSS improved equally.

Saw palmetto berry extract was able to significantly improve IPSS, urine flow, night time awakening to urinate, quality of life and prostate volume: that is, it actually shrunk the enlarged prostate. Importantly, meta-analysis of four studies confirmed that saw palmetto had no effect on sexual functioning, meaning that, unlike the drugs, it does not cause erectile dysfunction and there were significantly less ejaculation disorders. Specifically, saw palmetto improved IPSS by 5.73 points (to put that in perspective, an improvement of only 3.1 points was considered "clinically relevant"), urine flow improved by a significant 2.26 mL/s, men had to get up to urinate 1.56 fewer times per night, quality of life improved by a significant 1.07 points and prostate volume shrunk by 2.36 mL.

In long term studies that lasted a year or longer, results were even better with quality of life improving by 1.31 points and prostate volume shrinking by a full 5.37 mL.

Once again, the major benefit of the safety of the herb was clear. Long term use of saw palmetto was safe and well tolerated, included no adverse effects on sexual function. The researchers highlighted that, in an older population of men that is often on several medications, an effective treatment for BPH that is very safe and has "very limited" drug interactions" is "of relevance."

And now, at last, based on the results of this meta-analysis, the researchers recommend that saw palmetto berry extract "should be considered as a treatment option in the next update of LUTS [lower urinary tract symptoms associated with BPH] treatment guidelines."

This very exciting systematic review and meta-analysis firmly establishes the benefit of a herbal treatment over pharmaceutical treatment.

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