The Collison Newsletter April 2010



        Lifestyle & Herbal Treatments Saw Palmetto and Pygeum*  


Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, benign enlargement of the prostate and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate in older males (not due to cancer).

The Prostate 

The prostate is a gland located at the base of a man’s bladder, behind the pubic bone and base of the penis and in front of the rectum. This gland is the size of a walnut or plum, and weighs about 30g in young men. The prostate surrounds the urethra (the tube that carries the urine away from the bladder and transports semen during ejaculation). The prostate is not a part of the urinary system, but with its proximity to the urethra it can affect urinary function. A healthy prostate does not interfere with the flow of urine from the bladder. An enlarged gland can cause urinary symptoms.

Benign Prostatic Hyperplasia 

Benign prostatic hyperplasia (BPH) is the most common benign (non-cancerous) growth process in men.


“Hyperplasia” refers to an overgrowth of tissue or any abnormal accumulation of cells that causes an organ or area of the body to enlarge.


BPH is characterised by hyperplasia (rather than hypertrophy, where the cells just enlarge) of prostate cells, resulting in the formation of large fairly discrete nodules especially in the periurethral region of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra, thus interfering with the flow of urine.


The increase in prostate cells is due to a slowing of apoptosis (normal programmed cell death), not because of an increase in cell production. What triggers BPH is not well understood, but aging and testosterone (the predominant male sex hormone) are believed to be primary influences of its development.

Symptoms of BPH 

BPH symptoms only arise when the expanding nodules of the prostate tissue place enough pressure on the urethra to interfere with urine flow. Some men with a very enlarged prostate have no urethral obstruction; others with a modest enlargement can experience significant symptoms. Constriction of the urethra means that the muscle of the bladder has to contract more strongly to overcome the partial obstruction, leading to hypertrophy of the muscle of the bladder, making the bladder cavity smaller and decreasing its capacity to store urine.


The symptoms of BPH are linked to storage difficulties (reduced capacity of the bladder) or symptoms arising from problems with voiding (obstruction of the urethra).

Storage symptoms include:

Urinary frequency

Urgency (must void now)

Urgency incontinence

Nocturia (voiding at night).

Voiding symptoms include:

Difficulty in starting to urinate

Weak urinary stream

Hesitancy (needing to wait for the stream to start)

Intermittency (the stream starts and stops intermittently)

Straining to void

Dribbling (after the stream ends).


There can also be the sensation that the bladder is not empty after urinating. Urinary retention eventually occurs and there is proneness to bladder infection and to the development of bladder stones.

Diagnosis of BPH 

The International Prostate Symptom Score questionnaire (from the American Urological Association) can be used to assess the severity of lower urinary tract symptoms. There are seven questions graded:

0 (absent, not at all)

1 (less than 1 time in 5)

2 (less than half the time)

3 (about half the time)

4 (more than half the time)

5 (almost always).


The questions are: “Over the past month

1.      How often have you had the sensation of not emptying your bladder completely after you finished urinating?

2.      How often have you had to urinate again less than two hours after you finished urinating?

3.      How often have you found you stopped and started again several times when you urinated?

4.      How often have you found it difficult to postpone urination?

5.      How often have you had a weak urinary stream?

6.      How often have you had to push or strain to begin urination?

7.      How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?”


Summing the symptom grade, for each of the 7 questions, gives the score. The BPH severity is then assessed as: mild (1-7), moderate (8-19), severe (20-35).

Frequency of BPH 

About one in four men experience BPH-related symptoms by age 55. By age 75, more than 50% of men have BPH symptoms.

Treatment of BPH 

Treatment for BPH is necessary only if symptoms become intolerable. By age 80, 20-30% of men experience symptoms severe enough to require treatment.


Treatment options include:

·       Watchful waiting (best for men with minimal symptoms).

·       Plant-based remedies (phytotherapy).

·       Medications that either shrink the prostate (5-alpha-reductase inhibitors) or relax the muscle tissue in the prostate and bladder neck that constricts the urethra (alpha-adrenergic blockers).

·       Surgery to remove excess prostate tissue, including transurethral prostatectomy or transurethral resection of the prostate (TURP), and open prostatectomy, either suprapubic or retropubic.

·       Diet and lifestyle.


The purpose of his newsletter is to consider in detail two herbs that can be beneficial in the management of BPH, and to briefly look at diet, lifestyle and other supplements that can help in the management.


Saw Palmetto Extract 

Saw palmetto extract is a lipophilic extract of the fruit of saw palmetto (serenoa repens). It is rich in fatty acids and phytosterols. The plant is a small palm, up to 4 meters in height. The fruit is a large reddish-black drupe.


The extract is also called serenoa compound. Extracts of saw palmetto are standardised to contain a stated amount of serenoa compound.


Saw palmetto compound or serenoa compound is the most popular herbal preparation taken for BPH. It is well tolerated and has very few, infrequent side effects. When side effects do occur, they are mild and include headache, dizziness and nausea.


It is the herbal treatment of choice, based on the plant’s effectiveness and its lack of side effects.


An analysis of 21 well-conducted studies of saw palmetto (including more than 3,000 men with BPH) found that men taking the supplement were 76% more likely to have experienced symptom improvement than men taking a placebo. It reduces subjective micturition symptoms, improves urinary flow and reduces the volume of residual urine. It is especially effective in reducing night time urinary frequency (nocturia), which is often the most bothersome complaint reported.


Most men achieve some relief of symptoms within the first 30 days after starting to take the saw palmetto.


Long-term therapy showed continuing therapeutic success and good tolerance of saw palmetto.


In contrast to the many studies reporting good results with saw palmetto, there was one report in The New England Journal of Medicine (354: 557-566, 2006) of a randomised study that found no significant differences in symptoms among men taking saw palmetto and placebo.


Dose:  Each capsule should contain serenoa repens (saw palmetto) extract equivalent to dry fruit in the region of 3000mg, standardised to contain fatty acids between 220-240mg.  The recommended dose is one capsule, twice daily, with food.


Pygeum is a herbal remedy containing extracts from the bark of Prunus Africana. This evergreen tree is found in southern Africa, and is known as African plum tree, pygeum africanum or just pygeum.


The tree’s bark contains an oil with many active ingredients: waxes, fatty acids and other compounds including plant oestrogens and terpenes.  Pygeum’s principal biological activity is due to beta-sitosterol, a ‘phytosterol’.


Pygeum’s medicinal activities include:


Reducing oedema of the prostate

Inhibiting cellular hyperplasia of the prostate

Improving the natural flow of prostatic secretions

Regulating insulin activity

Regulating the immune system.


Pygeum is primarily used to treat BPH. It has also been found to be of use in chronic prostatitis (inflammation of the prostate), with and without prostate related sexual dysfunction, and infertility due to reduced prostatic secretions.


Numerous human studies (including at least 17 double blind trials) report that pygeum use in the treatment of BPH significantly reduces urinary hesitancy, urinary frequency and nocturnal frequency especially in men with mild to moderate severity. In one study, a double blind placebo study involving 263 men on a dose of 100mg per day for 60 days, two-thirds of the pygeum group reported satisfactory outcome, which was twice the improvement reported by the control group on placebo.


Pygeum appears to be relatively safe and non-toxic. The most common side effect is mild gastrointestinal distress (nausea, constipation or diarrhoea).


Dose:  The usual dosage of pygeum is 50-100mg twice per day of an extract standardised to contain 14% triterpenes, and 0.5% n-docosanol.

Other Herbs 

Small leaf willow (epilobium parviflorum) has anti-inflammatory properties and has been shown to reduce the symptoms of BPH. The dose is equivalent to 250mg of dry herb, daily.


Nettle, also called the nettle plant or stinging nettle (urtica dioica), has anti-inflammatory and anti-oxidant properties and has also been shown to reduce symptoms of BPH. The dose is equivalent to 300mg of dried plant, daily.


Both these are often combined with either saw palmetto or pygeum.


A healthy lifestyle is essential for health. The seven requirements for health, set out in Chapter 2 of my book How to Stop Feeling So Awful (see homepage), are:

·       Proper nutrition

·       Pure air

·       Pure water

·       Exercise

·       Sunshine

·       Rest

·       Positive thinking.


A healthy diet is one in which 75-80% of foods are alkali-forming and 20-25% are acid forming. This is discussed in detail in my September 2005 newsletter, Acid/Alkaline Balance - The Ideal Diet.


In particular, some foods are bad for prostate health and will aggravate BPH. These are foods that are:

·       High in cholesterol

·       High in fat, especially animal fat

·       High in animal flesh, especially red meats

·       Low in fibre (there is no fibre in animal products).


There should also be restricted intake of alcohol, especially beer, and coffee.


The ‘Ideal Diet’ is also set out in Chapter 2 of my book How to Live to 100+ Years Free from Symptoms and Disease (see homepage), and was summarised on page 30. The diet, for health, should be:

·       “Unprocessed, unrefined

·       Low in fat

·       Low in protein

·       Low in refined carbohydrates

·       Loaded with fresh fruit

·       Loaded with fresh vegetables

·       High in fibre

·       Properly balanced in the ratio of acid to alkali

·       Free of salt and caffeine

·       Free of chemicals and pesticide residues.”

Exercise, Weight and Sunlight 

Lack of regular aerobic exercise not only contributes to BPH, but may decrease the effectiveness of saw palmetto and pygeum and other prescribed medications.


Weight gain should be avoided and a Body Mass Index (BMI) of less than 25 should be the goal. Exercise will assist in weight loss and maintaining the ideal weight (in the region of BMI of 21).


The importance of sunlight in health is set out in my November 2007 newsletter Sunlight and Health.


The following should be considered for prostate health:

·       Zinc.

·       Omega 3-fatty acids.

·       Antioxidants - vitamins A, C, E, and selenium, as well as the antioxidants found in fruits and vegetables. See my January 2010 newsletter Phytochemicals.

·       Lycopene. The benefits of this antioxidant, found in such vegetables as tomatoes, have been set out in detail in my December 2009 newsletter Lycopene - A Powerful Antioxidant.


Both selenium and vitamin E have been shown to have a potential to prevent or slow the progression of prostate cancer.


Certain medications should be avoided, such as, for example, anticholinergic drugs like atropine. A thoughtful medical doctor will avoid prescribing such drugs in the presence of BPH. However, certain over-the-counter preparations such as antihistamines and nasal decongestants can aggravate the symptoms of BPH, and should not be taken.

Orgasm and Ejaculation 

Men who ejaculate (by intercourse or masturbation) more than five times per week during their twenties, have been shown to suffer from less prostate disorders such as BPH, prostatitis and prostate cancer in later life.


‘Prostate orgasm’ (digital massage of the prostate gland to produce a flow and elimination of seminal fluid (semen) without sexual arousal and ejaculation) is recommended by some for the treatment of BPH and is thought to be better than sexual ejaculation since no additional swelling of the prostate occurs with prostate orgasm.


The above is a brief overview of the common disorder Benign Prostatic Hyperplasia (BPH).


Prevention is the best way forward. A healthy lifestyle, with an emphasis on diet, is essential.


When treatment is necessary, a trial of saw palmetto and/or pygeum (they combine well), as well as the lifestyle changes suggested, would be the initial way forward.  Medication would be the next step and surgery a last resort.


Taking saw palmetto or pygeum in the absence of symptoms, and as a preventive of BPH, is believed by some researchers to either prevent or at least delay the development of BPH.


*Copyright 2010: The Huntly Centre.

Disclaimer: All material in the website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.


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