If you've ever hit a golf ball out of bounds on a Florida golf course, you've probably spent a fair amount of time crawling through native saw palmetto while trying to retrieve your ball. But did you know that the berries of this scrubby, saw-toothed fan palm can relieve urinary symptoms caused by benign enlargement of the prostate gland?

Symptoms of an Enlarged Prostate

Normally a walnut-sized gland, the prostate sits beneath the bladder and surrounds the urethra, the tube that drains the bladder. Its primary purpose is to make fluid that transports sperm during ejaculation. For unknown reasons, the gland begins to grow in middle age. As it grows, it can squeeze the urethra, which causes the following:

  • Difficulty when starting to urinate
  • Weak stream
  • Dribbling at the end of the stream

An enlarged prostate can also push against the bladder, which causes the following:

  • Need to get up at night to use the bathroom
  • Frequent urge to urinate
  • A feeling that the bladder doesn't completely empty

Nearly every man develops an enlarged prostate at some point in his life. Usually, enlargement is benign hence the name benign prostatic hyperplasia (BPH) . BPH is not prostate cancer. Saw palmetto is used to treat symptoms of benign enlargement, not prostate cancer.

An Alternative to Prescription Drugs

Saw palmetto has been used in Europe for years to relieve urinary symptoms caused by BPH. Conventional treatments for BPH include finasteride (Proscar) or drugs in the alpha blockers family. Finasteride is a hormone suppressor that cuts off the prostate's supply of growth hormones and causes it to shrink. Alpha blockers relax the smooth muscle of the prostate and the neck of the bladder, allowing improved urine flow. However, a substantial body of evidence tells us that saw palmetto is also an effective treatment approach.

A 2004 review published by the prestigious Cochrane Library analyzed the results of 21 randomized studies of saw palmetto, lasting from 4 to 48 weeks, and involving a total of over three thousand participants. The results provided strong evidence that saw palmetto is an effective treatment for BPH. It has been compared to Proscar as well as to alpha blockers, and appears to provide equal benefits.

Based on these results, saw palmetto, long used in Europe, has become an accepted treatment in the US as well.

Starving the Prostate

There are several theories on how saw palmetto work. It may prevent testosterone from converting to dihydrotestosterone (DHT). DHT is a hormone that enhances prostate growth. Saw palmetto may have other relevant effects as well, including reducing inflammation in the prostate and relaxing smooth muscle.

However, saw palmetto does not cure prostate cancer, prevent prostate cancer, or prevent BPH. All it does is relieve symptoms. The same is true of standard medications for BPH--with one exception: Proscar substantially shrinks the prostate and may reduce the need for surgery. Saw palmetto shrinks the prostate too, but to a lesser extent than Proscar. However, alpha blockers do not shrink the prostate at all.

Overall, saw palmetto caused the following:

  • a 28% improvement in urinary tract symptoms
  • a 25% reduction in evening trips to the bathroom
  • a 24% improvement in peak urine flow
  • a 43% reduction in residual urine in the bladder

Minimal Side Effects

Saw palmetto causes side effects less often than finasteride or alpha blockers.

"There appear to be no significant risks," says Dr. McConnell. One percent of men using saw palmetto have problems with getting and maintaining an erection; this same side effect tends to occur in 5% of men using finasteride.

And unlike alpha blockers, saw palmetto does not cause fatigue, dry mouth, rapid heart beat, and low blood pressure.

How to Use It

The proper dose of saw palmetto is 320 mg of extract each day. The extract should contain 85%-95% fatty acids and sterols.

Saw palmetto is cheaper than other drugs used to treat BPH, although it is not covered by insurance. Plan to pay $3-$15 per month. Finasteride costs $75-$100 per month. Expect relief from urinary symptoms in six weeks to three months.

Buyer Beware

However, saw palmetto, like other herbs, is not well-regulated. Some products may not contain the proper form of saw palmetto, or the amount specified on the label. To determine whether a certain product is reputable, check out the website www.consumerlab.com . This website analyzes herbal products to determine their quality.