Herbal supplements for BPH: Help or harm?

Herbal supplements for BPH: Help or harm?

For men plagued and frustrated with symptoms of an enlarged prostate or benign prostatic hyperplasia (BPH), are often willing to resort to less traditional methods of treatment.  One such method is the use of herbal supplements.  Many vitamin shops, health food stores, and drugstores have shelves filled with dietary supplements for “men’s health,” code words for prostate care. Men will find a variety of herbal supplements touting what they can do to relieve the hassle of fighting an aging prostate.  But do they really deliver on their promises and how safe are they to use?

The issue with supplements

Why would a man with BPH want to resort to using a supplement to begin with? One reason is that even though there are prescription drugs to treat the symptoms, some men are affected by their side effects finding them difficult to tolerate.   Men annoyed with the frequent need to urinate, have a weak stream or dribble, simply want relief and if an herbal supplement can deliver that need, many are willing to give them a try. 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.

Men from thousands of years ago also suffered from symptoms of BPH but would not have known of the function of the prostate.  Their remedies were derived from traditional Chinese and Japanese medicine which commonly used many herbs to treat urinary symptoms of BPH.

Today, almost three dozen plant compounds are utilized to help manage BPH according to a review paper in 2015.  European countries of Germany, France, and Austria, plant-based products are considered the first-line of treatment for mild to moderate urinary symptoms of BPH. Keep in mind, many of these supplements are proprietary formulas in which the manufacturers have sponsored research blurring their objectivity and making comparisons with other products difficult to assess.

However, dietary and herbal supplements found in various stores are not as closely regulated as the prescription medications a doctor prescribes. This means their quality, safety, and effects may vary. Any man considering using an herbal supplement for BPH should always consult first with his doctor for their opinion. Herbal supplements may react and cause problems with prescriptions medications, treatments, or tests a man is using or going to undergo.

Common herbal supplements promoted to help BPH

Here is a listing of the best-studied and most commonly used herbal supplements for treating BPH:

·      Saw Palmetto

This herbal supplement comes from the purple berries of the American saw palmetto plant. It may help shrink the prostate and improve urinary symptoms, by reducing the activity of the enzyme 5-alpha-reductase, which is how drugs like finasteride and dutasteride work.

Some studies have shown a benefit, however several large studies do not show that saw palmetto reduces the size of the prostate or eases urinary symptoms. Men may try it hoping to relive BPH and for some, it may help with reduced waking up at night to urinate.  For men who have had success with saw palmetto, it takes about 4 to 6 weeks to see results.

·      Beta sitosterol

A key compound in saw palmetto is beta sitosterol, a phytosterol that is marketed on its own and in various prostate formulas. This substance is found in many fruits, vegetables, soybeans, seeds, nuts, and other plant products.  Physterols are related to cholesterol found in animal cells and when consumed in large amounts, help lower cholesterol by blocking cholesterol absorption in the intestine.  Plant sterols also have effects on the hormone system and prostate.

Beta sitosterol does not affect the size of the prostate, but it may help the bladder to empty with a stronger urine flow and possibly improve BPH symptoms.  One study found some potential in beta sitosterol for treating BPH and other prostate disorders but there are many uncertainties.  This same study also warned that herbal preparations 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.

·      Rye grass pollen

A pollen extract from rye grass is also used to treat BPH symptoms such as painful urination, frequent urination, weak urine stream or urgent need to urinate. Overall the evidence has been inconsistent with most of the studies being small and methodologically flawed. Nevertheless, Natural Medicines rates rye grass extracts as possibly effective for treating BPH.  Side effects include allergic reactions as well as gastrointestinal distress.

Takeaway message

Any man experiencing urinary symptoms should talk with their doctor to make sure the cause is BPH and not some other condition.  If it is BPH, a man and his doctor can discuss the pros and cons of prescription medications and the use of herbal supplements. The best advice is to avoid the use of herbal products since the science is lacking on their effectiveness, lack of standardization, and the unreliability of what is really in the bottle.  Until more and better clinical trials are conducted, it’s best to be leery of using herbal supplements or combining them with BPH drugs.