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Supplement may reduce some prostate ills

Question: Can saw palmetto supplements help prevent or cure prostate problems, including cancer?

Answer: No evidence shows that saw palmetto supplements will prevent or cure prostate cancer. Some studies, however, indicate that the extracts from the berries of this small palm tree may relieve the symptoms of non-cancerous prostate enlargement, or what is called benign prostatic hyperplasia. Nevertheless, self-medication with saw palmetto pills or oils must be approached with caution.

Background. The active ingredient of the saw palmetto (Serenoa repens) is in the plant berries, which are found in bunches, like big grapes, and ripen to a dark greenish-purple color. The medicinal use of this fruit is not new. It was part of early Seminole Indian medicine, taken to relieve urinary tract irritation and to increase male potency. About 10 years ago, the commercial sale of saw palmetto supplements began to appear with the rising tide of botanical health products. Today, about 150-million pounds of the berries are picked each year in Florida, the world's major supplier of the fruit. Aside from perhaps relieving BPH symptoms, the growing popularity of saw palmetto is linked to claims by some herbalists that this supplement is an aphrodisiac and that it also can enlarge the busts of women. Notions that this product can improve the libido or increase breast size are totally unsubstantiated.

The saw palmetto-prostate connection. The prostate gland is located in front of the rectum and is wrapped around the tube by which urine is excreted from the bladder (urethra). The gland produces part of the seminal fluid secreted during ejaculation, and it interacts with certain male hormones. The prostate grows during puberty from pea-size to about as big as a walnut by age 20. In most men, it begins to enlarge further after age 50. This later-life growth (benign prostate hyperplasia, or BPH) does not cause prostate cancer. But it can lead to discomfort, infection and difficulty urinating.

Studies suggest that the extracts from saw palmetto berries may inhibit the ability of a chemical in the prostate _ dihyrotestosterone _ to stimulate prostate growth and may also relieve the symptoms associated with BPH. Apparently, saw palmetto works somewhat like the commonly prescribed prostate growth-controlling drug finasteride (Proscar). Still, all this is not quite clear. According to a 1996 review article in Urology, some preliminary studies show a positive effect, but no "well done" long-term studies of saw palmetto have been conducted to date.

Caution. Two point: First, many forms of palmetto berry extracts are on the market. Some contain additives and all kinds of combinations of other herbs, vitamins and minerals. For example, different brands contain red clover root, up to 80-percent alcohol, pumpkin seeds, buchu leaves, olive oil, corn silk, parsley and vegetable glycerine. Content and dosages of these, or any other supplement, are not regulated or standardized by the Food and Drug Administration. Consequently, you don't always know exactly what you are getting. If you purchase this supplement, do so at a store with a pharmacist who can tell you what you are actually buying. The saw palmetto dosage for BPH suggested by the Center for Alternative Medicine Research is 320 mg daily.

Second, and most important, see your doctor before experimenting with saw palmetto. Contrary to what some endorsements and advertisements say, many urologists believe these supplements may interfere with the accurate measurement, or mask the results of prostate-specific antigen, or PSA. This is the prostate cancer test. Don't take any chances. Saw palmetto supplements should be used only with careful medical supervision. Remember, prostate cancer is the most commonly diagnosed cancer in American men and the second most frequent cause of death (behind heart disease) in men older than 55.

Patrick J. Bird, dean of the College of Health and Human Performance, University of Florida, draws on a data base of more than 3,800 medical, health and fitness journals in preparing answers to questions in his column. Write with questions to Dr. Bird, College of Health and Human Performance, University of Florida, Gainesville, FL 32611.

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