Herbal Medicines that Treat Enlarged Prostate
Research has established that herbal medicines hold the promise for safely and effectively treating enlarged prostate – also called benign prostatic hyperplasia (BPH).
Most of these herbs are classified as 5α-reductase-inhibitors. 5α-reductases are enzymes that convert testosterone to dihydrotestosterone (DHT). This conversion is a primary cause for enlarged prostate.
When this conversion is blocked, the progression of benign prostatic hyperplasia is slowed. Other effects of these herbal remedies include:
• Androgen reduction
• Estrogen reduction
• Inhibition of a-receptors
• Inhibition of prostate cell growth factor
• Blockage of prolactin-induced prostatic growth
• Prostaglandin inhibition
• Strengthening of detrusor muscles
Let’s take a look at some of these herbs and the research proving their benefits (references below).
Nettles for BPH
A 2017 review of research found that Nettle root (Urtica dioica) is a potent 5α-reductase-inhibitor. It has also been shown to increase urine flow and decrease urine frequency in men. That of course means fewer trips to the bathroom but greater evacuation each time.
Nettles effects on prostate enlargement, however, may well be based upon its effects upon sex hormone binding globulin (SHBG), aromatase, epidermal growth factor and prostate steroid membrane receptors, according to a 2007 study from Germany’s University of Freiburg.
Nettles also contains a number of lignans, phytosterols, and antioxidants.
In a 2005 placebo-controlled study of 558 BPH patients, prostate size and PSA levels of men who took nettles went down significantly over a period of six months. Among the 287 patients who took the nettles, 81 percent had better urine flow. The average IPSS (International Prostate Symptom Score) scores went from 19.8 at the beginning of the trial to 11.8 at the end of 6 months.
In a 2013 study, 100 BPH patients took a placebo or 300 milligrams of nettles twice a day. In this study, the patients who took the nettles had a reduction of AUA (American Urological Association) scores that went from 26.5 to 2.1 after only 8 weeks. The placebo group saw no change in their AUA scores. The nettle patients also saw their PSA levels decrease significantly.
A number of other studies, with doses ranging from 600 to 1200 milligrams of nettle root per day have shown significant BPH improvement.
Combinations with nettles have also shown good results. In a 2007 Russian study of 257 prostate enlargement patients, a combination of sabal palmetto and nettles was given for six months. In this placebo-controlled study, one group was given 320 milligrams of sabal palmetto and 120 milligrams of nettles in capsules per day. Compared to the placebo group, the patients taking the sabal/nettles combo had significantly reduced lower urinary tract symptoms and IPSS scores.
Sabal palmetto (Sabal serrulata) is a taller variety of palm, with many of the same constituents as saw palmetto.
Saw palmetto for prostate enlargement
Saw palmetto (Serenoa repens) has been challenged by a series of reviews from a particular group of doctors. However, we find significant evidence that Saw Palmetto extract is a proven remedy for BPH. It is a 5α-reductase-inhibitor with a number of other benefits.
The series of Cochrane reviews was from the Veterans Affairs’ Center for Chronic Disease Outcomes. Though they found over 2,000 randomized controlled studies of saw palmetto, their research analyzed only 30 human clinical studies involving 5,222 men. Of these, only 21 were analyzed. Then each separate review only compiled meta information on a few studies at a time.
One of the reviews (2009) found that Saw palmetto supplementation produced better urinary symptom scores (by about 7.5%) than placebo, and reduced nighttime urination (nocturia) by 24%. Furthermore, self-reported improvement in symptoms was 76% higher among the saw palmetto patients.
In two of those studies, Saw palmetto supplementation showed similar improvement in symptom scores as the pharmaceutical Finasteride, but with fewer side effects and 18% fewer people withdrawing from the studies.
The researchers of this 2009 review concluded that:
“The evidence suggests that Serenoa repens provides mild to moderate improvement in urinary symptoms and flow measures. Serenoa repens produced similar improvement in urinary symptoms and flow compared to finasteride and is associated with fewer adverse treatment events.”
A study from 2000 by the same researchers reviewed 44 studies and eliminated all but 18 studies. This review found similar results as the 2002 and 2009 reviews found, with Saw palmetto providing symptom improvement over placebo, similar to pharmaceutical treatment but without the side effects.
Something odd then occurred, because two subsequent reviews in 2012 by the same group became increasingly selective, with negative embellishments that saw palmetto was no better than placebo. What happened? Did the pharmaceutical industry get involved?
Some of the excluded studies were significant. And later studies have shown great performance.
For example, a 2015 multi-center study of 165 BPH patients were treated with 160 milligrams per day of saw palmetto. They found the patients’ IPSS scores, urinary flow rate, and evacuation rates all went down significantly.
We should also note that another 2015 review of research found saw palmetto was effective for prostate treatment.
Furthermore, a 2016 Cochrane review from French, Spanish and Italian universities found that a particular saw palmetto supplement called Permixion was significantly better than placebo at reducing BPH symptoms. The research analyzed 12 studies and found that Permixion successfully increased flow rates and improved IPSS scores. The researchers concluded:
“The conclusions of the recent Cochrane meta-analysis on Serenoa repens [saw palmetto] in the treatment of lower urinary tract symptoms/BPH apparently do not apply to Permixon. Our meta-analysis showed that Permixon decreased nocturnal voids and Qmax compared with placebo and had efficacy in relieving lower urinary tract symptoms similar to tamsulosin and short-term finasteride. Moreover, Permixon had a favorable safety profile with a very limited impact on sexual function, which is significantly affected by all other drugs used to treat lower urinary tract symptoms/BPH.”
Permixion is a Saw Palmetto oil-based (lipidosterolicum oleosum) extract. Read the section below on choosing a Saw Palmetto supplement for more information on the differing extracts and saw palmetto supplements. This research supports the fact that the type of saw palmetto extract used is critical to its usefulness.
Saw Palmetto combinations
A 2013 review of research from medical scientists from Italy’s University of Messina investigated the data on Saw Palmetto (Serenoa Repens). They found clear evidence illustrating that Saw Palmetto mechanisms support its ability to reduce inflammation and balance androgen hormones, allowing the ability to reduce hyperplasia.
The researchers also found significant evidence that Saw Palmetto combined with Selenium and Lycopene has the potential for reducing inflammation related to BPH.
Selenium is an important trace element that provides antioxidant activity, helping to reduce inflammation among the selenoprotein cells. Lycopene is a carotenoid phytonutrient found in tomatoes, fruits and other plant foods, and has been found in independent research to help prevent or slow progression of BPH.
This combination of Saw Palmetto combined with Selenium and Lycopene has been strengthened recently by a new multicenter clinical trial by Italian researchers using 168 patients with BPH. This controlled and randomized study tested the effects of a combination of the three (Saw Palmetto, Selenium and Lycopene) against control groups, with and without the addition of pharmaceutical alpha-adrenergic blocker treatment, for three and six months.
The research found reduced inflammation among the Saw Palmetto-combination groups, and significantly reduced levels of T-cells associated with the inflammation mechanisms of BPH. The researchers concluded:
“Serenoa repens plus Selenium plus Lycopene may have an anti-inflammatory activity that could be of interest in the treatment of chronic prostate inflammation in BPH and/or prostatic intraepithelial neoplasia.”
How to select a Saw Palmetto extract
The issue among some Saw Palmetto research seems to be with the quality of the actual supplements used. Saw palmetto supplements come in a variety of shapes and sizes. Some have been more successful than others.
Confirming this, Ray Sahelian, M.D. has stated in a discussion of saw palmetto extract:
“In order for a saw palmetto product to be effective, it should either supply a daily dose of 320 mg of 85 to 95% fatty acids, or 640 mg of a 45% fatty acid extract. Some products that do not have these high potency fatty acid extracts may not be as effective.”
Furthermore, most Saw palmetto supplements are standardized extracts, typically standardized to the fatty acids within the fruit. The modern extract method now typically used for saw palmetto extracts is called supercritical CO2 with ethanol.
In a study of this method that tested CO2 supercritical extraction with Saw palmetto, St. John’s Wort, Kava and Echinacea, where the standardized ingredients (such as kavalactones from Kava) were found to have yielded from 2% to 12% by mass, the study found that: “Other desirable actives, such as chichoric acid and associated polyphenolic derivatives were not extracted.”
In other words, these standardized extracted herbal products do not readily convey to the final product the full breadth of the original herbs’ complex of active compounds.
While modern researchers conclude that the effectiveness of a medicine is typically due to a single chemical producing a biological mechanism in the body, this is not applicable in traditional applications of herbal medicine. Herbal medicines typically contain dozens if not hundreds of active biochemicals that work synergistically to produce a whole body effect.
Modern extract methodology often leaves behind many important active constituents through the extraction process.
This is a symptom of the same disease that modern pharmaceutical medicine has: The single-bullet theory. The notion that a single chemical will produce the healing effect.
This theory has led to more profits and patents along with adverse side effects, often from the very pharmaceutical-grade compounds originally derived from plants. More than 50% of pharmaceuticals can be traced to the plant compounds.
Turmeric extract and prostate enlargement
Clinical research from Italy has confirmed what laboratory research has found: That the Ayurvedic herb turmeric (Curcuma longa) increases quality of life and reduces symptoms of enlarged prostate – also known as benign prostatic hyperplasia or BPH.
The ancient Ayurvedic herbal remedy joins the list of several other nutraceuticals that have now been scientifically confirmed to reduce enlarged prostate.
For six months the researchers gave 33 patients diagnosed with benign prostatic hyperplasia with a turmeric extract of curcumin in a product called Meriva® in addition to standard conventional BPH treatment. A control group of 28 BPH patients matched for age and severity received only the conventional BPH treatment.
After the treatment the researchers utilized the International Prostate Symptom Score (IPSS) to evaluate the results of the two groups treated. While both groups experienced improvement in most symptoms, the curcumin-treated group experienced greater improvement. The curcumin-treated group also experienced higher quality-of-life scores than did the conventional treatment group.
The researchers concluded:
“In patients with BPH, the addition of Meriva® to the standard treatment contributed to the reduction of signs and symptoms of the disease without causing any significant additional side effect. This pilot experience suggests a potential novel clinical application of curcumin…”
The Meriva product is a lecithinized curcumin product. Lecithinized refers to lecithin being sprayed onto the product before packing. This gives the product the ability to deliver into the intestines with a minimum breaking down.
Lab tests confirm Turmeric effectiveness
This isn’t the first study that has indicated curcumin’s ability to treat enlarged prostate. A study from the Seoul National University College of Medicine found that curcumin inhibited hypoxia-inducible factor 1alpha (HIF-1alpha) in both animal and human prostrate cell tests. This inhibition resulted in a reduction of inflammation – hyperplasia – among the prostate cells. This, in turn, mediated epithelial-mesenchymal transition (EMT) markers, directly related to inflammation.
In addition, University of Rochester Medical Center researchers confirmed that epithelial-mesenchymal transition (EMT) markers were modulated by curcumin. Wayne State University School of Medicine researchers also found that curcumin reduces inflammation among prostate cells.
Other Herbs show efficacy for BPH
Other plants and herbs that have been reported to decrease BPH symptoms include:
• African grass root (Hypoxis rooperi)
• African plum tree bark (Pygeum africanum)
• Smallflower herb (Epilobium parviflorum)
• Rye pollen (Secale cereale)
• Pumpkin seeds (Cucurbita pepo)
Many of these, as well as peanuts, rice bran, corn and soybeans contain a substance called beta-sitosterol. This compound has proven beneficial in reducing prostate enlargement symptoms.
For example, a 1997 study from Germany’s Allgemeines Krankenhaus Celle Academic Hospital tested 177 BPH patients in 13 clinics around the country. This was a placebo-controlled double-blind study (as most above have been). Those given 130 milligrams of free beta-sitosterol per day over six months showed a significant improvement of symptoms compared to placebo. They had significantly increased urine flow rates and better bladder emptying rates.
In a 2013 study, a formula of Pygeum africanum (African plum tree), Cucurbita pepo (pumpkin seed), Epilobium parviflorum (Smallflower herb), Saw Palmetto and lycopene was clinically tested (a phase II trial) at the University of Queensland’s School of Medicine in Australia. In this randomized double-blind placebo-controlled trial using 57 men with benign prostate hypertrophy, the herbal formulation resulted in significant improvements compared to the placebo group.
The group receiving the herbal formula saw a 36% reduction in IPSS (International Prostate Symptom Score) results. The herbal formula group also experienced a 15% reduction in daytime urination frequency and nearly a 40% reduction of nighttime urination frequency. The researchers concluded:
“The herbal preparation was shown to be well tolerated and have a significant positive effect on physical symptoms of BPH when taken over 3 months, a clinically significant outcome in otherwise healthy men.”
Other herbs that have been shown to inhibit 5-alpha-reductase include Giant Dodder (Cucuta reflexa), Reishi mushroom (Ganoderma Lucidum), and Black pepper (Piper nigrum). Although clinical research on BPH is limited, their DHT-blocking may produce promising results.
Chinese Herbal medicine and prostate enlargement
While research on the use of herbs and nutrients for BPH is progressing, there is another entirely different angle on natural prostate treatment, one that has been overlooked by Western medicine and even Western herbalism. That is, the treatment of enlarged prostate in Traditional Chinese Medicine.
And needless to say, the research on Chinese herbs has been more rigorous and extensive, likely because there is more financial support for the funding of herbal medicine research among Chinese universities and hospitals.
Researchers from the University of Hong Kong’s School of Chinese Medicine reviewed 13,922 citations and found 31 clinical studies that tested 2,493 patients with enlarged prostates (volumes ranging from 22.8 to 52.4 ml). While over 80% of the studies were carried out in China, the rest were conducted in India, Peru and Japan.
These studies ranged in design, which included placebo-control, comparison to pharmaceutical treatment, and comparison to known Western herbal therapy treatment including Saw Palmetto and Pygeum africanum. The researchers then focused upon eleven of these 31 studies, as they satisfied their most rigorous protocols to quality and peer-review. These included studies that compared Chinese herbal medicine to tamsulosin and finasteride, either independently or both.
After their metadata calculations and various comparisons were completed, the research found that Chinese herbal therapies outperformed conventional Western pharmaceutical therapy in terms of reducing prostate inflammation and improving quality of life among the patients.
Among the 31 studies, the herbs that were most tested – in order of frequency – included:
- Cassia Cinnamon (called Rou Gui in TCM and studied in 17 of the 31 studies),
- Astragalus propinquus (called Huang Qi in TCM)
- Rehmannia sp. (Shu Di Huang in TCM)
- Cornus officinalis (Shan Zhu Yu in TCM)
- Fructus Corni
- Poria mushroom/fungus (Fu Ling in TCM)
- Turmeric (E Shu – also reviewed above)
- Phellodendron amurense (Huang Bo)
- Alisma plantago-aquatica (Ze Xie)
- Vaccaria segetalis (Liu Xing)
Treatment periods in the studies ranged from one month to a year. The metadata results found that Chinese herbal medicine – using both single herbs and combination therapy – was only slightly more effective than the pharmaceutical therapy (about 6% better).
However, the study found that Chinese herbal medicine was significantly more effective at reducing prostate volume and significantly more effective at increasing the quality of life among the prostate patients than both the pharmaceutical therapy and the western herb therapy.
This said, the researchers did note that further studies are suggested to confirm the evidence. But more importantly, they found that adverse side effects among those treated with Chinese herbal therapy was similar to side effects of the placebo patients studied.
In other words, there were little or no adverse side effects among those taking the Chinese herbal medicine. This is consistent among most if not all of the herbs discussed above.
Traditional Chinese medicine focuses on the movement of the Chi (or Qi) through the body and blockages of this Qi is considered as producing disease. In Chinese medicine, BPH is often considered “Long Bi” or blocked urination, along with “Zheng Jia” which indicates an abscess or swelling. As a result, tonification of the Ying among the kidneys is one of the goals for therapy in traditional Chinese medicine.
Herbs proven to treat BPH
While conventional medicine continues to look upon herbal medicine with suspicion and mistrust regarding its ability to treat BPH, clinical research is continuing to provide ample evidence of the efficacy of herbal therapy for this condition.
Historically, medicinal herbs have been used as whole roots, fruits or leaves, or through natural extraction methods such as water infusion (e.g., tea). This renders an array of plant compounds that balance each other and buffer each other’s effects.
Modern techniques have boosted our ability to extract these compounds assuming they are applied wisely.
If we examine the research, prostate enlargement relates not only to a single cause but to a combination of factors. Diets that maintain a high proportion of saturated fats, fried foods and other artery-damaging foods increase the risk of prostate enlargement, along with stress, lack of exercise and other lifestyle factors. Meanwhile, diets that maintain a variety of whole food plant-based nutrients have been shown to decrease the risk of prostate enlargement.
Holistic practitioners thus add dietary and lifestyle recommendations to saw palmetto and other beneficial herb formulas for a balanced approach to a healthier prostate. See your holistic health professional for personal recommendations.
Ghorbanibirgani A, Khalili A, Zamani L. The Efficacy of Stinging Nettle (Urtica Dioica) in Patients with Benign Prostatic Hyperplasia: A Randomized Double-Blind Study in 100 Patients. Iran Red Cres Med J. 2013;15(1):9-10. DOI:10.5812/ircmj.2386
Jakubczyk K, Janda K, Szkyrpan S, Gutowska I, Wolska J. Stinging nettle (Urtica dioica L.)–botanical characteristics, biochemical composition and health benefits. Pomeranian J Life Sci. 2015;61(2):191-8.
Lopatkin N, Sivkov A, Schläfke S, Funk P, Medvedev A, Engelmann U. Efficacy and safety of a combination of Sabal and Urtica extract in lower urinary tract symptoms–long-term follow-up of a placebo-controlled, double-blind, multicenter trial. Int Urol Nephrol. 2007;39(4):1137-46.
Morgia G, Cimino S, Favilla V, Russo GI, Squadrito F, Mucciardi G, Masieri L, Minutoli L, Grosso G, Castelli T. Effects of Serenoa repens, selenium and lycopene (Profluss®) on chronic inflammation associated with benign prostatic hyperplasia: results of “FLOG” (Flogosis and Profluss in Prostatic and Genital Disease), a multicentre Italian study. Int Braz J Urol. 2013 Mar-Apr;39(2):214-21. doi: 10.1590/S1677-5538.IBJU.2013.02.10.
Macdonald R, Tacklind JW, Rutks I, Wilt TJ. Serenoa repens monotherapy for benign prostatic hyperplasia (BPH): an updated Cochrane systematic review. BJU Int. 2012 May 2. doi: 10.1111/j.1464-410X.2012.11172.x.
Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(3):CD001423. Review. Update in: Cochrane Database Syst Rev. 2009;(2):CD001423.
Novara G, Giannarini G, Alcaraz A, Cózar-Olmo JM, Descazeaud A, Montorsi F, Ficarra V. Efficacy and Safety of Hexanic Lipidosterolic Extract of Serenoa repens (Permixon) in the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus. 2016 Dec;2(5):553-561. doi: 10.1016/j.euf.2016.04.002.
Zhan XX, Shang XJ, Huang YF. [Application of saw palmetto fruit extract in the treatment of prostate diseases]. Zhonghua Nan Ke Xue. 2015 Sep;21(9):841-6.
Kajal Chougule, Veerendra Yeligar, Manjunath Chougule, Sandip Murtale and Shital Kumar Patil. Indian herbs that act as 5-alpha reductase inhibitors. IJPCBS 2017, 7(3), 265-273. ISSN: 2249-9504.
Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review. JAMA. 1998 Nov 11;280(18):1604-9. Erratum in: JAMA 1999 Feb 10;281(6):515.
Pagano E, Laudato M, Griffo M, Capasso R. Phytotherapy of benign prostatic hyperplasia. A minireview. Phytother Res. 2014 Jul;28(7):949-55.
Wilt T, Ishani A, Mac Donald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(3):CD001423. Review. Update in: Cochrane Database Syst Rev. 2009;(2):CD001423.
Wilt TJ, Ishani A, Rutks I, MacDonald R. Phytotherapy for benign prostatic hyperplasia. Public Health Nutr. 2000 Dec;3(4A):459-72.
Minutoli L, Bitto A, Squadrito F, Marini H, Irrera N, Morgia G, Passantino A, Altavilla D. Serenoa Repens, lycopene and selenium: a triple therapeutic approach to manage benign prostatic hyperplasia. Curr Med Chem. 2013;20(10):1306-12.
Cathpole OJ, Perry NB, da Silva BMT, Grey JB, Smallfield BM. Supercritical extraction of herbs I: SawPalmetto, St John’s Wort, Kava Root, and Echinacea. Jour Supercr Fluids. 2002. Feb; 22(2):129-138.
Coulson S, Rao A, Beck SL, Steels E, Gramotnev H, Vitetta L. A phase II randomised double-blind placebo-controlled clinical trial investigating the efficacy and safety of ProstateEZE Max: a herbal medicine preparation for the management of symptoms of benign prostatic hypertrophy. Complement Ther Med. 2013 Jun;21(3):172-9. doi: 10.1016/j.ctim.2013.01.007.
Ma CH, Lin WL, Lui SL, Cai XY, Wong VT, Ziea E, Zhang ZJ. Efficacy and safety of Chinese herbal medicine for benign prostatic hyperplasia: systematic review of randomized controlled trials. Asian J Androl. 2013 Jul;15(4):471-82. doi: 10.1038/aja.2012.173.
Ledda A, Belcaro G, Dugall M, Luzzi R, Scoccianti M, Togni S, Appendino G, Ciammaichella G. Meriva®, a lecithinized curcumin delivery system, in the control of benign prostatic hyperplasia: a pilot, product evaluation registry study. Panminerva Med. 2012 Dec;54(1 Suppl 4):17-22.
Li Y, Ahmad A, Kong D, Bao B, Sarkar FH. Recent progress on nutraceutical research in prostate cancer. Cancer Metastasis Rev. 2013 Dec 28.
Parsai S, Keck R, Skrzypczak-Jankun E, Jankun J. Analysis of the anticancer activity of curcuminoids, thiotryptophan and 4-phenoxyphenol derivatives. Oncol Lett. 2014 Jan;7(1):17-22.
Kim HJ, Park JW, Cho YS, Cho CH, Kim JS, Shin HW, Chung DH, Kim SJ, Chun YS. Pathogenic role of HIF-1α in prostate hyperplasia in the presence of chronic inflammation. Biochim Biophys Acta. 2013 Jan;1832(1):183-94. doi: 10.1016/j.bbadis.2012.09.002.
Lu T, Lin WJ, Izumi K, Wang X, Xu D, Fang LY, Li L, Jiang Q, Jin J, Chang C. Targeting androgen receptor to suppress macrophage-induced EMT and benign prostatic hyperplasia (BPH) development. Mol Endocrinol. 2012 Oct;26(10):1707-15.
Klippel KF, Hiltl DM, Schipp B. A multicentric, placebo-controlled, double-blind clinical trial of beta-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. German BPH-Phyto Study group. Br J Urol. 1997 Sep;80(3):427-32.
Dedhia RC, McVary KT. Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2008 Jun;179(6):2119-25. doi: 10.1016/j.juro.2008.01.094.
Suzuki M, Ito Y, Fujino T, et al. Pharmacological effects of saw palmetto extract in the lower urinary tract. Acta Pharmacologica Sinica. 2009;30(3):271-281. doi:10.1038/aps.2009.1.
Chrubasik JE, Roufogalis BD, Wagner H, Chrubasik S. A comprehensive review on the stinging nettle effect and efficacy profiles. Part II: urticae radix. Phytomedicine. 2007 Aug;14(7-8):568-79.
Safarinejad MR. Urtica dioica for treatment of benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled, crossover study. J Herb Pharmacother. 2005;5(4):1-11.