There are countless natural nutrients and herbs that have an influence on health. Science has not yet fully evaluated all of these supplements. However, since many of these are available to the consumer, a number of people take them, and doctors use these supplements in their practice. Much anecdotal experience has accumulated.
Science generally frowns on anecdotes, and for good reason. They can sometimes be misleading, or inaccurate. However, sometimes clues can be gotten on how a medicine works in real life on real patients through anecdotes that can't be readily obtained through formal studies. Interesting effects of medicines can also be discovered from the actual users or doctors who are prescribing them. And that's the purpose of this chapter.
I interviewed a number of health care practitioners and individuals who have a great deal of experience with herbs. These interviews are presented in alphabetical order.
Lise Alschuler, N.D., is Chair of the Botanical Medicine Department at Bastyr University in Seattle, Washington. She regularly uses botanical medicines in her clinical practice.
"I use SP as my first choice, in a dose of 160 mg twice a day. If there's no improvement, I either change to a tea form of SP or the tincture. A few people don't respond to the capsules but they respond to the tea. Historically, saw palmetto tea has been used as a pelvic tonic because it may relax smooth muscles in the pelvis. I've also been known to prescribe SP at a dose of 160 mg four times a day. Occasionally someone may respond to this higher dose better than the lower dose. Once they respond to the higher dose, I'll gradually lower it to the level that keeps a patient satisfied.
"If the response to SP has not been adequate, I'll add Pygeum at a dose of 50 to 100 twice a day. I have not had patients report side effects on SP or Pygeum.
"If there's still no response to these two herbs, I prescribe Stinging nettle in the form of a tea. I've noticed that some people improve when Stinging nettle is added. This herb is sold in bulk form and it's easy to make tea from it. It's also available in capsules but I'm not aware that it's currently available in extract form.
"My regimen also includes zinc and pumpkin seeds, however, I think that their role is minor compared to the herbs."
James Balch, M.D., is a urologist in Trophy Club, Texas.
"In my experience, SP works about 50% of the time to improve symptoms of BPH. If SP, by itself, is not enough, then I add Pygeum to the therapy. This often brings the response rate up to 75%, and many patients are able to avoid surgery. I have not found any side effects with herbal therapies for BPH. If a patient does not respond to SP and Pygeum, I add finasteride (Proscar). Some patients respond very well to the combination of herbs and pharmaceutical medicines."
Stan Bazilian, M.D., is a physician in Philadelphia, Pennsylvania.
"I have a few patients on SP. All of them are not getting up at night as much as they used to. It usually takes about 2 weeks for the SP to be effective. No side effects have been reported."
Marie Bochniak, D.C., is Assistant Clinical Professor at Los Angeles College of Chiropractic.
"I have found saw palmetto to be useful in long-distance bicyclists. Sitting for hours or days on a bike can sometimes irritate and inflame their prostate gland. Many users of SP find relief of their prostate symptoms."
Cherry Briskey, N.D., is clinical faculty professor at South West Naturopathic Medical Center in Tempe, Arizona.
"I've had very good response to SP. Most of the men report a decrease in symptoms. Recently we've started treating a patient with polycystic ovary syndrome with SP in order to see if this herb can block some of the androgenic effects."
Donald Brown, N.D., is the President of Natural Product Research Consultants in Seattle, Washington.
"My top choice for treating BPH is SP, followed by beta-sitosterol. Other good options include Pygeum and nettles. I'm not a fan of pollen, although it could work well for chronic prostatitis. In my opinion, I don't think there's enough proof that zinc works.
"As to pumpkin seeds, the liposterolic extracts are approved to treat BPH in Germany. I think, though, that there's a lot of overlap between the actions of the different herbs that are high in fatty acids. They may have a similar method of interacting with prostate tissue.
"I personally don't have any objections to using finasteride with saw palmetto. I also don't have any problems using an alpha-blocker if necessary.
"Patients should realize that therapy for BPH might have to continue for a lifetime. If you stop using it, your symptoms could come back. I had a patient who flew to France on vacation and a few days later called me in a state of panic. He had forgotten his bottle at home, and now his symptoms had come back. He wanted to know if there were any stores in France where he could purchase this herb.
"The longest I've had a person on SP is 4 years and there's been no side effects reported."
Jim Duke, formally with the United States Department of Agriculture, At age 68, Mr. Duke has prostate enlargement and takes a combination of various herbs.
"I like ingesting herbs as part of my diet and like to consume the whole herb as opposed to taking extracts, but I have no problems with people ingesting extracts. I eat pumpkin seeds for their zinc content, and brazil nuts since they have a high amount of selenium. Recently I learned that pinto beans have more genistein [an anti-cancer nutrient] than soybeans, so I've started eating more of them. I recently was involved in a research project and we analyzed 75 different legumes. Kudzu was found to have one of the highest amounts of genistein.
"As to the therapy of prostate enlargement, I prefer the shotgun approach. That is, using many different herbs at one time to help a person improve quicker. Most patients with BPH are too impatient to try one herb at a time. Using multiple herbs at one time could provide quicker relief.
"I have heard suggestions that SP may help in slowing down male pattern baldness, but I'm not aware of any studies that prove this."
Terry Grossman, M.D., is in private practice in Lake-wood, California.
"The response of my patients to SP has been variable. Some report increased urine flow and a decrease in nocturia. I would say 40 to 50 percent notice an improvement. However, when I add Pygeum, the response usually increases to about 60 to 70 percent.
"I also give SP to male patients who are on DHEA. By the way, I used to prescribe high doses of DHEA in the past, but now I'm realizing that lower doses are effective with fewer side effects. I rarely use dosages more than 15 mg.
"Interestingly, I've had some luck treating BPH recently with a homeopathic medicine called Lycotodium. I'm not sure how it works."
Michael Janson, M.D., is President of the American College for the Advancement of Medicine
"Saw palmetto is unbelievable. I get very consistent results. Older men say their frequency at night drops from 3 or 4 to one. Recently I've started using it in combination with Pygeum and nettles."
Skye Lininger, D.C., in Portland, Oregon, reports treating more than 100 patients with SP.
"As a rule, at least 8 out of 10 patients respond to a combination of SP and Pygeum. I also use zinc and flax seed oil. Nettles is another herb I have been considering lately."
Bob Martin, D.C., is a chiropractic physician who also hosts a radio show on KFYI-AM 910, in Phoenix, Arizona.
"Saw palmetto is one of my top 10 favorite nutritional supplements—it's a home run for many patients. The longest I've treated an individual is 10 years, and there have been no side effects. Many times a patient happens to be on multiple medicines and nutrients and I try to minimize the number of medicines they are on by gradually eliminating each one. However, I can't do it with this herb. I have patients tell me, 'You're not taking my SP away from me.'
"SP works in most cases, but. not all the time. If somebody is too far-gone, that is, their prostate gland is too large and their symptoms severe, they have to initially be medicated by a pharmaceutical drug for a period of time. However, they often get side effects, such as a lowering of sex drive; and they want to start SP as soon as possible.
"When SP is not completely effective, I add Pygeum. The combination is better than each one alone."
Jan McBarron, M.D., is board certified in Preventive Medicine and practices in Columbus, Georgia.
"SP is an herb with great medical value. I have one patient who has been on it for at least 8 years without any side effects. In my opinion, since enlargement of the prostate begins in men in their late 30s, I think any man over age 40 should consider taking SP, perhaps a dose of 160 mg daily."
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Men's Health Erectile Dysfunction
