Pygeum

Overview

Pygeum (Pygeum africanum), also known as African plum (a related plant, African Cherry or Prunus africana is also used as pygeum to treat BPH), is a large evergreen tree that grows in the high plateaus of Southern Africa. The pygeum bark is traditionally powdered and drunk as a tea for genito-urinary complaints such as bladder pain and urinary difficulty. As with saw palmetto, pygeum has predominantly been used and tested throughout Europe for the treatment of Benign Prostatic Hyperplasia (BPH) and its most common symptoms including effectiveness in decreasing frequency of nocturnal urination, increasing urine volume, decreasing incidence of incomplete bladder emptying, and reducing prostate enlargement. In France and Italy, pygeum is the main course of natural treatment for BPH and is usually used in combination products that contain other herbal BPH treatments such as saw palmetto (the most popular in Germany) and nettle root. Increased demand for pygeum has led to over-harvesting and is threatening the survival of the species, with international trade currently being monitored.

Comments

Although the mechanism of action of pygeum is largely unknown, it is theorized to inhibit fibroblast hyperproliferation and prevent bladder contractile dysfunction through effects on 5-alpha-reductase, a major enzyme shown to play a role in prostate growth (Cristoni et al. 2000, Levin and Das 2000). As such, pygeum may decrease excessive prostate growth (hyperplasia) and could allow for better contraction of the bladder for more productive urination. Both of these actions could improve the quality of life of men with BPH. The chemical composition of pygeum bark extracts are known to be rich in phytosterols such as beta-sitosterol, beta sitosterone, and campesterol, as well as ferulic acid esters including n-docosanol, and triterpenes including oleanolic acid, crataegolic acid and ursolic acid.

Scientific Support

Animal studies indicate that partial bladder obstruction may lead to bladder contractile problems – with BPH-like symptoms prevented by pre-treatment with pygeum extract. In humans, several clinical trials have demonstrated the benefits of pygeum extract in alleviating symptoms of BPH (Breza et al. 1998, Chatelain et al. 1999, Ishani et al. 2000, Krzeski et al. 1993, Wilt et al. 2000, Wilt et al. 2002). In general, daily doses of pygeum bark extract at 25-100mg have demonstrated significant reductions in measures of the International Prostate Symptom Score (IPSS) of about 40% and increased quality of life (QOL) of about 30% (Breza et al. 1998). In one study, 209 patients with symptomatic BPH consumed 50mg or 100mg of pygeum extract for 2 months – with result showing similar effects in both dosage groups including 35% improvement in IPSS and 28% improvement in QOL (Chatelain et al. 1999). Other studies 18 controlled trials involving 1,562 men) have shown pygeum supplementation to decrease the frequency of nocturnal urination by 19%-32%, reduce residual urine volume by 24%, increase peak urine flow by 23%, and reduce nocturnal frequency by 32% (Breza et al. 1998, Ishani et al. 2000, Krzeski et al. 1993, Wilt et al. 2000).

The ferulic acid component of pygeum bark extracts has been noted to possess some modest anti-androgenic activity – leading bodybuilding enthusiasts to supplement with pygeum as a way to reduce conversion of testosterone to dihydrotestosterone (DHT) and thus enhance muscle cell exposure to free tesosterone. Such an effect has not been demonstrated in human trials. Likewise, the phytosterol component of pygeum bark extracts appear to compete with androgen precursors and in turn may be able to inhibit prostaglandin synthesis and provide a modest anti-inflammatory action (along with the triterpene components).

Safety/Dosage

Side effects for those taking pygeum are relatively rare and mild, and are generally gastrointestinal in nature. No drug interactions have been reported. It is important for any man with an enlarged prostate to consult with his personal physician to determine the cause of prostate enlargement and to rule out prostate cancer.

Pygeum africanum bark extract is generally taken twice per day in 50mg capsules, although taking 100mg in a single dose has been shown to be just as effective and safe. The extract consists of three groups of active constituents: phytosterols, pentacyclic triterpenoids, and ferulic esters of long-chained fatty alcohols. Thus, this oily extract is typically sold in softgel capsule form that are standardized 14% triterpenes and 0.5% n-docosanol.

References

1.Barry M. Review: Pygeum africanum extracts improve symptoms and urodynamics in symptomatic benign prostatic hyperplasia. ACP J Club. 2002 Sep-Oct;137(2):61.

2.Breza J, Dzurny O, Borowka A, Hanus T, Petrik R, Blane G, Chadha-Boreham H. Efficacy and acceptability of tadenan (Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): a multicentre trial in central Europe. Curr Med Res Opin. 1998;14(3):127-39.

3.Buck AC. Is there a scientific basis for the therapeutic effects of serenoa repens in benign prostatic hyperplasia? Mechanisms of action. J Urol. 2004 Nov;172(5 Pt 1):1792-9.

4.Chatelain C, Autet W, Brackman F. Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: a randomized, double-blind study, with long-term open label extension. Urology. 1999 Sep;54(3):473-8.

5.Cristoni A, Di Pierro F, Bombardelli E. Botanical derivatives for the prostate. Fitoterapia. 2000 Aug;71 Suppl 1:S21-8.

6.Ishani A, MacDonald R, Nelson D, Rutks I, Wilt TJ. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. Am J Med. 2000 Dec 1;109(8):654-64.

7.Krzeski T, Kazon M, Borkowski A, Witeska A, Kuczera J. Combined extracts of Urtica dioica and Pygeum africanum in the treatment of benign prostatic hyperplasia: double-blind comparison of two doses. Clin Ther. 1993 Nov-Dec;15(6):1011-20.

8.Levin RM, Das AK. A scientific basis for the therapeutic effects of Pygeum africanum and Serenoa repens. Urol Res. 2000 Jun;28(3):201-9.

9.Mathe G, Hallard M, Bourut CH, Chenu E. A Pygeum africanum extract with so-called phyto-estrogenic action markedly reduces the volume of true and large prostatic hypertrophy. Biomed Pharmacother. 1995;49(7-8):341-3.

10.McQueen CE, Bryant PJ. Pygeum. Am J Health Syst Pharm. 2001 Jan 15;58(2):120-3.

11.Strong KM. African plum and benign prostatic hypertrophy. J Herb Pharmcother. 2004;4(1):41-6.

12.Wilt T, Ishani A, Mac Donald R, Rutks I, Stark G. Pygeum africanum for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(1):CD001044.

13.Wilt TJ, Ishani A, Rutks I, MacDonald R. Phytotherapy for benign prostatic hyperplasia. Public Health Nutr. 2000 Dec;3(4A):459-72.

EDITOR'S NOTE: This monograph can be found in The Health Professional's Guide to Dietary Supplements (Lippincott, Williams & Wilkins) by Shawn M. Talbott, PhD and Kerry Hughes, MS

Saw Palmetto

Overview

Saw palmetto (Serenoa repens) is a dwarf (2-4 feet in height) palm tree found in the United States from the Carolinas to Texas. For centuries, the crude extracts of saw palmetto have been used to improve sperm production and to increase breast size and sexual vigor, but its most effective and only scientifically based use is to improve the symptoms of benign prostatic hyperplasia (BPH).

The premise for using saw palmetto is that it maintains normal prostate health by decreasing the metabolism and action of male steroids. Saw palmetto has been demonstrated to decrease the activity of 5-alpha reductase which stimulates the conversion of testosterone to dihydrotestosterone (DHT), its more active form. Since DHT is necessary for excessive growth (hyperplasia) of the prostate and is elevated in men with BPH, inhibition of 5-alpha reductase, and therefore DHT production, may alleviate BPH and the associated compression of the urethra (the tube that runs through the prostate gland to carry urine from the bladder). Additionally, studies have shown that saw palmetto helps to inhibit the production of various inflammatory factors, probably due to an effect of the fatty acids, thus serving to decrease overall prostate inflammation. The prescription medication for treating BPH, finasteride, is available as Proscar for BPH and a lower potency version called Propecia for treating hair loss in men (because the same conversion of testosterone to DHT is thought to result in thinning and loss of hair in men).

Comments

Considering that the possible health benefits are similar to the prescription drugs Proscar for BPH and Propecia for hair loss, and the fact that saw palmetto appears to be safe and effective and without side effects, in several scientific studies, saw palmetto should be considered an outstanding choice for natural therapy in diagnosed cases of BPH.

Scientific Support

Although studies of saw palmetto as a treatment for prostatitis has been disappointing (Kaplan et al. 2004), its effectiveness in treating BPH is supported by numerous well-controlled clinical trials. In one study of 155 men with BPH, International Prostate Symptom Scores (IPPS) and quality of life (QOL) were improved, as were measures of sexual function and prostate size following 6 months of supplementation with 320mg/d of saw palmetto extract (Pytel et al. 2002). In another study of 100 male outpatients, both 320mg/d and 480mg/d of saw palmetto extract for 3 months had similar significant effects in improving QOL scores, maximum and mean urinary flow rates, and residual urinary volume (Gainnakopoulos et al. 2002, Gerber et al. 2001). Several other smaller studies of saw palmetto extracts (160mg twice daily) have shown significant improvements in symptoms of BPH (Gerber et al. 1998) that are comparable to effects seen with drug treatment with the synthetic 5-alpha-reductase inhibitor finasteride (Sokeland 2000) such as improvements in maximum urinary flow rates, reduced trips to the bathroom, a greater ability to fully empty the bladder and an increased quality of life.

Safety/Dosage

Because saw palmetto has primarily been tested in adult males, it is not recommended for children, or for women who are pregnant or lactating. No drug interactions have been reported for saw palmetto (Markowitz et al. 2003). It is important to note that saw palmetto extract may only treat the symptoms of BPH, and therefore those with an enlarged prostate should consult with their physician on a regular basis to rule out prostate cancer or other causes of hypertrophy. Doses in clinical studies have typically used 160mg of the oil-based (“lipophilic”) berry extract taken twice a day (morning and evening) for at least 30 days (total daily dose of 320mg). Effective products are standardized for fatty acid and sterol content – approximately 80-90% total fatty acids and sterols is recommended.

References

1.Bauer HW, Casarosa C, Cosci M, Fratta M, Blessmann G. Saw palmetto fruit extract for treatment of benign prostatic hyperplasia. Results of a placebo-controlled double-blind study. MMW Fortschr Med. 1999 Jun 24;141(25):62.

2.Brown GA, Vukovich MD, Martini ER, Kohut ML, Franke WD, Jackson DA, King DS. Effects of androstenedione-herbal supplementation on serum sex hormone concentrations in 30- to 59-year-old men. Int J Vitam Nutr Res. 2001 Sep;71(5):293-301.

3.Brown GA, Vukovich MD, Martini ER, Kohut ML, Franke WD, Jackson DA, King DS. Endocrine and lipid responses to chronic androstenediol-herbal supplementation in 30 to 58 year old men. J Am Coll Nutr. 2001 Oct;20(5):520-8.

4.Brown GA, Vukovich MD, Reifenrath TA, Uhl NL, Parsons KA, Sharp RL, King DS. Effects of anabolic precursors on serum testosterone concentrations and adaptations to resistance training in young men. Int J Sport Nutr Exerc Metab. 2000 Sep;10(3):340-59.

5.Gerber GS, Kuznetsov D, Johnson BC, Burstein JD. Randomized, double-blind, placebo-controlled trial of saw palmetto in men with lower urinary tract symptoms. Urology. 2001 Dec;58(6):960-4; discussion 964-5.

6.Gerber GS, Zagaja GP, Bales GT, Chodak GW, Contreras BA. Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms. Urology. 1998 Jun;51(6):1003-7.

7.Gerber GS. Saw palmetto for the treatment of men with lower urinary tract symptoms. J Urol. 2000 May;163(5):1408-12.

8.Giannakopoulos X, Baltogiannis D, Giannakis D, Tasos A, Sofikitis N, Charalabopoulos K, Evangelou A. The lipidosterolic extract of Serenoa repens in the treatment of benign prostatic hyperplasia: a comparison of two dosage regimens. Adv Ther. 2002 Nov-Dec;19(6):285-96.

9.Kaplan SA, Volpe MA, Te AE. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. J Urol. 2004 Jan;171(1):284-8.

10.Markowitz JS, Donovan JL, Devane CL, Taylor RM, Ruan Y, Wang JS, Chavin KD. Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers. Clin Pharmacol Ther. 2003 Dec;74(6):536-42.

11.Marks LS, Partin AW, Epstein JI, Tyler VE, Simon I, Macairan ML, Chan TL, Dorey FJ, Garris JB, Veltri RW, Santos PB, Stonebrook KA, deKernion JB. Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. J Urol. 2000 May;163(5):1451-6.

12.McPartland JM, Pruitt PL. Benign prostatic hyperplasia treated with saw palmetto: a literature search and an experimental case study. J Am Osteopath Assoc. 2000 Feb;100(2):89-96.

13.Preuss HG, Marcusen C, Regan J, Klimberg IW, Welebir TA, Jones WA. Randomized trial of a combination of natural products (cernitin, saw palmetto, B-sitosterol, vitamin E) on symptoms of benign prostatic hyperplasia (BPH). Int Urol Nephrol. 2001;33(2):217-25.

14.Pytel YA, Vinarov A, Lopatkin N, Sivkov A, Gorilovsky L, Raynaud JP. Long-term clinical and biologic effects of the lipidosterolic extract of Serenoa repens in patients with symptomatic benign prostatic hyperplasia. Adv Ther. 2002 Nov-Dec;19(6):297-306.

15.Segars LW. Saw palmetto extracts for benign prostatic hyperplasia. J Fam Pract. 1999 Feb;48(2):88-9.

16.Sokeland J. Combined sabal and urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome. BJU Int. 2000 Sep;8 6(4):439-42.

17.Veltri RW, Marks LS, Miller MC, Bales WD, Fan J, Macairan ML, Epstein JI, Partin AW. Saw palmetto alters nuclear measurements reflecting DNA content in men with symptomatic BPH: evidence for a possible molecular mechanism. Urology. 2002 Oct;60(4):617-22.

18.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.

EDITOR'S NOTE: This monograph can be found in The Health Professional's Guide to Dietary Supplements (Lippincott, Williams & Wilkins) by Shawn M. Talbott, PhD and Kerry Hughes, MS.