Saw palmetto has been a popular treatment for lower urinary tract symptoms related to benign prostatic hypertrophy (BPH), a common condition in older men. However, recent evidence shows that the natural plant extract may not be as helpful as perceived.

Researchers at Massachusetts General Hospital studied 369 men, 45 years and older, with peak urinary flow rates of ≥ 4 mL/sec. They were randomized to either oral saw palmetto or placebo for 72 weeks. Dosage for saw palmetto started at 320 mg/day (usual dose), increasing to 640 mg/day at 24 weeks, and to 960 mg/day at 48 weeks. Participants’ symptoms were scored using the American Urological Association Symptoms Index (AUASI), a 35-point scale system. A reduction of 3 points on the index was considered clinically significant.

At 72 weeks, researchers did not find significant differences between the groups in nocturia, patient global assessments, indices of sexual function, continence, sleep quality, or prostatitis symptoms (level 1 [likely reliable] evidence). AUASI score mean reduction was 2.2 points for saw palmetto versus 2.99 points for placebo. (Barry MJ, et al. JAMA. 2011;306(12):1344).

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