Saw palmetto – dissapointing study

Take home message FIRST


  1. Saw palmetto taken alone is no better than placebo
  2. Herbalist, Naturopaths and other Complementary health care practitioners often use saw palmetto along with other agents, eg. Pygeum, rye pollen extract, beta sitosterol, nettle root, etc. an this combination may have beneficial effects when taken together
  3. There has always been synergistic value in medicinal plants taken together as oppose to taken individually
  4. This study, unlike other studies on saw palmetto had the best design:
  • Close to 400 subjects
  • Dose escalation to up to 960mg
  • Placebo randomized trial
  • In men with Mild to Moderate BPH (Barry et al. 2011)

It doesn’t get better than that.


My take on this


Great study  and well put together.

In the past saw palmetto has proven as beneficial when compared to Proscar, a popular drug used for BPH that shrinks the prostate and relieves symptoms. Avodart is the more modern type of drug with a similar mechanism – 5 alpha reductase inhibitor. It is thought that saw palmetto had similar, although weaker abilities with less side effects.

A study in 2005 (Bent et al), suggested that saw palmetto was no better than placebo in men with moderate to severe BPH. I barked at this study because they studied men with moderate to severe BPH at only 320mg a day.

No more barking from my end. This recent study went as high as 960mg and subjects had mild to moderate BPH. It is not clear that their urinary symptoms were derived from an enlarged prostate or from bladder dysfunction but that’s OK. I’ll let that slide.


The combination of saw palmetto with other natural agents, however, may still be highly useful to many men suffering from Lower Urinary Tract Symptoms (LUTS). Other useful agents include: rye pollen extract, pygeum, cranberry extract, beta sitosterol, etc without the side effects. For a complete list of studied natural nutrients for BPH and a description of this condition go the most credible prostate website on the net – prostate.net.


In Optimal Health,

Dr. Geo



Bent S, Kane C, Shinohara K, Neuhaus J, Hudes ES, Goldberg H, Avins AL.Saw palmetto for benign prostatic hyperplasia. N Engl J Med. 2006 Feb 9;354(6):557-66.

Barry et al, Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011 Sep 28;306(12):1344-51.


Update on Vitamin D and health


Take home message first

If one’s health goal is to stay healthy or slow the progression of most diseases, then consumption of at least 2000 IU of vitamin D is a good start.


Vitamin D 101 – for the layperson

Vitamin D does a whole lot more than sustain healthy bones by assisting in the absorption of calcium. There are receptors throught out the body that attach to vitamin D and regulates DNA.

In the past 20 years, vitamin D deficiency has been associated with:

  • Heart disease
  • Metabolic syndrome (combination of hypertension, fat deposit in blood vessels, diabetes, blood glucose imbalance and fat around the belly)
  • Cancer – especially colorectal cancer
  • Autoimmune diseases
  • Infections
  • Overall non-specific death (Melamed et al., 2008)

Who needs vitamin D supplementation the most?

Darker skin people, the obese and those who live in regions away from the equator where there is low ultraviolet B radiation from sunlight are in higher need of vitamin D supplementation. Yes, that’s pretty much all of us

It may not be a coincidence that cancer occurs more frequently in dark-skinned people, the obese, and in regions with limited exposure to ultraviolet B radiation from sunlight. Each of these factors is associated with low blood levels of vitamin D. Furthermore, cancer survival rates are lower when the diagnosis occurs in months of lower sunlight levels, suggesting a protective role of vitamin D. Studies suggest that vitamin D protects against numerous forms of cancer, including widely prevalent cancers such as those affecting the colon, prostate, breast, and lung. (Giovanucci 2005)


The cancer / vitamin D link


Colon cancer – A study of studies (meta-analysis) revealed that out of 35,000 people studied, those with normal vitamin D levels had lower risk of colon / bowel cancer. Other studies suggest that high calcium (1000mg) with 400IU of vitamin D a day offers no protection. To note, 400 IU a day is a ancient lower suggested dose that plays no role in modern nutrition. For most, 2000 IU is the minimum on should take.

Breast cancer – Also, a meta-analysis regarding vitamin D and the prevention of breast cancer demonstrated a 45% decrease in breast cancer risk for those in the higher blood levels of vitamin D compared with those at the lowest. (Hu et al, 2009) A clinical randomized trial, the gold standard, looking at over 1100 women,  showed that the incidence of breast cancer was lowered by daily supplementation with 1000 IU of vitamin D plus calcium in postmenopausal women (Lappe et al. 2007).


Prostate cancer – epidemiological studies, that is, a study designed to examine large group of people and its associations with its increase the risk of disease, indicate a strong link between vitamin D deficiency and prostate cancer. Test tube studies and animal studies do as well. Human studies with consumption of vitamin D have been inconsistent (Barnett et al. 2011) We yet do not know objectively what blood levels of vitamin D are most adequate (normal is between 30ng/ml – 100ng/ml) or what dosage is best for daily consumption for prostate cancer prevention or adjuvant treatment.

Final thoughts

Governmental agencies like the Institute of Medicine, IOM, fall short in their recent daily recommendations of vitamin D. After “careful” review of the literature, researchers from the IOM increased the daily dosage of vitamin D from 400IU to a marginal 600IU. Since most people have insufficient if not deficient levels of vitamin D, 600 units will not get virtually anyone to normal levels.

The absolute best way to determine adequate levels of vitamin D is to get a 25-hydroxy-vit D blood test from your practitioner and make sure levels are between 50ng/ml to 90ng/ml (mid to high normal.) A Calcium blood test is also adequate to assure hypercalcemia ( too much blood calcium) which can also cause problems. Based on my clinical experience, no one should take anything less than 2000 units of vitamin D3 a day with food or fish oil – anything higher should be monitored by a physician. This is particularly true for those who are obese, dark skin color or one who is not out in the sun much. By the way, if you are out in the sun and use sunscreen, all bets are off, no vitamin D production for you either.


In Optimal Health ,


Dr. Geo



M.L. Melamed, E.D. Michos, W. Post and B. Astor, 25-hydroxyvitamin D levels and the risk of mortality in the general population, Arch Intern Med 168 (2008), pp. 1629–1637

Giovannucci E. The epidemiology of vitamin D and cancer incidence and mortality: a review (United States). Cancer Causes Control. 2005 Mar;16(2):83-95.

P. Chen, P. Hu, D. Xie, Y. Qin, F. Wang and H. Wang, Meta-analysis of vitamin D, calcium and the prevention of breast cancer, Breast Cancer Res Treat 121 (2009), pp. 469–477.

J.M. Lappe, D. Travers-Gustafson, K.M. Davies, R.R. Recker and R.P. Heaney, Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial, Am J Clin Nutr 85 (2007), pp. 1586–1591.

Barnett, C.M, Beer, T;Prostate Cancer and Vitamin D; what does the evidence really suggest?; Urologic Clinics of North America; Volume 38, Issue 3 , August 2011, Pages 333-342

Urinary Tract Infections Prevention and Probiotics – new study


Urinary tract Infections (UTI’s)  are mostly common among woman and they often return after treatment. The common mainstream treatment is antibiotics.  In the naturopathic world, UTI’s are commonly treated with herbs like Uva Ursi and Cranberry juice.

A recent study to date looked at 319 college women presenting with an acute UTI. In this double-blind randomized trial participants were followed up until a second UTI or for 6 months, whichever came first. The study concluded that 8-oz dosage of  low-calorie cranberry juice twice per day gave no protection against the risk of recurring UTI among college-aged women (Barbosa-Cesnik et al. 2011). Research juice was formulated to be similar to the commercially available Ocean Spray and was sweetened with Splenda (sucralose), exactly as is the retail juice.  Cranberry supplement pills along with cranberry juice may be helpful in preventing UTI’s (Stothers 2002).

It must be pointed out that most cranberry juices on the market contain one third cranberry juice mixed with water and sugar. Because sugar has such a detrimental effect on the immune system, use of sweetened cranberry juice cannot be recommended. Fresh cranberry (unsweetened) or blueberry juice is preferred to avoid the deleterious effects of sugar consumption.

Probiotics and UTI study

In a randomized, double-blind phase 2 study, an intravaginal probiotic composed of Lactobacillus crispatus CTV-05 (Lactin-V, Osel Inc) reduced the rate of recurrent urinary tract infection (rUTI) in UTI-prone women by about 50% (Stapelton et al. 2011)

Probiotics 101

Probiotics are live microorganisms (in most cases, bacteria) that are beneficial microorganisms found in the human gut. Other names used include “friendly bacteria” or “good bacteria.” Probiotics are available to consumers mainly in the form of dietary supplements and foods.

Foods that contain probiotics include: yogurt, fermented and unfermented milk, miso, tempeh, and some juices and saurkraut. In probiotic foods and supplements, the bacteria may have been present originally or added during preparation.


There are 3 elements to Probiotics:

1.     The Genus (e.g.Lactobacillus or Bifidobacterium)

2.     The Species (e.g. Lactobacillus acidophilus and Bifidobacterium bifidus)

3.     The Strain (usually a bunch of capital letter and number e.g. CTV-05)

Although there are many benefits in taking oral supplements of probiotics, there is no scientific data that demostrates any benefit of oral intake of probiotics for UTI’s . The study highlighted here shows the beneficial effects of  probiotic  vaginal suppository of Lactobacillus crispatus CTV-05.


In Optimal Health,

Dr. Geo