The jury is still out on saw palmetto for prostate

Ask Dr. Keith Roach M.D

The jury is still out on saw palmetto for prostate

DEAR DR. ROACH: I read in your column recently that you suggested saw palmetto to a male reader who was having difficulty with his blood pressure dropping due to medications prescribed for his enlarged prostate. That was causing frequent trips to the bathroom and a weak urine stream. I have read a number of articles, both pro and con, about the effectiveness of saw palmetto for enlarged prostate. Further, there is the question of the consistency of over-the-counter supplements and whether they actually contain the ingredients in the amounts listed. Could you please offer some insight as to the effectiveness of saw palmetto for enlarged prostate, either from experience with patients or from actual research? Also, is there any good way to determine which brands of supplements are more likely to contain the ingredients as labeled? -A.R.

ANSWER: I believe I noted that the studies were conflicting; some studies show a benefit over placebo, but others -including a National Institutes of Health-funded study (not drug company-funded) and one from a respected group (the Cochrane collaborative), which was an evaluation of multiple studies — showed no benefit over placebo.

As you note, there is a high degree of variability of the active ingredients in saw palmetto from one brand to another. I am very cautious about recommending a particular brand. A 2004 study from UCLA showed tremendous variation between brands (which were not disclosed). A 2011 study in JAMA used a German product, but the study showed no benefit over placebo. A 2006 study in the New England Journal of Medicine used a proprietary blend, which also showed no benefit over placebo. Despite my best efforts, I cannot recommend any particular brand that is available in North America.

DEAR DR. ROACH: My blood pressure is controlled with meds. My husband has serious psoriasis. Is a hot tub safe for us? — M.F.

ANSWER: The use of a hot tub by someone with well-controlled hypertension is generally considered safe. A hot tub (or sauna) causes blood vessels in the skin to dilate (enlarge), which can cause a small drop in blood pressure. If the blood pressure is excessively controlled, this can cause some lightheadedness. However, a brief time (10 minutes) in a hot tub caused no problem in a group of hypertensive people who were well-treated.

For psoriasis, the use of a hot tub helps some people and makes other people have more flare-ups. It can be excessively drying to the skin, so moisturizing afterward is a good idea.

DEAR DR. ROACH: I have a 70-year-old male friend who claims that his face breaks out if he eats chocolate, even a small amount. I don't believe it! When I was a teenager, I learned that breakouts are due to hormones. Can chocolate cause an acne breakout? –B.C.H.

ANSWER: You learned correctly that adolescent acne is mostly due to hormonal changes, which tend to clog pores and allow skin bacteria to cause the familiar pimples of acne. However, your friend may be right, since a recent study showed an increase in pimples with ingestion of pure cocoa. That might be due to changes in the skin or in the bacteria living on the skin.

Chocolate doesn't have a big effect on most people, but it's certainly possible that it has a significant effect on your friend. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.