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Can Pygeum Help BPH?
Pygeum is an African traditional remedy with anti-inflammatory and anti-androgenic properties. These two medicinal effects are especially needed in reducing the size of enlarged prostate glands and preventing benign prostatic hyperplasia (BPH). Is pygeum an effective herbal remedy in the treatment of BPH? How does it work and how should it be used? This article answers these questions and more.
Pygeum refers to a large evergreen tree that is also known as Prunus africana and Pygeum africanum.
This tree grows well in the mountainous region of Sub-Saharan Africa especially in central and southern Africa. As with other members of its genus, the leaves of pygeum produce nectars from special organs known as extrafloral nectaries. These nectars attract anti-herbivore insects which, in turn, protect the leaves from other plant-eating insects.
Although pygeum produces fruits, it is not popular as a food source among the natives where it grows because of its bitter taste. However, some animals, especially gorillas, prefer eating these fruits and, in process, help in dispersing its seeds.
Pygeum has a long history of medicinal use in African traditional medicine and it has been extensively cultivated primarily for this purpose.
In fact, it is so widely used that it was listed as an endangered species in 1998. As a result, the international trade of pygeum is now being monitored so as to preserve its existence.
Medicinal extracts are now obtained from the bark of pygeum trees through a process that does not require cutting off the trees. Through this conservative process, the populations of the pygeum trees can be preserved while people can still make use of its medicinal benefits.
Pygeum bark extract is primarily known in traditional medicine for treating benign prostatic hyperplasia (BPH) but its medicinal benefit is not limited to improving prostate health. It is also used in treatment of inflammation, kidney diseases, erectile dysfunction and male baldness.
All of the four main groups of phytochemicals found in pygeum are beneficial to prostate health.
Different studies suggest that these phytochemicals appear to work synergistically to improve the symptoms of BPH. However, the most bioactive phytochemicals in pygeum are the phytosterols. Therefore, these components of pygeum extract are believed to exert the most important therapeutic effect in the treatment of BPH.
One of the mechanisms by which the phytosterols in pygeum work is by inhibiting the production of androgenic steroid hormones such as testosterone and dihydrotestosterone (DHT).
The phytosterols, especially beta-sitosterol, compete with the precursors of these androgens and, therefore, interfere with their syntheses. Since these androgenic hormones stimulate the growth and development of the prostate through hyperplasia (proliferation of prostatic cells), they are regarded as one of the main causes of BPH.
Therefore, by inhibiting the production of these androgens, pygeum reduces the effects of testosterone, and the more potent dihydrotestosterone, on the prostate. In this way, pygeum bark extract is able to relieve the symptoms of BPH.
In addition, the bioactive beta-sitosterol present in the pygeum also reduces inflammation in the prostate by inhibiting the production of prostaglandins.
Since the actions of prostaglandins are usually restricted to the specific area where they were secreted, low production of prostaglandins in the prostate will prevent the inflammation, and the enlargement, of the prostate.
Ester salts of the ferulic acid found in pygeum can also limit the production of androgen hormones in the prostate but through a mechanism different from the one employed by the phytosterols.
One way these esters work is by reducing the activity of prolactin which is involved in the uptake of testosterone in the prostate.
However, these esters can also inhibit androgen syntheses in the prostate just like the phytosterols do.
The ferulic acid esters are known to lower cholesterol levels in the prostate. Cholesterol in turn is required in the biosynthesis of androgens. By inhibiting androgen production through cholesterol, these esters reduce the activities of testosterone and DHT on the prostate.
The combination of the two mechanisms by which ferulic acid esters act prevents the enlargement of the prostate and relives the symptoms of BPH.
Lastly, the triterpenes also have an anti-inflammatory effects in the prostate though the mechanism by which they work is not properly understood.
However, it is believed that they block the action of a specific enzyme involved in the inflammatory process in the prostate.
The usual dosage of pygeum bark extract administered in various clinical studies is 50 mg taken twice per day. Although 100 mg of the extract were also used in a few cases and no adverse effects were recorded in those cases.
Pygeum bark extracts are usually standardized to contain 14% triterpenes and 0.5% n-docosanol. Therefore, it is important to choose a brand of pygeum supplement standardized according to this ratio of active ingredients. The extract is commonly sold in form of capsules and tinctures.
Many clinical trials have confirmed the safety of pygeum bark extract. Although, some cases reported side effects, they were all shown to be mild and were mostly gastrointestinal complaints.
Due to insufficient studies demonstrating the safety of pygeum extract in pregnant and lactating women, the extract should be avoided by these groups of women. The extract should also not be given to children.
Pygeum extract can interfere with hormonal drugs including those containing estrogen and testosterone. Therefore, it should not be combined with birth control pills or it may cause contraceptive failure.
In addition, pygeum should not be combined with drugs or supplements with estrogenic abilities. Therefore, pygeum can reduce the effectiveness of herbs containing phytoestrogens such as soy. Since soy products are also used in the treatment of BPH, the combination of the two herbal products may be less effective than either one.
On the other hand, pygeum increases the efficacies of herbs such as saw palmetto (Serenoa repens) and stinging nettle (Urtica dioica).
Since these herbs are also used to treat BPH, combining them with pygeum may provide better results.
While no drug interactions have been noted with pygeum, the herb has been shown to alter the activities of cytochrome P450 enzymes. These enzymes are primarily responsible for the breakdown of drugs in the body.
More specifically, pygeum strongly inhibits the cytochrome enzymes, CYP3A4 and CYP2C9. Therefore, it can affect the effectiveness of certain drugs and supplements.
Various clinical studies have investigated and confirmed the efficacy of pygeum bark extract in the treatment of benign prostatic hyperplasia.
For example, a group of German researchers examined the efficacy of Pygeum africanum extract in the treatment of urinary disorders due to benign prostatic hyperplasia.
The authors of this double-blind, placebo-controlled study published the results of their work in the German medical journal, Wiener Klinische Wochenschrift.
A total of 263 participants suffering from benign prostatic hyperplasia were recruited and examined from 8 different locations in Germany, France, and Austria. The participants were divided into two groups with one group receiving 50 mg of Pygeum africanum extract twice daily while the other group was given the same dose of placebo two times daily.
The patients were evaluated based on residual urine, uroflowmetry, early morning and late night urinary frequencies.
After the 2-month duration of the study, the results showed significant improvement in the patients who were given Pygeum africanum extract compared to those who took placebo.
Another 1998 study published in the journal, Current Medical Research and Opinion, investigated the efficacy of Pygeum africanum extract in the treatment of mild to moderate benign prostatic hyperplasia.
For this study, 85 participants suffering from mild to moderate BPH in 3 locations across Eastern Europe were recruited. All participants were between the ages of 50 and 75 years.
The participants of this study were given 50 mg of Pygeum africanum extract two times daily for a period of 2 months. A washout period of one month was also allowed after treatment to observe and evaluate any persisting symptoms and side effects.
The participants were evaluated based on the International Prostate Symptom Score (IPSS) and flowmetry assessments.
After the 3-month duration of the study, the result showed statistically significant improvement in all the participants and the improvement was shown to persist throughout the washout period. No adverse effects were recorded in any of the participants in this study.
The effectiveness of a combination of pygeum bark extract and stinging nettle (Urtica dioica) extract in the treatment of benign prostatic hyperplasia was investigated by a group of researchers from Poland.
This study was published in the journal, Clinical Therapeutic. The researchers recruited 134 patients with symptoms of benign prostatic hyperplasia and they were all between the ages of 53 and 84 years.
These participants were divided in two groups with one group receiving two capsules of combined 300 mg Urtica dioica root extract and 25 mg of Pygeum africanum bark extract daily. The other group was also given two capsules of the same combined extract but containing 150 mg Urtica dioica root extract and 13 mg of Pygeum africanum bark extract.
The result of the study showed significant improvement in all participants of the two groups after 28 days of treatment.
After another 28 days of further treatment, all the participants of the two treatment groups were also shown to have significantly improved and there were no significant difference between the two treatment groups.
Although five participants reported adverse effects in this study, none of them discontinued treatment as a result.
This study showed that the combination of stinging nettle and pygeum produced better results in the treatment of BPH than each of these herbs. In addition, the study provides an indication of the kind of doses of the combined extracts that were equally effective and well tolerated.
A different study also examined and compared the effectiveness of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia.
This randomized, double-blind study was also published in the journal, Urology. The researchers of this study recruited 209 patients for the first comparative phase while 174 patients were recruited for the open phase.
For the comparative phase, the patients were divided into 2 groups with one group receiving 50 mg Pygeum africanum extract two times daily while the other group received 100 mg once a day. The comparative phase lasted for a period of 2 months.
For the open phase, the patients were given 100 mg Pygeum africanum extract once a day for a period of 10 months.
All the patients were evaluated based on the following: International Prostate Symptom Score (IPSS), quality of life (QOL), and maximum urinary flow rate (Qmax).
The result of the study showed that all the patients improved and there was no significant difference in all the groups of the study. No adverse effects was reported in any of the groups used in the study.
This further established the safety of Pygeum africanum extract, and confirmed that it is the total dose of pygeum that matters and not whether it is taken once or twice daily.
To determine whether pygeum is indeed effective in the treatment benign prostatic hyperplasia, the American Journal of Medicine published the results of a complete meta-analysis of studies done to investigate the efficacy of Pygeum africanum extract in the treatment of BPH.
The authors of this meta-analysis reviewed studies found in popular databases of scientific researches such as Medline, Embase, Phytodok, and Cochrane Library.
A total of 18 studies which included randomized, placebo-controlled trials were reviewed and all the trials lasted a minimum of 30 days.
The result of the meta-analysis showed that benign prostatic hyperplasia can be effectively treated with Pygeum africanum extract with minimal adverse effects.
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