UNTIL middle age, most men hardly know that they have a prostate. This walnut-size gland is located below the bladder and surrounds the urethra, the tube that transports urine out of the bladder.

After the age of 30, the gland starts to grow and this may lead to what we call prostate enlargement or benign prostatic hyperplasia (BPH).

As BPH progresses, the swelling prostate pinches the urethra. It is painless, but it causes urinary difficulties. Symptoms include:

-The feeling that you need to urinate immediately;

-Difficulty getting started;

-Decreased flow;

-Difficulty finishing;

-Having to get up at night to urinate.

Why does the prostate swell?

This is due to age-related hormonal changes. Blood level testosterone declines, while levels of other hormones such as prolactin increases.

The ultimate result is an increase in the male sex hormone dihydrotestosterone (DHT) in the prostate.

An enzyme, 5-alpha reductase, converts testosterone to DHT which in turn causes BPH by stimulating the growth of prostate tissues.

While drugs and surgery may become necessary for men with severe BPH, others manage BPH with herbs alone, such as saw palmetto and pumpkin seed.

Studies have shown that saw palmetto relieves BPH symptoms.

European researchers compared saw palmetto extract against finasteride. The researchers gave 1,098 participants either the herb (160mg twice a day) or the drug (5mg a day) for 26 weeks.

After this duration, both treatments showed about the same kind of effectiveness.

Finasteride decreased BPH symptoms by about 39 per cent, while saw palmetto decreased it by 37 per cent.

Urine flow improved 30 per cent in those taking the drug and 25 per cent in those taking saw palmetto.

The study also noted that saw palmetto caused fewer side effects which affected libido and erection.

In addition, a group of Belgian researchers gave 505 men with BPH symptoms saw palmetto extract.

Six weeks later, their prostates were smaller, their urine flowed more freely and they reported significant improvement in their quality of life.

The only reported side effect of saw palmetto is the occasional mild abdominal distress.

Commission E, the German expert panel that judges the safety and effectiveness of herbal medicines, endorses saw palmetto for BPH.

Currently, an estimated 90 per cent of German men with BPH use the herb to treat their symptoms.

Another herb of value is pumpkin seed.

German researchers gave pumpkin seed extract to 2,245 BPH sufferers.

After 12 weeks, their symptoms decreased 41 per cent and their quality of life improved 46 per cent, with no side effects.

Pumpkin seeds are also one of the richest plant sources of the essential mineral zinc.

Some research suggests that the mineral is a 5-alpha reductase inhibitor, which would help treat BPH.

Pumpkin seeds on their own don't do much for BPH but in combination with saw palmetto, may be beneficial to BPH sufferers.

The writer is a pharmacist who is actively involved in the dissemination of information on natural healthcare and holistic therapies. For more information, she can be contacted at csyam@streamyx.com.

This story was first published in The New Straits Times on Apr 14, 2008.