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A Hope for the Prostate Among the Rattlesnakes
October 21, 2003
By TERESA BURNEY
IMMOKALEE, Fla. - On vacant lots and deep in swamps, beside
the roads and scattered through cow pastures - practically
everywhere in the Deep South - grows a wild berry that
offers hope of relief to millions of men.
The fruit of saw palmetto, known to botanists as Serenoa
repens, has been used in Europe to relieve the symptoms of
enlarged prostates for decades. Doctors there routinely
prescribe it.
But in the United States, saw palmetto has been relegated
to the ranks of dietary supplements, and until recently
enjoying little sanction from medical doctors.
Even without official approval of the medical
establishment, palmetto has become the fifth most popular
medicinal herb, according to the National Institutes of
Health.
Noting the herb's popularity and the results of some
short-term studies on its effectiveness, some doctors,
particularly urologists, are beginning to discuss it with
patients who have enlarged prostates, said Dr. Stephen E.
Straus, director of the institutes' National Center for
Complementary and Alternative Medicine.
"They say, `Let's give it a try,' " Dr. Straus said of the
doctors' advice. "I wouldn't say they prescribe it, but
they are willing to arouse some patients to follow that
approach and see how it works out."
Faced with that trend, the institutes have commissioned the
first longer-term studies of saw palmetto's effectiveness
and side effects.
About half of all men over 50 are afflicted with swollen
prostates, a noncancerous ailment formally known as benign
prostatic hyperplasia, the institutes say. The condition
accounts for at least 1.7 million doctor visits a year in
the United States, with estimated health care costs
exceeding $4 billion annually.
No one knows for sure how saw palmetto works, if it does. A
theory is that it may inhibit absorption of a form of
testosterone linked to the swelling of the prostate. Those
questions are likely to be settled in clinics and
laboratories.
But as with many herbal supplements, the process of
creating a saw palmetto product begins in a different
world, one of swamps and rattlesnakes, itinerant pickers
and casual roadside markets.
Immokalee, a town of 14,000 people on the edge of the
Everglades, is the epicenter of the market, which operates
about six weeks a year, from mid-August to the end of
September. The area, about 30 miles southeast of Fort
Myers, has an abundance of berries and workers to pick
them.
Pickers spend the cooler morning hours gathering berries;
by 3 p.m. their berry-stuffed pickup trucks and vans start
arriving at New Market Road, where buyers gather.
Harvesters typically sell to the highest bidder at the
moment, and prices change frequently. Early last month,
Timoeteo Resa, who was picking berries in Immokalee,
received 45 cents a pound. At that price, workers can
easily take home more than $100 in cash a day.
For consumers, a month's supply of saw palmetto ranges from
$4 to $20, according to ConsumerLab.com, an online
independent testing laboratory. Prescription medications
for the prostate ailment can cost $35 to $100 a month.
Picking the berries is hard, unpleasant and sometimes
dangerous, said Art Lozano, a berry buyer. "I don't do it,"
he said. "I hope I never have to do it. You should see the
snakes they bring me."
Rattlesnakes are common in the thickets. Humid heat,
turning the palmetto patches into steam baths, is a more
constant foe. Most of the time, workers pick along
roadsides and in vacant lots in peace. But sometimes,
landowners call local deputies to complain, and the workers
are asked to leave. Occasionally, they are fined for
trespassing.
Once bought, the sacks of berries are poured into wooden
bins big enough to hold 1,200 pounds of the fruit. The bins
are loaded onto semitrailers and hauled away to be dried
for preservation.
Where the berries go from there varies. Some are simply
ground, stuffed in gel capsules and sold. Some make two
trips across the Atlantic before they are sold.
Supplements like saw palmetto are subject to more rigorous
manufacturing practices in Europe than in the United
States. The saw palmetto capsules used in the N.I.H.
studies are supplied by an Italian company, Indena, which
was chosen because its product is considered high quality.
The company buys the dried saw palmetto berries from
Immokalee and ships them to Italy, where their essence is
extracted at high pressure with the help of carbon dioxide.
The extract is then sent to France, where the concentration
is enhanced, returned to Italy and onward to Florida, where
it is put into gel capsules in Tampa. From there it is sent
to study participants. The extract is tested several times
in the process to make sure it meets certain chemical
standards, said Dr. Edward M. Croom Jr., the scientific and
regulatory affairs manager for Indena USA East.
Dr. Straus of the health institutes said that the lack of
standardization in manufacturing and labeling of
supplements was a problem for consumers. The agency has
tested the contents of a variety of herbal supplements and
"the variability is enormous," he said.
"In some cases, people will buy a bottle of an herbal
supplement like they would buy a bottle of wine - if it has
a fancier label and costs more it's going to be better -
and that's not necessarily a good assumption."
People may buy saw palmetto like wine, but the berries,
which are orange when ripe, smell like the foulest
home-brew imaginable as they sit in the sun at Immokalee's
berry market.
The berries' resemblance to anything healthful or
attractive fades even more when they are trucked a few
miles out of town to Plantation Medicinals, one of the
largest saw-palmetto processors in the area. Pungent and
acrid do not begin to describe the odor emanating from the
company's berry dryers.
Michael Huffman, the chairman of Plantation, has long been
immune to the berries' aroma.
"Smells like money," Mr. Huffman said.
http://www.nytimes.com/2003/10/21/health/21PALM.html?ex=1067852663&ei=1&en=26f3226518f6977e
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